The intention behind a subjective assessment is to identify patients with dysphagia by observing the presence and absence of common signs and symptoms as well as discern the considerable factors like posture, position, weariness while eating a meal and certain environmental conditions. It also aims to evaluate the severity of the problems, determine alterations that cause them, plan rehabilitation and check the result of treatment. A speech pathologist generally includes the following procedures in their subjective assessment.
Studying a patient’s previous case history, on the basis of his/her medical records. The SLP also interviews the patient to know about the exact health issues and complications
Doing some oral tests such as, cranial nerve examination, structural diagnosis of oral mucosa, oral pharynx, jaw, lips, tongue and hard and soft palate, functional assessment of structures and muscles used in biting, chewing and swallowing, involving sensation, symmetry, tone, range, strength, motion and harmonization of movement, and observation of the movements of head, oral reflexes, neck control
Reading overall physical, psychological, social and cognitive position of a patient
Judging the patient’s living standard and quality, and transformation in functional status
Evaluation of the patient’s vocal quality and speech problems at baseline while observing certain changes by following bolus presentation
Monitoring the patient’s heart rate, oxygen saturation and other physiological conditions
Detection of the rate of bolus presentation and methods, involving cup, spoon, self-fed and examiner-fed, to find out the reactions on swallowing function
Observing and matching the situations of the patient consuming food in different environments
Diagnose the adequacy and frequency of salivating while swallowing and the ability to eat and swallow voluntarily
Assessment of anterior spillage and labial seal
Collecting evidences of oral control, comprising manipulation of bolus, transit and mastication, and the time needed to finish swallowing
Confirming the signs and symptoms of aspiration and penetration, including coughing and food getting stuck in the chest while eating a meal
Checking cough strength and the ability to clear throat and/or airway
Assessment of consistency during eating or being eaten to remove any negative effect of tiredness on eating or swallowing safety
Monitoring the respiratory rate and swallowing pattern, though they might vary from one individual to another in respect of age and physical consideration
When the cause of a swallowing disorder becomes hard to identify, an expert pathologist sits with the patient and discusses his/her medical history, examines the throat and mouth and follows the above-mentioned non-instrumental assessment processes to monitor some vital signs and thereafter carries on a complete swallowing problem treatment. A subjective or non-instrumental diagnosis can produce enough details to detect oral dysphagia but other physiological problems or aspiration in the pharyngeal stage can only be determined through instrumental or objective diagnosis.
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