Determining Whether Dysphagia Is Present: The Importance of a Clinical Swallow Exam

By Dr. Bonnie Slavych, Speech-Language Pathologist, CogniVantage

Before I move into today’s blog post, I would like to introduce myself and tell you why this blog post is particularly important.

My name is Bonnie Slavych, and I lead the PD Speak, Swallow, Learn program (formerly known as LOUD Together). I’m a speech-language pathologist (SLP) specializing in voice, swallowing, and upper airway disorders. I practice with CogniVantage, teach graduate courses on swallowing at Missouri State University, and lead the voice program at the University of St. Augustine. I have presented in more than 50 conferences, and I’ve had the opportunity to publish in this field, including co-authoring three books.

The Problem

Recently, I’ve been working with individuals with Parkinson’s disease who were referred for instrumental exams without first undergoing a clinical swallow exam (CSE). This issue became evident during group sessions and patient record reviews. In some cases, these referrals came from neurologists or general practitioners, while in others, a speech-language pathologist (SLP) made the referral without conducting a clinical swallow exam (CSE).

I’m writing about this topic because you need to know, as someone affected by Parkinson’s disease, the process of swallowing evaluation is necessary so that you can advocate for yourself. It’s also important for caregivers to be aware of this process to support their loved ones. While many healthcare providers, including speech-language pathologists (SLPs), may not be fully aware of the importance of a clinical swallow exam (CSE) before an instrumental exam, my goal is to shed light on this topic in a way that’s informative and empowering for everyone involved.

Now, on to the information that you’re looking for…

If you or a loved one has been experiencing difficulties with swallowing, you might be wondering what steps to take next. This process can feel overwhelming, but understanding the pathway to getting the right help can make a big difference. One of the most important steps in this process is getting a clinical swallow exam (CSE) before considering more advanced testing.

What Is Dysphagia?

Dysphagia is the medical term for swallowing difficulties. It can range from mild discomfort to more severe problems where food or liquid might not move smoothly from the mouth to the stomach. If you’re having trouble swallowing, it’s necessary to address it early to prevent complications like malnutrition, dehydration, or aspiration pneumonia.

Why It’s Important to Start with a Clinical Swallow Exam

When there’s a concern about dysphagia, the first step is to see a speech-language pathologist (SLP) for a clinical swallow exam (CSE). This exam is a necessary starting point in evaluating your swallowing function. Here’s why:

1. Personalized Evaluation: During a clinical swallow exam (CSE), the speech-language pathologist (SLP) will take time to understand your specific situation. They’ll ask about your medical history, observe your swallowing during different tasks, and listen to your concerns. This personalized approach helps the SLP gather essential information before moving to more complex testing.

2. Non-Invasive Initial Assessment: A clinical swallow exam (CSE) is non-invasive. It doesn’t require any special equipment—just the speech-language pathologist’s (SLP) expertise and your participation. This allows the speech-language pathologist (SLP) to assess your swallowing in a comfortable, familiar setting without any added stress.

3. Determining the Need for Further Testing: The clinical swallow exam (CSE) helps the speech-language pathologist (SLP) determine whether more advanced testing is necessary. Not everyone needs an instrumental exam, like a videofluoroscopic swallow study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES). By starting with the clinical exam, the SLP can decide if these tests are needed or if your swallowing issues can be managed through other means.

The Role of Instrumental Exams

If the speech-language pathologist (SLP) finds that there are significant concerns during the clinical swallow exam (CSE), they may recommend an instrumental exam. These tests provide a more detailed view of what’s happening when you swallow, allowing for precise diagnosis and treatment planning. It is important that these exams do not happen before the clinical swallow exam (CSE). It is equally important that they are conducted only when necessary, as they are more involved and require specialized equipment.

Caregiver Involvement

As a caregiver, your role in this process is vital. You can help by:

• Observing and Reporting: Pay close attention to any changes in swallowing behavior, such as coughing during meals, changes in eating habits, or unexplained weight loss. Share these observations with the speech-language pathologist (SLP) during the clinical swallow exam (CSE).

• Supporting Through the Process: Encourage your loved one to be open during the clinical swallow exam (CSE) and provide comfort during the assessment. If further testing is needed, help with scheduling and transportation to ensure everything goes smoothly.

Actionable Steps

If you suspect dysphagia:

1. Talk to Your Healthcare Provider: Express your concerns and ask for a referral to a speech-language pathologist (SLP) for a clinical swallow exam (CSE).

2. Schedule a Clinical Swallow Exam: This is the first step in determining the presence of dysphagia. If your healthcare provider suggests an instrumental exam, such as a videofluoroscopic swallow study (VFSS) or a modified barium swallow study (MBSS), ask them to first refer you for a clinical swallow exam (CSE) with a speech-language pathologist (SLP) who specializes in swallowing disorders.

The Importance of Seeing a Knowledgeable SLP

Not all speech-language pathologists (SLPs) specialize in swallowing, and it’s so important that the person conducting your clinical swallow exam (CSE) is well-versed in this area. The clinical swallow exam (CSE) is more than just watching you swallow food and liquid; it’s a comprehensive evaluation where the speech-language pathologist (SLP) will try different strategies and teach exercises that might improve your swallowing function. This initial assessment is key because it sets the stage for any further testing or interventions.

During the clinical swallow exam (CSE), the speech-language pathologist (SLP) will observe how you manage different textures and volumes, and they will introduce specific strategies to see if they help you swallow more safely and effectively. These might include changes in posture, swallowing techniques, or exercises designed to strengthen the muscles involved in swallowing.

Collaborative Approach to Instrumental Exams

The findings and observations from your clinical swallow exam (CSE) are critical and will be shared with the speech-language pathologist (SLP) or other healthcare provider who conducts your instrumental exam. This collaborative approach means that when it’s time for the instrumental exam, the provider already has a clear understanding of what’s happening with your swallowing. They’ll know which strategies to focus on, whether you’re performing them correctly, and most importantly, whether they’re actually working for you.

If the strategies identified during the clinical swallow exam (CSE) are effective, that’s fantastic—it means you have a solid starting point for managing your dysphagia. If they aren’t as effective as hoped, the instrumental exam allows the provider to see what’s happening inside your body and make additional recommendations. This way, the assessment is not only more accurate but also more tailored to your specific needs.

Why This Matters

The thoroughness and expertise of the (SLP) conducting your clinical swallow exam (CSE) can make a significant difference in the management of your swallowing disorder. By working with a speech-language pathologist (SLP) who is knowledgeable and experienced in this area, you’re taking an important step toward ensuring that your care is effective and appropriate for your unique situation. This foundation of careful observation and strategic planning is essential for your long-term health and quality of life.

Up Next on the CogniVantage Blog...

In our upcoming post, we'll explore the various reasons why a clinical swallow exam (CSE) may not be performed initially. While a CSE is necessary in evaluating swallowing difficulties, certain scenarios such as medical emergencies may lead directly to instrumental exams. We'll discuss when and why healthcare providers might skip the clinical swallow exam (CSE), the implications of this approach, and what you can do if you find yourself in this situation. Understanding the possibilities is necessary for you receive the most appropriate and effective care for your swallowing. Stay tuned!