The first step in identifying dysphagia in a patient with bilateral hemispheric stroke is to perform a swallow screen. As speech-language therapists are generally not available after 5pm or on weekends, certain hospital staff, mainly nurses, are specifically trained to use a validated test to screen for aspiration risk in stroke patients (Ministry of Health, 2010). If the patient fails the screen, the patient must be placed nil-by-mouth and a referral made to an SLT for further assessment.
Typically, the screening should include observation of the patient’s level of consciousness and postural control. Following this, if the patient is deemed capable of actively participating and can be supported in an upright position, the medical professional should then observe the patient’s oral hygiene and their overall control of oral secretions (Barber, Fink, Gommans, Hanger & Baker, 2006). The next step is for the medical professional to perform the water swallow test. The steps of the water swallow test are illustrated by the chart below.
(Barber et al., 2006)