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The Importance of Swallow Screenings

Angela Mansolillo, MA, CCC-SLP, BCS-S

April 1, 2020

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Question

Why should swallow screenings be done? 

Answer

Why do we bother with the swallow screenings and not just move on to a full assessment? Research has actually shown that the earlier we identify individuals who are potentially struggling with dysphagia – specifically, the aspiration component - the better they do. The earlier we identify the risk and get interventions going, the better these folks do over the long run. A screening allows for that early identification because a screening can be done even if the SLP is not available.

Another reason for a screening is that it allows for more accurate referrals for full assessments. In facilities that do not do screenings, referrals to speech pathology are made based on what the nurse thinks should be done or what the doctor thinks should be done, and whether or not they think we could contribute something useful. We do not necessarily want to be dependent on another individual's practice patterns. Screenings allow those referrals to be accomplished in a more objective way.

A third rationale for screenings is that they help us identify patients who are at high risk of aspiration. When I say “we,” I am not just talking about SLPs; rather, I mean “we” as the healthcare team. Screenings help the nurse and the doctor on the floor, or the emergency room (ER) physician or ER nurse, identify those folks who are at high risk so that we can get some supports and plans in place, regardless of whether the SLP is readily available.

Alternately, screenings help to facilitate return to oral feeding and oral medication. If the screening is being done in the emergency room at three o'clock in the morning, and the client passes the screen, he can then have that sandwich that he wants, or she can take the medications that the physician feels are important to get in. If the team waits for the SLP to come, it might be hours before the patient is able to get those medications or return to eating. In other words, if patients pass the screening, they are able to return to oral feeding and get their medications earlier. Overall, then, it is just a more efficient way of approaching dysphagia in a healthcare setting. It helps to identify those at-risk people more quickly, and we do not have to put restrictions in place for longer than they need to be. Additionally, screenings give us better referrals in the long run so that we can use the time we do have for assessment more efficiently.

Please refer to the SpeechPathology.com course, Back to Basics: Swallow Screening: How, when, and who​, for more information on making informed, evidence-based choices regarding appropriate screening tools specific to their particular patient populations and settings.


angela mansolillo

Angela Mansolillo, MA, CCC-SLP, BCS-S

Angela Mansolillo, MA, CCC-SLP, BCS-S, is a Speech-Language Pathologist and Board Certified Specialist in Swallowing Disorders with over 30 years of experience. She is currently a senior Speech-Language Pathologist at Cooley Dickinson Hospital in Northampton, Massachusetts where she provides evaluation and treatment services for adults and children with dysphagia and is involved in program planning and development for inpatient and outpatient programming including quality improvement initiatives, patient education, and clinical policies and protocols.  In addition, she is an adjunct faculty member at Elms College Department of Communication Sciences and Disorders in Chicopee, Massachusetts.  Over the course of her career, she has worked in a variety of clinical settings, provided numerous regional and national presentations, and lectured at several colleges and universities throughout Massachusetts. 

Ms. Mansolillo received her Bachelor of Arts degree in Communications from Rhode Island College in 1983 and earned her Master of Arts in Speech-Language Pathology in 1985 from the University of Connecticut. She is a member of the American Speech-Language-Hearing Association and is a member of Special Interest Division 13, which focuses on swallowing and swallowing disorders.

 


Related Courses

Back to Basics: Swallow Screening: How, when, and who
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Video

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Screening of swallow function is a well-regarded tool to identify individuals who are potentially at risk of dysphagia and in need of full swallow assessment, but the options are many and varied. This "back to basics" course will teach participants to make informed, evidence-based choices regarding appropriate screening tools specific to their particular patient populations and settings.

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Speech Language Pathologists are often asked to make recommendations for safe swallowing of medications for patients with dysphagia, but have limited information about pharmacodynamics. This course will provide clinicians with the information they need to understand and manage swallowing-related medication effects, identify potential impacts of food and thickener on medication effectiveness, and prevent medication errors in their clients with dysphagia.

Back to Basics: Applying Clinical Reasoning to the Clinical Swallow Assessment
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The clinical swallow evaluation, or bedside swallow evaluation, is sometimes a maligned component of dysphagia assessment because of its inability to definitively assess for aspiration. This course will provide participants with an understanding of the applications of clinical assessment, appropriate components for inclusion, and direction for forming conclusions and making recommendations based on clinical observations.

Aspiration Pneumonia: It's Not Just Aspiration
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Do dysphagia and aspiration inevitably lead to aspiration pneumonia? Our current evidence base suggests that the answer is, in fact, no. This course will enable clinicians to identify the clients on their caseload who are at higher risk for illness and to identify and address those risk factors that can be modified to reduce the likelihood of aspiration-related illness.

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Effective evaluation and management of dysphagia in adults requires thorough knowledge of the anatomy and physiology of swallowing and the relationship to the functions of respiration. Structures, functions and neurophysiology of the aerodigestive tract are discussed, including detailed information about cranial nerves.