THE PATIENT’S PERSPECTIVE
The first visit starts the minute we meet. Are you ambulatory (able to walk) alone or with another? As we walk toward the therapy room or kitchen table we talk. I subjectively assess cognition (attention, memory, problem solving), vocal quality, pragmatics (social appropriateness in communication) and medical concerns. We discuss recent doctor visits. I assess posture, stature and proportional weight. We converse while establishing rapport. I ask if you are having eating, chewing and or swallowing issues.
I explain that I will look into your mouth and watch breathing, eating, chewing and swallowing of different food items. If possible your kitchen is the BEST place for collecting this information and observation. I ask them about pill taking behaviors. I ask about respiratory or “breathing” activities associated with daily living skills (those reported to their doctor or not reported). I listen to the quality of your cough, throat clear and vocal quality.
I look into your mouth for missing teeth, overall dental health, symmetry, strength and functionality of the oral and pharyngeal anatomy to process foods and liquids.
I take your oxygen saturation levels at rest, during and after swallowing.
I may listen, watch and feel for pain during a dry swallow using a stethoscope. I listen, watch and feel your breath with your cheeks puffed.
I then proceed to talk about food preferences and difficulties.
I watch, listen and feel the rise and fall of your larynx as we trial foods and liquids of varying consistencies. I ask about prior swallowing exams and results.
We discuss my observations and recommendations.