National Simulation Health Service
Speech Pathology Department
CLINICAL SWALLOW EXAMINATION (CSE)
Patient: ________________ URN: _________ Date of assessment: ________ Assessor: ________________
Observations/Review of End of bed chart
Current diet/nutritional status:
Diet – general or modified
Nil by Mouth awaiting SP review
Non-oral feeding: e.g. nasogastric tube (NGT), nasojejunal tube (NJT), percutaneous endoscopic
gastrostomy (PEG), percutaneous endoscopic jejunostomy (PEJ), intravenous fluids (IV fluids), total
parenteral nutrition (TPN).
Level of Alert and stable Drowsy but rousable Non-responsive/unable
Alertness Responsive Fluctuating alertness to be roused
Fatigued during session
Behaviour Cooperative Agitated Unable to maintain
Non cooperative Aggressive attention
Positioning Lying in bed (LIB) Sitting upright in bed Difficulty establishing
Resting in bed (RIB) (SUIB) appropriate posture (e.g. poor
Sitting out of bed (SOOB) head control/sitting
balance/staff required to
assist
Hearing/sight Glasses Hearing adequate Wearing hearing aids
Details: Hearing impaired No hearing aids
Dentition/oral Natural dentition Dentures Oral hygiene
hygiene Details: Details:
Respiratory SpO2 ______________ Respiratory Rate (RR) _________
Status Please select from the below:
Room air O2 via NC (nasal cannula) ________ FiO2 ___________________
Communication
Language spoken: _________________________ Interpreter required? Yes / No
Is the patient able to follow basic instructions?
Can the patient functionally communicate their needs/wants? E.g., pain, hunger, thirst, need
for the toilet etc.
Are there any concerns regarding the patient’s communication skills? If yes, provide details:
dysarthria
dysphonia
dyspraxia
AAC user Details:_________________________________________________________
Other? Specifiy:__________________________________________________________
Is there a need for further assessment of this patient’s communication skills?
Provide details:
___________________________________________________________________________
National Speech Pathology Simulation Project 2014-2018 2
National Simulation Health Service
Speech Pathology Department
Oromotor / cranial nerve assessment
Comments/Notes
Cranial Nerve Observations **Strength, Symmetry, Speed, ROM,
Coordination**
CNV Jaw opening / closing
Jaw opening / closing
Trigeminal with resistance
Jaw strength
Lateral movement of
jaw
CNVII Facial symmetry at rest
Raise / lower eyebrows
Facial Close / open eyes
Frown
Lips protrusion (kiss)
Lips retraction (smile)
SMR protrusion /
retraction of lips (oo-
ee)
Lip seal (puff cheeks
and hold air)
CNIX, CNX Soft palate elevation
(“ah”)
Glossopharyngeal Vocal quality
and Vagus Volitional cough
Dry swallow
Breath support
CNXII Tongue at rest
Tongue protrusion
Hypoglossal Tongue lateralisation
Lateralisation with
resistance
Tongue elevation (nose)
Tongue depression
(chin)
Elevation / depression
SMR
Tongue ROM (lick lips)
DDK
Other comments:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
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National Simulation Health Service
Speech Pathology Department
Swallowing assessment
Current Oral diet NBM (nil by mouth) Alternative feeding:
nutritional Details: NGT / NJT
status PEG / PEJ
TPN
Thin fluids Normal diet Single sips
Consistencies Mildly thick fluids Soft diet Continuous drinking
trialled Moderately thick fluids Minced-moist diet Mixed consistencies
Extremely thick fluids Puree diet Other:
Quantity trialled: Rate of intake: Independence with
Other Details: Adequate feeding:
information Slow Self-feeding
Too fast Requires assistance
Details: Details:
Phase of
Parameters to observe/assess Comments/Notes
swallow
Oral Lip seal
Oral manipulation / control
of bolus
Mastication of solids
Oral preparation / transit
time
Nasal regurgitation
Oral residue post swallow Location of residue ________________________
Prompt required to clear? Yes / no; Effective Y/N
Pharyngeal Swallow initiation / trigger
Number of swallows per
bolus
Hyolaryngeal excursion
Breath-swallow synchrony
Vocal changes post swallow
(i.e. wet voice)
Airway protection i.e.,
Cough/throat clear – is it
immediate or delayed.
Were any compensatory swallow strategies trialled? Yes No
Details:
_________________________________________________________________________
_________________________________________________________________________
Other comments:
_________________________________________________________________________
_________________________________________________________________________
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National Simulation Health Service
Speech Pathology Department
Summary of findings
Dysphagia: Nil Oral Phase Pharyngeal Phase
Severity: Mild Moderate Severe
Dysphagia characterised by:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Patient at risk of aspiration: Yes No
Details:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Recommendations
NBM Referrals required: _________________________________________________________
Oral diet Fluids: ________________________ Diet: __________________________________
Safe swallow/compensatory strategies:
_________________________________________________________________________
_________________________________________________________________________
Instrumental assessment required?
_________________________________________________________________________
_________________________________________________________________________
Swallow rehabilitation plan:
_________________________________________________________________________
_________________________________________________________________________
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National Simulation Health Service
Speech Pathology Department
Spoken Naming Cueing Hierachy (Cardell and Lawrie, 2012)
Clinician’s Cueing Hierachy:
Note: Encourage the individual to silently rehearse each word ‘in their head’ before saying the word
aloud to optimise the retrieval of the correct phonological form.
Target = ‘bed’
1. Phonemic cue (PC) It starts with a ‘b’.
2. Semantic cue (SC) You sleep in it.
3. Sentence completion cue (Sent) You sleep in a ______.
4. Sentence completion and phonemic cue (Sent & PC) You sleep in a b______.
5. Anagram using letter tiles (An)
6. Written word cue/arrange letter tiles (W)
7. Written word cue and phonemic cue (WC &PC)
8. Repetition (Rep)
Note: The above hierarchy is not ‘set in cement’. Use your clinical judgement to modify the hierarchy
of cues, according to the client’s individual processing profile.
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