Additional+Assessments+to+Consider


 * Additional Assessments to Consider **


 * SEMG (Surface Electromyography) **

Surface Electromyograhpy (SEMG) is a technique used to provide visual feedback to the patient during their practice of swallowing (Cicero & Murdoch, 2006). The machine detects the electrical activity of the muscles and the patient can learn to use the muscles which have been affected in a more efficient way for a better swallow.

=** Modified Evans Blue Dye Test **= =** Modified Evans Blue Dye Test (MEBD) is used to detect aspiration at bedside (Groher & Crary, 2010). This test would be done if the patient had obstruction of the airway post-surguray and a tracheotomy was inserted. The patient is given a liquid or semisolid and colour is added to distinguish any aspirated material from other secretions. Blue food colouring is no longer used due to issues regarding sterilisation and food allergies. Sterile methylene blue is preferable (Cherney, 1994). **= =** Donzelli et al. (2001) found that FEES maintains both high intra- and interrater reliability in detecting the critical features of pharyngeal dysphagia and aspiration using either blue-dyed or non-blue-dyed foods. There was a high false-positive result from the MEBD. **= =** The following article is recommended reading containing guidelines for evaluating a patient with a tracheotomy: **=
 * Cherney, L. R. (1994). Clinical management of dysphagia in adults and children (second ed.). Gaithersburg, Md.: Aspen Publishers, Inc. (pp 57-59). **

Ultrasound is non-invasive as it does not penetrate bone so its use is limited to the soft tissue of the oral cavity, salivary glands and parts of the oropharynx (Cichero & Murdoch, 2006). This population is already being exposed to radiation so limiting procedures such as VFSS should be considered. Study of tongue movement and control of bolus in the oral preparation and oral phases of swallowing is useful for this patient population. This procedure can be done with the patient in upright or supine position (Cichero & Murdoch, 2006). A transducer is placed submentally below the chin to obtain an image. Ultrasound cannot pass through bone so it cannot be used to assess aspiration or pooling.
 * Ultrasound **

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