2. Clinical Evaluation of Patients with Dysphagia: Importance of History Taking and Physical Exam

Assessment of dysphagia may include instrumental or noninstrumental measures—frequently both. The clinical evaluation is a collection of, largely, non-instrumental measures, which may include a comprehensive history, a detailed oral motor and sensory physical exam, and trial swallows of liquids and foods. Each aspect of the clinical evaluation serves a unique purpose yet contributes to a more comprehensive understanding of the swallowing problem. The fi ndings from the clinical evaluation provide information about a patient’s functional feeding and swallowing behaviors and determine the need for therapeutic intervention and/or additional instrumental testing. Patients at risk for dysphagia, and thus in need of a clinical evaluation, can be determined from screening. This chapter will describe each aspect of the clinical evaluation and screening and provide the value of each.