CD 5671 Neurogenic Disorders
Sample History for Assessment Report
Sample 1 - Dysphagia

Patient Name: Hazel Wood

Age: 72

Referral source: Dr. Jones, neurologist

Referral: "evaluate swallowing"

Pt status: acute inpatient

Medical History:

Interview

 
Are you having any difficulty swallowing?  Yes
Tell me what kind trouble you are having. Food sticks in my throat when I swallow
When did it start? Last month when I had a cold
Did it come on gradually or suddenly? All at once
Has it gotten any better or worse? No, it's pretty much the same
Do you notice it all the time? Pretty much
Show me where it sticks (Points to right side of thyroid cartilage)
Do all things stick there? It's worse with bread and muffins
Do you cough or choke? no
Do you have any pain when you swallow? no
Are liquids or solids easier for you? I don't have any difficulty with liquids
Do have heartburn or reflux? I take Zantac every day
Have you noticed any drooling or difficulty swallowing your saliva? no
Does food ever go up into your nose when you swallow? no
Do you have a dry mouth? yes
Do you take any medications that dry your mouth? My high blood pressure medication seems to make it worse
Have you lost any weight? I wish
How is your appetite? Fine
Have you noticed any changes in your voice? I haven't fully gotten over this cold. I still have a frog in my throat.
Have you had any colds or congestion? Yes, I had that cold a month ago and haven't gotten over it.

Oral Mechanism Exam


 
Target Elicitation Observations
Facial Symmetry Have subject look straight at you no asymmetries
Lips Smile 

Pucker 

Open 

Close tight 

Puff up cheeks, hold against resistance

nl 

nl 

nl 

nl 

nl

Tongue Stick straight out 

Left 

Right 

Left and Right quickly 

Elevation 

Retraction 

Protrusion & lateral movement against resistance (with tongue blade)

nl 

nl 

nl 

nl 

nl 

nl 

nl 

Oral Cavity Open wide Upper and lower dentures 

Jaw ROM wnl 

Velum Say "ah" 

Elicit gag reflex by touching anterior faucial arches, posterior faucial arches, or base of tongue. Elicit gag on both sides

not elicited
Voice Maximum Phonation Time 

s:z ratio 

Pitch glides

"ah" = 16 

"sss" = 15 

"zzz" = 17 

pitch assessed informally wnl 

vocal quality slightly hoarse and wet

Bedside Swallowing Assessment


 
Observation Liquid (water, coffee) Puree (applesauce) Solid (bread, cookie)
Oral
Lip seal nl nl nl
Bolus formation, chewing nl nl prolonged
Retention none none none
Reflex prompt prompt delayed?
Pharyngeal
Laryngeal elevation nl nl nl
Coordination (repeated swallows, 4 point test) nl nl disrupted
Cough none none none
Vocal quality unchanged unchanged unchanged