7.2 Videofluoroscopic assessment of swallowing

Question 1

What is a Radiographic Assessment?

2

Answer 1

Patients are positioned in an upright posture

They drink and eat specific amounts of barium of different consistencies.

(Barium sulfate is a radio-opaque compound that shows up during x-ray)

Question 2

What does a Radiographic Assessment evaluate?

2

Answer 2

Impairments in the swallowing physiology

Efficacy of therapeutic strategies

Question 3

What are the consistencies of barium used in Radiographic Assessments?

(4)

Answer 3

Thin liquids – 3cc., 5cc., 10cc., continuous sips (3 Oz)

Nectar thick/Honey thick liquids

Pudding

Solids

Question 4

What types of views are used in Radiographic Assessments?

2

Answer 4

Lateral

Anterior

Question 5

What do we need to identify before a Radiographic Assessments?

Answer 5

Anatomical landmarks

Question 6

During a Radiographic Assessments, what is usually placed on the mastoid to measure hyoid movement?

Answer 6

A penny

Question 7

When performing Radiographic Assessments, what should the clinician always wear?

Answer 7

Radiation shields

Question 8

What do we look for during Radiographic Assessments?

9

Answer 8

Oral preparation

Oral transit time

Initiation of swallowing – is it delayed or normal?

Closure of velopharynx

Closure of the epiglottis

Retraction of the tongue base

Elevation of the hyoid

Opening of the UES

Phrayngeal transit durations

Question 9

What postural changes can be used for Prolonged Oral Transit?

Answer 9

Tilting head back

Question 10

What postural changes can be used for Delayed Swallow Initiation?

Answer 10

Chin tuck

Question 11

What postural changes can be used for Impaired Tongue Base Retration?

Answer 11

Chin tuck

Question 12

What postural changes can be used for Unilateral Laryngeal Dysfunction?

Answer 12

Head rotation to impaired side

Question 13

What postural changes can be used for Unilateral

Pharyngeal/Pyriform Sinus Residue?

Answer 13

Head rotation to impaired side

Question 14

What postural changes can be used for Unilateral Oral + Pharyngeal Weakness?

Answer 14

Head tilt to the unimpaired side

Question 15

Head tilts are always performed to the __________ because this ___________.

Answer 15

Good side

Facilitates the use of the good side

Question 16

Head rotations are always performed to the __________ because this ___________ and __________.

Answer 16

Bad side

Shuts off the bad side

Forces use of the good side

Question 17

What maneuvers might we ask a patient to perform during a Radiographic Assessments?

Answer 17

Supraglottic swallow

Effortful swallow

Masako

Question 18

What is a Supraglottic Swallow?

4

Answer 18

Hold breath

Swallow hard

Cough

Swallow again

Question 19

What is a Effortful Swallow?

What is it used for?

Answer 19

Very hard swallow

Training

Question 20

What is a Masako?

What is it used for?

Answer 20

Holding the tongue between the teeth when swallowing

Training

Question 21

What other strategies might we ask a patient to perform to clear residue during a Radiographic Assessments?

Answer 21

Liquid Wash

Repeat Swallows

Question 22

What is a Liquid Wash?

Answer 22

Each swallow is followed by liquid

Question 23

What are Repeated Swallows?

Answer 23

Multiple Swallows

Question 24

How do we report VFSS Results?

3

Answer 24

Report physiological abnormality and bolus flow correlates.

Start report with the oral phase and finish with the UES.

Quantify everything possible (mildly delayed swallow initiation, moderate pyriform sinus residue, etc.)

Question 25

What outline should we use when writing swallowing evaluation reports?

(4)

Answer 25

Broad diagnosis

Abnormal functions

Functions WNL

Proof (mention consistence, amount, patient reaction)