Dysphagia Treatment for New Clinicians: 15 Important FAQs

In this article, we answer the dysphagia treatment questions most often asked by graduate clinicians, clinical fellows, and new grads. 

If you’re a new clinician, you’re in the right place! And if you’re a veteran, bookmark this article for your next student (or get a few ideas of your own!) 

For step-by-step guidance to all of your frequently asked questions, visit our shop and online course. Now eligible for 1.55 ASHA CEUs!

1. What’s The Difference Between A Swallow Screen & Clinical Swallow Examination?

Swallow screens and examinations are important parts of your assessment toolkit…but what are they, exactly?

Let’s dive into what you need to know to assess with confidence.

What is a swallow screen?

A swallow screen is a quick tool that indicates if dysphagia is present or not. It’s typically pass-fail.  

Swallow screens often focus on identifying the overt signs of aspiration, like coughing or choking. You can use a swallow screen at any time throughout the course of treatment. 

Another important role of a swallow screen is determining if a complete clinical swallow examination is warranted.

What’s the best swallow screen?

One evidence-based swallowing screen is the Yale Swallow Protocol. Read our article for a step-by-step guide, plus a free assessment form.

Who can complete a swallow screen?

Speech-language pathologists, trained nurses, and doctors can complete a swallow screen.

Is a swallow screen billable?

In the United States, swallowing screens are typically not billable, whereas a clinical swallow examination is billable.

What is a clinical swallow evaluation?

A clinical swallow evaluation (CSE) is a comprehensive assessment of a patient’s swallowing abilities. It provides the foundation of your dysphagia treatment plan.

What’s the goal of a clinical swallow evaluation?

When you do a clinical swallow evaluation, you’ll have several goals.

One is to identify what factors contribute to dysphagia so that you can make a diagnosis and referrals as needed.

Another goal is that it will help you make recommendations for safe and efficient nutrition.

Other goals of a CSE:

• Determine whether your patient needs an instrumental assessment
• Decide what education to provide
• Help you make a dysphagia treatment plan (Garand et al., 2020)

Read a step-by-step guide to Clinical Swallow Evaluations for more details.

What are the steps of a clinical swallow evaluation?

Unlike a swallow screen, a CSE is not pass-fail. It involves several steps, including:

• A chart review
• Patient/caregiver interview
• Oral-mechanism examination
• Food/liquid trials
• Your recommendations
• Patient/caregiver education

2. What Do I Bring To A Clinical Swallow Evaluation?

A question that new clinicians often ask is, “What supplies do I need for a clinical swallow evaluation?” Let’s review the PPE, tools, consumables, and extras you should bring.

What personal protective equipment should I bring?

Depending on the setting, you may need to bring your own Personal Protective Equipment (PPE). This may include:

• Sanitizer
• Gloves
• Mask (if preferred or there’s an active cough)
• Other PPE, if required due to infection (gown, booties, etc.)

What tools do I need for a clinical swallow evaluation?

In many settings, you’ll use the oral hygiene supplies that the patient already has.

• Flashlight or penlight
• Pulse oximeter
• Tongue depressor
• Oral hygiene supplies, including a toothbrush, toothpaste, mouthwash, denture care, and toothettes/sponges
• Chapstick/lip/mouth moisturizer

What food and liquid should I bring?

Since you will assess eating and drinking, you’ll need to have food/liquid supplies. Have at least a few food and liquid options ready, including:

• Cups, straws, spoons/utensils
• Ice-chips
• Water
• Thin liquids (juice)
• Carbonated sugar-free beverage
• Puree textures (applesauce, pudding) 
• Minced and moist textures (cottage cheese, minced banana) 
• Soft and bite-sized textures (soft chopped-up meat with sauce, peaches)
• Regular texture (cereal bar, toast)​

Should I thicken liquids?

There is some controversy around whether or not to thicken liquids at the bedside. Research recommends doing an instrumental assessment before recommending thickened liquids (Kaneoka et al., 2017; Rodrigues et al. 2023).

What else should I bring to a clinical swallow evaluation?

• Dysphagia handouts, including safe swallowing strategies.
• A visual diagram of the larynx and swallowing phases
• Extra paper, pen/pencil
• Surveys (EAT-10, Reflux Symptom Index)
• Screeners and assessments for possible cognitive-communication, voice, and/or language deficits.

See our shop for handouts and assessments.

3. How Do I Get My Facility To Complete Oral Care?

Oral care is a crucial step in keeping your patients with dysphagia safe and healthy (Fields, 2008; Hua et al., 2016; Juthani-Mehta et al., 2013; Watando et al., 2004).

But what are your options if your facility isn’t doing it consistently?

Offer Staff A Handout

Educate, educate, educate!  A simple way to get staff on board is to provide handouts about the importance of oral care. 

There are handouts available online, or you can create your own. Emphasize that oral care decreases the risk of pneumonia and overall medical costs. Plus, it can improve a patient’s swallowing abilities (Affoo, 2022).

Do An Inservice

Another way to get staff on board is to provide an in-service. Talk about how to complete adequate oral care, how oral care is the key to decreasing the risk of aspiration pneumonia, and ways your facility can implement an oral care program.  

Demonstrate proper oral care techniques on another staff member using oral hygiene supplies during the in-service.

Order Oral Hygiene Products

You can also talk with your materials management team about ordering oral hygiene products, including:

• Toothbrushes
• Toothpaste
• Non-alcoholic mouthwash
• Denture care supplies (storage containers, soaking basins, denture tablet cleaners, denture brushes, etc.)
• Suction toothbrushes
• Oral sponges/toothettes

This is part 1 of our FAQ series. If you enjoyed it, read Part 2: How To Deal With Difficult Patients,

More Dysphagia Treatment Materials

References

• Affoo, R.H. & Hachey, S. (2022). Integrating Oral Health in Speech-Language Pathology Practice: A Viewpoint. Perspectives of the ASHA Special Interest Group, 7(3), 868-878. https://doi.org/10.1044/2022_PERSP-21-00277
• American Speech-Language-Hearing Association. Adult Dysphagia. Retrieved September 29, 2024 from https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/
• Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
• Garand, K. L. F., McCullough, G., Crary, M., Arvedson, J. C., & Dodrill, P. (2020). Assessment Across the Life Span: The Clinical Swallow Evaluation. American journal of speech-language pathology, 29(2S), 919–933. https://doi.org/10.1044/2020_AJSLP-19-00063
• Fields L. B. (2008). Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit. The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses, 40(5), 291–298. https://doi.org/10.1097/01376517-200810000-00007
• Juthani-Mehta, M., De Rekeneire, N., Allore, H., Chen, S., O’Leary, J. R., Bauer, D. C., Harris, T. B., Newman, A. B., Yende, S., Weyant, R. J., Kritchevsky, S., Quagliarello, V., & Health ABC Study (2013). Modifiable risk factors for pneumonia requiring hospitalization of community-dwelling older adults: the Health, Aging, and Body Composition Study. Journal of the American Geriatrics Society, 61(7), 1111–1118. https://doi.org/10.1111/jgs.12325
• Leder, S. B., & Suiter, D. M. (2014). The Yale Swallow Protocol: An Evidence-Based Approach to Decision Making. Springer International Publishing.
• Hua, F., Xie, H., Worthington, H. V., Furness, S., Zhang, Q., & Li, C. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. The Cochrane database of systematic reviews, 10(10), CD008367. https://doi.org/10.1002/14651858.CD008367.pub3
• Kaneoka, A., Pisegna, J. M., Saito, H., Lo, M., Felling, K., Haga, N., LaValley, M. P., & Langmore, S. E. (2017). A systematic review and meta-analysis of pneumonia associated with thin liquid vs. thickened liquid intake in patients who aspirate. Clinical rehabilitation, 31(8), 1116–1125. https://doi.org/10.1177/0269215516677739
• Rodrigues, D.S., de Souza, P.T.D.R., Orsi, J.S.R., Souza, P.H.C., & Azevedo-Alanis, L.R. (2023). Oral care to reduce costs and increase clinical effectiveness in preventing nosocomial pneumonia: A systematic review. The journal of evidence-based dental practice, 23(2), 101834. https://doi.org/10.1016/j.jebdp.2023.101834
• Watando, A., Ebihara, S., Ebihara, T., Okazaki, T., Takahashi, H., Asada, M., & Sasaki, H. (2004). Daily oral care and cough reflex sensitivity in elderly nursing home patients. Chest, 126(4), 1066–1070. https://doi.org/10.1378/chest.126.4.1066