Manual for the Videofluorographic Study of Swallowing

by Logemann, Jeri A.

• ISBN13: 9780890795842
• ISBN10: 0890795843
• Edition: 2nd
• Format: Paperback
• Copyright: 1993-06-01
• Publisher: Pro Ed

Table of Contents

Preface	xiii
Acknowledgments	xv
Assessment of Need and Readiness for the Modified Barium Swallow	1	(6)
Role of the Bedside Clinical Assessment of Swallowing	1	(1)
Patient's Readiness for Radiographic Study	2	(2)
Ability to Accept Food into the Mouth	3	(1)
Ability to Open the Mouth Voluntarily	3	(1)
Identification of Optimal Oral Stimuli and Bolus Types	4	(1)
Identification of and Compensation for Swallowing Apraxia	4	(1)
Identification of and Compensation for Abnormal Oral Reflexes	4	(1)
Identification of Particular Postural or Behavioral Needs	5	(1)
Patient and Family Counseling Regarding Expectations of the Radiographic Study	5	(2)
Normal Radiographic Anatomy and Physiology of the Oropharynx	7	(22)
Lateral Plane	7	(8)
Anatomy	7	(2)
Physiology	9	(6)
Posterior-Anterior Plane	15	(3)
Anatomy	15	(2)
Physiology	17	(1)
Variations in Normal Anatomy and Physiology	18	(7)
Infants and Young Children	18	(1)
Older Adults	19	(2)
Head-and-Neck Surgical Patients	21	(1)
Oral Cancer Procedures	21	(1)
Hemilaryngectomy	22	(1)
Supraglottic Laryngectomy	23	(1)
Total Laryngectomy	23	(1)
Total Laryngectomy, Pharyngectomy, and Esophagectomy Reconstructed by Gastric Pull-Up	24	(1)
Variations in Normal and Abnormal Oropharyngeal Physiology	25	(4)
Changes in Timing of the Oral and Pharyngeal Phases---Bolus Volume Effect	25	(1)
Changes in Timing of the Oral and Pharyngeal Phases---Bolus Viscosity Effect	26	(1)
Protective Behaviors	26	(1)
Compensatory Behaviors	27	(2)
Modified Barium Swallow Procedure	29	(16)
Rationale for the Modified Barium Swallow Procedure	29	(1)
Equipment for the Radiographic Study	30	(3)
Accessory Equipment	33	(1)
Standard Procedure for the Modified Barium Swallow	34	(8)
Positioning the Patient	34	(1)
Supplies	34	(1)
Initial Radiographic Observations	35	(1)
Bony and Soft Tissue Anatomy	35	(1)
Abnormal Movement Patterns at Rest	36	(1)
Food Presentation Protocol: Lateral View	37	(1)
Measured Liquid Boluses	37	(2)
Cup Drinking	39	(1)
Saliva Swallowing	39	(1)
Paste and Masticated Boluses	39	(1)
Eating	39	(1)
Food Presentation Protocol: Posterior-Anterior View	40	(1)
Measuring Oropharyngeal Swallowing Parameters	41	(1)
Report Writing	42	(1)
Patient-Family Counseling After the Videofluoroscopic Study	42	(1)
Radiation Safety	42	(3)
Variations in the Modified Barium Swallow Procedure	45	(28)
Trial Therapy: Introduction of Management or Treatment Strategies to Improve the Patient's Swallow	45	(15)
Postural Variations	48	(1)
Tilting the Head Forward, Chin Down	48	(1)
Tilting the Head Backward	49	(1)
Rotating the Head to the Damaged Side	49	(1)
Head Rotation Combined with Chin Down	50	(1)
Tilting the Head to the Stronger Side	50	(1)
Lying on the Side or Back	50	(1)
Summary of Postural Changes	51	(1)
Increasing Sensory Input	52	(1)
Voluntary Maneuvers to Protect the Airway	53	(1)
Supraglottic Swallow	54	(1)
Extended Supraglottic Swallow---The ``Dump and Swallow'' Technique	55	(1)
Supersupraglottic Swallow	56	(1)
Voluntary Maneuvers to Improve Clearance of the Bolus	57	(1)
Washing Food Through the Pharynx	58	(1)
Effortful Swallow	58	(1)
Mendelsohn Maneuver	59	(1)
Summary	60	(1)
Special Populations	60	(8)
Spinal-Cord-Injured Patients with Bracing	61	(1)
Tracheotomized Patients	61	(1)
Ventilator-Dependent Patients	62	(1)
Patients with Cerebral Palsy and Other Movement Disorders	63	(1)
Apraxic Patients	64	(1)
Visually Impaired Patients	64	(1)
Infants and Young Children	65	(1)
Positioning	65	(1)
Desensitization for Acceptance of Food	65	(1)
Selection and Presentation of Food	66	(1)
Head-Injured Patients	67	(1)
Mentally Retarded or Developmentally Delayed Patients	67	(1)
Variations in Food Presentation	68	(3)
Consistency of Food Presented	68	(1)
Flavor of Food Presented	68	(1)
Order of Food Presentation	68	(1)
Amount of Food Presented	69	(1)
Method of Food Presentation	69	(2)
Special-Purpose Tests	71	(1)
Fatiguing the Patient	71	(1)
Assessing Spasm Versus Stricture in Total Laryngectomees	71	(1)
Modifications in Viewing Structural Detail	71	(1)
Magnification	71	(1)
Still Radiographs	72	(1)
Videoprints	72	(1)
Summary	72	(1)
Radiographic Symptoms and Swallowing Disorders	73	(42)
The Lateral View	74	(34)
Disorders in Oral Preparation of the Swallow	75	(1)
Cannot Hold Food in the Mouth Anteriorly---Reduced Lip Closure	75	(1)
Cannot Form a Bolus---Reduced Range of Tongue Motion or Coordination	75	(1)
Cannot Hold a Bolus---Reduced Tongue Shaping and Coordination	75	(1)
Material Falls into Anterior Sulcus---Reduced Labial Tension or Tone	76	(1)
Material Falls into Lateral Sulcus---Reduced Buccal Tension or Tone	76	(1)
Abnormal Hold Position---Tongue Thrust; Reduced Tongue Control	77	(1)
Other	77	(1)
Disorders in the Oral Phase of Deglutition	78	(1)
Delayed Oral Onset of Swallow---Apraxia of Swallow; Reduced Oral Sensation	78	(1)
Searching Motion; Inability to Organize Tongue Movements---Apraxia of Swallow	79	(1)
Tongue Moves Forward to Start the Swallow---Tongue Thrust	79	(1)
Residue (Stasis) in the Anterior Sulcus---Reduced Labial Tension or Tone	79	(1)
Residue (Stasis) in the Lateral Sulcus---Reduced Buccal Muscle Tension or Tone	79	(1)
Residue (Stasis) on the Floor of the Mouth---Reduced Tongue Shaping or Coordination	80	(1)
Residue (Stasis) in a Midtongue Depression---Scar Tissue in Tongue	80	(2)
Residue (Stasis) of Food on the Tongue---Reduced Tongue Range of Movement; Reduced Tongue Strength	82	(1)
Disturbed Lingual Contraction (Peristalsis)---Lingual Discoordination	82	(1)
Incomplete Tongue-to-Palate Contact---Reduced Tongue Elevation	82	(1)
Adherence (Residue) of Food on Hard Palate---Reduced Tongue Elevation; Reduced Lingual Strength	82	(1)
Reduced Anterior-Posterior Lingual Action---Reduced Lingual Coordination	82	(1)
Repetitive Lingual Rolling---Parkinson's Disease	82	(1)
Uncontrolled Bolus or Premature Loss of Liquid or Pudding Consistency into the Pharynx---Reduced Tongue Control; Reduced Linguavelar Seal	83	(2)
Piecemeal Deglutition	85	(1)
Oral Transit Time (in Seconds)	85	(1)
Other	85	(1)
Disorders in Triggering the Pharyngeal Swallow---Transition Between the Oral and Pharyngeal Stages of Swallow	85	(1)
Delayed Pharyngeal Swallow	85	(3)
Timing the Pharyngeal Delay	88	(1)
Disorders in the Pharyngeal Phase of Deglutition	89	(1)
Nasal Penetration During Swallow---Reduced Velopharyngeal Closure	89	(1)
Pseudoepiglottis (After Total Laryngectomy)---Fold of Mucosa at the Base of the Tongue	90	(1)
Bony Outgrowth from the Cervical Vertebrae---Cervical Osteophytes	91	(1)
Coating of Pharyngeal Walls After the Swallow---Reduced Pharyngeal Contration Bilaterally	92	(1)
Vallecular Residue---Reduced Posterior Movement of the Tongue Base	92	(2)
Coating in a Depression on the Pharyngeal Wall---Scar Tissue; Pharyngeal Pouch	94	(1)
Residue at Top of Airway---Reduced Laryngeal Elevation	94	(2)
Laryngeal Penetration and Aspiration---Reduced Closure of the Airway Entrance (Arytenoid to Base of Epiglottis)	96	(1)
Etiologies of Laryngeal Penetration	96	(5)
Aspiration During Swallow---Reduced Laryngeal Closure	101	(1)
Stasis or Residue in Both Pyriform Sinuses---Reduced Anterior Laryngeal Movement; Cricopharyngeal Dysfunction; Stricture	102	(1)
Residue Throughout the Pharynx---Generalized Reduction in Pharyngeal Pressure	103	(1)
Pharyngeal Transit Time (in Seconds)	103	(1)
Other	103	(1)
Posture or Treatment Introduced	103	(1)
Disorders in the Cervical Esophageal Aspect of Deglutition	104	(1)
Esophageal-to-Pharyngeal Backflow---Esophageal Abnormality	105	(1)
Tracheoesophageal Fistula	105	(1)
Zenker's Diverticulum	106	(1)
Reflux	107	(1)
The Posterior-Anterior View	108	(7)
Oral Preparatory Phase	108	(1)
Unable to Align Teeth---Reduced Mandibular Movement	108	(1)
Unable to Lateralize Material with the Tongue---Reduced Tongue Lateralization	108	(1)
Unable to Mash Material---Reduced Tongue Elevation	108	(1)
Material Falls into the Lateral Sulcus---Reduced Buccal Muscle Tension or Tone	108	(1)
Material Falls to the Floor of the Mouth---Reduced Tongue Control	108	(1)
Bolus Spread Across the Mouth---Reduced Lingual Shaping and Fine Tongue Control	108	(1)
Posture or Treatment Introduced	108	(1)
Pharyngeal Phase of Deglutition	109	(1)
Unilateral Vallecular Residue---Unilateral Damage to Posterior Movement of the Tongue Base	109	(1)
Residue in One Pyriform Sinus---Unilateral Pharyngeal Wall Damage	109	(1)
Reduced Laryngeal Movement Medially---Reduced Vocal Fold Adduction	110	(1)
Unequal Height of the Vocal Folds	111	(1)
Other	111	(4)
Measurement of Swallow from Videofluorographic Studies	115	(12)
Duration of Bolus Movement	115	(2)
Oral Transit Time	116	(1)
Pharyngeal Transit Time	116	(1)
Pharyngeal Delay Time	117	(1)
Esophageal Transit Time	117	(1)
Oropharyngeal Swallow Efficiency (OPSE)	117	(1)
Temporal Measures of Swallow Events	118	(1)
Coordination of Pharyngeal Swallow Events	118	(1)
Range of Structural Movement	119	(1)
Biomechanical Analysis	120	(1)
Applications of Measurements from Videofluoroscopy	120	(2)
Attaining Proficiency in Measurement and Observation from Radiographic Studies	122	(1)
Combining Videofluorographic Studies with Other Methodologies for Studying Swallow	123	(4)
Manometry and Videofluorography	124	(1)
Manofluorography	125	(1)
Electromyography and Videofluorography	126	(1)
Decision Making During the Radiographic Study	127	(16)
Apraxia of Swallow or Delayed Oral Onset of Swallow	128	(2)
Reduced Range of Tongue Motion	130	(2)
Delayed Triggering of the Pharyngeal Swallow	132	(2)
Reduced Closure of the Laryngeal Vestibule (Airway Entrance)	134	(2)
Reduced Laryngeal Closure	136	(2)
Unilateral Pharyngeal Weakness	138	(2)
Reduced Hyoid and Anterior Laryngeal Movement and Cricopharyngeal Dysfunction	140	(3)
Report and Recommendations	143	(4)
Relevant Background and History	143	(1)
Description of Swallow Function	143	(1)
Recommendations	144	(3)
Effects of Treatment Strategies	144	(1)
Suggestions for Nutritional Management	144	(1)
Speed of the Swallow	144	(1)
Amount of Aspiration	145	(1)
Recommended Therapy Procedures	145	(1)
Recommended Schedule for Reevaluation	146	(1)
Recommendations for Other Consultations or Assessments	146	(1)
Sample Reports	147	(8)
Inpatient Evaluation Reports	147	(2)
Inpatient Evaluation: Normal	147	(1)
Inpatient Evaluation: Oral-Phase Disorders, Pharyngeal Phase Normal	147	(1)
Inpatient Evaluation: Focus on the Pharyngeal Phase	148	(1)
Inpatient Evaluation Followed by Outpatient Reassessment: Head-Injured Four-Year-Old Child with Unilateral Pharyngeal Damage and Reduced Laryngeal Movement	148	(1)
First Inpatient Evaluation	148	(1)
Second Inpatient Evaluation	148	(1)
Outpatient Follow-Up	149	(1)
Inpatient Evaluation: Posthemilaryngectomy	149	(1)
Outpatient Evaluation Reports	149	(6)
Outpatient Evaluation: Bilateral Cortical Stroke	149	(1)
Outpatient Follow-Up Evaluation: Poststroke	150	(1)
Outpatient Evaluation: Brain-Stem Stroke---Three Weeks Poststroke	150	(1)
Outpatient Evaluation: Supraglottic Laryngectomy with Two Follow-Up Examinations	151	(1)
First Outpatient Evaluation	151	(1)
First Outpatient Follow-Up	151	(1)
Second Outpatient Follow-Up	151	(1)
Outpatient Evaluation with One Follow-Up Examination: Closed Head Injury	152	(1)
First Outpatient Evaluation	152	(1)
First Outpatient Follow-Up	152	(1)
Outpatient Evaluation: Total Laryngectomy	153	(1)
Outpatient Evaluation: Palate-Reshaping Prosthesis	153	(2)
Appendix A. Purchasing Sources for Equipment for Positioning Patients During the Radiographic Procedure	155	(2)
Appendix B. Videofluorographic Worksheet	157	(6)
Appendix C. Audiovisual Aids Available on Swallowing and Swallowing Disorders	163	(4)
References	167