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Path to Dysphagia Diagnosis
  • Virginia Stroud

The importance of instrumental exam

Dear SLPs and nursing staff:

Thank you all so much for your continued referrals!

You all mean so much to us here at DDS. We continue to strive to be the industry leader for mobile videofluoroscopic swallowing study (VFSS) in Oklahoma.

You all are on the front lines fighting the “dysphagia battle” everyday. We know it’s not an easy job and our goal is to be an ally in that endeavor.

I'm introducing this blog to provide some handy tips and tools to help you with your dysphagia patients. Please let me know what you think and if there are future topics you would like to see discussed.

As always reach out to us via email, text or social media. We value your opinion!

Happy swallowing,

Virginia Stroud, MS, CCC-SLP




This patient demonstrated no overt s/s of aspiration during the initial evaluation, but after a family member mentioned hearing a wet gurgly voice the SLP ordered a study.

The SNF administrator has hesitant to do the test, but the results quickly changed their mind as to the importance of properly diagnosing dysphagia with instrumental tools. Now the SLP can modify diet, educate the patient and staff on strategies, and provide appropriate skilled therapy based on these results!



ASHA’s current position for indications of instrumental exam:

  • Concerns regarding the safety and efficiency of swallow function

  • Contribution of dysphagia to nutritional compromise

  • Contribution of dysphagia to pulmonary compromise

  • Contribution of dysphagia to concerns for airway safety (e.g., choking)

  • The need to identify disordered swallowing physiology to guide management and treatment

  • Inconsistent signs and symptoms in the findings of a non-instrumental examination

  • The need to assist in the determination of a differential medical diagnosis related to the presence of pathological swallowing

  • Presence of a medical condition or diagnosis associated with a high risk of dysphagia

  • Previously identified dysphagia with a suspected change in swallow function that may change recommendations

  • Presence of a chronic degenerative condition with a known progression or the recovery from a condition that may require further information for the management of oropharyngeal function

SOURCE: American Speech-Language-Hearing Association. (n.d.). Adult Dysphagia. (Practice Portal).October 20, 2017,

As clinicians, we can become savvy at identifying patients that may or may not have a swallowing disorder based on a bedside. But as you are well aware, none of us are born with x-ray vision, hence the need for a comprehensive instrumental examination! How do we know what the problem is, what strategies to use, which diet is optimal, and what to focus our treatment on until we perform a VFSS?

"none of us are born with x-ray vision, hence the need for a comprehensive instrumental evaluation"

This leads to another question. How do I convince my administrator that my patient needs a VFSS? We'll be going over this topic in our next blog post -- STAY TUNED!



Why do we need to perform clinical and instrumental assessments post CVA?

Incidence of dysphagia in stroke populations was as low as 37% when identified using cursory screening procedures and as high as 78% when identified using instrumental assessments.

SOURCE: Martino, R ., Foley, N.,Bhogal, S.,Diamant, N., Speechley, M., & Teasell, R. (2005). Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke, 36, 2756–2763.

In short, we are not great at identifying swallowing disorders without performing an a true clinical or instrumental assessment. We may be missing over 40%+ of patients with dysphagia when performing just a screening. Wow!


Short on time but want to geek out to current topics in dysphagia with the experts?

Check out the dysphagia podcast “Down the Hatch” with Ianessa Humbert and Alicia Vose.

You can listen to it for FREE:

Thank you for checking in this month. Please share and send us some topics you'd like to see covered in our upcoming blog posts. Stay tuned in for our next post, "how to talk to your administrator about ordering a VFSS"

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