Swallowing Assessments

Being able to swallow is such an important part of our daily living. Having difficulty swallowing (a condition medically known as ‘dysphagia’) can be a stressful, sometimes even distressing condition, especially if it makes it difficult to eat food and hydrate.

If you regularly experience trouble swallowing, you may need to undergo a swallowing assessment to find out what the problem is and how best to treat it. Home Caring offers clinical bedside swallowing assessments for seniors and people living with disabilities, in the comfort of their own home. Here is some information on dysphagia, how a swallowing assessment works, and what to expect if you need to have one.

• What is dysphagia?
• How does a swallowing assessment work?
• Who might need a swallowing assessment?
• What happens in a swallowing assessment?
• Non-instrumental swallowing assessment
• Instrumental swallowing assessment
• How can a swallowing assessment benefit me?
• Where can I receive a swallowing assessment?
• Swallowing assessments and cultural sensitivity

What is dysphagia?

Dysphagia is when someone has difficulty swallowing. It can be caused by all sorts of conditions, such as weak muscles in your throat, dementia, poor cognitive function, poor muscle coordination and control and coordination, stroke, head injury, Parkinson’s disease, motor neurone disease, cerebral palsy or achalasia (a condition that impacts your oesophagus).

If you have dysphagia, your health professional may request you undergo a swallowing assessment to find out what the problem is.

How does a swallowing assessment work?

A swallowing assessment (sometimes called a ‘dysphagia assessment’) diagnoses what kind of swallowing problem someone has, and the best way to intervene and treat them. This assessment must be conducted by a university-trained speech pathologist who is accredited with Speech Pathology Australia. It can be undertaken in a hospital, aged care facility, disability accommodation or in your own home.

In a swallowing assessment, the speech pathologist will observe your swallow function, along with examining your ability to communicate, general health, cognitive function, what your nutrition is like, and any environmental and behavioural factors that may be causing you to have trouble swallowing.

Two types of swallowing assessments may be conducted to help diagnose your problem: an instrumental swallowing assessment which uses instrumental techniques, and a non- instrumental swallowing assessment which is conducted without the use of implements, (often called a ‘bedside swallowing assessment’)

Instrumental swallowing assessments

An instrumental swallowing assessment is generally used to evaluate a person’s oral, pharyngeal, laryngeal, upper oesophageal and respiratory function in relation to the way they swallow.

It can be conducted with other health professionals (for example, a radiologist) especially if a Video Fluoroscopic Swallowing Study (VFSS) or Fibreoptic Endoscopic Evaluation of Swallowing (FEES) is required. Like non instrumental swallowing assessments, it also includes a thorough case history, oral mechanism exam, and an examination of your overall physical, social, cognitive and behavioural health.

Non-Instrumental swallowing assessment

A clinical bedside swallowing assessment is when a qualified speech pathologist thoroughly examines the way you swallow, including whether you get fatigued during a meal, your posture and position while eating, and what your environment is like.

During the bedside swallowing assessment, the speech pathologist will look for signs and symptoms of dysphagia, and how severe they may be. They may:

• Examine how you eat (or how you are fed by your carer)
• Take your case history and review your medical records
• Monitor your physiological condition (e.g. your heart rate and breathing)
• Talk to your home carer, family members and other health professionals associated with your care
• Ask you about how you perceive your function, and if you’ve experienced any changes in your functional status and quality of life
• Assess your overall health in relation to your swallowing ability
• Look at your communication, speech and vocal quality
• Look at your ability to secrete saliva, (e.g. the frequency and adequacy of
  spontaneous saliva swallowing, and your ability to swallow voluntarily)
• Assess how well you can keep your lips sealed, whether food spills from your mouth and evidence of oral control (e.g. how you chew)
• Identify signs of food possibly entering your lungs (e.g. throat clearing, coughing when you swallow)
• Assess your ability to clear your airways and your cough strength
• Conduct an oral mechanism exam
• Conduct a cranial nerve assessment
• Assess your face, jaw, lips, tongue, palate, oral pharynx and the mucous inside your mouth
• Conduct a functional assessment of the muscles you use to swallow
• Look at your head-neck control, posture, oral reflexes and any involuntary movements you may make while you eat

How can a swallowing assessment benefit me?

Undergoing a swallowing assessment is a crucial step towards finding the best treatment to help you swallow more safely and effectively.

After conducting their assessment, the speech pathologist will evaluate your condition by putting together your case history, medical records, their physical examination, previous screenings you may have undergone, and information from your other caregivers and health professionals.

This helps them to:

• Diagnose your swallowing disorder
• Develop a prognosis for your improvement
• Understand your swallowing function, including any breakdowns.
• Work out the safest, most efficient way for you to drink and eat
• Identify any interventions and supports that can help you
• Refer you to other services or professionals who can help you
• Provide counselling, education and training for you, your carers and your healthcare providers

Where can I receive a swallowing assessment?

Home Caring has a dedicated team of highly qualified speech pathologists who can conduct swallowing assessments for people who have trouble swallowing. We are also an NDIS registered health provider, and help people living with disabilities. For more information please get in touch.

Swallowing assessments and cultural sensitivity

At Home Caring, we are committed to respecting everyone’s beliefs and cultural backgrounds. Our examiners conduct bedside swallowing assessments in a way that is considerate of each client’s religious, cultural and personal beliefs.

We also consider how your culture may influence activities of daily living – including your dietary requirements, and any religious practices that may be associated with food and drink.