What are we assessing with instrumentation?
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
What are different names for VFSS (videofluoroscopic swallow study)
Modified barium swallow (MBS)
Cookie swallow test
Dynamic swallow study
IS NOT: barium swallow (only esophagus), esophagram
How much radiation does VFSS expose the pt to?
About ~0.2mSv per exam
What is the ALARA principle?
As low as reasonably achievable
- exams should be efficient and well planned
- poorly planned can result in higher exposure or repeat exams
What should the clinician wear to prevent effects from radiation?
Lead apron
docimeters
thyroid collar
What should the frame rate be for VFSS?
About 30 frames per second, pulsed (adheres to ALARA)
Because the clinician should stay out the radiation field as most as possible, what is highly desirable?
to have the patient self feed
Pts should sit in a _____ chair
non metal
Pts should be told not to
shrug shoulders
FEES vs. VFSS
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
Standard protocol for VFSS
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
Penetration aspiration scale
- Material does not enter the airway
- Material enters the airway, remains above VFs and is ejected
- Material enters airway, remains above the VFs, and is not ejected
- Material enters airway, contacts VFs and is ejected
- Material enters airway, contacts VFs and is not ejected
- Material enters airway, passes below VFs and is ejected into the larynx or out airway
- Material enters airway, passes below Vfs and is not ejected from trachea despite effort
- Material enters the airway, passes below VFs, and no effort is made to eject.
What else must be done with the PAS scale?
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?
What are alternatives to MBSimp?
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
Sections of documentation
Introductory statement Results (assessment) Impressions Recommendations and plans Patient education
