As a major fangirl of instrumental assessment, I have been challenged a few times on the need for clinical assessment. And….I agree. Instrumental assessment provides data that you can’t get in any other way, period. But this is also just as true for clinical assessment and the information gathered during that process. The best, most appropriate plan of care for patients with dysphagia comes when we, as clinicians, combine this information, along with patient goals and perspective, to move forward.
This case is a great example of how you just can’t rely on the data gathered during an MBS, nor the clinical assessment. During the clinical assessment, the patient demonstrated multiple swallows per bite, the SLP suspected pharyngeal residues/weak pharyngeal contractions, but wanted an MBS study to be certain. Our Michigan team came in and actually saw oral differences-with piecemeal deglutition and not a whole lot of bolus formation happening. However, since our SLP had taken a look in the patient’s mouth before beginning the study, she knew to expect this, since the patient had a very large torus palatine. (You can also see the torus during the study if you watch closely.) Had our SLP not taken a look clinically, the patient may have been assessed to have an oral impairment-maybe even recommended a soft or puree-even though this is perfectly normal for this patient. Had the facility SLP not referred for the MBS, the patient may have been giving unnecessary therapy for pharyngeal contractions. Only by combining all information were the SLPs able to arrive at an appropriate plan of care.
Our best work for our patients will always come when we put together the whole picture of the patient and add in patient perspective. This combination is what evidenced practice is all about.
See article below for info and picture of torus palatine!