Step 2: Evaluate for oral-pharyngeal dysphagia: Identify aspiration risk and appropriate diet prescription
Based on the evidence obtained by clinical history, physical examination, and a basic screening test (e.g., EAT-10), oral-pharyngeal dysphagia may be suspected and subsequently, the physician will order evaluation by the multidisciplinary healthcare team. The dietitian may conduct a comprehensive nutrition assessment, determining the nutritional risk and needs of the individual. The nurse will provide direct patient care and may conduct relevant procedures (e.g., record daily fluid intake). The dysphagia specialist (specially-trained speech-language pathologist, logopedist, etc.) will determine aspiration risk and identify the appropriate diet prescription (the texture of solids, and the volume and viscosity of liquids). The volume-viscosity swallow test (V-VST) is a sensitive clinical method to identify patients with oral-pharyngeal dysphagia whose swallowing could be improved by intervention with liquids of specific volume and viscosity6. An important feature of the V-VST, is that it can help improve the detection of swallowing dysfunction, including silent aspiration. Widespread use of this evidence-based method will facilitate appropriate early management oral-pharyngeal dysphagia.