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Pediatric Dysphagia Evidence Map
Instrumental Assessment

Endoscopy

 

 
 

 

External Scientific Evidence

  

Evidence-Based Practice Guidelines

New York State Department of Health, Early Intervention Program; U.S. Department of Education
 
Clinical Practice Guideline: Report of the Recommendations. Motor Disorders, Assessment and Intervention for Young Children (Age 0-3 Years)
New York State Department of Health, Early Intervention Program. (2006).
Albany (NY): NYS Department of Health, Publication No. 4962, 322 pages
.
 
Added: July 2011
 
Description
This guideline provides recommendations regarding assessment and intervention for young children with developmental motor disorders and cerebral palsy, a static central nervous system disorder.  The target audiences for this guideline are parents and professionals. The recommendations are classified A, B, C, D1 or D2, based on the strength and quality of evidence. Level A recommendations are considered “strong evidence” based on high quality evidence from two or more efficacy studies. Level B recommendations are considered “moderate evidence" and based on evidence from at least one high quality efficacy study. Level C recommendations are "limited evidence" and based on evidence from at least one efficacy study with moderate quality or applicability to the topic.  Level D1 and D2 are consensus recommendations. Level D1 recommendations are consensus panel opinion based on information not meeting criteria for evidence in systematic reviews and Level D2 recommendations are based on information where a systematic review has not been done. 
 
Recommendations
Some children may need additional evaluation using instrumental assessments such as a videofluoroscopic swallow study (VFSS) or flexible endoscopic examination of swallowing (FEES) (Evidence Level D2) (pp. 68–75). 
 
 
 
 
Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)
 
Royal College of Speech and Language Therapists Clinical Guidelines: 5.5 Cleft Palate & Velopharyngeal Abnormalities
Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd.
 
Added: July 2011
 
Description
This guideline provides recommendations for the assessment and treatment of cleft palate and velopharyngeal abnormalities. The target audience for this guideline is speech-language pathologists. Recommendations are based on randomized controlled trials (Level A Evidence), well-conducted clinical studies (Level B Evidence), or expert opinion (Level C Evidence). 
 
Recommendations
Recommend differential diagnosis of velopharyngeal dysfunction with direct and indirect assessment tools which can include videofluoroscopy and perceptual evaluation, nasendoscopy, and acoustic and airflow measurements when possible (Level B Evidence). 
 
 
 
 
Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)
 
Royal College of Speech and Language Therapists Clinical Guidelines: 5.8 Disorders of Feeding, Eating, Drinking & Swallowing (Dysphagia)
Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd.
 
Added: July 2011
 
Description
This guideline provides recommendations for the assessment and management of swallowing disorders in children and adults. This guideline is intended for speech-language pathologists. Populations included, but were not limited to, stroke, traumatic brain injury, autism spectrum disorder, cerebral palsy, Parkinson’s disease and head and neck cancer. Each recommendation is graded A (requires at least one randomized controlled trial), B (requires at least one well-conducted clinical study), or C (requires evidence from expert committee reports). 
 
Recommendations

"A videofluoroscopic or fibre-optic endoscopic evaluation of swallowing should be carried out if necessary (and if there are no clinical contraindications) to improve visualization of the upper aerodigestive tract, assess aspiration and residue, facilitate techniques and therapeutic strategies to reduce aspiration and improve swallowing efficiency, compare baseline and post-treatment function, and to further diagnose (Level A Evidence)" (p. 65).

 
 
 
 

Evidence-Based Systematic Reviews

No evidence-based systematic reviews were found.
 
 
 
 

Clinical Expertise/Expert Opinion

 
Consensus Guidelines  
American Speech-Language-Hearing Association
 
Roles and Responsibilities of Speech-Language Pathologists in the Neonatal Intensive Care Unit: Guidelines
American Speech-Language-Hearing Association. (2005).
Retrieved from: http://www.asha.org/docs/html/GL2005-00060.html
 
Added: July 2011
 
Description
This is a guideline providing recommendations on the roles and responsibilities of speech-language pathologists (SLPs) providing care in the Neonatal Intensive Care Unit (NICU). Recommendations are provided pertaining to assessment and management of communication, feeding, and swallowing of infants. 
 
Recommendations
  • Instrumental swallowing assessment methods include, but are not limited to, videofluoroscopic swallow study (VFSS), endoscopy, and ultrasonography (US). 
  • Instrumental assessments such as scintigraphy and radionuclide milk scanning may differentiate aspiration resulting from swallowing from aspiration related to gastroesophageal reflux.
  • During instrumental assessment of swallowing, cardiac, respiratory, and oxygen saturation monitors may assist in determining any changes to physiologic or behavioral condition. Other signs include color changes, nasal flaring, and sucking/swallowing/breathing patterns. Cervical auscultation may also be useful to estimate timing of swallowing and assessment of breathing sounds.

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American Speech-Language-Hearing Association
 
Preferred Practice Patterns for the Profession of Speech-Language Pathology
American Speech-Language-Hearing Association. (2004).
Retrieved from: http://www.asha.org/docs/html/PP2004-00191.html.
 
 
Added: July 2011
 
Description
This Preferred Practice Patterns for the Profession of Speech-Language Pathology document is a description of recommended practice for many areas of assessment and management in the scope of practice for SLPs. The guiding principles for each clinical service are discussed in terms of service provider, expected outcome, clinical indication, clinical processing, setting, equipment, safety precautions, and documentation. 
 
Recommendations
Evaluation may be static or dynamic and includes instrumental diagnostic procedures such as videofluoroscopic swallow study, endoscopic evaluation of swallowing, and ultrasound with consideration for positioning, presentation, and viscosity. 
 
 
 
 
American Speech-Language-Hearing Association
 
Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders: Technical Report
American Speech-Language-Hearing Association. (2001).
Retrieved from: http://www.asha.org/docs/html/TR2001-00150.html.
 
 
Added: July 2011
 
Description
This ASHA position statement provides information regarding the role of the SLP in evaluation and management of children and adults with feeding and swallowing disorders and discusses the scope and rationale for SLP services. 
 
Recommendations

“The methods used to examine swallowing function in pediatric patients include videofluoroscopic swallow study, endoscopic assessment of swallowing function, and ultrasonography. Scintigraphy or radionuclide milk scanning, is used to identify aspiration from swallowing or gastroesophageal reflux and to examine gastric emptying time” (p. 12).

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American Speech-Language-Hearing Association
 
Clinical Indicators for Instrumental Assessment of Dysphagia [Guidelines]
American Speech-Language-Hearing Association. (2000).
Retrieved from: http://www.asha.org/docs/html/GL2000-00047.html.
 
 
Added: July 2011
 
Description
This ASHA guideline provides recommended clinical indicators for the use of instrumental assessment when assessing swallowing in patients with oral, pharyngeal, or upper esophageal dysphagia. The guideline does not distinguish between pediatric and adult populations or distinguish by etiology. 
 
Recommendations
  • An instrumental examination is indicated when:
    • There are inconsistencies between the patient’s signs and symptoms and clinical examination findings;
    • Confirmation of a suspected medical diagnosis or differential diagnosis is necessary;
    • Oropharyngeal dysphagia could potentially be contributing to nutritional or pulmonary compromise;
    • There is a concern regarding the safety and efficiency of the swallow;
    • The patient is a candidate for swallowing rehabilitation and specific instrumental assessment results may guide management and treatment.
  • An instrumental examination may be indicated when:
    • The patient has a medical condition associated with a high risk for dysphagia (e.g., neurologic, pulmonary, gastrointestinal problem, head/neck radiotherapy, craniofacial abnormalities);
    • The patient has previously been diagnosed with dysphagia and a change in swallowing function is suspected;
    • The patient has a cognitive or communicative deficit that does not allow for completion of a clinical examination;
    • The patient has a chronic degenerative disease and oropharyngeal function may require assessment for appropriate management.
  • Instrumental examination is not indicated when:
    • Findings from the clinical examination do not identify dysphagia;
    • The patient is too medically unstable to tolerate an instrumental assessment;
    • The patient is unable to cooperate/participate in an instrumental assessment;
    • The results of the instrumental assessment will not change the patient’s clinical management. 
 
 
 

Client/Patient/Caregiver Perspectives

 
No information was found pertaining to client/patient/caregiver perspectives.
 
 
 




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