Assessment of Swallowing 2023 Questions and Answers
Complete
screening, clinical evaluation, and instrumental evaluation
What are the 3 ways one can assess swallowing?
screening
given broadly to groups of people to determine if any of them have the condition in
question (pass/fail)
- easy to administer, inexpensive, accuracy; high sensitivity, low specificity
high sensitivity = few false negative results; should help rule out the disorder
low specificity = identify more patients than have the disorder
Explain what high sensitivity and low specificity means with screening.
no, (e.g., nurse may do this)
Is it only SLP's who can do a swallow screening?
1. Risk of pneumonia is 11 times higher for patients with severe dysphagia and
aspiration
2. Hospitals using mandatory and formal dysphagia screening have lower
pneumonia rates than those without a screening
3. Health incentive and financial incentive to screen high risk patients
Why do we do swallow screenings? (3)
To determine:
1. The likelihood that dysphagia is present
2. The need for formal swallow evaluation
3. Whether it is safe to feed the patient orally (for the purposes of nutrition,
hydration, and administration of medication)
4. Whether the patient requires referral for nutritional or hydrational support
What are the goals of a swallow screening? (4)
1. A known history of dysphagia
2. A medical diagnosis that frequently involves swallowing impairment (e.g.,
stroke)
3. Reduced level of consciousness
4. Overt signs of difficulty swallowing or aspiration
5. Complaints of difficulty swallowing
Screening procedures are usually used to determine whether any of the following
represent a risk of dysphagia and/or a reason to maintain an NPO status for the patient:
...? (5)
1. Interview or questionnaire
2. Observation of the signs and symptoms of oropharyngeal dysphagia
3. Formulation of appropriate recommendations, including the need for a full
swallow function assessment
4. Communication of results and recommendations to the team responsible for
the individual's care
What compromises a screening? (4)
Speech-language pathologists
Nurses
, Physicians
Others
Screening requires little examiner expertise or interpretation
Who should screen?
1. The Toronto Bedside Swallowing Screening Test (TOR-BSST)
- Health care professionals
2. Gugging Swallowing Screen
- SLPs
3. Massey Bedside Swallowing Screening
- Nurse administered
4. Modified Mann Assessment of Swallowing Ability (MASA)
- Physician administered (Neurologist)
What are the different types of screening tools? Who are they typically used with?
- Widely used clinical screening to determine the risk of aspiration
- Patients are given 3 ounces of water and asked to drink the entire amount
- Not appropriate for every patient
Describe the 3 Ounce Water Swallow Test.
inability to consume the entire 3 ounces or coughing or throat clearing within 1
minute of test administration
How does one fail the 3 ounce water swallow test?
1. Orientation and command following
What is your name?
Where are you right now?
What year is it?
2. Command following
Done in conjunction with oral‐mechanism exam
Open your mouth
Stick out your tongue
Smile
3. 3‐ounce water swallow test (part of the Yale Swallow Protocol)
Describe the Yale Swallow Protocol and it's 3 parts.
screening = pass/fail (e.g., 3 ounce water test)
clinical = more in depth assessment (e.g., beside swallow eval.)
instrumental = using an instrument (e.g., FEES)
What is the difference between screening, clinical, and instrumental?
Clinical evaluation
the initial form of testing performed by physicians and establishes the patient-clinician
relationship; same for the SLP
1. Instrumental diagnosis and management may not be available or feasible
2. Should precede instrumental testing to help determine the best intervention
Clinical swallow evaluation is completed for two reasons:
1. Examine structure and function
2. Form hypothesis regarding cause and effect
3. Support or refute diagnosis of dysphagia
Complete
screening, clinical evaluation, and instrumental evaluation
What are the 3 ways one can assess swallowing?
screening
given broadly to groups of people to determine if any of them have the condition in
question (pass/fail)
- easy to administer, inexpensive, accuracy; high sensitivity, low specificity
high sensitivity = few false negative results; should help rule out the disorder
low specificity = identify more patients than have the disorder
Explain what high sensitivity and low specificity means with screening.
no, (e.g., nurse may do this)
Is it only SLP's who can do a swallow screening?
1. Risk of pneumonia is 11 times higher for patients with severe dysphagia and
aspiration
2. Hospitals using mandatory and formal dysphagia screening have lower
pneumonia rates than those without a screening
3. Health incentive and financial incentive to screen high risk patients
Why do we do swallow screenings? (3)
To determine:
1. The likelihood that dysphagia is present
2. The need for formal swallow evaluation
3. Whether it is safe to feed the patient orally (for the purposes of nutrition,
hydration, and administration of medication)
4. Whether the patient requires referral for nutritional or hydrational support
What are the goals of a swallow screening? (4)
1. A known history of dysphagia
2. A medical diagnosis that frequently involves swallowing impairment (e.g.,
stroke)
3. Reduced level of consciousness
4. Overt signs of difficulty swallowing or aspiration
5. Complaints of difficulty swallowing
Screening procedures are usually used to determine whether any of the following
represent a risk of dysphagia and/or a reason to maintain an NPO status for the patient:
...? (5)
1. Interview or questionnaire
2. Observation of the signs and symptoms of oropharyngeal dysphagia
3. Formulation of appropriate recommendations, including the need for a full
swallow function assessment
4. Communication of results and recommendations to the team responsible for
the individual's care
What compromises a screening? (4)
Speech-language pathologists
Nurses
, Physicians
Others
Screening requires little examiner expertise or interpretation
Who should screen?
1. The Toronto Bedside Swallowing Screening Test (TOR-BSST)
- Health care professionals
2. Gugging Swallowing Screen
- SLPs
3. Massey Bedside Swallowing Screening
- Nurse administered
4. Modified Mann Assessment of Swallowing Ability (MASA)
- Physician administered (Neurologist)
What are the different types of screening tools? Who are they typically used with?
- Widely used clinical screening to determine the risk of aspiration
- Patients are given 3 ounces of water and asked to drink the entire amount
- Not appropriate for every patient
Describe the 3 Ounce Water Swallow Test.
inability to consume the entire 3 ounces or coughing or throat clearing within 1
minute of test administration
How does one fail the 3 ounce water swallow test?
1. Orientation and command following
What is your name?
Where are you right now?
What year is it?
2. Command following
Done in conjunction with oral‐mechanism exam
Open your mouth
Stick out your tongue
Smile
3. 3‐ounce water swallow test (part of the Yale Swallow Protocol)
Describe the Yale Swallow Protocol and it's 3 parts.
screening = pass/fail (e.g., 3 ounce water test)
clinical = more in depth assessment (e.g., beside swallow eval.)
instrumental = using an instrument (e.g., FEES)
What is the difference between screening, clinical, and instrumental?
Clinical evaluation
the initial form of testing performed by physicians and establishes the patient-clinician
relationship; same for the SLP
1. Instrumental diagnosis and management may not be available or feasible
2. Should precede instrumental testing to help determine the best intervention
Clinical swallow evaluation is completed for two reasons:
1. Examine structure and function
2. Form hypothesis regarding cause and effect
3. Support or refute diagnosis of dysphagia
