Evaluation Begins Here

Speech Pathologist Medical Reference Sheet


The Evaluation Begins Here!

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B/P – Optimal: Systolic 120, Diastolic 80

Normal 130 85

High Norm 130-139 85-89

HTN Stage 1 140-159 90-99

Stage 2 160-179 100-109

Stage 3 +180 +110


Normal rate is 14 inspirations per min.

Breath Sounds:

Rhonchi – course, dry rales

Rales – abnormal resp sound

Wheeze – whistling sound

Congestion – gurgly sound


Normal adult rate varies 60-80 beats per min.



Normal 98.6 F

A temp spike resulting from aspiration will occur 30 minutes to 1.5 hours after a meal

Pulse Oximetry

Pulse and degree of O2 saturation should be maintained at 95%-100%. Below 90% is abnormal. This is notable after aspiration.



Infiltrate – Fluid or cells infiltrated into lung tissue

Telecasts – Collapsed lung tissue from fluid or air.

Aspiration is typically noted in RLL

Nutrition and Hydration

Energy needs range from 1200 calories a day to over 200 for those who are depleted.

BUN – WNL: 9-12

Lower than 6 could result in:


Renal Failure



BUN of 25+ coupled with Creative of 1.5+ may be the result of:

Kidney and or renal Failure

Muscle Breakdown

Albumin – WNL 3.5-5.5

Lower than 2.1 could be a result of:


Blood Loss




Over hydration


Fact: Labs are typically decreased in a dysphagia patient and 30% of all hospital patients are malnutritioned and 35-85% of long-term care residents.



Some items should be avoided to keep from drying mucous membranes

  • No dairy products: milk, ice cream, cheese etc (thicken mucous)
  • No chocolate in any form: drinks, candy, cookies, etc.
  • No brown colored sodas: Coke, Pepsi, Dr. Pepper, etc.
  • No coffee or tea
  • No alcoholic drinks
  • No smoking
  • Fruit juices and non-brown colored drinks, and water are allowed

Dysphagia Deficits

Oral Phase Deficits

Oral Hold – decreased lingual coordination, apraxia, and cognition.

Lingual rolling – secondary to lingual coordin.

Tongue pumping – secondary to lingual coordination

Piecemeal deglutition – possibly due to fear of swallowing or decreased coordination

Oral Residues – decreased lingual mvmt, strength and coordination

Hard palate residue – decreased tongue tip elevation

Soft palate residue – decreased velopharyngeal elevation


Pharyngeal Deficits

Delays – If there is a delay there is posterior bolus leakage before the swallow

1-3 sec – mild

4-6 sec – moderate

7-10 sec – severe

10+ = profound or absent/nonfunctional

Residues – These move, that is why they are important. Either base of tongue, aryepiglottic folds, posterior pharyngeal wall, or subepiglottic residue, or vestibular wall

Retention – This is something you find in the valleculae or the pyriforms. It may be unilateral or bilateral.

Valleculae – decreased tongue base retraction, epiglottic dysfunction

Pyriforms- decreased laryngeal elevation or cricopharyngeal dysfunction.

Retention can be due to decreased pharyngeal motility, pressure or peristalsis.


Before the swallow – decreased lingual control, swallow delay

During the swallow – decreased or delayed laryngeal closure. Delayed swallow initiation, decreased lingual control. Epiglottic dysfunction is also a contributing factor.

After the swallow – pharyngeal residue



Before the swallow – decreased lingual control, swallow delay

During the swallow – decreased laryngeal closure.

After the swallow – pharyngeal residue or retention or vestibular residues.


Muscles of the Larynx

Laryngeal Elevators – Diagastric, Mylohyoid, Geniohyoid, Stylohyoid, Hyoglossus

Laryngeal Depressors – Omohyoid. Sternohyoid, Sternothyroid, Thyrohyoid




Diagnosis that can include Dysphagia Acquired Central Disorders – Stroke, Head Injury, Alzheimer’s


Movement Disorders –Parkinson ’s disease, Huntington Chorea, Myasthenia Gravis, Multiple Sclerosis, Wallenburg Syndrome, Friedreich’s ataxia, Wilson’s Disease, Shy Drager Syndrome, Gulliane Barre Syndrome


Neuromuscular Disorder – Bulbar Palsy, ALS


Acquired Peripheral Disorder – Carcinoma, Diabetes (uncontrolled)


Neurodevelopmental Disorder – Cerebral Palsy


Systematic Diseases – AIDS, Lupus, Sjogrens Syndrome, Scleroderma


Other – Laryngectomy, Tracheostomy, Tiri, Cervical Fusion, Radiation, Osteophytes, Zenker’s Diverticulum, Esophageal Obstruction, COPD, CHF, Renal Failure, Wallenburg, Meningitis, Lyme disease, Creutzfeldt-Jakob Disease, Tardive Dyskinesia, Torticollis, Goiters, Chagas Disease, Spinal injury, Mental Retardation, Vitamin B-12 deficiency, GERD