Swallow Screening
Evaluation of swallowing may be performed on individuals of any age and with any disease, and may include a screening, clinical exam, and/or instrumental exam. If a screening is employed, its goal is to identify the risk of dysphagia. If the risk exists, then a referral is made for a dysphagia evaluation (Box 3.1 and 3.2). This evaluation may include both clinical and instrumental components, but not all patients will get (or need) both of these. The goal of the dysphagia evaluation is to identify the presence and nature of the swallow deficit, as well as inform the therapeutic process. Currently, there is no standard of care for a dysphagia evaluation. The dysphagia clinician is skilled in both clinical and instrumental exams, and typically engages some combination of approaches to provide maximal benefit for the patient.
Box 3.1: Schematic relationship between screening and evaluation
Box 3.2: Comparison between screening and evaluation
Adult Screening
Screening procedures are used throughout medicine to identify individuals who are at risk for a condition or disease. Hence, a dysphagia screening is used to detect individuals who are at risk for dysphagia. Ideally, dysphagia screening tools should be valid and reliable, easy and quick to administer, and provide a pass/fail format, thus allowing for a quick determination of the likelihood of a swallow disorder. Using a pass/fail determination, a fail would evoke a comprehensive dysphagia evaluation (Swigert, Steele, & Riquelme, 2007). A screening may also elucidate the need for referral(s) to other medical health professionals. Box 3.3 schematically depicts various screening formats and possible red flags that may indicate a risk of dysphagia.
Box 3.3: Screening formats and associated red flags for dysphagia
Clinical Note
A screening may be an: (1) interview, questionnaire, or medical chart review, (2) observation or report of clinical signs or symptoms associated with dysphagia, (3) administration of liquid or other oral intake, or (4) presence of a specific disease (such as CVA), medical status (such as presence of tracheotomy), or specific events in the medical history (such as history of pneumonia) (Daniels, Ballo, Mahoney, & Foundas, 2000; Logemann, Veis, & Colangelo, 1999).
Clinical Note
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Although the Joint Commission for health care’s standards recommend the completion of a dysphagia screening in certified stroke centers, dysphagia screenings are not the standard of care at all medical facilities (Masrur et al., 2013). Some medical facilities incorporate a dysphagia screening as part of their routine admission. Medical facilities that use a formal dysphagia screening procedure have lower rates of aspiration pneumonia (Hinchey et al., 2005). When facilities use a dysphagia screening, an SLP or other medical professional may perform the procedure. When the screening is not performed by the SLP, the SLP may be invo