Instrumental Assessment



Instrumental assessments make up one part of a comprehensive assessment of swallowing. As Instrumental assessments are a significant undertaking, they usually occur once a clinical examination has been performed, and specific questions have been formulated for the instrumental assessments to answer (Groher & Crary, 2010; Logemann, 1993).

There are two common instrumental assessments that provide objective information about the anatomy and physiology of the mechanisms used in swallowing. These two assessments are videofluoroscopy (VFS), and the fibreoptic endoscopic evaluation of swallowing (FEES). Both of these methods provide information about the presence or absence of dysphagia in patients with COPD, and have distinct advantages over the other (Groher & Crary, 2010).
Still shots of a VFS (left) and a FEES (Right).
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Different food affects the swallowing pattern in COPD patients in different ways (Gross, Atwood, Ross, Olszewski, & Eichhorn, 2009), therefore various consistencies should be trialled during instrumental assessment. Knowledge of normal and impaired swallow physiology is also a key requirement for interpreting both VFS and FEES.

Dysphagia in COPD is primarily related to the coordination of breathing and swallowing (Gross et al., 2009), therefore the most important stage of the swallow to assess are the oral and pharyngeal stages. While aspiration is one of many presentations in COPD related dysphagia, it is the most concerning. Just under half of aspiration in COPD patients can silent aspiration (Good-Fratturelli, Curlee, & Holle, 2000), therefore instrumental assessment is vital in its detection.

This section provides a brief overview of the VFS and the FEES, and will not detail the exact method in which these assessments are conducted. Instumental assessments are carried out by different professionals in different workplaces; therefore if a VFS or FEES is being considered for a patient, the relevant procedures for your organisation should be followed. For specific information regarding these assessments, refer to the relevant references.



References

Good-Fratturelli, M., Curlee, R., & Holle, J. (2000). Prevalence and nature of dysphagia in va patients with COPD referred for videofluoroscopic swallow examination. Journal of Communication Disorders, 33(2), 93-100.

Groher, M., & Crary, M. (2010). Dysphagia: Clinical management in adults and children. Maryland Heights, MO: Mosby Elsevier.

Gross, R., Atwood, C., Ross, S., Olszewski, J., & Eichhorn, K. (2009). The coordination of breathing and swallowing in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 179(7), 559-565.

Logemann, J. (1993). Manual for the videofluorographic study of swallowing (2nd ed.). Austin, TX: Pro-Ed.