Clinical Swallowing Evaluation part 1 2025
NOTES FROM 1/22/25
The CES means it is not instrumental
You did something external (hands on) to the body
Includes chart review
Physical exam of the structures of swallowing
It is important to have that physical exam
Most of the time this will also involve direct observations of swallowing liquids and solids, but this is only part of it.
Instrumental exam is more precise (modified barium swallow)
Physical exam, observation of swallowing, chart review
Condition that could result in silent aspiration: ALS, stroke, cerebral palsy, acute stroke
Looking at the phsyical problem, but also their emotions, any handicap, any problems their swallowing problem may cause them
Scope of swallowing exam includes body functions related and unrelated to swallowing, personal and environmental factors that may (or may not) influence swallowing
ID current swallowing functions, presence and potential causes of dysphagia
Make a note of their mental state, like if they are alert and responsive, cooperative or not
ID strategies to ensure immediate swallow safety or we may need to introduce compensatory strategies like dietary modification, changing head position; and then developing a plan for management, particularly if things are not well
What is the impact of their swallowing disorder on them and on the people in their life
Multidisciplinary team: EMT, OT, PT, radiologist, gastroenterologist, PA, neurologist, dentist, nutritionist
A screening is the initial step before the evaluation, more of a quick set of tasks. Used to tell us if they need further testing and if there are signs of a problem
Look for signs and symptoms
In their medical record, stroke would tell you if they may have dysphagia.
A person can say they’re not eating very well or much or they have reflux, heartburn, or recurrent pneumonia, coughing while eating that makes you think its a swallowing problem that they may not link it to
MGH swallow screening tool: 2 part dysphagia screening tool
Alertness, comprehension, cooperation, respiration, aphasia
These are all tests to rate/ score during a swallow Eval
Water is optional if the rest of the ratings are low
If a person has had an acute stroke, and they are not coughing when you give them water, they may be silently aspirating!
Some of these screenings can only be administered by an SLP, some only by PT or nurse or OT. This can give different perspectives, less availability of SLP. We are not the only one that can recognize signs of swallowing disorders
Features of screening tools: they are easy, time and cost effective, ideally should be able to be administered by diff. Team members, high sensitivity, high specificity, good pass fail criteria
Things to caution about screenings: screening may not accurately detect signs of aspiration and penetration in:
severely ill people ( bc the whole body is in crisis so there will be different responses than their normal response),
medical fragility (be very careful and observant),
people who have significant communication impairments and cannot follow directions (you won’t know if they have followed your commands and you cannot ask them about sensations)
People with sensory problems (if someone has had a neuro event or condition, their senses in the sensory tract could be missed)
Know diff. Between real eval and screening!!!! All components of each
Some specialized screenings for aspiration include the 3 oz water test, cervical oscillation, modified Evans blue dye
Cervical oscillation: taking stethoscope and listening to swallow on person
Page 1: Clinical Swallowing Evaluation SPATH 6544
Title of clinical course or topic
Page 2: Introduction to Swallowing Assessment
ICF Framework: Focuses on various facets of swallowing assessment
Body structures and functions related to swallowing
Functionality influencing eating or drinking
Swallowing activities and participation
Activities/participation in eating/drinking events
Personal and environmental factors affecting swallowing
Page 3: Aims of Swallowing Evaluation
Goals:
Identify current swallowing functions (both typical and atypical)
Determine presence and causes of dysphagia
Establish immediate strategies for swallow safety
Assess continuation/modification of diet
Evaluate compensatory strategy effectiveness
Formulate a swallowing management plan
Analyze quality of life impacts and third-party disability
Page 4: Multidisciplinary Dysphagia Team
Team Composition:
Speech Language Pathologist (SLP) – team leader
Dietitian
Medical specialists (e.g., otolaryngologist, neurologist)
Dentist
Occupational Therapist
Physiotherapist
Nurse
Social Worker
Page 5: Swallowing Screening
Overview of the initial assessment process
Page 6: Screening vs. Clinical Examination
Contrast between screening and clinical (bedside) examinations
Introduction to instrumental assessments
Page 7: Screening Outcomes
Assessment criteria:
Simple Yes/No responses
Evaluate likelihood/risk of dysphagia (High/Low)
Page 8: Example of Screening Tool
MGH-Swallow Screening Tool (MGH-SST):
Essential elements of screening documented
Reference to video materials for further learning
Page 9: SCOTT&WHITE Healthcare Dysphagia Screening Tool
Patient Identification Protocols:
Assessing level of alertness/responsiveness
Specific questions regarding patient's swallowing capabilities
Protocols in case of a negative finding
Importance of conducting water tests and observations
Page 10: UT Nursing Swallowing Test
Procedure:
Initial screening requirements before PO intake
Step-by-step assessment criteria to be met
NPO status required if any criteria are not met
Documentation required for all findings
Page 11: Reliable Screening Techniques
Overview of screening tools with high reliability & validity:
Barnes Jewish Hospital Stroke Dysphagia Screen
Modified Mann Assessment of Swallowing Ability (MMASA)
Emergency Physician Swallowing Screening
Toronto Bedside Screening Test (TOR-BSST)
Page 12: Modified Mann Assessment of Swallowing Ability (Mini MASA)
Instructions for Utilization:
Assessment indicators with scoring guide
Recognization of significant findings based on scores
Thresholds for advancing diets or further assessments
Page 13: Characteristics of Dysphagia Screening Tests
Screening Features:
Inclusion of various swallowing and nonswallowing item tests
Sensitivity, specificity, reliability, and duration details
Page 14: Screening Tool Features
Key Attributes:
Ease of administration
Cost-effectiveness and time-efficient
Clear criteria for pass/fail
High sensitivity and specificity for dysphagia identification
Page 15: Limitations of Screening
Screening Constraints:
Potential inaccuracy for patients who are severely ill or have communication impairments
Limitations in detecting aspiration or penetration issues
Page 16: Specialized Screenings - Aspiration Risk
Introduction to screenings designed specifically for aspiration risk
Page 17: Aspiration Screening Methods
Various methods of aspiration assessment:
3 Oz Water Test
SpO2 Measurement
Cervical Auscultation
Modified Evans Blue Dye Test
Page 18: 3 Oz Water Test- started here 1/29/25
Testing method overview:
Quick and straightforward method
Recognized drawbacks including high false-negative rates
do you see signs or not of aspiration
Page 19: SpO2 Monitoring
Importance of oxygen saturation levels in aspiration risk assessments
Noting significant drops ("> 2") as indicators
look for does it dip when they eat? may be a sign of aspiration
Page 20: Cervical Auscultation
Visual representation and introduction to cervical auscultation methods for dysphagia evaluation
Page 21: Class Demonstration of Screening Methods
In-class practical assessments:
Utilizing various tests (3 oz water, dry swallow)
Page 22: Modified Evans Blue Dye Test
Procedure for patients with tracheostomy:
Detecting aspiration presence via blue dye suctioning
give patient something to eat, and if something runs out of the trachea, that means they aspirated. id the tube is closed off, the food will go around the tube and to the lungs. you dye their food blue so you can see it and watch the tube to look for the blue to see if they aspirated
Page 23: Blue Dye Suction Results
Interpretation of suction results:
Valid/invalid result classifications for aspiration confirmation