| Question | Answer |
| 3 Major Components of CSE | 1. medical history
2. physical examination of the swallowing mechanism (OME)
3. test swallows |
| Purposes of CSE | - determines presence of dysphagia but does not disprove or prove aspiration
- gives insight to anatomical and physiological factors
- relative complication risks
- alternate means of management
- additional tests needed |
| Relative Complication Risks of Dysphagia | - aspiration
- dehydration
- malnutrition
- loss of enjoyment |
| 6 Reasons for CSE | 1. determine potential cause
2. develop a working hypothesis
3. tentative treatment plan
4. develop further questions
5. is the pt ready for treatment?
6. instrumental eval? |
| Outcomes of CSE | - determine underlying neuromuscular function
- onset, progression pattern, symptoms/signs
- influencing factors
- monitor progression
- estimate prognosis
- estimate long-term outcomes |
| Limitations of CSE | - lack of methods for scoring
- inconsistencies in observations
- complete information not provided
- aspiration/penetration cannot be viewed
- only one moment in time |
| Additional Factors to Monitor/Consider | - heart rate
- pulse oximetry (oxygen is bound to hemoglobin)
- respiration |
| Signs and Symptoms of Hypoventilation | - fatigue
- hallucinations
- lethargy
- disturbed sleep
- depression
- reduced appetite |
| Signs | - objective
- clinical measures/observations of behaviours during an exam |
| Symptoms | - subjective
- patient-reported change in bodily functions or sensations |
| Pulmonary Defence Risk Factors for Pneumonia | - oral hygiene
- loss of anatomical defences
- blunted airway reflexes
- impaired mucocillary clearance
- weakened immune system |
| Chart Review | 1. current hospital status
2. Hx and nature of the problem
3. medical conditions
4. medications
5. airway device hx?
6. hx and current nutrition status |
| Interview Questions | - when did it start
- how did it progress
- what foods/liquids cause issues
- do things get stuck
- pain?
- food allergies?
- baseline diet
- health history |
| Observations during Ax | - LOA/mental status/behaviour
- affect
- nutritional state
- motor speech
- lang
- independence
- hydration
- medical/health aids |
| General Physical Findings | - respiration
- speech/voice
- mobility
- upper extremity function
- visual and auditory systems
- muscle and bodily stability
- coordination |
| More Observations | - positioning
- alertness
- speech & lang
- attention to the task
- desire to eat
- agitation |
| Oral Phase Observations | - adequacy of chewing
- oral clearance/residue
- duration of the oral phase
- endurance/fatigue
- manner of feeding
- behaviours during feeding
- pocketing
- premature spillage |
| Pharyngeal Phase Observations** | - signs of airway compromise
- vocal quality (before and after the swallow)
- weakness (unilateral often)
- decreased strength of pharyngeal constriction
- residue
- decreased hyolaryngeal elevation
- delayed initiation d/t decreased sensation |
| Signs of Airway Compromise | - post swallow expiration
- airway congestion
- coughing/throat clearing
- change in breathing pattern
- shortness of breath post swallow
- increased resp rate
- wheezing |
| Vocal Quality (Before and After Swallow) | - wetness?
- difficulty clearing secretions?
- dry?
- endurance or fatigue over time |
| Esophageal Phase Observations ** | - effortful, repeated swallows
- regurgitation
- pt report globus sensation
- reflux
- increased transition time |
| PO for CSE | - ice chips
- water
- nectar thick liquids or thickening agent
- purees
- mixed consistency (fruit cup)
- dry solids (graham cracker/cookies) |
| Objectives for MBSS | - evaluate anatomy and physiology
- ID pattern of impaired physiology
- ID consequences
- evaluate the effect of compensatory strategies
- confirm pt symptoms
- make predictions |
| MBSS MUST | - CSE fails to address the clinical questions presented by pt or symptoms
- dysphagia characteristics are vague
- respiration compromise
- underlying medical problems
- results required to set clinical course ** |
| MBSS MAYBE | - direction of swallow rehab
- high risk of aspiration due to pre-existing med dx
- swallowing demonstrates an overt change
- status fluctuates |
| MBSS NO | - pt is in a fragile condition
- pt won't fit into the machine
- pt is not likely to cooperate
- clinical judgement is such that the results will not alter clinical course* |
| FEES MUST | - CSE fails to address the clinical questions presented by pt or symptoms
- dysphagia characteristics are vague but esophageal issues are not detected
- results are required to set clinical course
- MBSS is not an option |
| FEES NO | - blood range doesn't permit
- nasal fractures/complex facial features
- pt is agitated
- pt has a CSF leak |
| OME V Trigeminal | - touch different parts of face
- open jaw and resist
- move jaw side to side |
| OME VII Facial | - raise eyebrows
- close eyes tightly
- puff out cheeks
- purse out your lips
- smile
- put lips around a straw |
| OME X Vagus | - voliltional cough
- stick out your tongue and say "ahhhhh" and then ah-ah-ah
- palpitate the swallow |
| OME XII Hypoglossal | - stick tongue out
- move tongue up and down
- move tongue side-to-side
- press tongue against the side of your cheek
- sweep teeth with tongue |
