Swallowing Assessment Protocols in England by qng18193

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Assessment Protocols
in England
By: Rebecca Vice and
    Mary Katherine Bradley
Research Question

  What assessment protocols are used in
   England to evaluate swallowing ability,
   and how do they compare to that used in
   the United States?
Information was compiled
   Interviews with Natalie Gill and Julia Lawson
    (England STs)
   The Royal College of Speech Language
    Therapy Handbook
   The Community Quality Three-3rd Edition
   Logemann, J. A. (1998). Evaluation and
    Treatment of Swallowing Disorders (2nd ed.).
    Austin, TX: PRO-ED, Inc.
SLT Mission Statement &
Scope of Practice
  To provide evidence-based services that
   anticipate and respond to the needs of
   individuals who experience speech, language,
   communication, and/or swallowing difficulties.
  Speech language therapists work in
   partnership with these individuals and their
   families and other professionals and agencies
   to reduce the impact of these often isolating
   differences on people’s wellbeing and their
   ability to participate in daily life.
SLT Definition
  Speech language therapists (SLT) are the lead
   experts regarding communication and
   swallowing disorders. SLTs lead on
   assessment, differential diagnosis, intervention
   with and management of individuals with
   communication and swallowing disorders.
   Where appropriate and with the individual
   agreement, the SLT will liaise and work closely
   with other agencies and other professions
   including complementary treatment.
Education Requirements
  High School until age 16
  Continue with A levels until age 18
  Bachelor of Science in Speech and Language
   Therapy (3 to 4 years)
  Training for dysphagia (Postgraduate Degree-6
  Masters Degree to specialize
  Must be registered through the Health
   Professional Council and the Royal College of
Cultural Breakdown

  70% Caucasian
  20% Asian (predominately Indian and
  10% Other (African, Jamaican, Polish,
   and Chinese)
  Dartmouth Rehabilitation House
    3-6 patients a day (45 minute sessions)
    Swallowing Assessment: about 1 time a week
  Home Setting
    Swallowing Assessments: about 6 a week; reassess
     1 week after first evaluation
  Hospital
    Swallowing Assessments: Varies between 1 to 12
     referrals per day; Average caseload: 30 patients
     Monday-Wednesday; Reviews every patient every
Underlying Pathologies of
Swallowing Disorders
  Home Setting
    Stroke and Parkinson’s Disease
    Dementia
  Hospital Setting
    Cancer
    Structure Related
    Neurological (i.e. stroke, Parkinson’s Disease, ALS,
     MS, Huntington’s Disease)
    Head Injury
    Dementia
Swallowing Assessment
  ST-Assessment
  OT-Utensils (hand to mouth)
  PT-Positioning, monitor chest for
  Nurse
  Doctor
Assessment Protocols
in the England
  Bedside Evaluation (Clinical Swallowing Assessment)
     Case History, Medical History, History of Chest Infection, Current
      Feeding, Speak with Family
     Consistencies Tested in Home and Hospital Settings:
           Teaspoons of water
           Sips of water from an open cup
           Teaspoons of yogurt
           In the Hospital: sometime pureed consistencies are used (i.e. pureed
            apple/banana or ice cream) or a bread/biscuits if patient is on a semi-solid
     Oral Assessment: Range and Strength
     Assess oral and pharyngeal timing of swallow
         4 finger test
     Check for signs of aspiration: (coughing, vocal changes, watery eyes,
      residue in the cheeks or soft palate area)
Cont. Assessment
Protocols in England
  Barium Swallowing Assessments and
   FEES are completed by consultants,
   doctors, and ENTs (Not SLTs)
    The SLT can refer for these assessments if
     needed, but this is rarely done (only done if
     the SLT is unsure about presence of
Swallowing Assessments
  in the United States
 Bedside Screening Procedure
   To provide indirect evidence of a swallowing
    disorder (does not provide information on the
    physiology of a disorder)
 Modified Barium Swallow Procedure
   To define abnormalities in anatomy and physiology
    causing the patient’s symptoms
   To identify and evaluate treatment strategies that
    may help the patient swallow safely and efficiently
   Assesses whether aspiration is occurring and why
Evidence to Support
Swallowing Assessment in
 The Community Quality Three-3rd Edition
 Clinical Guidelines according to the Royal College of
  Speech Language Therapy
 Hospital Care Pathways specific to each disorder (i.e.
  stroke, Parkinson’s Disease, Multiple Sclerosis, etc.)
    Must coincide with the Royal College and National Health
     Service Guidelines
    Each pathway lists the minimum requirements per disorder (i.e.
     how often seen, expected protocol, etc.)
 SLTs felt confident in the reliability and accuracy of their
  bedside assessment protocol due to their research
Summary of Swallowing
Assessment in England
 Bedside evaluation is the primary tool used to
  assess swallowing
 Bedside evaluation is completed in various
  environments (i.e. acute care, nursing homes,
  home setting)
 MBS is not performed on a regular basis
 Yogurt and water are the only consistencies
  used in swallowing assessment despite wide
  range of diet recommendations (puree, soft,
  semi-solid, normal)
Summary Continued…

  Differences in consistency definitions (i.e.
   wide range for what is considered puree)
  Reduced productivity (caseload and
   treatment time)
  Different education requirements

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