Physical+Examination

Physical Examination The physical examination of dysphagia considers the structural and functional musculature needed for swallowing (ASHA, 1997). This physical examination can be though-of as three phases, including (Cichero, 2006): i. Immediate observations
 * Client alertness levels and levels of client cooperation
 * Client’s fatigability
 * can client achieve a safe swallow position independently? If not, how many people are required to achieve this position?
 * Note the presence of a feeding tube and/or tracheostomy
 * does the person appear to be an appropriate weight
 * Note any shortness of breath and/or respiratory rate (should be between 16-10 breathes per minutes at rest)

ii. Communication and Cognition
 * Is client oriented to person, place and time
 * Do they understand and hear you
 * Subjectivly note voice quality (i.e., is it wet or gurgly?)

iii. Oropharyngeal Assessment o Ask person to cough and clear throat. Attempt to compare this with their ability to clear throat and cough reflexively. The strength of voluntary and reflexive cough and throat clearing should be noted. Differences in strength between reflexive and voluntary protection should be noted (Cichero, 2006).
 * Inspection of oro-cavity and orophaynx
 * <span style="display: block; font-family: Tahoma,Geneva,sans-serif;">Note oral hygiene
 * <span style="display: block; font-family: Tahoma,Geneva,sans-serif;">Saliva management
 * <span style="display: block; font-family: Tahoma,Geneva,sans-serif;">Cranial nerve assessment (of CN VII, IX, X, XI, and XII)
 * <span style="display: block; font-family: Tahoma,Geneva,sans-serif;">Ability to protect the airway

Cichero, J. (2006). Clinical Assessment, Cervical Ausculation and Pulse Oximetry. In J.A.Y. Cichero & B.E. Murdoch (Eds). //Dysphagia: Foundation, Theory and Practice//. Chichester: Wiley.
 * References**