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Abstract
The bedside assessment for dysphagia is considered a noninstrumental procedure that typically includes the following: gathering information regarding the current swallowing problem, reviewing medical history, observing signs relevant to the patient’s medical status, conducting a structural/functional examination of speech and swallowing structures, and observing the patient during trial swallows. The results of this examination determine whether further instrumental assessment of dysphagia is required. The most important consideration initially is aspiration risk and suitability for oral feeding. Although a detailed examination of swallowing mechanisms may be desirable, it is usually difficult and often unnecessary to subject patients to such procedures, which may have greater relevance in patients with persistent dysphagia. The challenge is to develop simple bedside assessments that can be administered by a range of professionals in day-to-day clinical practice. Most bedside screening described in the literature have focused on identifying overt signs of aspiration, but they have limitation to detect silent aspiration, for that a comprehensive evaluation of swallowing it must.
This study was done on forty patients, age ranged from 20 to 68 years, with a mean of 43.08 years + 13.60.Twenty three patients were males (57.5%) and seventeen patients were females (42.5%).The male to female ratio among studied patients was 3:2. There is no significance difference between neurogenic anon-neurogenic patients as regards sex and age.The results according to signs and symptoms revealed there was only a significant statistical different regarding dysphagia onset.The results of the study revealed that most of the patients had oral motor structure and recorded a significant difference between both groups of neurogenic and non-neurogenic patients.No significant findings obtained according to initial swallowing examination.Trial of drinking 3oz (90ml) water test revealed a significant difference between neurogenic and non-neurogenic as regards presence of choking and dysphonia. During observation of eating on neurogenic and non-neurogenic patients results shows significant statistical different regarding oral movement in chewing. Findings of cervical auscultation between both groups neurogenic and non-neurogenic patients revealed there were significant differences as regards click-clunk sound and wet breath sound. Anatomic-physiologic findings by FEES scoring protocol, data obtained revealed no significant difference between neurogenic and non-neurogenic patients with variables results regards status of standing secretions in hypopharynx.
The clinical observation during delivery of food and liquid to assess directly the swallowing of these materials, revealed significant differences as regards mastication, oral preparatory liquids and oral transit time, location of residue (outside larynx and on rim of the larynx) and aspiration after the swallow. Therapeutic maneuver was tried and reported 45% of non-neurogenic patients were taught to used effortful swallow, 30% of neurogenic patients they taught to use supraglottic swallow and 15% merge with chin-tuck, while 20% of non-neurogenic were taught to use chin-tuck and 20% tried with Mendelsohn maneuver.