82 Questions
What is the definition of a VFSS?
Dynamic fluoroscopic image of moving bolus and oropharyngeal structures which is recorded on videotape or digital disk
What positions are patients in during the VFSS?
Seated position, occasional standing, video chair, booster seat for peds
During the oral phase, we can visualize poor labial closure/drooling and anterior loss of PO. What else can be visualized on VFSS?
Drooling/anterior loss Prolonged oral prep) Tongue pumping and lingual mvmt (Parkinson’s) Serial or piecemeal deglutition Oral stasis/residue Poor mastication Decreased tongue elevation to palate
During a fees, part of the pharyngeal phase is obliterated by pharyngeal walls and bolus during the swallow when the endoscopic light is blocked. This is known as the ______.
White-out
Fees can be used even with excessive oral secretions to assess PT’s tolerance of oral secretions.
True
VFSS is performed to assess the pathophysiology of swallow dysfunction to determine LT and St goals and plan for nourishment and hydration. Why else do we perform VFSS?
Aspiration is occurring Severity of swallow dysfunction Which PO consistencies, if any, are safe Which strategies will improve safety of PO intake Pathophysiology of swallow dysfunction re: LT and ST goals and plan for nourishment and hydration
What planes are observed during the VFSS?
Lateral and A-P planes
During the pharyngeal phase, we can visualize penetration/aspiration: when, why, how much, response. What else can we visualize?
Delayed initiation of swallow trigger; bolus head past angle b/n base of tongue and mandible Reduced hyoid elevation Reduced laryngeal elevation Reduced pharyngeal contraction, contractile wave Vallecular stasis, residue Deviant epiglottic function –penetration Pyriform sinus stasis, residue Reduced laryngeal closure; in A-P view, have pt. vocalize to observe VF adduction Poor C-P opening (timing and duration); greater opening required for thicker consistencies Reflux into pharynx
FEES involves passing a flexible nasal-endoscope that is connected to a ____________ source and ____________ to view the procedure and passed through the nose into the hypopharynx. The _____________ tip of the endoscope determines which structures are being viewed.
Light Monitor Distal
During FEES, we can assess pharyngeal/laryngeal sensitivity, all aspects of airway protection, and the pharyngeal and pre-esophageal phases of swallowing. What else can we assess/visualize?
assesses pharyngeal/laryngeal sensitivity assesses all aspects of airway protection assesses pharyngeal and pre-esophageal phases of swallow assesses premature spillage of material into pharynx prior to swallow assesses delayed or multiple pharyngeal swallows assesses laryngeal penetration without aspiration assesses tracheal aspiration assesses location and amount of residue after the swallow reflux
For VFSS which plane should be viewed first? Which plane do we view when there are concerns about symmetry?
Lateral; AP
During a VFSS, you can view the oral and pharyngeal phases, as well as view the cervical esophagus.
True
When given the choice, SLPS should opt to perform FEES over VFSS because it is cheaper and more practical.
False
You cannot view real-time penetration/aspiration or amount during FEES.
True
We cannot attempt compensatory strategies during a FEES due to the presence of the endoscope.
False
ndicate when penetration/aspiration (before, during and after) the swallow is likely to occur based on the following impairments: Poor bolus control and delayed trigger Reflux and reside Reduced laryngeal closure and airway protection
Before, after, during
What are 2 contradictions for VFSS?
Have reduced level of alertness Extremely ill Behavioral factors: combative, or other behaviors that prevent a good study Machines are small - claustrophobic and obese
Facilitates utilize a uniform approach when administering PO trials.
True
How much should the VFs rise during VFSS when looking at laryngeal elevation?
1-2 cervical vertebrae
FEES involves passing a fiberoptic laryngoscope through the nasal cavity into the hypopharynx. We can view the larynx and surrounding structures from a superior view. This requires the clinician to be an expert in identifying the anatomical structures from a ______ view.
“Birds eye”
All stages of swallowing can be visualized during a FEES.
False
FEES is ⅓ to ¼ less than the cost of modified barium swallow.
True
Early diagnosis of dysphagia (within a few days of admission) can increase daily reimbursement for management of this condition.
True
Provide 2 examples of disadvantages of VFSS
Radiation exposure Not all pts can participate or cooperate Limited window Not always representative of “real life” conditions
Who is present during the VFSS?
SLP and Radiologist
VFSS: Who provides the patient with the instructions? Who presents the PO trials? o interprets the VFSS?
SLP, SLP, SLP and Radiologist
Provide 3 benefits of using FEES vs VFSS
Direct visualization of the pharynx and larynx. No exposure to radiation. No need for ingestion of contrast. Can be completed in the patient’s natural environment. Can assist with differential diagnosis of dysphagia (vs reduced vocal fold mobility, GERD, polyps, etc).
When assessing the esophageal phase, it is okay for the SLP to write: “Zenker’s Diverticulum noted at the level of C5-C6
False
Provide 3 possible contraindication for performing FEES
bleeding disorders/blood thinners (coumadin) fainting seizure disorder known sensitivity to local anesthesia movement disorders (hyperkinetic) nose trauma acute cardiac problems
Provide 3 possible adverse reactions to FEES
Nosebleed fainting vasovagal response – mechanical stim to upper airway with an instrument; usually causes fainting but can cause dysrhythmia or bradycardia in pts with cardiac hx laryngospasm allergic reaction to topical anesthesia (not used by SLPs) infection sinusitis laryngitis minor laryngo-pulmonary trauma
What is an indicator of poor saliva management during a FEES assessment?
Accumulation of secretions
What is the purpose of assessing laryngeal closure during a FEES assessment?
To assess airway protection
Why is it important to assess sensation during a FEES assessment?
To assess decline in sensation
What is the purpose of using green or blue dyed material during a FEES assessment?
To assess penetration and aspiration
What can happen to the lens during a FEES assessment?
It becomes coated with secretions or food/liquid
What is the importance of positioning the scope to see the vocal folds and advancing bolus simultaneously during a FEES assessment?
To assess timing and amount of penetration/aspiration
What is the primary purpose of instrumental evaluation, including FEES?
To describe the physiological components of the swallow
What is the main limitation of FEES in terms of assessing swallowing phases?
Cannot assess the oral phase of swallowing
What is the role of the distal tip of the endoscope in FEES?
Determines which structures are being viewed
Why has ASHA endorsed the practice of FEES?
Because it is within the scope of practice of SLPs, provided they have attained competence through training and education
What is the main advantage of FEES in terms of patient comfort?
It is a more comfortable and less invasive procedure compared to VFSS
What is the purpose of the thumb lever in FEES administration?
To raise the distal tip of the endoscope up and down
What is the primary reason FEES is not intended to replace the fiberoptic exam done by ENT?
To assess the integrity of the laryngeal and pharyngeal structures
According to Langmore et al. (1991), what is the significance of the comparison between FEES and MBS?
There is a statistically significant agreement between FEES and MBS in identifying aspiration
When is it more appropriate to use MBS instead of FEES?
When assessing oral phase impairments
What is a unique requirement for clinicians performing FEES?
Expertise in identifying anatomical structures from a 'birds eye' view
What is a common goal of both MBS and FEES?
To assess swallowing function
In which situation would FEES be preferred over MBS?
When reassessing swallowing function
What is the main advantage of using FEES over VFSS?
It is a more portable and practical assessment tool
What is the purpose of using blue or green dye during a FEES examination?
To make the food and liquid more visible during the examination
What is the term used to describe the obliteration of the pharyngeal phase during a FEES examination?
White-out
What is the primary advantage of using FEES over VFSS in terms of cost?
FEES is less expensive than VFSS
What is the primary purpose of using FEES in the assessment of swallowing function?
To assess the pharyngeal and laryngeal phases of swallowing
What is the benefit of using FEES in patients with excessive oral secretions?
It can be used to assess the patient's tolerance of oral secretions
What is the purpose of using topical anesthesia during a FEES examination?
To reduce the patient's discomfort during the examination
What is the advantage of using FEES in terms of patient convenience?
It can be performed at the bedside in a variety of settings
What is the primary disadvantage of using FEES in terms of visualization?
It cannot visualize the esophageal phase
What is the benefit of using FEES in terms of patient education and biofeedback?
It allows patients to view their swallowing function in real-time
What is the purpose of using barium with different consistencies in a VFSS?
To evaluate the patient's ability to swallow different textures and consistencies
What is the advantage of using commercially available pre-thickened barium in a VFSS?
It eliminates the need for modifying the barium consistency
What is the significance of understanding how the barium stimuli map to the different levels on the IDDSI Framework?
It is important for making appropriate recommendations upon completion of the study
What is the role of the IDDSI Testing Methods in a VFSS?
To understand how the barium stimuli map to the different levels on the IDDSI Framework
What is the disadvantage of VFSS in terms of radiation exposure?
It exposes the patient to radiation
What is the primary purpose of performing a videofluoroscopy swallow study (VFSS)?
To assess the pathophysiology of swallow dysfunction and determine long-term and short-term goals
What is the benefit of using VFSS in assessing swallowing function?
It allows for real-time visualization of the swallow mechanism
Which of the following is a contraindication for VFSS?
Patients with a reduced level of alertness
What is the purpose of mixing food with barium during a VFSS?
To visualize the swallow mechanism
Which of the following can be viewed during a VFSS?
The oral and pharyngeal phases of swallow, as well as the cervical esophagus
What is the primary goal of using VFSS in assessing swallowing function?
To develop a plan for nourishment and hydration
What is the characteristic of oral-transit time in mild dysphagia?
Less than 5 seconds
When is non-oral supplement to oral feeding recommended?
When patient has oral dysphagia and slows food intake, but no risk of aspiration
What is the characteristic of oral residue in mild dysphagia?
Less than 1/4 of bolus in anterior portion of oral cavity
What is the general rule for oral-pharyngeal transport?
Swallow does not exist if oral-pharyngeal transport is more than 15 seconds
When is oral feeding recommended?
When patient has no pharyngeal impairment and responds well to techniques
What is the characteristic of severe dysphagia?
Suspected risk for aspiration and oral-pharyngeal transport of more than 10-15 seconds
When would you recommend NPO to a patient?
When the patient's symptoms indicate pharyngeal involvement with severe risk of aspiration
What is a common misconception about G-tube feedings in patients with terminal illnesses?
G-tube feedings are helpful in patients with terminal illnesses
What is a potential risk associated with tube feedings?
Aspiration
What is the role of the speech-language pathologist in the assessment and treatment of medically fragile patients with swallowing difficulties?
To educate the patient and family about swallowing mechanisms and risks
What is a consequence of tube feedings, according to research?
No change in activities of daily living
What is a consideration that speech-language pathologists should take into account when making recommendations about tube feedings?
The patient's and family's concerns and expectations
Can view every phase of the swallow.
MBS
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