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?
- Risk of pneumonia is 11 times higher for patients with severe dysphagia and
aspiration - Hospitals using mandatory and formal dysphagia screening have lower pneumonia
rates than those without a screening - Health incentive and financial incentive to screen high risk patients – Why do we do
swallow screenings? (3)
To determine: - The likelihood that dysphagia is present
- The need for formal swallow evaluation
- Whether it is safe to feed the patient orally (for the purposes of nutrition, hydration,
and administration of medication) - Whether the patient requires referral for nutritional or hydrational support – What are
the goals of a swallow screening? (4) - A known history of dysphagia
- A medical diagnosis that frequently involves swallowing impairment (e.g., stroke)
- Reduced level of consciousness
- Overt signs of difficulty swallowing or aspiration
- 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) - Interview or questionnaire
- Observation of the signs and symptoms of oropharyngeal dysphagia
- Formulation of appropriate recommendations, including the need for a full swallow
function assessment - 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? - The Toronto Bedside Swallowing Screening Test (TOR-BSST)
- Health care professionals
- Gugging Swallowing Screen
- SLPs
- Massey Bedside Swallowing Screening
- Nurse administered
- 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?
- Orientation and command following
What is your name?
Where are you right now?
What year is it? - Command following
Done in conjunction with oral‐mechanism exam
Open your mouth
Stick out your tongue
Smile - 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