telefluoroscopy in dysphagia management james l. coyle communication science and disorders...
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Telefluoroscopy in Telefluoroscopy in Dysphagia ManagementDysphagia Management
James L. CoyleJames L. CoyleCommunication Science Communication Science
and Disorders and DisordersUniversity of PittsburghUniversity of Pittsburgh
Speech Language PathologySpeech Language Pathology
Diagnose and Treat Diagnose and Treat – Communication DisordersCommunication Disorders
Motor Speech DisordersMotor Speech Disorders
Language DisordersLanguage Disorders
Cognitive DisordersCognitive Disorders
Voice DisordersVoice Disorders
Swallowing DisordersSwallowing Disorders
Swallowing FunctionSwallowing Function
Oral Transit of Food and Liquid to Oral Transit of Food and Liquid to PharynxPharynx
Transfer of Food and Liquid through Transfer of Food and Liquid through Pharynx to EsophagusPharynx to Esophagus– NutritionNutrition– HydrationHydration
Airway Protection to Avoid:Airway Protection to Avoid:– Aspiration Related DiseaseAspiration Related Disease– ChokingChoking
Swallowing Disorders (Dysphagia)Swallowing Disorders (Dysphagia)
Dysphagia Dysphagia – 5-15% of Community Acquired Pneumonia are 5-15% of Community Acquired Pneumonia are
Aspiration RelatedAspiration Related– Neurogenic DysphagiaNeurogenic Dysphagia
Stroke-45-75%Stroke-45-75%
Traumatic Brain Injury-10-35%Traumatic Brain Injury-10-35%
Neurodegenerative Diseases-ALS, MS, PD, MGNeurodegenerative Diseases-ALS, MS, PD, MG
Dementia, Institutionalized PatientsDementia, Institutionalized Patients
– Iatrogenic (caused by treatment of other Iatrogenic (caused by treatment of other conditions) Dysphagiaconditions) Dysphagia
– Adults and Children, Females and MalesAdults and Children, Females and Males
Swallowing DisordersSwallowing Disorders
Diagnosis of Oropharyngeal DysphagiaDiagnosis of Oropharyngeal Dysphagia– Clinical Bedside Screening ExaminationClinical Bedside Screening Examination– Diagnostic Instrumental Imaging Diagnostic Instrumental Imaging
EvaluationEvaluationVideofluoroscopyVideofluoroscopy
Fiberoptic imaging (FEES, EGD)Fiberoptic imaging (FEES, EGD)
Ultrasonographic ImagingUltrasonographic Imaging
– Nonimaging Instrumental EvaluationNonimaging Instrumental EvaluationManometry, EMG, etc.Manometry, EMG, etc.
DiagnosisDiagnosis
Videofluoroscopic DiagnosisVideofluoroscopic Diagnosis– Speech PathologistSpeech Pathologist– RadiologistRadiologist– Solid Food, LiquidSolid Food, Liquid– Dynamic AssessmentDynamic Assessment– Video, Digital RecordingVideo, Digital Recording– DiagnosisDiagnosis– Therapy PlanningTherapy Planning
Swallowing DisordersSwallowing Disorders
Biomechanical AnalysisBiomechanical Analysis– Food is misdirected by biomechanical Food is misdirected by biomechanical
errorserrorsAnd enters the lungsAnd enters the lungs
– Pneumonia, chokingPneumonia, choking– Nutritional CompromiseNutritional Compromise– Social DisadvantagesSocial Disadvantages– DehydrationDehydration– Medication AdministrationMedication Administration
Swallowing DisordersSwallowing Disorders
Examiner Experience VariesExaminer Experience Varies– Rural SettingsRural Settings– Unusual DiagnosesUnusual Diagnoses– Unfamiliar PopulationsUnfamiliar Populations
Swallowing DisordersSwallowing Disorders
Treatment Planning Treatment Planning May VaryMay Vary– Diet ModificationDiet Modification– Behavioral ManeuversBehavioral Maneuvers– Enteral Tube FeedingEnteral Tube Feeding
Telefluoroscopic ExaminationTelefluoroscopic Examination
Off the shelf hardwareOff the shelf hardware
Near-real timeNear-real time
Remote ExpertRemote Expert
Data AnalysisData Analysis
Report GenerationReport Generation
Patient DatabasePatient Database
Perlman, A.L., Witthawaskul, W. (2002). Real-time Remote Telefluoroscopic Assessment of Patients with Dysphagia. Dysphagia, 17, 162-167
Telefluoro-Telefluoro-scopic scopic ExaminationExamination
3 Phases3 Phases
Remote Remote Expert Expert AnalysisAnalysis
Remote Remote Therapy Therapy PlanningPlanning
Imaging Imaging InterpretationInterpretation
AdvantagesAdvantages– Structural AbnormalitiesStructural Abnormalities– Image EnhancementImage Enhancement– Experience of ExpertExperience of Expert– Improve PrecisionImprove Precision
Remote TrainingRemote Training
TreatmentTreatmentPlanningPlanning
Diet Modification
Compensatory Strategies
Rehabilitation
Referral
Telemedicine and DysphagiaTelemedicine and Dysphagia
Remote Home MonitoringRemote Home Monitoring
Follow UpFollow Up
Modification of Plans without Clinic VisitsModification of Plans without Clinic Visits
TelefluoroscopyTelefluoroscopy
Goals: Reduce Dysphagia Related Goals: Reduce Dysphagia Related Morbidity Morbidity – ...in rural settings...in rural settings
– ...for those without transportation...for those without transportation
– ...to reduce healthcare costs...to reduce healthcare costs
– ...and to improve access to expert ...and to improve access to expert cliniciansclinicians
Thank YouThank You
Perlman, AL and Witthawaskul, W (2002). Perlman, AL and Witthawaskul, W (2002). Remote, real-time, interactive, internet-based Remote, real-time, interactive, internet-based videofluoroscopic assessment of videofluoroscopic assessment of swallowing. swallowing. American Telemedicine Association 2002 ConferAmerican Telemedicine Association 2002 Conferenceence, Los Angeles, CA, June 6, 2002. , Los Angeles, CA, June 6, 2002.
TelefluoroscopyTelefluoroscopy in Dysphagia in Dysphagia ManagementManagement
James L. Coyle, M.A., CCC-SLPJames L. Coyle, M.A., CCC-SLPCommunication Science Communication Science and Disorders and DisordersUniversity of PittsburghUniversity of Pittsburgh