The Clinical Swallow Evaluation (CSE) is a widely used but controversial tool used by Speech Pathologists when evaluating dysphagia patients. The purpose and composition of a CSE is highly variable. The four basic components of a CSE includes: history, oral/motor praxis, voice, and trials swallows. The content of these four basic components as well as additional components is determined by the setting and the clinician performing the CSE. This variability contributes to the controversy surrounding the use of Clinical Swallowing Evaluations.
Aside from the variability in composition there are several arguments against the clinical usefulness of, accuracy of, and need for the CSE. The CSE can also very in purpose as both a screening and assessment
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Warning signs that appear during the Clinical Swallow Evaluation can give the clinician insight into the possible results of a more formal Video Fleuroscopic Swallow Study (VFSS). If aspiration is suspected during the CSE it is 10 times more like to show up on VFSS. A Clinical Swallow Evaluation assesses neuromuscular, behavioral, and environmental factors involved in successful swallowing and eating. This comprehensive view of eating and swallowing provides valuable insight in determining intervention methods and potential complications.
Ultimately the decision for or against CSE is made by the clinician and potentially the needs of the patient. Personally, I will include CSE in my clinical toolbox as a screening tool, but not as a tool for assessment. The insight into neuromuscular, behavioral, and environmental factors is extremely valuable and necessary for implementing intervention. A Clinical Swallow Evaluation contributes valuable information but should not stand alone as an assessment method due to its inability to determine where the breakdown occurs in abnormal
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
The clinician administered the Bedside Swallow Evaluation. The purpose of this evaluation is to determine if further testing is warranted due to performance of swallowing function. The patient will consume a variety of textures and consistencies. The patient is first presented with water from a spoon and asked to swallow it as the clinician places a gloved hand on the patient’s throat, as for the clinician to feel the typical anterior-superior movement of the larynx. After the patient finishes swallowing the clinician asks the patient to produce a prolonged phonation to observe voice quality. The patient is then instructed to take a single sip form a cup with thin liquid (clinician checks larynx movement present and vocal quality), take three
When patients finally seek help, they will usually present with a combination of symptoms such as worsening dyspnea, chronic coughing with sputum production which may or may not include acute chest pain and wheezing (Zab. M. 2014)
The ability to swallow is an intricate process that includes the coordinated effort of cranial nerves and multiple muscles. Pathophysiology of aspiration is such that, food or liquid is misdirected down the respiratory pathway. In most cases aspiration will occur as it travels via the straighter path to the right main bronchus and onward to the right lower lobe of the lung (Eisenstadt, 2010). Dysphagia’s incidence after a stroke varies due to the location of the stroke and occurs between 28%-79% of the time (Lakshminarayan et al., 2010). Current state has bodies of authority without an approved dysphagia measure based on evidenced. These entities hospitals would look to for consensus and guidance are the American Heart Association (AHA), Centers for Disease Control (CDC), and The Joint Commission (TJC) (Solis, n.d.). Without the endorsement of a screening tool, hospitals may not be persistently utilizing a dys...
Please list the references and clinical resources that you use in your review of this document. These references should support any clinical or extensive revisions or additions that you make. Aside from known common best practices, references are required. We reserve the right to request additional references. References and resources used:
Saunders has a history of asthma and in conjunction with a respiratory assessment an asthma assessment will be required. A brief patient history is needed to evaluate, looking for a history of rapid onset, exaggerated use of β-agonists and mechanical ventilation for asthma. Symptoms sound is taken into account, in the case of Mr. Saunders he is experiencing shortness of breath, speaking in short sentences, presenting wheezing, flushed appearance as well as dyspnoea. Additionally, the severity of the symptoms should be taken into account, how often they occur and whether they cause exercise limitations or nocturnal wakening (Kaufman, 2012). It is also important to establish any medications whether it be prescribed, over the counter, or herbal remedies that the patient may be taking as some medications have been known to exacerbate asthma (Kaufman, 2012). In addition to exploring clinical history, it is also important to obtain objective data to support the diagnosis (Kaufman, 2012). Physical examinations are a part of an asthma assessment and are very essential to help backup the diagnosis. Respiratory rate, heart rate and pulse paradoxus are all sections of the physical examination. In conjunction with these a spirometry is also required. A spirometry is best pathway of identifying airflow obstruction which will make a definitive diagnosis of asthma (Kaufman, 2012). This assessment required the patient to use maximum force to expel the air from their lungs, as fast and hard as possible. This process is measure over 1 second and conducted 3 times, thus the highest recording of the three is taken (Kaufman, 2012). A result lower than 70% strongly indicates airway obstruction; hence lower the ratio, the more severity of the obstruction (Kaufman,
Please list the references and clinical resources that you use in your review of this document. These references should support any clinical or extensive revisions or additions that you make. Aside from known common best practices, references are required. We reserve the right to request additional references. References and resources used:
When evaluating Suzy for the first time, the Speech Language Pathologist could utilize several screening tools to address the possible need for further exploration. As Calis et al. (2008) explained in their article regarding screenings, the Dysphagia Disorders Survey (DDS) and the Schedule for Oral-Motor Assessment (SOMA) are both a quick check, which can be completed in a naturalistic environment and are non-invasive screening tools. It is also extremely important to
Assessment is a crucial aspect of what speech language pathologists do on a daily basis. After seeing someone for treatment, they are constantly assessing the situation and deciding if adjustments need to be made. During the assessment process, the interview and case history are helpful sources for the speech language pathologist to start formulating his or her hypothesis of what is wrong.
Estimated frequency of symptoms on more than one-third of days for at least 3 months prior to screening (e.g., wheezing, breathlessness, chest tightness, cough, nocturnal awakening) despite treatment with high dose ICS and long-acting ß2-agonist (LABA) with or without continuous oral
Stewart-Brown, S. and Farmer, A. (1997) Screening could seriously damage your health BMJ; 314: 533
Criteria C states that the symptoms aren’t due to the direct physiological effects of a substance. There was no evidence that
During the therapy session, they administered VitalStim therapy. VitalStim was used for the patient because he was suffering with difficulty swallowing also known as dysphasia. Electrical stimulation is used to aid muscle strengthening and muscle recruitment to rehabilitate the swallow. The clinician applied the VitalStim while working with the patient on swallowing exercise. To make this happened she has the patient read one to two pages out a book to get the VitalStim to be effective. The patient was not only working on dysphasia, but was also working on aphasia and apraxia. All of these focuses are being worked on, but the therapy session that I saw was
There are 2 types of breathing, costal and diaphragmatic breathing (Berman, 2015). Costal refers to the intercostal and accessory muscles while diaphragmatic refers to breathing using your diaphragm (Berman, 2015).It is important to understand the two different types of breathing because it is vital in the assessment of the patient. For example, if a patient is suing their accessory muscles to aid in breathing then we can safely assume that they are having breathing problems and use a focused assessment of their respiration. Assessing respiration is fairly straightforward. The patient’s respiration rate can be affected by anxiety so a useful to avoid this is to check pulse first and after you have finished that, while still holding their pulse point, check their respiration rate. Inconspicuous assessment avoids the patient changing their breathing because they know they are being assessed which patients can sometimes do subconsciously. Through textbooks and practical classes I have learned what to be aware of while assessing a patient’s respiratory rate. For example; their normal breathing pattern, if and how their health problems are affecting their breathing, any medications that could affect their respiratory rate and also the rate, depth, rhythm and quality of their breathing (Berman, 2015). The only problem I found while assessing respiration rate was I thought it seemed a bit invasive looking at the