Clinical+Assessment

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** Clinical Assessment **

Clinical assessment involves the following according to Groher & Crary (2003): · a review of the patient’s medical status (covered in the case history section here) · an oro-facial examination (which assesses the functioning of the cranial nerves) · an assessment of cognitive and behavioural status · a clinical/mealtime observation of the patient swallowing a variety of food and liquids

Clinical assessment indicates the presence or absence of a symptom and is most useful for investigating the oral phase of swallowing. SLT’s should be aware that because of the poor ability of the clinical exam to characterize the pharyngeal phase of the swallow, it should be thought of as a ‘screening tool’ rather than a ‘diagnostic tool’ (Cichero & Murdoch, 2006).

A clinical assessment will often be required after surgery as patients will be at high risk for swallowing difficulties(Groher & Crary, 2010). It may also be done any time during or post-radiation if swallowing function has had a noticeable change. For a thorough explanation of clinical indicators for clinical assessment see the file below with information from the American Speech-Language-Hearing Association. (2000). Clinical Indicators for Instrumental Assessment of Dysphagia [Guidelines]. Also available from [|ASHA]



= After a referral is received, a medical and case history is completed, and a picture of the patient’s level of functioning is formed, a plan for assessment should be created. The materials needed for a clinical assessment could include some of the following according to Murray (1999): = = · gloves = = · a tongue depressor for examining the soft palate and oral cavity = = · a pen torch for examining the oral cavity = = · a stethoscope for cervical auscultation = The clinical/mealtime observation will require some or all of the following: = · food = = · liquid = = · thickener = = · straw = = · cup and utensils =

The client may need special utensils such as a glossectomy spoon so it is best to find out what you may need before beginning the assessment (Murray, 1999). If the patient is fed by a family member you may arrange a time when they will be present to observe the feeding technique and discuss concerns.

= If you have not been able to conduct an interview with a patient you may have to rely on the medical history in the patients file. When greeting a patient you should bring the following: = = · medical history form = = · cranial nerve assessment = = · a clinical swallowing assessment form =

Some areas for follow-up questions or observation according to the American Speech-Language-Hearing Association. (2000): = · current method of nutrition and nutrition status compared to prior status. = = · behavioural characteristics such as level of alertness, cooperation, motivation. = = · cognition and communication skills. = = · any problems with appropriate positioning of patient. = = · oral motor structure, sensation and function. =

Oro-Facial Examination 