Videofluoroscopy and Swallowing Studies for Neurologic Disease: A Primer

Abstract

Many patients with neurologic impairment due to stroke, multiple sclerosis, trauma, bulbar palsy, and other disorders have difficulty swallowing. Videofluoroscopy can provide important information on patterns of impairment of the swallowing mechanism, allowing important changes in patient treatment. The detailed videofluoroscopic evaluation required to provide this information is now seldom taught and is practiced by relatively few radiologists. The aim of this article is to (a) describe the indications for videofluoroscopic swallowing studies in the evaluation of patients with neurologic conditions affecting swallowing, (b) describe the techniques for evaluating the swallow mechanism with videofluoroscopy in a standardized manner, and (c) use cine videofluoroscopy to illustrate the range of abnormalities that can be demonstrated for some of these conditions and discuss the effect of patient treatment.

The videofluoroscopic swallowing study shows a sustained improvement of dysphagia in children with Niemann–Pick disease type C after therapy with miglustat

“…All phases of the swallowing motion were analyzed and patients were classified as having oral and/or pharyngeal phase dysfunction, according to Gates et al [2006]. Oral-phase dysfunction was suggested by the observation of anterior positioning of bolus, weakness of labial or buccal muscles, tongue hypomobility, incoordination of tongue motion.…”

“…The Dysphagia Severity Rating Scale was adapted from Gates et al [2006] as described in Table IIA. A 7-point score was attributed to penetration/aspiration in the airways (Penetration/Aspiration Score, PAS), similarly to Gates et al [2006], as described in Table IIB.…”

“…The Dysphagia Severity Rating Scale was adapted from Gates et al [2006] as described in Table IIA. A 7-point score was attributed to penetration/aspiration in the airways (Penetration/Aspiration Score, PAS), similarly to Gates et al [2006], as described in Table IIB. The severity of clinical conditions and neurological involvement was assessed according to an original severity scale, later adapted to the NPC disability scale (DS) proposed in the literature [Iturriaga et al, 2006;Wraith et al, 2009]; the total score and the partial scores for ambulation, manipulation, language and swallowing have been summarized at different time points for each patient.…”

Swallow monitoring through apnea detection in breathing signal

“…Detecting a person's swallow events can enable such food/drink intake monitoring applications. An invasive method for swallow detection is Videofluoroscopy which is used to evaluate patients with neurological conditions affecting swallowing [5]. While providing ample information about different aspects of the swallow process, these methods are too involved and cumbersome to be used for everyday monitoring and food/drink intake analysis purposes.…”

Radiation Safety for the Speech-Language Pathologist

“…Established parameters to reduce exposure to radiation during fluoroscopy are well-documented and include time, distance, and shielding [4,12,[14][15][16][17][18][19][20][21][22][23]. The typical fluoroscopic time for VFSS procedures runs between 30 s and 8 min [24,25].…”