DtH 12: Piecing Together the Clinical Swallowing Evaluation (CSE)

The Clinical Swallowing Evaluation (CSE) is a critical part of dysphagia management. However, it is often misused and over interpreted. In this high-energy installment of Down the Hatch (The Swallowing Podcast) SLPs Rinki Varindani Desai and Beth Shah, along with Hosts Ianessa Humbert and Alicia Vose, discuss whether the CSE should really be considered a screening and if swallowing is actually being evaluated at all.

7 Replies to "DtH 12: Piecing Together the Clinical Swallowing Evaluation (CSE)"

  • Laura Jackson
    September 14, 2017 (2:41 am)

    Great podcast as always. Excellent points were made, but application could be expanded. I think this needs a follow up of a “how to do a clinical swallow eval and a how to/what to document”. Unfortunately many of us were taught that you can “assume” way more than you actually can from a BSE. Examples of application are great teaching tools. Thanks for considering.

    • Laura Jackson
      September 14, 2017 (3:05 am)

      Another question-can you explain how to assess oral transit time and pharyngeal swallow delay at bedside bc many people write this in reports but Im confused on how they are able to know when oral transit begins/ends. At best you could say “suspect prolonged oral transit time due to…” or suspect pharyngeal delay due to… and state your observations?

      • Ianessa Humbert
        September 15, 2017 (12:48 am)

        Hi Laura,

        I’m replying to both of your comments. Glad you enjoy Down the Hatch.

        I agree that many were taught that you can assume more than the CSE can actually show you. A CSE how-to is certainly in order! I have some future ventures coming up with swallowing training and education and a CSE how to is definitely part of that! For your second question. Oral transit time cannot be assessed without videofluoroscopy because the position of the bolus cannot be tracked while the mouth is closed. You might be able to suspect prolonged OTT (but you still need to indicate why), but you cannot confirm that it is prolonged or even provide a specific duration.

        Thanks for your comments and astute questions.
        Dr. Humbert

        • Katarina Byrne
          October 24, 2017 (11:36 pm)

          Great to hear you have some CSE training planned. Is it likely to be available online? I’m in Australia so can’t attend your face-to-face courses, but very keen to learn more!

  • Victoria Dao
    September 26, 2017 (10:36 pm)

    Dr. Humbert. Do you have a sample of what statements are ok to say in an evaluation? A report sample? I really would like to enhance my writing skills.

    • Ianessa Humbert
      September 26, 2017 (10:47 pm)

      Hi Victoria, I do not have samples of what to say, but I always encourage people not to layer on too much interpretation of what cannot be seen or confirmed at the bedside. For example, “Aspiration suspected due to coughing immediately after 10ml thin liquids were presented to by cup; laryngeal movement appreciated via palpation” is better than “Patient aspirated on thin liquids swallowed via cup”. 1. You don’t know if they aspirated 2. You can’t confirm that a swallow occurred 3. Laryngeal movement is good to note, but it can’t confirm the presence of a swallow, much less adequacy of airway protection. I know that is not very specific, but you may have given us an idea for a future Dow the Hatch! Hope it helps.

  • Grace Lee
    November 9, 2017 (11:04 pm)

    Dr. Humbert and Dr. Vose- given your experiences at Johns Hopkins Hospital, could you shed some light on documentation do’s and don’ts when writing a VFSS or FEES exam? I understand that the clinical evaluation has limitations, but I wonder if there are cautions that have to be taken when writing up instrumental patient evaluations? Please let me know.

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