Speech-Language and Swallow Evaluations

Background

As a whole, speech-language pathology assessments are conducted for the examination of speech, language, cognitive abilities, and swallowing safety and function. Within the medical setting, there are a number of types of evaluations performed by speech-language pathologists (SLPs) that provide valuable information to guide medical management of patients. These assessments include clinical swallowing evaluations and instrumental swallowing exams such as modified barium swallow (MBS) study and the fiberoptic endoscopic evaluation of swallowing (FEES). Other assessments are of communication, including assessment of speech, language, voice, cognition, and the need for supportive devices to facilitate communication.

Medications may affect many aspects of the skills involved in speech, language, cognition, and swallowing, including alertness, awareness, motor functioning, lubrication of the oropharyngeal mucosa, and esophageal health and functioning. Many medications may affect a patient’s ability to swallow safely. This can occur potentially both in the short term during performance of an exam and with chronic medications used over time by affecting overall presentation of the oropharyngeal swallow mechanism. Many of these medications may also affect a patient’s performance on assessments of speech, language, and cognitive functioning if they affect parameters such as alertness, awareness, cognitive levels, and muscular integrity for articulatory precision and speech production. ^{, ,}

How to Use It

In the medical setting, particular emphasis is placed upon evaluation of swallowing function and safety to identify and reduce the risk of aspiration. Reducing the risk of aspiration limits morbidity due to aspiration pneumonia and resultant respiratory compromise. The purpose of the swallowing assessment is to examine whether oral feeding is safe and appropriate at the time of exam, and, if so, to determine the least restrictive dietary consistencies and appropriate swallow strategies to maximize safety for oral intake. Swallowing assessments also provide guidance for rehabilitation of swallow function in dysphagia therapy if clinically indicated based upon etiology, prognosis, and ability to participate.

Assessment of speech, language, and cognition serves to identify impairments in varied aspects of communication, and to identify need for assistive communication devices. Working closely with physicians, SLPs play an important role in assisting with differential medical diagnoses for neurologic and communication disorders based upon types of motor speech impairments or language impairments. These collaborations also assist in providing access to communication for those with respiratory compromise requiring a tracheostomy tube, or for patients with head and neck cancer requiring laryngectomy. These evaluations ascertain needs for rehabilitative services, needs for assistive communication devices, and the findings provide goals for therapeutic interventions to facilitate improvement in effectiveness of communication. ^,

How It Is Done