Modified Mondays: It’s Just a Feeling
As I mentioned in last weeks’ cat meme (I still cannot believe that part of my job is creating cat memes-which, incidentally, can be harder than you might think: last week I was Googling “cat looking uncomfortable while being hugged”), laryngeal palpation has long been a part of the SLPs clinical assessment tool box. And while we can gain some information from this practice, it is really important that we don’t overestimate what we can learn about the patient’s swallow.
Research has shown that the data doesn’t really support our ability to judge laryngeal movement as impaired or not impaired, and since we can’t see where the bolus is inside when we feel the larynx move, we cannot use this method to assess timeliness either. Furthermore, there is a wide range of how much a larynx will move in a normal swallow, and this can change as we age. Finally, the jury is still out on whether hyoid movement in particular is associated with penetration/aspiration events. So what are we really assessing with palpation? We can say that there was movement…. but truly cannot say that the movement is impaired (or not) and we cannot say that it was timely (or not).
This patient has a history of a CVA- and if you really watch the hyoid and the larynx throughout the clips, you will see plenty of movement. However, you will NOT see airway closure… or really even a swallow at all. We can’t know what we would have “judged” this patient’s laryngeal movement to be at bedside-but I am willing to bet at least some of those movement would have felt pretty significant.
As I have said in the last few MM, clinical swallow evaluations can provide critical information, and should be a key piece of dysphagia assessment, we just need to make sure that the documentation of this clinical assessment supports what we can actually determine at bedside, and not step into “feelings”.
See links below for more information:
Assessing hyolaryngeal excursion: Comparing quantitative methods to palpation at the bedside and visualization during videofluoroscopy (nih.gov)
Physiological Variability in the Deglutition Literature: Hyoid and Laryngeal Kinematics (nih.gov)
Determining the Relationship Between Hyoid Bone Kinematics and Airway Protection in Swallowing | Journal of Speech, Language, and Hearing Research (asha.org)