Clinical Assessment
This assessment framework is based on Cichero and Murdoch’s (2006) “Clinical Assessment of Dysphagia” model.
According to Volicer and Hurley (1998) dysphagia frequently occurs in individuals with later stage dementia. Groher and Crary (2010) note that continued weight loss can be the first sign of swallowing difficulties in individuals with dementia. Knowledge of neuroanatomy will enable you to determine whether there are any symptoms that are additional to the primary diagnosis (Cichero et al. 2006).

Curfman (2005) suggests ascertaining the following information, in addition to the medical diagnosis (which is moderate to late stage dementia):
· Current weight and any recent changes.
· The present diet and any altered diets previously tried.
· Eating habits and the type of food that is consumed at meal times and outside of meal times.
· Self-feeding skills.
· Eating and chewing difficulties.
· Previously demonstrated signs or symptoms of coughing, choking and with what consistencies.
· Any test results eg: chest x-ray and any history of pneumonia.

At the end of your assessment you will need to indicate how the individuals nutritional and hydration needs will be met (Cichero et al. 2006) which may be orally, non-oral or a combination. Research indicates that dehydration and malnutrition are prevalent in residents living in skilled nursing facilities (Curfman, 2005).
Current level of alertness must be established prior to initiating a swallow assessment (Cichero et al. 2006). The therapist also needs to be aware of current medication (Cichero et al 2006). Medications that dry the oral and pharyngeal mucosa can increase difficulty in swallowing. This is because the food is mixed with saliva when chewing to form a bolus ready for swallowing (Seikel, 2010).

The necessary criteria for a valid assessment according to Cichero et al (2006) include:

Is the individual alert and able to participate in an oromotor exam and swallowing evaluation?

Is the individual cooperative? (this may be a factor as poor comprehension will result in poor compliance).

Are they agitated?

Are they able to sit in an upright position or do they need support to achieve this?

Is the individual able to mobilise?

Are they likely to fatigue easily?

Communication and Cognition

Chichero et al (2006) advise assessing orientation to time, place and person as a screening tool. Orientation is likely to be poor in this population.

Oral Trials
Prior to an oral trial you should assess whether the client's voice is harsh, breathy, hoarse or is wet sounding.
If the individual demonstrates safe swallow of their saliva, with no compromise of their airway, the SLT may proceed to grossly assess their swallow with food (Groher & Crary, 2010 p.178)

As each individual varies in their swallowing ability, commence the test swallows with the consistency you deem safest. Groher and Crary (2010) describe the four consistencies as:
·Thin liquid
· Thick liquid
· Pudding consistency
· Semi-solid.

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