Speech Language Pathology – Swallowing Assessment
Initial Summary: Mrs. Illtoe is a 67-year-old female. She is married and has three adult children.
Mrs.Illtoe's past medical history includes bilateral ptosis (drooping eyelids) and fatigue with no specified
diagnosis.
Oral Mechanism Examination: The oral mechanism
examination revealed appropriate strength and
mobility throughout. Left droop and right droop
assymetries reference her bilateral ptosis.
Cranial Nerve V (Lip Sensation)
WFL
Mild
Moderate
Severe
Cranial Nerve V (Ant. Lingual Sensation)
WFL
Mild
Moderate
Severe
Cranial Nerve VII (Lip Seal)
WFL
Mild
Moderate
Severe
Cranial Nerve VII (Ant. Lingual Taste)
WFL
Mild
Moderate
Severe
Cranial Nerve VII (Facial Symmetry)
WFL
Mild
Moderate
Severe
Cranial Nerve IX (Post. Lingual Sensation)
WFL
Mild
Moderate
Severe
Cranial Nerve IX & X (Velar Movement/Gag)
WFL
Mild
Moderate
Severe
Cranial Nerve X (Voice)
WFL
Mild
Moderate
Severe
Cranial Nerve XII (Lingual strength & motility)
WFL
Mild
Moderate
Severe
Assymetries
Left droop
Right droop
Hyolaryngeal Excursion
WFL
Mild (3/4”)
Moderate (1/2”)
Severe (<1/2”)
Clinical Bedside Swallow Evaluation:
Oral Prep/Oral Phase: Mrs. Illtoe revealed appropriate strength and mobility during the oral mechanism
examination per clinician observation. Her swallowing structures involved within the oral preperatory
and oral phases appeared within functional limits. However, mild to moderate delay of the pharyngeal
swallow was noted.
Pharyngeal Phase: Initial presentations indicated adequate hyolaryngeal functioning within functional
limits. However, Mrs. Illtoe's hyolaryngeal excursion decreased over the course of multiple
presentations. Mrs. Illtoe presented with a consistent cough following the swallow of densely textured
solids. Coughing may be an indication of residuals with the pharyngeal cavities.
Esophageal Phase: The patient reported no feelings of pain or tightness in the throat or chest, indicating
esophageal functioning within functional limits.
Summary: This clinical bedside swallow evaluation was not representative of a normal swallow. The
patient demonstrated mild oral dysphagia and moderate pharyngeal dysphagia. Initially, Mrs. Illtoe's
voice was clear and well articulated, which may relate to her intact oral strength and mobility during the
oral mechanism examination. However, her articulatory precision declined throughout the session,
which may demonstrate decreased endurance and increased fatigue of the oral structures over time.
Changes in Mrs. Illtoe’s voice were noted thoughout the presentations of liquids and solids. Her voice
following thin liquids was clear, indicating effective pharyngeal clearance. Her voice became wet and
gurgly following the swallows of nectar to honey thick liquids. This change in resonance may be due to
residuals within the pharyngeal cavity following presentations of thick liquids. Dense solids were
Speech Language Pathology – Swallowing Assessment
consistently followed by a cough, which may be another indication of pharyngeal residuals. A decline in
her hyolaryngeal excursion and a delay in pharyngeal swallow onset was also noted thorughout the
assesment. Coughing and declined hyolaryngeal excursion also raises concerns of potential penetration
and/or aspiration. The esophageal phase appears to be within functional limits.
Videofluroscopic Swallowing Evaluation:
Oral Prep/Oral Phase: The oral preparatory phase and the oral phase are within functional limits. The
patient demonstrated efficient oral transit.
Pharyngeal Phase: The pharyngeal phase became increasingly impaired over time, resulting in a
moderate impairment. Mrs. Illtoe demonstrated effective pharyngeal transit and complete clearance
over the first several presentations. As the study progressed, nectar to honey thick liquids left mild
pharyngeal residuals. Initially, solids left mild pharyngeal residuals as well. During following
presentations, Mrs. Illtoe demonstrated moderate to severe pharyngeal residuals with dense solids and
moderate residuals with honey thick liquids. Upon swallow completion, Mrs. Illtoe penetrated both
liquid and solid residuals to the level of the vocal folds. Penetration lasted for an extended period of
time. Trace aspiration was noted.
Esophageal Phase: The patient's esophageal phase (upper 1/3) was within functional limits.
Summary Table:
Bolus
Oral Phase
Thin
n/a
Nectar
WFL
Pharyngeal Phase
n/a
Mild pharyngeal
residuals
Moderate
pharyngeal
residuals
Esophageal Phase
n/a
WFL
Aspiration-Penetration
n/a
n/a
WFL
(6) Trace residual
material entered
airway, contacted the
vocal folds for an
extended duration
despite coughing, and
then passed below
n/a
n/a
(6) Trace residual
material entered
airway, contacted the
vocal folds for an
extended duration
despite coughing, and
then passed below
(6) Trace residual
material entered
airway, contacted the
vocal folds for an
Honey
WFL
Puree
Banana
Cake
n/a
n/a
WFL
n/a
n/a
Moderate to severe
pharyngeal
residuals
n/a
n/a
WFL
Cookie
WFL
Moderate to severe
pharyngeal
residuals
WFL
Speech Language Pathology – Swallowing Assessment
extended duration
despite coughing, and
then passed below
Summary: Mrs. Illtoe demonstrated moderate to severe pharyngeal dysphagia. Results indicate an
overall dyscoordination of the patient’s swallowing mechanism. The worsening nature of the
impairment is a result of factors contributing to weakness of the pharyngeal structures and musculature.
This results in paitent fatigue.
Penetration and trace aspiration of honey-thick and dense solid residuals was observed. Compensatory
strategies of the effortful swallow and the liquid wash were examined during the videofluroscopy. The
effortful swallow was intially effective to clear oral and pharyngeal residuals, but quickly increased Mrs.
Illtoe's fatigue and decreased her swallowing safety. Mrs. Illtoe would only benefit from the effortful
swallow if used sparingly (1-2x per meal) and continuation of the strategy should based on her response.
The liquid wash strategy effectively eliminated honey-thick and dense solid residuals from the
pharyngeal cavity. It is recommended Mrs. Illtoe use the liquid wash strategy during each meal to
increase swallowing safety.
Mrs. Illtoe would also benefit from alternating food textures throughout each meal to facilitate the
clearing of any residuals. Specifically, a dysphagia mechanically altered (NDD 2) diet with thin liquids is
reccommended. Minimal to no assistance is needed. This information should be considered alongside
her diagnosis before treatment and intervention begins. For a complete evaluation, Mrs. Illtoe is being
referred to neurologist Dr. Jerry Hoepner to rule out any neurological disorders related to her increasing
fatigue and weakness.
Recommendations/Goals:
1. Diet:
Long Term: Mrs. Illtoe will tolerate a least restrictive diet during each meal, for a minimum of
two weeks to ensure swallowing safety.
Short Term: Mrs. Illtoe will tolerate a NDD 2 diet with thin liquids, for a minimum of two
weeks to ensure swallowing safety.
2. Compensatory Strategies:
Long Term: Mrs. Illtoe will independently implement the swallowing strategy "liquid wash"
during each meal to increase swallowing safety by clearing residuals, per self report.
Short Term: Mrs. Illtoe will implement the swallowing strategy "liquid wash" following staff
and/or a trained family member cues during each meal to increase swallowing safety by
clearing residuals for at least two weeks.
Speech Language Pathology – Swallowing Assessment
3. Patient and Family Education
Long Term: After prompted by the clinician, Mrs. Illtoe and family will demonstrate an
understanding of her current swallowing status, diet modifications, and compensatory
strategies to facilitate swallowing success by verbally sharing information and answering
questions.
Short Term: Mrs. Illtoe and family will be provided with information on Mrs. Illtoe's current
swallowing status, diet modifications, and compensatory strategies to facilitate swallowing
success in a variety of modalities (e.g., both verbal and visual information) over two
consecutive weeks.
4.
5.
Speech Language Pathologist: Piper Doering