The Videofluorographic Swallowing Study

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This article describes the evidence for the physiologic foundation and interpretation of the videofluorographic swallowing study (VFSS). The purpose and clinical efficacy of VFSS are explained. Standardization of the VFSS procedure, protocol, interpretation, and reporting is highlighted as a critical step in future clinical practice and research. Individualized evidenced-based rehabilitation strategies are presented as key components that are systematically applied during the VFSS procedure and integrated into the swallowing management plan. A new tool that has been developed and tested for the quantification of swallowing impairment is introduced.

Section snippets

Videofluorographic swallowing study: an indirect sensory and motor examination

Swallowing is an array of synergistic interdependent movements, initiated by a complex set of sensory inputs that generate motor responses. These motor responses create pressures and forces to propel ingested materials through the upper aerodigestive tract and simultaneously protect the upper airway. Although the VFSS does not use direct measures of sensation and muscle strength, the following evidence suggests that trained examiners can make accurate and reliable clinical judgments about the

Swallowing physiology: foundation for videofluorographic swallowing study

Swallowing is a complex physiologic event comprised of simultaneous and sequential contractions of muscles of the oral–facial region, pharynx, larynx, and esophagus. Descriptions of swallowing physiology were attempted well before the development of a sophisticated modality for viewing the rapid contractions and movements of the muscles and structures associated with swallowing. In 1813, Magendie [49] was the first to separate swallowing into phases or stages representing the anatomic regions

Move toward standardization

By definition, a gold standard is a test against which all other tests are measured. The VFSS has often been described as the gold standard for the evaluation of oropharyngeal swallowing. However, a single test is unlikely to provide the best assessment of swallowing for every patient and condition. Other imaging methods, such as flexible endoscopy, may supplant or complement VFSS examination. Nonetheless, clinical use data indicate that VFSS is the preferred method by most practicing

Standardization: videofluorographic swallowing study procedure and protocol

The descriptions if the VFSS as originally described by Logemann [40] continue to be followed in most clinical practices [42], [65]. Patients are initially positioned in the lateral view, and regions of visualization include the oral cavity, pharyngeal cavity, larynx, and cervical esophagus. The visualization field includes the lips anteriorly, nasal cavity superiorly, cervical spinal column posteriorly, and the entire PES inferiorly [35], [38], [40], [41], [43]. The larynx should be in full

Standardization: videofluorographic swallowing study terminology, interpretation, and reporting

In addition to testing the role for standardizing the VFSS protocol, the study by Martin and colleagues [66] also intended to rigorously test the reliability, content, construct, and external validity of a new MBS tool (MBSImp) to quantify swallowing impairment. The tool includes an ordinal scaling methodology of each of the previously described set of physiologic components, whereby each score represents a unique observation from the VFSS. The tool shows content and construct validity and good

Videofluorographic swallowing study: a rehabilitation examination

A primary purpose of a VFSS is to determine the effect of various behavioral and sensory interventions on the physiologic function of the swallowing mechanism. Several studies have shown the ability to detect immediate effects of compensatory strategies (bolus volume, consistency and taste, postural alterations, swallowing, and respiratory maneuvers) on swallowing physiology [9], [14], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82]. The systematic

Summary

Strong evidence has shown VFSS to be the ideally suited method for identifying and quantifying the presence and nature of oropharyngeal and cervical esophageal swallowing disorders. The ability to assess overlapping and interdependent structural movements as they relate to bolus flow in real time throughout the swallowing process has had high clinical yield. When the VFSS protocol is standardized, interpreted, and reported by trained clinicians using standardized and validated measures,

Acknowledgments

We wish to thank all of the patients who have contributed to our knowledge by allowing us the opportunity to care for them and learn from them when volunteering for our clinical studies. Dr. Martin-Harris gratefully acknowledges her funding sources that include the National Institute on Deafness and Other Communication Disorders at the National Institutes of Health (NIDCD K23 DC005764) and the Mark and Evelyn Trammell Trust, Atlanta Georgia.

We wish to extend our gratitude to our colleagues at

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