Speech-language pathologists (SLPs) frequently conduct bedside swallow evaluations (BSEs) to assess swallowing function in patients with dysphagia. These evaluations are crucial for identifying swallowing difficulties and determining the need for further diagnostic testing, such as a videofluoroscopic swallowing study (VFSS). While a formal, standardized bedside swallow evaluation form from ASHA isn't publicly available as a PDF download, this guide will walk you through the key components of a thorough BSE and point you towards resources that can assist in developing your own comprehensive evaluation form.
Understanding the Bedside Swallow Evaluation
A BSE is a quick, preliminary screening tool used to identify potential swallowing problems. It’s non-invasive and can be performed at the patient's bedside, making it ideal for initial assessments in various settings, including hospitals, skilled nursing facilities, and outpatient clinics. Remember that a BSE is not a replacement for a VFSS; it serves as an important stepping stone in the diagnostic process.
Key Components of a Comprehensive Bedside Swallow Evaluation:
The following elements are typically included in a thorough BSE. You can adapt these components to create your own form, customizing it to suit your specific needs and patient population:
1. Patient History:
- Medical History: This includes relevant diagnoses (e.g., stroke, cancer, neurological disorders), medications (especially those with potential side effects impacting swallowing), and surgeries.
- Dietary History: Assess the patient's current diet consistency (e.g., pureed, mechanical soft, regular), any difficulties during mealtimes, and any recent changes in appetite or food intake.
- Symptoms: Document the patient's reported symptoms, such as coughing, choking, difficulty initiating swallows, food sticking, drooling, or shortness of breath during or after eating.
2. Oral Mechanism Examination:
- Oral Cavity Inspection: Observe the lips, teeth, tongue, hard and soft palates for any structural abnormalities, such as lesions, missing teeth, or asymmetry.
- Cranial Nerve Assessment: Assess cranial nerves V (trigeminal), VII (facial), IX (glossopharyngeal), X (vagus), and XII (hypoglossal) through observation of facial symmetry, tongue movements, gag reflex, and vocal quality. Note any weakness or asymmetry.
- Oral Motor Skills: Evaluate the patient's ability to perform tasks such as lip closure, tongue protrusion, lateralization, elevation, and the strength and range of motion of their jaw.
3. Swallowing Assessment:
- Trial Swallows: Observe the patient's swallowing ability with varying consistencies of food and/or liquids (e.g., ice chips, thin liquids, nectar-thick liquids, pudding). Pay close attention to coughing, choking, or other adverse events.
- Vocal Quality: Assess the patient's voice quality before, during, and after swallows, noting any changes in voice quality that may suggest aspiration.
- Post-Swallow Examination: Assess the patient’s oral cavity for residual food or liquid after swallowing.
4. Clinical Impression and Recommendations:
- Summarize your findings from the history, oral mechanism exam, and swallow assessment.
- Provide a concise clinical impression, including whether swallowing impairment is present and the severity of the impairment.
- Offer recommendations for management, such as dietary modifications, compensatory strategies, and referral for further testing (VFSS).
Where to Find Resources for Developing Your Own Form
While a pre-made ASHA-branded PDF is unavailable, you can adapt existing templates or create your own. Look for resources that reflect current best practices in dysphagia management. Consult your institution's guidelines and resources available to clinicians. Remember to always tailor your assessment to the individual needs of each patient. Thorough documentation is crucial for effective patient care and communication among the healthcare team.
