Swallowing and Prediction of Dysphagia Severity Essay Example for Free

Swallowing and Prediction of Dysphagia Severity EssayIntroduction Daniels, McAdam, Brailey, and Foundas (1997) reviewed belles-lettres from Linden, Kuhlemeier, and Patterson (1993) and examined signs of aspiration, but specifically half-dozen risk factors, including dysphonia, dysarthria, insane gag reflex, abnormal willing cough, percentage depart after swallow, and cough after swallow. They thus designed their study in an attempt to link the six signs of aspiration to the diagnosis and severity of dysphagia. The purpose of the study was to determine whether the six risk factors approximated the VSS in acknowledgement of dysphagia severity (Daniels et al. , 1997). It was hypothesized that the presence of any one factor could predict at least mild dysphagia or normal swallowing on a video fluoroscopic swallow study (VSS) and that two factors could predict moderate dysphagia. Methods (Procedures) fifty-nine male veterans, ages 41-88, with recent neurological deficits wer e recruited for the study and had one of the following issues unilateral left hemispheric ill-treat (22 men), bilateral hemispheric damage (18 men), and bilateral hemispheric damage (13 men), or brainstem lesions (6 men).The men were assessed by a neurologist exploitation CT or MRI scans upon admission to view and localize lesions. They were then rescanned 2 weeks later if the initial scans yielded negative results. Excluded from the study were agitated patients and patients with a history of disorders and diseases other than rap that would cause dysphagia. Within 5 days of admission, the men were given an oropharyngeal exam of gag reflex, volitional cough, speech, and voice. A video fluoroscopic assessment was also given that consisted of 3,5,10, and 20 ml, and tsp of barium paste along with half of a cookie to be swallowed. A swallow study was also performed by administering 5 ml of liquid, and then giving 10 and 20 ml volumes, which were administered twice each, unless(prenom inal) the patients immediately had a negative chemical reaction such as a cough. After each swallow, the men phonated ah to see if there was a convince in vocal quality.Results The VSS served as the outcome variable in determining dysphagia severity, which ranged from mild dysphagia to normal swallowing (scores 0-1 1 if two or more of the six risk factors were present and 0 if one or less were present) to moderate to awful dysphagia (scores 2-4). The reliability for the scores was 92%. 74% of the 59 patients had varying dysphagia severity, while 5.1% had stark(a) dysphagia. 13.6% had moderate to severe dysphagia along with aspiration, while 25.4% had moderate dysphagia, and 25.4% had normal swallowing. 47% had dysphonia, 63% had dysarthria, 27% had abnormal volitional cough, 42% had abnormal gag reflex, 41% had a cough after swallow, and 19% had voice change after swallow (Daniels et al., 1997). Discussion/Conclusion The results of this study demonstrated that this clinical asses sment has expediency in the evaluation of acute stroke patients with probable dysphagia who may be at risk for the phylogenesis of aspiration (Daniels et al., 1997).Also discussed was the fact that this assessment does not account for silent aspiration. In conclusion, early spotting of aspiration by using this short assessment can reduce aspiration and pneumonia in patients if turn to early in their hospital stay. Commentary This article provides helpful information for clinicians practicing in a medical setting. The article includes a flow chart to help determine which patients require further evaluation. Ill and physically challenged patients can avoid the physical distress of unnecessary testing with a proper bedside evaluation, and moderate to severe respiration can be caught early to prevent pneumonia. This study was performed in 1997, and clinicians are still using this method today, proving its reliability in early detection of aspiration.