Clinical Swallow Evaluation in 5 Steps

A clinical swallow evaluation or ‘bedside swallow evaluation’ can help you detect dysphasia.

In this article, you’ll learn:

What Is A Clinical Swallow Evaluation?

A clinical swallow evaluation helps determine the presence and severity of dysphagia.

If you’re looking for a free template, ASHA made a great one. Download and be on your way!

But if you want step-by-step guidance, keep scrolling.

Since a clinical swallow evaluation is a non-instrumental assessment, your findings will be limited. It can’t tell you if your patient is aspirating or what’s going on with their swallowing physiology or anatomy.

Only instrumental assessments (modified barium swallow study or flexible endoscopic evaluation of swallowing) can give concrete evidence of aspiration and swallowing anatomy or physiology.

But clinical swallow evaluations are still very helpful!

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Clinical Swallow Evaluation vs Swallowing Screen?

A swallowing screen is a quick tool for determining if someone needs a full swallow evaluation. A screen often focuses on identifying overt signs of aspiration.

There’s strong evidence that early screening of at-risk patients decreases the incidence of pneumonia (Yang et al., 2023).

A screen can also indicate if a patient needs support from a dietician for their nutrition and hydration (ASHA, n.d.)

Depending on the setting, screens are done by speech-language pathologists, nurses, physicians, or other healthcare providers. SLPs often train other disciplines on how to do the swallow screen.

While there’s no one preferred tool, there are quite a few evidence-based swallowing screens, including:

Who Needs A Clinical Swallow Evaluation?

The following medical conditions may need a clinical swallow evaluation:

(Puntil & Suiter, n.d.)

Bedside Swallow Evaluation PDF

See The Evaluation Pack for a ready-made bedside swallow evaluation PDF.

It guides you through a full evaluation, with scripts and reminders of what to observe.

How To Do A Clinical Bedside Swallow Exam

Here’s how to do a clinical bedside swallow evaluation.

1. Do A Chart Review

Do a chart review of your patient’s medical and clinical history. Look for:

2. Check With Nursing

Ask the patient’s nurse about:

3. Interview The Patient

Ask the patients and/or caregivers about their swallowing, nutrition and hydrate intake, and any signs and symptoms they have noticed. Confirm relevant medical history.

4. Complete An Oral Mechanism Examination

Throughout the oral mechanism exam, you’ll observe strength, range of motion, and symmetry.

Asymmetry may signal innervation or neurological issues (stroke, nerve injury, etc.) While decreased strength and range of motion may signal atrophy or dysarthria.

If you suspect underlying structural or neurological issues, refer out to neurology, gastroenterology, or otolaryngology, as appropriate.

And be sure to offer encouragement throughout! Thank your patients and acknowledge their hard work.

OME: Mandible (Cranial Nerve V)

  1. Observe the symmetry of their mouth and jaw at rest.
  2. Say, “Open your mouth.”
  3. Ask them to close their mouth.
  4. Place a few fingers under their chin and say, “Open your mouth again.”
  5. Place a few fingers on their chin (just below their lower lip), and say, “Close your mouth.”
  6. Say, “Move your jaw from side to side,” modeling as needed.
  7. Say, “Jut your jaw out” or “Move your jaw out,” modeling as needed.
  8. Then, place a clean gloved hand on their chin and gently push.
  9. Say, “Pull your jaw in.”

OME: Lips (CN VII)

  1. Observe symmetry of their lips at rest.
  2. Say, “Move your lips side to side,” modeling as needed.
  3. Say, “Pucker your lips like you’re about to whistle,” modeling as needed.
  4. Press a tongue depressor or a clean gloved finger on their lips. Say, “Push against this.”
  5. Say, “Smile wide.”
  6. Say, “Pucker, smile, pucker, smile,” modeling as needed.
  7. Say, “Puff up your cheeks [with air] [like a blowfish].” Then say, “Keep them puffed up,” as you gently press using a clean gloved finger.
  8. Say, “I’m going to gently touch your cheeks. Please close your eyes and raise your hand when you feel my touch.” Use the stick-end of a cotton swab and touch various parts of their lower face.

OME: Tongue (CN XII)

  1. Say, “Open your mouth,” and observe tongue at rest.
  2. Say, “Stick out your tongue.” Test their stimulability by prompting them to stick their tongue out even further.
  3. Place a tongue depressor against the tip of their protruded tongue. Say, “Push against this.”
  4. Say, “Stick your tongue out and up.” Test strength using the tongue depressor.
  5. Say, “Stick your tongue out and down.” Test strength using the tongue depressor.
  6. Say, “Press your tongue inside your cheek,” modeling as needed. Then, place a clean gloved finger against their cheek and say, “Push against this.”
  7. Say, “Pull your tongue back.”
  8. Say, “Lick all around your teeth.”
  9. Say, “Lick all around your lips.”
  10. Say, “I’m going to gently touch your tongue and mouth. Please close your eyes and raise your hand when you feel my touch.” Use the stick-end of a cotton swab and touch various parts of their tongue and inner cheeks.

OME: Velum

  1. Say, “Open your mouth,” and use a penlight to observe their velum at rest.
  2. Say, “Say ‘ahhh.’”
  3. Say, “Say ‘ah ah ah ah ah.’”

OME: Reflexes (CN IX, X)

  1. Say, “I’m going to place this in your mouth. Open your mouth wide,” then gently touch the back of their throat with a tongue depressor.
  2. While their mouth is open, observe faucial arches at rest.

OME: Other Observations

  1. While their mouth is open during any of the above tasks, observe dentition and oral mucosa.
  2. Say, “Lift your eyebrows.”
  3. Say, “Cough.”
  4. Say, “Clear your throat.”
  5. While gathering their case history and completing the patient interview, note any observations about dysarthria, oral apraxia, voice, and resonance.

5. Complete PO trials

Complete oral care before doing PO trials.

And if the patient is NPO, refer to the instrumental evaluation report before doing PO trials.

Depending on the results, you can decide whether you believe your patient will safely complete PO trials

PO Trials: Yale Swallow Protocol or 3-ounce Water Test

If your patient is NPO, consider using ice-chips. Make sure to complete oral care beforehand.

Throughout the 3-ounce water test, observe the following: