Swallowing Assessment Protocols in England

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Swallowing Assessment Protocols in England

• By Rebecca Vice and
• Mary Katherine Bradley

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Research Question

• What assessment protocols are used in England to
  evaluate swallowing ability, and how do they
  compare to that used in the United States?

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Information was compiled using

• Interviews with Natalie Gill and Julia Lawson
  (England STs)
• The Royal College of Speech Language Therapy
  Handbook
• The Community Quality Three-3rd Edition
• Logemann, J. A. (1998). Evaluation and Treatment
  of Swallowing Disorders (2nd ed.). Austin, TX
  PRO-ED, Inc.

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SLT Mission Statement Scope of Practice

• To provide evidence-based services that
  anticipate and respond to the needs of
  individuals who experience speech, language,
  communication, and/or swallowing difficulties.
• Speech language therapists work in partnership
  with these individuals and their families and
  other professionals and agencies to reduce the
  impact of these often isolating differences on
  peoples wellbeing and their ability to
  participate in daily life.

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SLT Definition

• Speech language therapists (SLT) are the lead
  experts regarding communication and swallowing
  disorders. SLTs lead on assessment, differential
  diagnosis, intervention with and management of
  individuals with communication and swallowing
  disorders. Where appropriate and with the
  individual agreement, the SLT will liaise and
  work closely with other agencies and other
  professions including complementary treatment.

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Education Requirements

• High School until age 16
• Continue with A levels until age 18
• Bachelor of Science in Speech and Language
  Therapy (3 to 4 years)
• Training for dysphagia (Postgraduate Degree-6
  months)
• Masters Degree to specialize
• Must be registered through the Health
  Professional Council and the Royal College of SLT

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Cultural Breakdown

• 70 Caucasian
• 20 Asian (predominately Indian and Pakistani)
• 10 Other (African, Jamaican, Polish, and Chinese)

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Caseload

• Dartmouth Rehabilitation House
• 3-6 patients a day (45 minute sessions)
• Swallowing Assessment about 1 time a week
• Home Setting
• Swallowing Assessments about 6 a week reassess
  1 week after first evaluation
• Hospital
• Swallowing Assessments Varies between 1 to 12
  referrals per day Average caseload 30 patients
  Monday-Wednesday Reviews every patient every week

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Underlying Pathologies of Swallowing Disorders

• Home Setting
• Stroke and Parkinsons Disease
• Dementia
• Hospital Setting
• Cancer
• Structure Related
• Neurological (i.e. stroke, Parkinsons Disease,
  ALS, MS, Huntingtons Disease)
• Head Injury
• Dementia

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Swallowing Assessment Team

• ST-Assessment
• OT-Utensils (hand to mouth)
• PT-Positioning, monitor chest for aspiration
• Nurse
• Doctor

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Assessment Protocols in the England

• Bedside Evaluation (Clinical Swallowing
  Assessment)
• Case History, Medical History, History of Chest
  Infection, Current Feeding, Speak with Family
• Consistencies Tested in Home and Hospital
  Settings
• Teaspoons of water
• Sips of water from an open cup
• Teaspoons of yogurt
• In the Hospital sometime pureed consistencies
  are used (i.e. pureed apple/banana or ice cream)
  or a bread/biscuits if patient is on a semi-solid
  diet
• Oral Assessment Range and Strength
• Assess oral and pharyngeal timing of swallow
• 4 finger test
• Check for signs of aspiration (coughing, vocal
  changes, watery eyes, residue in the cheeks or
  soft palate area)

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Cont. Assessment Protocols in England

• Barium Swallowing Assessments and FEES are
  completed by consultants, doctors, and ENTs (Not
  SLTs)
• The SLT can refer for these assessments if
  needed, but this is rarely done (only done if the
  SLT is unsure about presence of aspiration).

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Swallowing Assessments in the United States

• Bedside Screening Procedure
• To provide indirect evidence of a swallowing
  disorder (does not provide information on the
  physiology of a disorder)
• Modified Barium Swallow Procedure
• To define abnormalities in anatomy and physiology
  causing the patients symptoms
• To identify and evaluate treatment strategies
  that may help the patient swallow safely and
  efficiently
• Assesses whether aspiration is occurring and why

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Evidence to Support Swallowing Assessment in
England

• The Community Quality Three-3rd Edition
• Clinical Guidelines according to the Royal
  College of Speech Language Therapy
• Hospital Care Pathways specific to each disorder
  (i.e. stroke, Parkinsons Disease, Multiple
  Sclerosis, etc.)
• Must coincide with the Royal College and National
  Health Service Guidelines
• Each pathway lists the minimum requirements per
  disorder (i.e. how often seen, expected protocol,
  etc.)
• SLTs felt confident in the reliability and
  accuracy of their bedside assessment protocol due
  to their research results.

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Summary of Swallowing Assessment in England

• Bedside evaluation is the primary tool used to
  assess swallowing
• Bedside evaluation is completed in various
  environments (i.e. acute care, nursing homes,
  home setting)
• MBS is not performed on a regular basis
• Yogurt and water are the only consistencies used
  in swallowing assessment despite wide range of
  diet recommendations (puree, soft, semi-solid,
  normal)

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Summary Continued

• Differences in consistency definitions (i.e. wide
  range for what is considered puree)
• Reduced productivity (caseload and treatment
  time)
• Different education requirements