Role of the Speech and Language Therapist in Assessment of Oral Feeding Gail Robertson Specialist Speech and Language Therapist

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Role of the Speech and Language Therapist in
Assessment of Oral FeedingGail
RobertsonSpecialist Speech and Language Therapist
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Terminology

• Dysphagia
• Eating, Drinking and swallowing Difficulties
  (EDS)
• Swallowing problem
• Feeding disorder / difficulty

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Phases of swallowing

• Oral Preparatory phase
• Oral phase
• Pharyngeal phase
• Oesophageal phase

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Stage One and Stage Two
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Stage Three and Stage Four
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Effective Swallowing

• Safe and effective swallowing is a complex act
  requiring the coordination of
• Cranial nerves, the brain stem and cerebral
  cortex
• 26 muscles of the mouth, pharynx and oesophagus

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To assess oral motor skillsAssess eating and
drinking Assess safety of swallowing To share
information and contribute to planning within the
Multidisciplinary Team(including parents/carers)
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• Medical History
• Including birth history, diagnosis particularly
  neurological conditions, respiratory problems,
  reflux etc
• Feeding History
• Including tube feeding, development, behaviour,
  nutrition, gagging/choking etc
• Parents/carers views, concerns

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Assessment of Oral Motor Skills

• Assess oral structures and control of oral
  movements for eating , drinking and swallowing
  including reflex behaviour
• Oro-Facial Exam/Observation
• Ability to control oral secretions

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Assessment of Eating and Drinking

• How is child fed?
• Position, who feeds, self-feeding, utensils
• What is child eating and drinking?
• Consistency, texture, amount, temperature, taste

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Assessment of Eating and Drinking

• How does child deal with food/drink?
• Sucking, biting, chewing, drinking, abnormal
  movements, spillage, indications of poorly
  coordinated or unsafe swallow
• How long does it take and what happens
  afterwards?
• Coughing, vomiting

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Assessing safety of swallow

• Swallow may be poorly coordinated, delayed or
  absent
• Clinical signs indicating an unsafe
  swallow/aspiration cough, choke, colour change,
  wet voice, refusal, changes in breathing, poor
  weight gain, frequent chest infections
• VFSS objective assessment (has limitations)
• Silent aspiration

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Videofluroscopic Swallowing Study

• Visualise the swallowing mechanism
• Objective evaluation
• Present different consistencies
• BUT
• Positioning
• Brief
• Variability
• Should not be taken in isolation

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Evaluation

• Is the child safe
• Does the child have oral skills required
• Can the child achieve and maintain nutritional
  requirements
• Quality of life for child and carers