Recovery ‐ Newsletter of the GBS Association of NSW
September 2016
compromised. Facial weakness is evident in up to half
of patients diagnosed with GBS (Lyu & Chen, 2004)
which can lead to dysphagia. The combination of cranial
nerve dysfunction and weak respiratory musculature
significantly compromises airway protection which puts
patients with GBS at risk of food/fluids entering the
lungs. An objective assessment such as e.g. FEES is
always indicated in patients with GBS to further
investigate swallow function, allow for a baseline
assessment and provide appropriate recommendations.
From page 2
Overview of Speech Pathology and Fiberoptic
Endoscopic Evaluation of Swallowing (FEES)
The term Dysphagia derives from the Latin “Dys” –
difficulty/disordered; and Greek “phagia” – to eat.
Swallowing is a complex action involving volitional and
reflexive activities of more than 30 muscles and nerves.
Swallowing includes an oral, pharyngeal and
oesophageal stage. Speech Pathologists assess,
diagnose and treat people with oral and pharyngeal
dysphagia. Once assessed, Speech Pathologists provide
swallowing exercises and/or strategies for people who
have difficulties. We can also modify their diets and
fluids to reduce the risk of acquiring a food/fluid related
pneumonia, coughing and discomfort.
Guillain-Barré Syndrome (GBS) and FEES
Chen, Donofrio, Frederick, Ott and Pikna (2004)
describe a high percentage of oral and pharyngeal stage
dysfunction in patients with GBS who completed an
objective assessment. FEES is a valuable tool during the
stages of recovery of GBS. It is the most effective way
to assess secretion management, airway protection and
pharyngeal impairment for patients with GBS. As
patients with GBS often have pharyngeal involvement,
objective assessments are necessary to further
investigate the patients swallowing function and provide
appropriate diet/fluids, strategies and exercises.
A bedside dysphagia assessment provides inadequate
information regarding the pharyngeal stage of
swallowing and underestimates the risk of aspiration by
up to 40% when compared with objective assessment
(Splaingard, Hutchins, Sulton, Chaudhuri, 1988).
Therefore, objective assessments such as an MBS or
FEES are required. Currently, Ryde Hospital does not
have access to any objective assessment on site.
FEES is an instrumental procedure used to evaluate
swallowing function and guide the treatment of
swallowing disorders. It involves passing a scope with a
camera attached into the nasal cavity and down the
throat to provide direct visualisation of the surface
anatomy of the structures of swallowing.
For our patients with GBS, FEES will allow the Speech
Pathologist to:
Ryde Hospital Speech Pathology Department requires
the purchase of a laryngoscope as Ryde currently does
not have access to an objective swallowing assessment.
In 2015, 43% of dysphagia patients at Ryde Hospital
would have benefited from e.g. FEES. Bedside
dysphagia assessments provide inadequate information
regarding the pharyngeal stage of swallowing and
underestimate the risk of aspiration by up to 40% when
compared with objective assessment.
Evaluate the movement of these structures in
response to swallowing regular food and drink.
Evaluate swallowing using different foods and
liquids in real time with video recording.
Modify diets/fluids based on this evaluation.
Prescribe exercises and manoeuvres based on
this evaluation for patients with GBS.
Provide patients with biofeedback during
swallowing therapy.
Re-evaluate improvement or deterioration from
baseline.
Educate the patient and family about diet
choices and therapy plans based on patient
physiology and function.
Have a record of any adverse events.
Guillain-Barré Syndrome (GBS) and Dysphagia
Patients with Guillain-Barre Syndrome (GBS) often
present with a pharyngeal stage dysphagia which
requires objective assessment in order to: evaluate
movement of structures, prescribe diets/fluid, exercises
and manoeuvres.
The images on the left show the size of the current
equipment which is not available at Ryde Hospital,
meaning patients need to be transported back and forth
for evaluation – not practical for a GBS patient. Portable
equipment - on the right – is about the size of a laptop
and portable, meaning quicker access for a GBS patient.
Depending on the affected nerves, swallowing
dysfunction will vary from mild deficits to severe
deficits. As GBS progresses to the respiratory and facial
musculature, the ability to swallow is often
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