Assessment


 * Introduction **

(5:a) This section will examine clinical and instrumental assessments. Important points to keep in mind when assessing patients with total glossectomy and post-surgery radiation will be reviewed. As discussed here, the oral preparation stage, oral stage and pharyngeal stage ﻿of swallowing are most often affected (Groher & Crary, 2010; Kendall, 1997; Murray, 1999).

Oral cancers and their treatment can impair tongue movement so the assessment of tongue function is particularly important for this patient population (Brady, Hildner, Hutchins, 1999).

Post surgery Scarring from surgery at the tongue base will limit anterior tongue mobility and can lead to pharyngeal residue (Cicero & Murdoch, 2006). Swallowing function may seem to degrade or improve during the postsurgical healing process (Cicero & Murdoch, 2006). This is because edema and muscle functioning can be further complicated by the effects of tissue fibrosis from radiation. The alternative is that after swelling subsides and muscle functioning improves, the swallow may appear to improve.

Assessment Assessment may take place soon after surgery or re-assessment may be necessary even 3-10 years later as radiation as effects can seen many years post-treatment (Cicero & Murdoch, 2006). Assessment will provide information if altenative feeding is being considered. Some patients will receive swallowing therapy and may need to be re-assessed to note any changes in levels of functioning. The effectiveness of various compensatory strategies such as using a modified diet may need to be examined (Groher & Crary, 2010). Some patients who have been receiving alternative feeding methods will need to be assessed to determine whether they can safely return to oral feeding.

The layout for the assessment section will be the following:

Knowledge & Skills

Clinical Assessment

Oro-Facial Examination

Clinical or Mealtime Observation

Additional Areas for Consideration

Instrumental Assessment

FEES

VFSS

Additional Assessments to Consider

Report

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