Week 9

Question 1

What are we assessing with instrumentation?

Answer 1

Oral prep deficits
-manifestation: pre-mature spillage (liquids only), piecemeal deglutition, pocketing, poor bolus formation
Efficiency deficits
-manifestation: post-swallow residue
Safety deficits:
-manifestation: penetration, aspiration
Sensory deficits
-manifestation: lack of response

Question 2

What are different names for VFSS (videofluoroscopic swallow study)

Answer 2

Modified barium swallow (MBS)
Cookie swallow test
Dynamic swallow study

IS NOT: barium swallow (only esophagus), esophagram

Question 3

How much radiation does VFSS expose the pt to?

Answer 3

About ~0.2mSv per exam

Question 4

What is the ALARA principle?

Answer 4

As low as reasonably achievable

• exams should be efficient and well planned
• poorly planned can result in higher exposure or repeat exams

Question 5

What should the clinician wear to prevent effects from radiation?

Answer 5

Lead apron
docimeters
thyroid collar

Question 6

What should the frame rate be for VFSS?

Answer 6

About 30 frames per second, pulsed (adheres to ALARA)

Question 7

Because the clinician should stay out the radiation field as most as possible, what is highly desirable?

Answer 7

to have the patient self feed

Question 8

Pts should sit in a _____ chair

Answer 8

non metal

Question 9

Pts should be told not to

Answer 9

shrug shoulders

Question 10

FEES vs. VFSS

Answer 10

VFSS

• involved radiation exposure, specialized staff and equipment
• primarily collected in lateral view
• allows to see entire swallow at once and view of esophagus
• must be short in duration and requires barium stimuli

FEES

• portable
• can be used with more food or drink at longer duration
• can not see actual swallow (whiteout effect)
• allows for observation of post-swallow residue for long periods to assess aspiration risk

Question 11

Standard protocol for VFSS

Answer 11

Begin with an item that most pts can tolerate (5 ml thin liquid)

-allows for:
comparing the pt across time and or treatment (or degeneration)
compare to other pts or populations (literature)
compare to healthy normal
share info across clinicians/facilities

Question 12

Penetration aspiration scale

Answer 12

1. Material does not enter the airway
2. Material enters the airway, remains above VFs and is ejected
3. Material enters airway, remains above the VFs, and is not ejected
4. Material enters airway, contacts VFs and is ejected
5. Material enters airway, contacts VFs and is not ejected
6. Material enters airway, passes below VFs and is ejected into the larynx or out airway
7. Material enters airway, passes below Vfs and is not ejected from trachea despite effort
8. Material enters the airway, passes below VFs, and no effort is made to eject.

Question 13

What else must be done with the PAS scale?

Answer 13

Commenting on TIMING in relation to the swallow

Before: Spill of material from the mouth? Delayed swallow initiation?

During: Incompleted laryngeal closure? Delayed swallow initiation?

After: Post swallow residue? Abnormal respiratory-swallow pattern?

Question 14

What are alternatives to MBSimp?

Answer 14

Description of swallowing

• PROS: easy, fast, no official training
• CONS: highly subjective, poor reliability, no transfer between clinicians

Measurement

• PRO: highly reliable, compare to research literature
• CONS: special training, costly, time-consuming

Question 15

Sections of documentation

Answer 15

Introductory statement
Results (assessment)
Impressions
Recommendations and plans
Patient education