portable pre-swallow

visualises: pharyngeal path of bolus

More objective Post swallow

oral cavity
advantages oral/pharyngeal residue
Allied health professionals observations
MDT complex swallowing posterior pharynɡeal wall
(Cook + Kahrilas 1999)
disorder team
SLT
larynɡeal vestibule
dietician
FEES anatomy
swallow
chest physiotherapy
Timing

GERIATOLOGIST

medical specialists procedure dye tinted bolus observed with videostroboscopy

otolaryngologist

NEUROLOGIST approaches swallow whiteout

disadvantages
Gastroenterologist Expertise/equipment availability Limited

RADIOLOGIST
nurses

Barium permeated food/drink

pulmonologist counsellors
objective oral cavity
patient + family
procedure moving X-ray
pharyngeal cavity

safe larynx

establish nutrition/hydration
trachea
Appropriate
primary management goal (acute)
objectivity and consistency
minimise aspiration risk gold standard
Advantages
Aspiration observable
take account of patient wishes video fluoroscopy

baseline and monitoring functions

all movements/structures involved observed

patient preferences
approaches, assessments and not portable
cognitive status Cook and Kahrilas 1999
Holistic Considerations... interventions for swallowing disorders assessments Disadvantages
Radiation exposure
nature
swallowing disorder medical status
training/expertise
severity Time and cost
Quality of Life Equipment

includes oro-motor exam availability

Ax oral/laryngeal function
QOL impact
diet modifications
Presentation of a variety of consistencies
need trained carer
choking
aspiration indicators
ease ant-post. propulsion Changing colour
body postures
oral residue Respiration rate

protect upper airway swallowing techniques /postures behavioural observation of swallows

based on: wet voice pre-swallow
bedside swallowing Ax
resp. onset timing wet voice post swallow

vocal fold closure swallowing techniques coughing pre-

saliva management!
e.g. supraglottic swallow SLT skill/experience During
airway expulsion
Post
subjective
protect upper aiway temperature
purpose: silent aspiration monitor
disadvantages
improve safety on subtances strength
vulnerable to aspiration Chest status
exercises
Not objective
ROM

Co-ordination
1 consistency only
awareness interventions
Improve oral/pharyngeal movement blue dye added to food/liquid presented
in bedside swallowing Ax blue dye in secretions
timing aspiration indicator

thermo-tactile stimulation sensory input treatments regular suctioning over 12 hours

tracheostomy patients:
blue dye swallowing test
false positives
disadvantages

time/swallow
thermochemical stimulation low-cost
Advantages
sip capacity
direct swallow rehab Quick
impulsivity management?
Hamdy et al 2003
No equipment needed

posterior pharyngeal wall movement

Masako manouvre (exercise)
Huckabee et al 2005
UES opening
manouvers

laryngeal elevation suprahypoid mm. strength

Shaker Exercise
healthy adults (Shaker et al 1997)

adults c. impared UES function

Shaker et al 2002

Cook and Kahrilas 1999 contradictory evidence re.

aspiration risk Non-oral feeding... alternative feeding
risk of pneumonia with N.oral feeding Crogan et al 1994

"work"
oral feeding effortful?

QOL impact