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1
Equipment: Pen-light, tongue depressors and
mouth swabs
I find these items essential to perform any bedside or
outpatient swallow assessment. Thorough examination
of oral musculature and anatomy are greatly assisted
by these items, and I would never leave my office
without them!
2
Gloves, eye goggles, hand wash
I consider universal precautions for infection control to
be indispensable in working with dysphagia. During
bedside swallow examination, you frequently come
into contact with the oral mucosa and saliva. It is also
possible that coughing may increase your risk of
exposure to transmissible infections. Simple barrier
protection (gloves and eye goggles) and hand washing
with good technique before and after contact
significantly reduce the risk to both yourself and your
patient.
3
My multidisciplinary team
Management of dysphagia is an area of specialty for
speech pathology. However, working in a team of
health professionals can really increase the options you
have available for your patient.
n
Input from medical staff is often essential to
establish a diagnosis for the underlying condition
related to dysphagia. Medical referral (and joint per
formance) is also often necessary for instrumental
examinations such as videofluoroscopy and fibre
optic endoscopic evaluation of swallowing (FEES).
n
Our allied health colleagues – our job would be
much more difficult without physiotherapists to
advise on respiratory support and positioning,
occupational therapists to assist with seating and
modified cutlery, dietetics to work towards the most
appropriate nutrition and hydration options, and
social workers to help our patients source assistance
in the community.
n
Nurses frequently carry out and monitor our
recommendations, and may be the first to identify
the need for a speech pathology referral.
4
The Passy-Muir tracheostomy observation
model
This model is a coloured plastic 3D representation of
the head and neck in mid saggital cross-section. It is
M
y
T
op
10 R
esources
for
D
ysphagia
Asher Peet
I am a senior speech pathologist at Sir Charles Gairdner Hospital in Western Australia graduated from
Curtin University of Technology in 2005, and have worked in an acute adult setting since that time.
My major fields of interest are dysphagia, tracheostomy and FEES.
As a speech pathologist in an acute tertiary hospital, I work predominantly with acquired
swallowing disorders in an adult population. I find this area of work to be both challenging and
rewarding, and the resources below to be invaluable in offering my clients a better service. I hope that
other clinicians will also find them useful, either as a way to support their own skills or to share our
knowledge with patients, caregivers and other health professionals.
extremely useful in pointing out the anatomical
structures involved in swallowing to patients, families
and other health professionals. In particular, I find it
helps laypersons to visualise the location of the trachea
and oesophagus, and understand the mechanisms of
aspiration. It also has a “stoma” available for the
placement of a tracheostomy tube – you can place and
demonstrate the type of tube relevant to your patient. A
wonderful way to practise inflating and deflating cuffs,
and placing and removing valves and inner cannulas.
5
Recipes for “thinning down” thickened
fluids at bedside
Patients with dysphagia often need to have their
swallowing function assessed with various fluid con
sistencies. These consistencies may not be available in
pre-mixed form at all sites. It is therefore important to
ensure that the viscosity of the fluid you assess the
patient with will be the same as the viscosity you order
for them to have day to day. Studies have shown that
“eye testing” or “spoon testing” is not a reliable way of
measuring viscosity. At Sir Charles Gairdner Hospital
in Western Australia, we have developed recipes to
dictate how much fluid will be required to add to a
L900 thickened fluid, to make a L400 or L150, according
to our guidelines based on the line spread test. This
strategy aims to provide a cost-effective and reliable
way of having consistent viscosities for bedside assess
ment.
6
A dysphagia “show bag”
When patients are placed on a modified diet and fluids,
they need adequate education and support to be able to
understand the need for the changes and to produce
them in the home environment. At Sir Charles Gairdner
Hospital, patients and families are provided with a
“show bag” upon discharge that includes education
brochures, thickening powder samples and brochures,
catalogues for commercially pre-mixed fluids, an
instructional leaflet regarding their type of diet, and
additional items as required (for example, Biotene
products for oral care).
7
A neuroanatomy and physiology
“cheat sheet”
Another item I wouldn’t leave my office without! The
neurological control of swallowing is complex, and it is
MULTICULTURALISM AND DYSPHAGIA
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p eech
P
athology
A
ustralia