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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4464_Библиотеки_им_академика_М_И_Перельмана.pdf
Appendix
8
Clinical Swallowing
Examination Sample Form
PART 1
Name of clinician: Date of examination:
Name of patient: Gender: F/M DOB:
Education level:
Current swallowing status
Type of tube feeding:
Feeding assistance: Independent/Assisted
Time for each meal: Short/Normal/Extended
Type of diet (IDDSI level): Food ; Fluids
Volume per swallow: Food ; Fluids
General health/medical status
Activities of daily living (ADL): Independent/Partially assisted/Complete dependent
Mobility: Normal/Paresis (Left/right; upper/lower)/Walk with assistance/Bed-bound
Medical history: Stroke/Head-neck-cancer/Head-trauma/Dementia/Parkinson’s/Others:
History of pneumonia: Y/N; if so, when: _____________________________
Current medications:
continues
343
344 CLINICAL MANAGEMENT OF SWALLOWING DISORDERS
Clinical Swallowing Examination Sample Form continued
General Observations
PART 2
Oral motor exam
Structures Ax Items Ax Task Results
Severity Rating*
0 = normal
5 = severely
impaired
Lip Strength Puff checks 5 s/maximum duration (mark
complete or incomplete and final duration)
Coordination Alternate between /i/ and /u/, count
how many set (i-u) in 5 s
Range of
movement
Symmetry At rest Note: drooling/
Diadochokinesis /pa/ (count how many in 10 s) /10 s 0 1 2 3 4 5
Jaw Strength Open mouth while pushing on chin 5 s (mark
Coordination Number of sets of open/close jaws in
Range of
movement
Symmetry At rest Note: deviation
Distance between corners /i/ 0 1 2 3 4 5
During smile 0 1 2 3 4 5
During pursing 0 1 2 3 4 5
complete or incomplete and final duration)
5 s
Open mouth to largest extent 0 1 2 3 4 5
Depressed mandible 0 1 2 3 4 5
incomplete seal
Weakness on
L/R
(L/R)
/i-u/ 0 1 2 3 4 5
0 1 2 3 4 5
/u/ 0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
APPENDIX 8. CLINICAL SWALLOWING EXAMINATION SAMPLE FORM 345
Severity Rating*
0 = normal
5 = severely
Structures Ax Items Ax Task Results
impaired
Jaw
continued
Diadochokinesis /ja/ (count how many in 5 s) /10 s 0 1 2 3 4 5
Tongue Strength Push cheek from inside against external
pressure
Push against tongue depressor upon protrusion 0 1 2 3 4 5
Coordination Number of times touching corners of
mouth alternatively in 5 s
Range of
movement
Protrusion/retraction 0 1 2 3 4 5
Anterior elevation 0 1 2 3 4 5
Posterior elevation 0 1 2 3 4 5
Right lateralization 0 1 2 3 4 5
Left lateralization 0 1 2 3 4 5
Symmetry At rest (Deviates to L/R) 0 1 2 3 4 5
During protrusion (Deviates to L/R) 0 1 2 3 4 5
Appearance At rest Note: Atrophy/fasciculation/dry
(xerostomia)/edematous/redness/
lesions/ulcers
L: 0 1 2 3 4 5
R: 0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
Diadochokinesis /ta/ (count how many in 10 s) /10 s 0 1 2 3 4 5
/ka/ (count how many in 10 s) /10 s 0 1 2 3 4 5
/pataka/ (count how many in 10 s) /10 s 0 1 2 3 4 5
Face Strength Muscle tone 0 1 2 3 4 5
Symmetry At rest Note:
During smile 0 1 2 3 4 5
asymmetry/tics
0 1 2 3 4 5
Weakness on
Raise eyebrows 0 1 2 3 4 5
L/R
Close eyes tightly 0 1 2 3 4 5
Oral
Dentition
cavity
Larynx Cough strength Sound Pressure Level (SPL) dB 0 1 2 3 4 5
Respiratory
Maximum Phonation Time (MPT) s 0 1 2 3 4 5
support
continues
346 CLINICAL MANAGEMENT OF SWALLOWING DISORDERS
Clinical Swallowing Examination Sample Form continued
PART 3
Trial swallows
Indicate symptoms observed while the client swallows the following consistencies. Please indicate the
volume and type of consistency in the first row.
Consistency
Symptoms
NAD
No swallowing reflex
Anterior spillage
Poor bolus control
Chewing difficulty
Prolonged oral transition
Nasal regurgitation
Delayed triggering of
pharyngeal swallow
Reduced laryngeal
elevation
Before
swallow
____ mL Thin ____ mL _____ ___ mL _____ Cracker
T1 T2 T3 T1 T2 T3 T1 T2 T3 T1 T2 T3
Cough
Throat clearing
Double/Multiple swallow
Gurgly voice
Shortness of breath
Oral residue
(postswallow)
During
swallow
After
swallow
Answers to Study Questions
Chapter 1
1. B
2. C
3. B
4. D
5. C
6. B
7. B
Chapter 2
1. C
2. Age T
Type of bolus T
Quality of dentition F
3. There are anatomical and physiological
changes at the oral cavity with age. The type
of liquid (thickness and volume) will affect
how the liquid is processed in the oral phase.
As chewing is not involved in swallowing
liquid, the quality of dentition will not affect
the oral phase of swallowing liquid.
4. C
5. C
6. D
7. C
Chapter 3
3. B
4. C
5. A
Chapter 5
1. C
2. B
3. B
Chapter 6
1. B
2. C
3. C
Chapter 7
1. D
2. A
3. C
Chapter 8
1. C
2. B
3. D
1. C
2. A
3. B
4. D
5. B
6. B
7. D
8. E
Chapter 4
1. D
2. A
347
Chapter 9
1. E
2. B
3. D
Chapter 10
1. D
2. A
3. D
4. D
5. A
348 CLINICAL MANAGEMENT OF SWALLOWING DISORDERS
Chapter 11
1. D
2. D
3. D
4. A
5. D
Chapter 12
1. D
2. D
3. D
4. D
5. D
Chapter 13
1. C
2. A
3. D
4. D
5. B
6. C
Index
Note: Page numbers in bold type reference non-text material.
3-oz water swallow test (WST), 126, 127
A
Abdominal pain, eosinophilic esophagitis and, 84
Abscess, lung, described, 64
Academy of Nutrition and Dietetics, 191
IDDSI launched, 193
Acellular, VFI and, 109
Achalasia, 78
HRM and, 152
throat discomfort and, 277
Acid
LPRD and, 83–84
reflux
eosinophilic esophagitis and, 84
GERD and, 80
regurgitation, GERD and, 80
Acidity aspirate and, aspiration and, 63
ACSS (Anterior cervical spine surgery)
swallowing disorders and, 90
treating, 90–94
Acute
airway obstruction, 63
care
patients, swallowing disorders and, 13
setting, dysphagia and, 9
respiratory distress syndrome (ARDS), aspiration
and, 63
Stroke Dysphagia Screening, 127
Acyclovir, side effects of, 85
Adipokines, colostrum and, 230
Advance directive, 219
Aerodigestive tract
muscular dysfunction of, 249
pediatric dysphagia and, 247
skull base surgery and, 112
swallowing disorders medications and, 85
tumors and, 101
upper
disorders, 67
tumor in, 13
Afferent fibers, tumors and, 101
Age, taste and, 34
Aggression, BPSD and, 215
Aging, dysphagia and, 10–11
Aging population
chronic diseases and, 213
cognitive changes in, 213
cortical changes in, 212
dementia and, swallowing and, 214–217
described, 212
dysphagia and, 12–13
EMST device for, 180
feeding assistance, 218
ethical considerations, 218–219
tips for, 217
nutrition in, 214
physical changes in, 212–213
sarcopenia and, 212–213
swallowing and, 212–214
changes in, 213–214
pharyngeal phase, 213
tube feeding and, 215–217
Air pulse generator, FEESST and, 144
Airway
obstruction, acute airway, 63
pressure changes, 114
protection, 175
during swallowing, 61
Akathisia, neuroleptic drugs and, 88
Allergens, eosinophilic esophagitis and, 84
Allergies, human milk and, 226
ALS (Amyotrophic lateral sclerosis), 68–71
bolus transport and, 70
dysphagia and, 206
malnutrition, 206
Alzheimer disease, dysphagia and, rate of, 12
Amantadine, side effects of, 85
Amazon basin, Chagas disease, 84
Ambulatory care, of newborns, 227
American Academy of Pediatrics, 238
on milk to solids, 257
American Geriatrics Society, tube feeding and, 216
349
350 CLINICAL MANAGEMENT OF SWALLOWING DISORDERS
American Speech- Language-Hearing Association
(ASHA), “clinical indicators for instrumental
assessment of dysphagia,” 141
American Speech-Language-Hearing Association
(ASHA), 124
Evidence Maps, 125
IDDSI launched, 193
MBS recommendation by, 147
purpose of CSE, 128
swallowing screening and, 125
American trypanosomiasis, 84
Aminoglycosides
myasthenia gravis and, 73
Parkinson disease and, 85
Amyloidosis, esophageal dysmotility and dysphagia.,
79–80
Amyotrophic lateral sclerosis (ALS), 68–71
bolus transport and, 70
dysphagia and, 12, 12, 206
malnutrition, 206
Anaerobic pneumonia, 64
Analysis of Swallowing Physiology Analysis of
Swallowing Physiology: Events, Kinematics
and Timing (ASPEKT), 150
Ansa
cervicalis, 60
hyoglossus, 60
Anterior cervical
faucial pillars
bolus and,43
spine disorders, 90–94
surgery (ACSS)
swallowing disorders and, 90
treating, 90–94
TTOS and, 171
Antibiotics, 85
hospital-acquired aspiration pneumonia and, 64
Anticonvulsants, side effects of, 87–88
Antihistamines, 85, 87
Antihypertensives, 87
Anti-inflammatory medication, breast engorgement
and, 240
Antimuscarinics, 87
Antineoplastic agents, side effects of, 87
Antioxidants, colostrum and, 230
Antipsychotic medications, 87–88
side effects of, 88
Antispasmodics, 87
Antituberculosis medications, side effects of, 85
Antiviral agents, side effects of, 85
Anxiety, BPSD and, 215
Anxiolytics, 88
Aorta, giant cell arteritis and, 89
Aphagia
defined, 4
pneumonia and, 6–7
Aphasia, co-occurrence of, 11
Aphthous ulcers, Chron’s disease and, 89
Appetite, BPSD and, 215
ARDS (Acute respiratory distress syndrome),
aspiration and, 63
Aripiprazole lauroxil, 87
Arytenoid, adduction/medialization, 112
Arytenoidopexy, 112
ASD (Autism spectrum disorder), 247
case study, 282–283
dysphagia and, 275
effects of, 246
ASHA (American Speech-Language-Hearing
Association), 124
“clinical indicators for instrumental assessment of
dysphagia,” 141
Evidence Maps, 125
IDDSI launched, 193
MBS recommendation by, 147
purpose of CSE, 128
swallowing screening and, 125
ASPEKT (Analysis of Swallowing Physiology), 150
Asphyxiation, head of bed and, 247
Aspirates
acidity of, aspiration and, 63
liquid, 63
Aspiration, 61–63
acute airway obstruction and, 63
aging population and, 213
airway
pressure changes and, 114
protection and, 175
ALS and, 69
anxiolytics and, 88
controlling, nonsurgical methods of, 180
CSE and, 128
described, 4, 61
Duchenne dystrophy and, 74
ethical considerations, 218–219
laryngectomy and, 109
long-term dysphagia and, 116
medialization laryngoplasty and, 111
myasthenia gravis and, 74
pharyngeal stage
after, 62
before, 62
during, 62
postswallow, 106
INDEX 351
prandial
classification of, 62
defined, 61
Mendelsohn’s classic review of, 61
pulmonary syndromes and, 63
risk factors, 64
silent, 63, 136
swallowing therapy and, 180, 182
tolerance to, 62–63
tongue cancer and, 104
tracheotomy tube and, 113–114
vocal folds closure and, 61
Aspiration pneumonia, 6–7, 63–67
CVA and, 10
bacterial infections and, 64
diagnosis of, 64
Duchenne dystrophy and, 74
dysphagia and, 9
high risk conditions, 65
altered mental status, 65
prolonged mechanical ventilation, 65
neuromuscular disorders and, 67
oral hygiene and, 166
recurrences of, 11
stroke and, 71
tracheotomy tube and, 113–114
types of, 64
Zenker diverticulum and, 117
Aspirin, 85
Assistive devices
mealtimes, 272
vacuum-assisted bottles, 272
Asymmetric tonic neck reflex, 254
Ataxia, anticonvulsants and, 87
Athetoid movements, antipsychotic medications and,
88
Atrophies, spinal muscular, 75
Atypical reflux, GERD and, 80
Auerbach plexus, sarcoidosis and, 90
Australian foods and fluids scales, 200–201
Australian Standardized Definitions and
Terminology for Texture-Modified Foods and
Fluids, 200–201
Autism spectrum disorder (ASD), 247
case study, 282–283
dysphagia and, 275
effects of, 246
Autoimmune, 88
disorders, 88–90
dysphagia and, 10–11
swallowing and, 7
Autologous fat, VFI and, 109
Axonotmesis, 154
Azathioprine
dermatomyositis and, 74
polymyositis and, 75
AZT (Zidovudine), side effects of, 85
B
Babies
high feeding frequency, 233–234
medically complex, nursing a, 237
premature, 236–237
sleepy, breastfeeding and, 234
Babinski reflex, 69, 254
Bacterial infections
aspiration pneumonia and, 64
of oral cavity, 84
of oropharynx, 84
Balloon dilation, achalasia and, 78
Barium
calculator, 147
esophagram, Zenker diverticulum and, 83
swallow, 156
thickened liquids and, 147
Barnes Jewish Hospital Stroke Dysphagia Screen, 127
Barrett esophagus, 83
Basal cells, radiation therapy and, 116
Bromhexine, 117
BDST (Burke Dysphagia Screening Test), 72, 127–128
Beckwith-Wiedemann syndrome, 247
Bedside Swallowing Assessment, 127
Bedsores, 205
Behavioral and psychological symptoms of dementia
(BPSD), 215
Behavioral
dysphagia, 248
symptoms, of dementia, 215
Benzodiazepines, dysphagia and, 88
Bile, GERD and, 80
Biomedical ethics, 16–17
principles, 219
Birth, premature, 236–237
Bite
reflex, 133
sized foods, defined, 197
Bitter taste, 34
Blisters
ocular cicatricial pemphigoid and, 90
pemphigus vulgaris and, 89–90
Blood
pressure, EMST and, 180
vessels, scleroderma and, 90