A speech and language pathologist makes use of various clinical instrumental techniques to test oral, laryngeal, pharyngeal, esophageal and respiratory functions since they are responsible for swallowing. Therefore, the motives of the instrumental or objective assessment are to enable SLP to:-
Observe the structures of the digestive tract and the upper airway along with oral cavity, pharyx, larynx, velopharyngeal port and esophagus
Evaluate the functions of the oral structures and muscles that help in swallowing as well as measure, infer and spot sensation, strength, pressure, rate, tone, range and timing of movement
Evaluate effectiveness and coordination of lingual, pharyngeal, velopharyngeal and laryngeal movement while swallowing
Ascertain the presence, reason, seriousness and timing of aspiration by viewing bolus control, and flow and specify the efficiency and safety of bolus volumes and consistencies
Make a screen test of the anatomy and function of esophagus to get evidence for determining dysphagia
Various indications are found in patients with swallowing problems that point at the need of objective assessment. They are:-
Inconsistent signs and symptoms with diagnosis on clinical assessment
Concerns for airway safety, pulmonary or nutritional compromise
Presence of a critical medical condition or a diagnosis suggesting a high risk of swallowing disorder
Presence of a chronic degenerative condition and a progressive disease or recovery from a particular disease that requires greater information for the management and treatment of oropharyngeal function.
Once the indications are clear, the speech pathologist proceeds to make instrumental evaluations such as- video fluroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES). Video fluroscopic swallowing study, commonly known as modified barium swallow test provides visualization of the throat, the back of the tongue, larynx and esophagus. It is performed on an individual after he/she eats solids or drinks liquid with barium in it. The whole swallowing process is then seen on an X-ray. On the other hand, fiberoptic endoscopic evaluation is a portable process in which a lighted scope is thrust into the nose to observe swallowing on a screen. But unlike the VFSS, the FEES does not allow viewing of oral and esophageal stages of swallowing.
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