The 3 Questions You Need to Answer During the CSE

The Clinical Swallow Evaluation (CSE) can be one of the most important parts of your entire evaluation.

No, we can’t get the big picture of the swallowing process of each person that we are assessing, but we can get so much information beyond the physiology and anatomy.

You might be surprised by the 3 most important questions you can ask during the CSE. Now hear me out before you decide I’m full of ….

Question #1

What was your swallowing like before (the most recent episode)?

I can’t tell you how many times I see a new patient that is now having trouble swallowing, or are they?

They were admitted to the hospital with pneumonia, which was determined to be aspiration pneumonia. They had a swallow study completed and based on the results, while they were sick with pneumonia, they were placed on a modified diet and told they have dysphagia.

When you talk to the person and their family or caregivers, they’ve never had any difficulty with swallowing. They have no significant history with respiratory issues or with pneumonia in the past.

In fact, they didn’t even know there was such a thing as dysphagia.

Now, they are barely eating, barely drinking because they are not happy with their current diet.

The before is so important here because once they are no longer sick, they may no longer have issues with swallowing. They may have always had silent aspiration that never caused any other issues.

All of this may be critical in creating a plan of care with your patient and their family/caregivers.

Question #2

What is your current level with swallowing? What difficulties are you experiencing?

This question can help you gauge how the patient feels they are doing with swallowing.

If they tell you something like, I cough with liquids all the time and it’s miserable. I just want to stop coughing when I drink.

If they tell you, I have no issues when I eat or drink. I clear my throat sometimes, but that’s normal for me.

These responses tell you how the patient views their current “dysphagia.”

Think of it this way. If you don’t have any pain, limited movement or other abnormality in your arm, are you gong to be seeking treatment for your arm?

If the person, family/caregiver sees no issues with swallowing and just continually question why you are there, they probably won’t feel a need for exercises or any other treatment approach.

We may also be wanting to get the person in for an instrumental assessment, however they may not want it. Sometimes no matter how much you educate or state the reason why the instrumental assessment is so important, the person may just not want it and that is their decision and their right.

Your education here may be vital. Education on what dysphagia is, how treatment with dysphagia works and your proposed plan of care for this person that you can then build and modify with your patient and their caregivers.

Question #3

When we’re done with our therapy, where would you like to be with your swallowing?

This question is also important. When I work with patients in speech therapy, I always ask what their end goal may be. Not everyone has the same end goal. Not everyone is working to be able to eat steak and drink a beer again.

This one has shocked me also, but not everyone wants to be able to get rid of their feeding tube.

For some people, just being able to eat ice cream from time to time or being able to drink liquids is enough for them.

We can’t push “our” goals onto someone that wants something different for themselves and we have to accept the fact that we can’t “fix” every single person or situation.

Learning what your patient’s goals are is an important driving factor in their plan of care.

When We Ask the Right Questions

We still need to ask the questions to interview the patient. About their oral care, about their experiences with swallowing, everything we need to know.

When we ask the 3 questions I wrote about above, we can include the patient and their family/caregivers in their treatment plan.

Make sure you are asking the right questions to help guide you in the right direction with your plan of care.

Did you know that you can access all the Dysphagia Ramblings handouts in one spot? You can download all the handouts AND sign up for the Dysphagia Ramblings newsletter…Dysphagia Unboxed right here.

Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation? Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care? Are you struggling with your treatment plan? You probably need the The Clinical Dysphagia Toolkit Bundle if you answered yes. You can get your copy here.