[Editors note. This mini-series was a collaborative effort by Sharon C. Meier, MS CCC-SLP (Able Speech and Voice in Osprey, Florida), Jan Pryor, MA CCC-SLP BCS-S, and Ellen Conover, MS CF-SLP. Part one focused on swallowing disorder symptoms; this part, part two, focuses on what to expect during an initial swallowing assessment. NFOSD would like to thank each of our contributing authors.]
The first visit starts the minute we meet. Are you ambulatory (able to walk), alone or with another? As we walk toward the therapy room, dining room or kitchen table, we talk. I subjectively assess cognition (attention, memory, problem solving), vocal quality, pragmatics (social appropriateness in communication) and medical concerns. We discuss recent doctor visits. I assess posture, stature and proportional weight. We converse while establishing rapport. I ask if you are having eating, chewing and or swallowing issues.
If possible, your own kitchen is the BEST place for collecting this information and observing you. If this is not possible, I may ask you to bring in foods or liquids that cause swallowing problems in order to evaluate your swallowing difficulties firsthand.
Questions I would ask during my interview may include:
– Your current diet
- Typical foods/liquids you enjoy and/or avoid
- Frequency of meals
- Caloric intake
– History of dysphagia
- Symptoms you are experiencing
- Onset, frequency, duration, and severity of symptoms
- Unintended weight loss or reduced appetite
– Any altered eating habits
- Assistance eating
- Modified food textures
- Consumption of small, frequent meals
- Postural adjustments to facilitate swallowing
- Alternate solids and liquids
- Tendency to take small bites
- Excessive chewing
- Pill taking behaviors – Are they hard to swallow whole? Do they need to be crushed?
- Family history – neurologic history or history of dysphagia
– Medical history
- Current medications
- Pulmonary history (frequent or recurrent bronchitis, history of pneumonia)
- Medical diagnoses that may contribute to swallowing problems including, but not limited to:
- Stroke
- Parkinson’s
- Amyotrophic Lateral Sclerosis (ALS)
- Multiple Sclerosis
- Muscular Dystrophy
- Oral, Pharyngeal or Laryngeal cancer
- Radiation therapy
- Neurosurgery
- Cervical Spine Disease
- Chronic, Pulmonary Disease (such as COPD)
- Gastroesophageal Reflux
- Prior swallowing exams and results
I explain that I will look into your mouth and then watch you breathe in order to examine the structure and function of the body parts involved in swallowing.
I look into your mouth for missing teeth, overall dental health, symmetry, strength and functionality of the oral and pharyngeal anatomy to process food and liquid.
I ask you to perform different tasks with your face, lips and tongue to test for strength, coordination and range of motion of the muscles involved in containing, chewing, manipulating and swallowing.
I have you perform voice and speech tasks, such as sustaining a tone as long as possible, repeating syllables and saying “ah” to get the soft palate to elevate. I listen to the quality of your cough, throat clear and vocal quantity and quality.
I may listen, watch and feel for pain during a dry swallow using a stethoscope. I listen, watch and feel your breath with your cheeks puffed.
I take your oxygen levels at rest and after swallowing.
I observe you eat, chew and swallow some different foods and liquids, including water, applesauce or a cracker. I watch, listen and feel the rise and fall of your larynx as we trial foods and liquids of varying consistencies.
We then discuss my observations and talk through a set of recommended next steps, which may include a set of exercises, maneuvers or postures, change in diet texture and/or referral for further evaluation. The most common include a: 1) Modified Barium Swallow Evaluation, and 2) Flexible Endoscopic Evaluation of Swallowing (FEES) exam.