Swallow test helps clinicians protect stroke patient airways

New assessment technique provides another option for patients at risk of choking

BROOKS – Stroke patients at risk of choking can now benefit from a new assessment tool now offered at the Brooks Health Centre and Medicine Hat Regional Hospital.

The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) assessment involves a flexible tube with a camera on the end which goes down the patient’s throat. Speech language pathologists are able to clearly see the vocal cords and surrounding anatomy on a monitor to see what happens, in real time, when a patient swallows and to ensure the airway is properly protected.

“The biggest advantages of FEES are that we can repeat the procedure as frequently as needed as there is no radiation exposure,” says Ajay Mysore Narasimha, the speech language pathologist who brought the tool to the Medicine Hat hospital after providing similar assessments to patients at the London Health Sciences Centre in London, Ont.

“With FEES, there’s no wait time. It’s portable, quick and easy, and only requires help from a speech language pathologist. It’s helping us meet current stroke guidelines that a means of nutrition be established within 24 to 48 hours.”

Up to 65 per cent of new acute stroke patients experience dysphagia, or swallowing impairment. Of those initially affected, up to half do not recover functional swallowing by six months after the onset of the stroke, which leads to increased risk of food in the lungs, pneumonia and death.

The FEES test can be done wherever the patient is receiving care while family is in the room.

Previously, stroke patients in Brooks would have to travel to Medicine Hat for videofluoroscopy, which involves swallowing a variety of liquids and foods mixed with barium while a radiologist takes video X-rays of the mouth and throat. This involved numerous care providers and services, including Emergency Medical Services to transport patients to a hospital, as well as radiologists, technicians and speech language pathologists.

Linda Dusome is grateful her husband of 45 years, Edward, was able to undergo a FEES test on his long-term care unit at the Brooks Health Centre. Edward, 69, was told he’d never walk, talk or eat again after he had a stroke 18 years ago that resulted in locked-in syndrome, a rare neurological disorder that damages the brain stem. Since then, he has been eating pureed solids.

Recently, he started to choke more during meals. His family and care team wanted an assessment to make sure the act of eating isn’t putting him at risk. After the FEES assessment, Edward has decided to consume his food and water via a tube in his stomach.

“The test was amazing,” says Linda, who appreciated being able to be in the room with Ed while the test was being done. “FEES confirmed our suspicions that Ed should stop eating, but it was important for him to be able to make that decision on his own. FEES helped him do that.”

“FEES is a good alternative for patients who don’t have immediate access to videofluoroscopy,” says Dr. Ziets Hendriks, Edward’s physician. “It’s a great example of clinicians working with patients and families to provide seamless, convenient care that adds to a patient’s quality of life. I’m pleased we’re able to bring this tool to Brooks and surrounding communities.”

Since implementing FEES at Medicine Hat Regional Hospital, patient wait times for swallow assessments have decreased by 57 per cent.

Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.

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