SLP Team Shines in Boston
The speech-language pathology team at Cape Cod Hospital present findings of instrumental swallow evaluations and show the value of looking beyond traditional bedside evaluations.
“Nobody ever thinks about their swallowing until something goes wrong.”.
It’s something Robert Melchionna, MS, CCC-SLP, BCS-S, supervisor of inpatient rehab at Cape Cod Hospital, often tells patients. Through their research, Melchionna and his speech-language pathology (SLP) colleagues are highlighting the important role instrumental swallow evaluations can play in patient care.
The team recently presented its findings at the Massachusetts Speech-Language-Hearing Association annual conference in Boston. Their poster, “Why So Many Instrumental Exams? If You’re Not Looking, You’re Guessing,” focused on the value of instrumental swallow evaluations and what can be missed through a traditional bedside assessment alone.
A bedside swallow evaluation involves an SLP observing a patient eating and drinking and looking for signs of swallowing difficulty. Instrumental evaluations go a step further, allowing clinicians to actually see what is happening during the swallow. Cape Cod Hospital uses two types: fiberoptic endoscopic evaluation of swallowing (FEES), which uses a small camera passed through the nose to view the throat, and modified barium swallow (MBS), which uses fluoroscopy, or live X-ray imaging.
“Things that we’re finding are things that we wouldn’t be able to see just evaluating the patient at bedside,” said Joanna Guerrero, MS, CCC-SLP. “If I’m seeing a patient, I can’t tell they have a paralyzed vocal cord. But using a small camera to examine the throat, I can see how their vocal cords are moving and assess how that’s impacting their swallow and their voicing.”
A closer look
Cape Cod Hospital SLP team in Boston: Graduate student Jenna Higgins, Joanna Guerrero, Robert Melchionna and Melanie Reynolds.
Those findings included anatomical abnormalities and instances of penetration or aspiration, including “silent aspiration,” in which material enters the airway without triggering a cough or other obvious reaction. In some cases, the team has also discovered previously unknown masses or tumors.
Over six months, from November 2025 through April 2026, the team tracked 640 instrumental swallow evaluations — 211 fiberoptic endoscopic evaluations of swallowing (FEES) and 429 modified barium swallow (MBS) studies. The results showed that 58.4 percent of patients had findings that could not have been identified through a bedside evaluation alone.
Instrumental evaluations can also help clinicians determine which strategies and treatments may help an individual patient swallow more safely.
“We can track strategies and techniques to improve their swallow that we wouldn’t know were working if we weren’t somehow looking directly at their anatomy while they’re swallowing,” said Melanie Reynolds, MS, CCC-SLP, who often works with head and neck cancer patients in the radiation oncology department.
Growing impact
Greater access has also meant the team can provide instrumental evaluations to more patients who may benefit from them, rather than having to prioritize a limited number of studies.
Instrumental studies increased from 491 in 2022 to 1,016 in 2025, aided by improved access to FEES through disposable scopes and additional outpatient MBS appointment slots.
“As we’ve increased our instrumental assessments, our overall referrals for speech have increased significantly,” Reynolds said. “The medical teams are seeing the value we’re adding to their clinical assessment and helping them put the pieces of the puzzle together.”.
That growing recognition is reflected not only in the team’s caseload, but also in the response to its research outside Cape Cod Hospital.
Melchionna said the team is already hearing from SLPs they met at the conference who were inspired by their findings.
“They’re using some of this information to help support changes in their own departments,” he said, “and move toward a more contemporary, evidence-based approach. It’s rewarding to see that what we’re doing here can have an impact beyond our own hospital.”.
