Search

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

Purpose This clinical focus article considers the roles of the clinical swallow examination (CSE) as a clinically meaningful assessment method used in both adult and pediatric populations. Method This clinical focus article explores the utility of the CSE across the life span. Specifically, components, reliability, standardized assessments, and limitations of the CSE within the adult and pediatric populations are highlighted. Conclusions The CSE remains a crucial assessment tool for the speech-language pathologist. The experienced clinician can make important judgments regarding patient safety and function. If the CSE is conducted mindfully and methodically, findings can help chart the course of care for individuals needing additional assessment and possibly intervention.

Purpose: The purpose of this study was to determine if a significant difference in labial strength exists between healthy controls, individuals who had experienced a stroke with no deficits, individuals who had experiencd a stroke and dysarthria, and in- dividuals who had experienced a stroke with dysar- thria and dysphagia. Method: Four groups participated in the study: a control group of healthy adults and 3 experimental groups of patients with a diagnosis of stroke. The experimental groups were characterized according to the following features: labial weakness only, dysar- thria, and dysarthria and dysphagia. All participants performed an oral motor evaluation, diadochoki- netic rates, clinical swallow evaluation, and bilateral measurements of labial strength using the Iowa Oral Performance Instrument (IOPI; Iowa Oral Performance Instrument Medical, 2010). Results: Significant differences in labial strength were S peech production and deglutition are complicated acts requiring precise, se- quenced movements involving the cen- tral nervous system, peripheral nervous system, and muscles. Recent clinical research on articulation and the oral preparatory and oral phases of the swallow has focused on the role of the tongue in speech pro- duction and deglutition (Goozee, Murdoch, & The- odoros, 2001; Neel & Palmer, 2012; Steele, Bailey, Molfenter, Yeates, & Grace-Martin, 2010; Stierwalt &