Non-instrumental swallowing assessment and evaluation
Clinical swallowing evaluation – non-instrumental
This evaluation includes a detailed case history, an assessment of the motor and sensory function of the cranial nerves involved in swallowing, and an observational assessment of your eating and drinking. It provides the clinician with vital information that helps guide treatment recommendations and/or need for instrumental swallowing assessment.
Cough reflex testing
Cough reflex testing is part of the cranial nerve examination included in our non-instrumental clinical swallowing evaluation. It indicates if a person likely to be able to clear food or fluid from their airway.
Instrumental swallowing assessment and evaluation
Videofluoroscopic Swallowing Study (VFSS)
A videofluoroscopic swallowing study is a moving x-ray of swallowing. It enables the speech-language therapist to assess the physiology of your swallowing, your swallowing safety, and guides management and treatment of your swallowing disorder. No special preparation is required prior to the procedure.
We are the only private clinic in New Zealand to offer videofluoroscopic swallowing studies. We have our own Fluorostar system on-site and all our therapists are trained in Radiation Safety. In addition, Dr Ian Cowan is available as a consulting radiologist when required. A detailed diagnostic report is provided and if applicable treatment options discussed based on the findings of this assessment.
You can find more information about VFFS in this VFSS Information pamphlet.
Videoendoscopic Endoscopic Evaluation of Swallowing (VEES)
Videoendoscopic Endoscopic Evaluation of Swallowing (VEES) uses a flexible nasendoscope to assess swallowing. The nasendoscope is passed through your nose until the throat is in view. You are given food and drink, dyed with food colouring, to eat and drink whilst the nasendoscope is in place; this facilitates direct visualisation of your throat to enable assessment of your swallowing. VEES is unique, in that it also enables the assessment of how you manage your saliva. VEES can also be used to provide biofeedback as you participate in swallowing rehabilitation.
High Resolution Pharyngeal Manometry
High-Resolution Manometry (HRM) evaluates pressures in the throat when swallowing. There are 36 pressure sensors that measure circumferentially, averaging across up to 12 (adult catheter) or 16 (pediatric catheter) pressure sensing segments in each sensor. This provides us with information about the co-ordination of swallowing and the pressures generated when swallowing.
In addition to its role in evaluation, HRM can provide visual biofeedback during rehabilitation. For example, pharyngeal HRM provides visualization of the upper esophageal sphincter (UES), and patients can train relaxation of the UES during swallowing with this unique biofeedback tool. Also, we have a special HRM impedance catheter that can record the flow of ionic substances. With its 18 impedance electrodes in addition to the 36 pressure sensors, we can ‘watch’ the flow of food and drink when mixed with saline.
Other common diagnostic techniques, such as fluoroscopy and endoscopy, rely on a clinician’s subjective interpretation of moving images for diagnosis. Pharyngeal manometry, contrastingly, provides quantitative data that can be measured and compared in an objective manner.
Ultrasound uses high frequency sound pressure waves to visualise internal body structures and movements. Ultrasound offers many advantages compared to other imaging techniques as it is non-invasive, safe, relatively inexpensive, and portable, making it ideal for use in rehabilitative medicine. In swallowing rehabilitation, ultrasound can give clinicians information about the size of the muscles involved in swallowing (under the chin) as well as biomechanical changes during swallowing.
Communication assessment and evaluation
This evaluation includes a detailed case history, and at least two or more of the following: a cognitive screen; a standardized assessment of the 4 modalities of language (understanding spoken language, understanding written language (reading), verbal expression, and writing); psycholinguistic assessments; assessment of language in a functional context; and patient self-rated questionnaires, including a quality of life survey.
This evaluation includes a detailed case history, evaluation of the underlying processes of speech (including respiration, phonation, resonance, articulation and prosody), speech intelligibility, and patient self-perception of their communication in everyday communication situations. These assessments may also be used as outcome measurements following a block of therapy.