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

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Telefluoroscopy in Dysphagia Management

James L. Coyle

Communication Science and Disorders

University of Pittsburgh

speech language pathology
Speech Language Pathology
  • Diagnose and Treat
    • Communication Disorders
      • Motor Speech Disorders
      • Language Disorders
      • Cognitive Disorders
      • Voice Disorders
      • Swallowing Disorders
swallowing function
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
swallowing disorders dysphagia
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
swallowing disorders
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.
diagnosis
Diagnosis
  • Videofluoroscopic Diagnosis
    • Speech Pathologist
    • Radiologist
    • Solid Food, Liquid
    • Dynamic Assessment
    • Video, Digital Recording
    • Diagnosis
    • Therapy Planning
swallowing disorders7
Swallowing Disorders
  • Biomechanical Analysis
    • Food is misdirected by biomechanical errors
      • And enters the lungs
    • Pneumonia, choking
    • Nutritional Compromise
    • Social Disadvantages
    • Dehydration
    • Medication Administration
swallowing disorders8
Swallowing Disorders
  • Examiner Experience Varies
    • Rural Settings
    • Unusual Diagnoses
    • Unfamiliar Populations
swallowing disorders9
Swallowing Disorders
  • Treatment Planning May Vary
    • Diet Modification
    • Behavioral Maneuvers
    • Enteral Tube Feeding
telefluoroscopic examination
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

telefluoro scopic examination
Telefluoro-scopic Examination
  • 3 Phases
  • Remote Expert Analysis
  • Remote Therapy Planning
imaging interpretation
Imaging Interpretation
  • Advantages
    • Structural Abnormalities
    • Image Enhancement
    • Experience of Expert
    • Improve Precision
  • Remote Training
treatment planning
TreatmentPlanning

Diet

Modification

Compensatory Strategies

Rehabilitation

Referral

telemedicine and dysphagia
Telemedicine and Dysphagia
  • Remote Home Monitoring
  • Follow Up
  • Modification of Plans without Clinic Visits
telefluoroscopy
Telefluoroscopy
  • Goals: Reduce Dysphagia Related Morbidity
    • ...in rural settings
    • ...for those without transportation
    • ...to reduce healthcare costs
    • ...and to improve access to expert clinicians
thank you
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+@pitt.edu