The JAYS Observational Assessment of Paediatric Dysphagia is described as a ‘complete’ and ‘flexible’ assessment package for paediatric dysphagia. It is ‘complete’ in that it aims to cover the whole process of assessment from referral to treatment, taking into account a variety of issues related to dysphagia (including nutrition and oro-aversion), and ‘flexible’ in that it is highly adaptable to the individual child’s history, presenting symptoms and treatment needs.
The assessment comes in an A4 booklet consisting of a series of forms and accompanying procedure pages with instructions for each form. The following areas are covered: ‘Medical History’, ‘Non-Oral Assessment’, ‘Feeding History from Carer’, ‘Oro-Motor Abilities’, ‘Mobility, Posture and Positioning During Eating and Drinking’, ‘Meal Observation’, ‘Oro-Aversion Assessment’ and ‘Clinical Swallow Assessment (Drink/Food)’. These assessments can then be summarised in two ways, as a ‘Summary of Assessment for Notes’ and a ‘Summary of Assessment for Other Professionals’. Finally a checklist is given to ensure all relevant issues related to the child have been considered. The authors allow photocopying of the white assessment pages for use with future clients. It is recommended that the Medical History and Summary pages should always be utilised, but the use of other pages will depend on the clinical presentation of individual patients.
The assessment was originally developed for the 2+ years age group but further sections are in production related to neonates and to adults with learning disabilities. The assessment should be used by therapists already trained on a registered (post-basic) course in dysphagia. It is also intended as part of a holistic assessment of a child’s overall skills and development and unlikely to be used in isolation.
This assessment brings together and puts into published form the sort of observational procedure which many therapists have devised for themselves, but is most welcome for that. The A4 booklet is handy with forms in plastic wallets, and procedure pages and forms lying next to each other for easy reference. The summary sheets for notes and for other professionals are an excellent idea and will save therapists time in practice whilst communicating the salient points. All sections focus on the most relevant issues for that area of assessment, and give enough information to stimulate more detailed in-depth investigation of that area if required. It is very pleasing to see an assessment which takes into account carers’ and other professionals’ concerns and which acknowledges the importance of dealing with sensory-based feeding disorders as part of the SLT’s remit.
The assessment gives the overall impression of a workable, daily tool for assessment of the child with dysphagia. Essentially it is hypothesis-driven, allowing a reflective approach to assessment whilst clearly guiding the therapist’s observations along the relevant pathways. The references quoted show that guidance has been sought from those texts which are currently most used by therapists working in the field of paediatric dysphagia, eg. Arvedson and Brodsky, Wolf and Glass. The authors have obviously put in a great deal of time and effort to instil their knowledge and experience into the assessment; it has been well trialled by therapists working in the field and the authors are approachable and have an open attitude to helpful feedback.
The JAYS assessment is very much a basic assessment tool which will not be sufficient in some of the more complex cases of dysphagia, eg. tracheostomised patients, premature babies, cleft palate. It is essentially in checklist form and does not use a scoring procedure, and is presumably not intended as a research tool. It seems expensive until one takes into account that the assessment forms may be copied and further copies of the whole assessment can be purchased at a reduced rate.
Overall, the ‘JAYS’ is to be recommended as a welcome aid to the assessment of paediatric dysphagia and is likely to become the tool of choice in the everyday working practice of the paediatric dysphagia therapist.
Ruth M. Miller
Advanced Dysphagia Course
Manchester Metropolitan University