Telefluoroscopy in Dysphagia Management

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Telefluoroscopy in Dysphagia Management
James L. Coyle Communication Science
and Disorders University of
Pittsburgh
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Speech Language Pathology

• Diagnose and Treat
• Communication Disorders
• Motor Speech Disorders
• Language Disorders
• Cognitive Disorders
• Voice Disorders
• Swallowing Disorders

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Swallowing Function

• Oral Transit of Food and Liquid to Pharynx
• Transfer of Food and Liquid through Pharynx to
  Esophagus
• Nutrition
• Hydration
• Airway Protection to Avoid
• Aspiration Related Disease
• Choking

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Swallowing Disorders (Dysphagia)

• Dysphagia
• 5-15 of Community Acquired Pneumonia are
  Aspiration Related
• Neurogenic Dysphagia
• Stroke-45-75
• Traumatic Brain Injury-10-35
• Neurodegenerative Diseases-ALS, MS, PD, MG
• Dementia, Institutionalized Patients
• Iatrogenic (caused by treatment of other
  conditions) Dysphagia
• Adults and Children, Females and Males

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Swallowing Disorders

• Diagnosis of Oropharyngeal Dysphagia
• Clinical Bedside Screening Examination
• Diagnostic Instrumental Imaging Evaluation
• Videofluoroscopy
• Fiberoptic imaging (FEES, EGD)
• Ultrasonographic Imaging
• Nonimaging Instrumental Evaluation
• Manometry, EMG, etc.

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Diagnosis

• Videofluoroscopic Diagnosis
• Speech Pathologist
• Radiologist
• Solid Food, Liquid
• Dynamic Assessment
• Video, Digital Recording
• Diagnosis
• Therapy Planning

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Swallowing Disorders

• Biomechanical Analysis
• Food is misdirected by biomechanical errors
• And enters the lungs
• Pneumonia, choking
• Nutritional Compromise
• Social Disadvantages
• Dehydration
• Medication Administration

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Swallowing Disorders

• Examiner Experience Varies
• Rural Settings
• Unusual Diagnoses
• Unfamiliar Populations

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Swallowing Disorders

• Treatment Planning May Vary
• Diet Modification
• Behavioral Maneuvers
• Enteral Tube Feeding

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Telefluoroscopic Examination

• Off the shelf hardware
• Near-real time
• Remote Expert
• Data Analysis
• Report Generation
• Patient Database

Perlman, A.L., Witthawaskul, W. (2002). Real-time
Remote Telefluoroscopic Assessment of Patients
with Dysphagia. Dysphagia, 17, 162-167
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Telefluoroscopic Examination
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Telefluoro-scopic Examination

• 3 Phases
• Remote Expert
  Analysis
• Remote Therapy
  Planning

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Biomechanical Analysis
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Imaging Interpretation

• Advantages
• Structural Abnormalities
• Image Enhancement
• Experience of Expert
• Improve Precision
• Remote Training

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TreatmentPlanning
Diet Modification
Compensatory Strategies
Rehabilitation
Referral
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Telemedicine and Dysphagia

• Remote Home Monitoring
• Follow Up
• Modification of Plans without Clinic Visits

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Telefluoroscopy

• Goals Reduce Dysphagia Related Morbidity
• ...in rural settings
• ...for those without transportation
• ...to reduce healthcare costs
• ...and to improve access to expert clinicians

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Thank You

• Perlman, AL and Witthawaskul, W (2002). Remote,
  real-time, interactive, internet-based
  videofluoroscopic assessment of swallowing.
  American Telemedicine Association 2002
  Conference, Los Angeles, CA, June 6, 2002.

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Telefluoroscopy in Dysphagia Management
James L. Coyle, M.A., CCC-SLP Communication
Science
and Disorders University of Pittsburgh
jcoyle_at_pitt.edu