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Answering Orientation Questions and Following Single-Step Verbal Commands: Effect on Aspiration Status

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Abstract

In the acute-care setting patients with altered mental status as a result of such diverse etiologies as stroke, traumatic brain injury, degenerative neurologic impairments, dementia, or alcohol/drug abuse are routinely referred for dysphagia testing. A protocol for dysphagia testing was developed that began with verbal stimuli to determine patient orientation status and ability to follow single-step verbal commands. Although unknown, it would be beneficial to ascertain if this information on mental status was predictive of aspiration risk. The purpose of this investigation was to determine if there was a difference in odds for aspiration based upon correctly answering specific orientation questions, i.e., 1. What is your name? 2. Where are you right now? and 3. What year is it?, and following specific single-step verbal commands, i.e., 1. Open your mouth. 2. Stick out your tongue. and 3. Smile. In a consecutive retrospective manner data from 4070 referred patients accrued between 1 December 1999 and 1 January 2007 were analyzed. The odds of liquid aspiration were 31% greater for patients not oriented to person, place, and time (odds ratio [OR] = 1.305, 95% CI = 1.134–1.501). The odds of liquid aspiration (OR = 1.566, 95% CI = 1.307–1.876), puree aspiration (OR = 1.484, 95% CI = 1.202–1.831), and being deemed unsafe for any oral intake (OR = 1.688, 95% CI = 1.387–2.054) were, respectively, 57, 48, and 69% greater for patients unable to follow single-step verbal commands. Being able to answer orientation questions and follow single-step verbal commands provides information on odds of aspiration for liquid and puree food consistencies as well as overall eating status prior to dysphagia testing. Knowledge of potential increased odds of aspiration allows for individualization of dysphagia testing thereby optimizing swallowing success.

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Authors and Affiliations

  1. Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, P.O. Box 208041, New Haven, CT, 06520-8041, USA

    Steven B. Leder

  2. School of Audiology and Speech-Language Pathology, The University of Memphis, 807 Jefferson Ave., Memphis, TN, 38105, USA

    Debra M. Suiter

  3. Speech and Swallow Center, Yale-New Haven Hospital, 20 York St., YPB-468, New Haven, CT, 065210-3202, USA

    Heather Lisitano Warner

Authors
  1. Steven B. Leder
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  2. Debra M. Suiter
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  3. Heather Lisitano Warner
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Correspondence to Steven B. Leder.

Additional information

The work for this study was performed at Yale University School of Medicine and The University of Memphis.

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Leder, S.B., Suiter, D.M. & Lisitano Warner, H. Answering Orientation Questions and Following Single-Step Verbal Commands: Effect on Aspiration Status. Dysphagia 24, 290–295 (2009). https://doi.org/10.1007/s00455-008-9204-x

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  • DOI: https://doi.org/10.1007/s00455-008-9204-x

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