Additional+Areas+for+Consideration

** Additional Areas for Consideration **  (5:f) A stethoscope is placed on the patient’s neck at the level of the vocal folds and the clinician listens for the sounds associated with swallowing (Rommel, 2006). Pre and post swallow sounds should be compared. Changes in the respiratory rate or an increase in respiratory congestion may be a sign of aspiration. If inspiration occurs during the swallow, the patient is at risk for penetration of the vocal folds.
 * Cervical Ausculation **

A disadvantage of this method is that inter-rater reliability on detection of aspiration or penetration is only fair (Cicero & Murdoch, 2006). This measure doesn't offer a direct view of the swallowing mechanism or explain the cause of dysphagia.

Pulse oximetry is measuring the oxygen levels in the blood based on the premise that when aspiration occurs there will be a drop in oxygen levels (Cicero & Murdoch, 2006). Patients who aspirate will also show a drop in oxygen saturation levels. Rather than predicting aspiration, oxygen saturation levels, when used with a clinical/mealtime assessment, can give increased sensitivity for detecting aspiration.
 * Pulse oximetry: Oxygen saturation levels Spo₂ **

There is no standard assessment for a clinical/mealtime observation.
 * Assessments **

The following are published assessments that do not require further training. A summary of these assements can be found from the American Speech-Language-Hearing Association. (2000). Clinical Indicators for Instrumental Assessment of Dysphagia [Guidelines]. [|ASHA]

-AusTOMs for Speech Pathology: Swallowing Scale

-Dworkin-Culatta Oral Mechanism Exam and Treatment System (D-COME-T)

-Establishing Dysphagia Programs

-Hines Functional Dysphagia Scale (HFDS)

-Oral Motor/Feeding Rating Scale

-Oral Speech Mechanism Screening Examination- Third Edition (OSMSE-3)

Instrumental Assessment