Videofluroscopic Assessment

Question 1

What is barium?

Answer 1

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

Question 2

Describe, simply, a videofluoroscopic assessment.

Answer 2

Patients are positioned in an upright posture and drink and eat specific amounts of barium of different consistencies.

Question 3

What are the two views that we conduct a videofluoroscopic exam at?

Answer 3

Anterior-posterior

Lateral

Question 4

What are the two main purposes of conducting a videofluoroscopic exam?

Answer 4

Assess (impairments in) swallowing physiology

Evaluate the efficacy of therapeutic strategies

Question 5

What does VFSS stand for?

Answer 5

Videofluoroscopic Swallow Study

Question 6

Using barium sulfate, what kinds of different consistencies and volumes are used in the VFSS?

Answer 6

Thin liquids – 3cc., 5cc., 10cc., continuous sips (3 Oz)
Nectar thick/Honey thick liquids
Pudding
Solids

Question 7

If a patient cannot tolerate a thin liquid, what is the next step? Why?

Answer 7

Try a compensatory strategy. To keep the diet recommendation as least restrictive as possible.

Question 8

Describe the penny’s purpose in this exam.

Answer 8

A penny is usually placed on the mastoid to measure hyoid movement.

Question 9

If you have a patient who cannot tolerate ANY liquid consistencies (Thin, nectar, honey), what could you potentially do after that?

Answer 9

Nothing by mouth. Our bodies need both hydration and nutrition. They might require additional support.

Question 10

What do you look for during a VFSS?

Answer 10

Oral preparation and 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
The opening of the UES
Pharyngeal transit durations

Penetration/aspiration

Question 11

What are the three most important compensatory strategies we will use?

Answer 11

Chin tuck
Head tilt
Head rotation

Question 12

What postural change can help prolonged oral transit?

Answer 12

Head back

Question 13

What postural change can help Delayed swallow initiation?

Answer 13

Chin tuck

Question 14

What postural change can help Impaired tongue base retraction?

Answer 14

Chin tuck

Question 15

What postural change can help Unilateral laryngeal dysfunction?

Answer 15

Head rotation to impaired side

Question 16

What postural change can help Unilateral pharyngeal/pyriform sinus residue?

Answer 16

Head roation to impaired side

Question 17

What postural cahnge can help Unilateral oral and pharyngeal weakness?

Answer 17

Head tilt to the unimpaired side.

Question 18

What is the head tilt/head rotation rule?

Answer 18

A head tilt is always towards the stronger side.

A head rotation is always towards the weaker side.

Question 19

When can you use a head tilt?

Answer 19

Vallecular reside and pyriform sinus reside

Question 20

When can you use a head turn/rotation?

Answer 20

Pyriform sinus reside.

Question 21

List two additional strategies for residue clearance.

Answer 21

Liquid wash

Repeat swallows

Question 22

What three points were made about VFSS reports?

Answer 22

Report physiological abnormality and bolus flow correlates.

Better to start writing your report from the oral phase till the opening of the UES.

Quantify everything possible. E.g. Mildly delayed swallow initiation, moderate pyriform sinus residue.

Question 23

What is NPO?

Answer 23

“Nil Per Os”

Latin for “Nothing by mouth”