Fri 30th Aug 2013
Session 2 / Talk 2
11:05 – 11:22
HEAPHY 1 & 2
DIAGNOSTIC
Deborah McKELLAR
ABSTRACT
This presentation will give a brief outline of the reasons SLT’s perform
VFSS and what we aim to achieve. We will explore the clinical view
required and some of the barriers to achieving this. Case studies will be
presented.
Videofluoroscopy Study of
Swallowing (VFSS)
Deborah McKellar
Clinical Leader Speech Language Therapy
Waikato Hospital
What do SLT’s do?
• Communication
• Swallowing
– Assessment
– Advice/recommendations
– Rehabilitation
Swallowing Assessments
• “Bedside” assessment
– Silent aspiration risk
• Objective assessment
– FEES (fiberoptic endoscopic evaluation of
swallowing)
– VFSS (videofluoroscopic study of swallowing)
FEES
Videofluoroscopic Study of Swallowing
• Sometimes referred to as Modified Barium Swallow
VFSS
VFSS vs Barium Swallow
• VFSS
– Focus on anatomy and physiology of oral, pharyngeal,
laryngeal and upper oesophageal parameters.
– Uses a variety of foods, fluids and strategies.
– Performed by radiologist and/or SLT.
• Barium swallow
– Examines the upper gastrointestinal tract focusing on
esophagus and stomach.
– Identifies motility issues or structural abnormalities in the
oesophagus.
– Performed by radiologist.
Why do we do VFSS?
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Investigate cause/physiology of dysphagia
To guide dysphagia rehabilitation
Assess for aspiration risk – silent aspiration
Where clinical condition does not match the clinical
swallowing evaluation
Not everyone with dysphagia needs a VFSS
What we do?
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•
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Trial a variety of consistencies of food/fluid
Trial strategies e.g. chin tuck, head turn
Trial different delivery methods
Assess fatigue effects
What are we looking at?
• Oral parameters
• Oral transit parameters
• Pharyngeal parameters
• Crico-oesophogeal parameters
• Laryngeal parameters
A normal swallow
What do we look for?
• Aspiration – before, during or after the swallow
• Difficulty controlling food/fluid in the mouth
• Difficulty initiating the swallow
• Residue after the swallow – unable to clear pharynx
Aspiration
• Not an automatic reason to stop the procedure
• “a degree of aspiration may be necessary in order to
gain a clear assessment of swallow physiology”
• May need to trial other strategies and consistencies
What do we need to see?
• Need to view mouth, pharynx, laryngx and upper
oesophagus
• Need to see the start of the swallow
• Often will need to keep screening after the swallow
• AP view is often required – symmetry
• Oesophageal screen
Limitations
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Patient mobility/sitting balance
Patient co-operation
Equipment logistics
Shoulders
NZSTA recommendations
• Must have a swallowing/feeding evaluation before
the VFSS
• SLTs should have access to high quality images and
slow motion playback
• SLTs are not qualified to make medical diagnosis or
identify structural deviations
Videopalatogram
• Looks at palate movement (velopharyngeal closure)
during speech
• Small amount of barium squirted into patient’s nose
to coat structures
• Synched speech and video required
• Aids in decisions regarding palate surgery (surgery
vs speech therapy)
• NZSTA Clinical Practice Guideline on
Videofluoroscopic Study of Swallowing (VFSS) April
2011
• The Dynamic Swallow DVD