Manual for the Videofluorographic Study of Swallowing

, by Logemann, Jeri A.

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ISBN: 9780890795842 | 0890795843
Cover: Paperback
Copyright: 6/1/1993

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Supplemental Materials

Preface

xiii

Acknowledgments

Assessment of Need and Readiness for the Modified Barium Swallow

(6)

Role of the Bedside Clinical Assessment of Swallowing

(1)

Patient's Readiness for Radiographic Study

(2)

Ability to Accept Food into the Mouth

(1)

Ability to Open the Mouth Voluntarily

(1)

Identification of Optimal Oral Stimuli and Bolus Types

(1)

Identification of and Compensation for Swallowing Apraxia

(1)

Identification of and Compensation for Abnormal Oral Reflexes

(1)

Identification of Particular Postural or Behavioral Needs

(1)

Patient and Family Counseling Regarding Expectations of the Radiographic Study

(2)

Normal Radiographic Anatomy and Physiology of the Oropharynx

(22)

Lateral Plane

(8)

Anatomy

(2)

Physiology

(6)

Posterior-Anterior Plane

(3)

Anatomy

(2)

Physiology

(1)

Variations in Normal Anatomy and Physiology

(7)

Infants and Young Children

(1)

Older Adults

(2)

Head-and-Neck Surgical Patients

(1)

Oral Cancer Procedures

(1)

Hemilaryngectomy

(1)

Supraglottic Laryngectomy

(1)

Total Laryngectomy

(1)

Total Laryngectomy, Pharyngectomy, and Esophagectomy Reconstructed by Gastric Pull-Up

(1)

Variations in Normal and Abnormal Oropharyngeal Physiology

(4)

Changes in Timing of the Oral and Pharyngeal Phases---Bolus Volume Effect

(1)

Changes in Timing of the Oral and Pharyngeal Phases---Bolus Viscosity Effect

(1)

Protective Behaviors

(1)

Compensatory Behaviors

(2)

Modified Barium Swallow Procedure

(16)

Rationale for the Modified Barium Swallow Procedure

(1)

Equipment for the Radiographic Study

(3)

Accessory Equipment

(1)

Standard Procedure for the Modified Barium Swallow

(8)

Positioning the Patient

(1)

Supplies

(1)

Initial Radiographic Observations

(1)

Bony and Soft Tissue Anatomy

(1)

Abnormal Movement Patterns at Rest

(1)

Food Presentation Protocol: Lateral View

(1)

Measured Liquid Boluses

(2)

Cup Drinking

(1)

Saliva Swallowing

(1)

Paste and Masticated Boluses

(1)

Eating

(1)

Food Presentation Protocol: Posterior-Anterior View

(1)

Measuring Oropharyngeal Swallowing Parameters

(1)

Report Writing

(1)

Patient-Family Counseling After the Videofluoroscopic Study

(1)

Radiation Safety

(3)

Variations in the Modified Barium Swallow Procedure

(28)

Trial Therapy: Introduction of Management or Treatment Strategies to Improve the Patient's Swallow

(15)

Postural Variations

(1)

Tilting the Head Forward, Chin Down

(1)

Tilting the Head Backward

(1)

Rotating the Head to the Damaged Side

(1)

Head Rotation Combined with Chin Down

(1)

Tilting the Head to the Stronger Side

(1)

Lying on the Side or Back

(1)

Summary of Postural Changes

(1)

Increasing Sensory Input

(1)

Voluntary Maneuvers to Protect the Airway

(1)

Supraglottic Swallow

(1)

Extended Supraglottic Swallow---The ``Dump and Swallow'' Technique

(1)

Supersupraglottic Swallow

(1)

Voluntary Maneuvers to Improve Clearance of the Bolus

(1)

Washing Food Through the Pharynx

(1)

Effortful Swallow

(1)

Mendelsohn Maneuver

(1)

Summary

(1)

Special Populations

(8)

Spinal-Cord-Injured Patients with Bracing

(1)

Tracheotomized Patients

(1)

Ventilator-Dependent Patients

(1)

Patients with Cerebral Palsy and Other Movement Disorders

(1)

Apraxic Patients

(1)

Visually Impaired Patients

(1)

Infants and Young Children

(1)

Positioning

(1)

Desensitization for Acceptance of Food

(1)

Selection and Presentation of Food

(1)

Head-Injured Patients

(1)

Mentally Retarded or Developmentally Delayed Patients

(1)

Variations in Food Presentation

(3)

Consistency of Food Presented

(1)

Flavor of Food Presented

(1)

Order of Food Presentation

(1)

Amount of Food Presented

(1)

Method of Food Presentation

(2)

Special-Purpose Tests

(1)

Fatiguing the Patient

(1)

Assessing Spasm Versus Stricture in Total Laryngectomees

(1)

Modifications in Viewing Structural Detail

(1)

Magnification

(1)

Still Radiographs

(1)

Videoprints

(1)

Summary

(1)

Radiographic Symptoms and Swallowing Disorders

(42)

The Lateral View

(34)

Disorders in Oral Preparation of the Swallow

(1)

Cannot Hold Food in the Mouth Anteriorly---Reduced Lip Closure

(1)

Cannot Form a Bolus---Reduced Range of Tongue Motion or Coordination

(1)

Cannot Hold a Bolus---Reduced Tongue Shaping and Coordination

(1)

Material Falls into Anterior Sulcus---Reduced Labial Tension or Tone

(1)

Material Falls into Lateral Sulcus---Reduced Buccal Tension or Tone

(1)

Abnormal Hold Position---Tongue Thrust; Reduced Tongue Control

(1)

Other

(1)

Disorders in the Oral Phase of Deglutition

(1)

Delayed Oral Onset of Swallow---Apraxia of Swallow; Reduced Oral Sensation

(1)

Searching Motion; Inability to Organize Tongue Movements---Apraxia of Swallow

(1)

Tongue Moves Forward to Start the Swallow---Tongue Thrust

(1)

Residue (Stasis) in the Anterior Sulcus---Reduced Labial Tension or Tone

(1)

Residue (Stasis) in the Lateral Sulcus---Reduced Buccal Muscle Tension or Tone

(1)

Residue (Stasis) on the Floor of the Mouth---Reduced Tongue Shaping or Coordination

(1)

Residue (Stasis) in a Midtongue Depression---Scar Tissue in Tongue

(2)

Residue (Stasis) of Food on the Tongue---Reduced Tongue Range of Movement; Reduced Tongue Strength

(1)

Disturbed Lingual Contraction (Peristalsis)---Lingual Discoordination

(1)

Incomplete Tongue-to-Palate Contact---Reduced Tongue Elevation

(1)

Adherence (Residue) of Food on Hard Palate---Reduced Tongue Elevation; Reduced Lingual Strength

(1)

Reduced Anterior-Posterior Lingual Action---Reduced Lingual Coordination

(1)

Repetitive Lingual Rolling---Parkinson's Disease

(1)

Uncontrolled Bolus or Premature Loss of Liquid or Pudding Consistency into the Pharynx---Reduced Tongue Control; Reduced Linguavelar Seal

(2)

Piecemeal Deglutition

(1)

Oral Transit Time (in Seconds)

(1)

Other

(1)

Disorders in Triggering the Pharyngeal Swallow---Transition Between the Oral and Pharyngeal Stages of Swallow

(1)

Delayed Pharyngeal Swallow

(3)

Timing the Pharyngeal Delay

(1)

Disorders in the Pharyngeal Phase of Deglutition

(1)

Nasal Penetration During Swallow---Reduced Velopharyngeal Closure

(1)

Pseudoepiglottis (After Total Laryngectomy)---Fold of Mucosa at the Base of the Tongue

(1)

Bony Outgrowth from the Cervical Vertebrae---Cervical Osteophytes

(1)

Coating of Pharyngeal Walls After the Swallow---Reduced Pharyngeal Contration Bilaterally

(1)

Vallecular Residue---Reduced Posterior Movement of the Tongue Base

(2)

Coating in a Depression on the Pharyngeal Wall---Scar Tissue; Pharyngeal Pouch

(1)

Residue at Top of Airway---Reduced Laryngeal Elevation

(2)

Laryngeal Penetration and Aspiration---Reduced Closure of the Airway Entrance (Arytenoid to Base of Epiglottis)

(1)

Etiologies of Laryngeal Penetration

(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

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Manual for the Videofluorographic Study of Swallowing

Table of Contents

Supplemental Materials