Dysphagia Evaluation Practices of Speech and Language Therapists in Ireland: Clinical Assessment and Instrumental Examination Decision-Making

Abstract

Abstract. The purpose of this study was to investigate clinical assessment practices and instrumental examination decision-making by speech and language therapists (SLTs) in Ireland. A 21-question survey (including patient scenarios) was sent to 480 SLTs in Ireland. A total of 261 completed surveys were returned (54%), providing demographic information on SLTs currently working in Ireland and their services. Of these 261 surveys, 70 provided the data for the study, focusing on SLTs currently working in dysphagia, with adults/seniors at least some of the time. The results also showed clinician variability regarding which components are included in a bedside clinical examination of swallowing, with a high degree of consistency for only 11 of the 20 components. Clinicians agreed in their instrumental vs. noninstrumental evaluation recommendations for two of the six patient scenarios, with wide variability in clinical decision-making. Possible influences on clinical decision-making are discussed in relation to the findings of similar previous studies, as well as the current status and future needs of dysphagia training and services in Ireland.Key words: Dysphagia -Bedside evaluation of swallowing -Instrumental assessment -Videofluoroscopy -Speech and language therapyAssessment -Deglutition -Deglutition disorders.It is well-established that speech and language therapists (SLTs) are the lead experts in communication and swallowing disorders, including the assessment, differential diagnosis, intervention and management of individuals with these disorders [1,2]. With regard to the management of individuals with a swallowing disorder (dysphagia), in particular, inappropriate management can place patients at high risk of aspiration, respiratory infections, choking/death, poor nutrition and weight loss, poor health, anxiety and stress within the family, hospital/admission or extended hospital stay, and reduced quality of life [1,3,4]. The goals of swallowing evaluations are to determine the presence, nature, and cause of the swallowing problem, current level of dysfunction, and nutritional status, and to develop strategies for stabilization and rehabilitation [5]. To achieve these goals it is clearly important that dysphagia evaluation and management practices within the SLT profession are consistent, clear, and well-defined.Numerous policy statements have been published by several national professional bodies defining the SLTÕs role in dysphagia management and the requisite knowledge base and skills, policies, and guidelines for intervention, and areas of research [2,6,7]. According to these policies and guidelines, the SLTÕs scope of practice includes both the clinical/ bedside examination and instrumental assessment of the oral, pharyngeal, and upper esophageal phases of swallowing function [1]. The clinical bedside examination for dysphagia is a noninstrumental procedure that usually includes gathering information on the current swallowing problem, reviewing medical history, observing signs relevant to the patientÕs me...

Dysphagia training for speech-language pathologists: Implications for clinical practice

“…The questionnaire used in the current study was developed through modifications and adaptations of available published surveys and guidelines in the area of speech-language pathology (Bateman, Leslie, & Drinnan, 2007;Martino, Pron, & Diamant, 2004;MathersSchmidt & Kurlinski, 2003;O'Donoghue & Dean-Claytor, 2008;Pettigrew & O'Toole, 2007;Speech Pathology Australia, 2004;Ward, Jones, Solley, & Cornwell, 2007). Prior to distribution, clarity and content of the questionnaire was validated by a group of Malaysian and Australian SLPs.…”

Avaliação clínica da deglutição em unidade de terapia intensiva

“…Cervical auscultation is increasingly being used to supplement clinical swallowing assessment. The sounds associated with swallowing have been investigated using accelerometers and microphones for acoustic characteristics and possible prediction of aspiration (10,14,17,26,27) . The use of cervical auscultation varies in its reported reliability, and validity in terms of comparison to videofluoroscopic swallow study (VFSS) (17,25,27,28) .…”

Implications of Variability in Clinical Bedside Swallowing Assessment Practices by Speech Language Pathologists

“…Furthermore, the suggestion that these patterns are non-random is supported by the considerable similarity across self-report studies regarding the components that 90% of SLPs across Ireland, the UK, the USA and Australia reported that they do 'usually/always' use (see Table 1) [7][8][9][10][11]. Across these studies, it has been speculated that components may have been less frequently used because the research evidence is not strong or has ruled them out as irrelevant (e.g., gag reflex, cervical auscultation), the survey components were ambiguous (e.g., whether speech and language screening was conducted meant informally or via a standardised assessment) or SLPs may not have had access to required training (e.g., indirect laryngoscopy).…”

“…However, there is considerable variation with regard to the components SLPs self-report as routinely included in this assessment process [7][8][9][10][11]. The few standardised protocols available are either screening tools [12,13] or have been validated only on patients poststroke [14].…”

“…The broader aspects of SLP CBSA practices have received limited attention and have focussed on standardising and validating assessment practices [14] or identifying what components SLPs self-report as including in their CBSA. Interestingly, SLPs themselves report that less than half of the components of bedside assessments that are considered important are used 'usually/always' [7][8][9][10][11]. These findings have led to a call for increased consistency in clinical practice via standardisation of the clinical examination to manage this variability.…”