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474
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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
Pharynx (continued)
normative data, in adults, 73
surgery that affects, 400–401
Phenylephrine (Neo-Synephrine), 41, 67
Phonatory Aerodynamic System (PAS),
238
Physical activity, 293–294
Physical examination, 38–43, 56–58
Physical status, 189
Physicians’ Desk Reference, 37
Physiology
airway/pharyngeal, 273–274
after chemoradiation, 408–413,
411–412
of normal deglutition, 1–44
Picky Eating Questionnaire, 330
Pill or pill-induced esophagitis, 353, 353,
379
Piriform sinuses
barium radiographic evaluation of, 94
flexible endoscopy examination of, 75,
75, 76, 76
Pitch control or range, 58
Planimetry, high-resolution impedance,
181, 182
Plummer-Vinson syndrome, 354
PM (polymyositis), 359, 379–382
Pneumonia
aspiration, 274–276, 365, 367–368
in head and neck cancer patients,
394, 395, 405–406, 406
in head and neck cancer patients, 394,
395, 405–406, 406
ventilator-associated (VAPs), 276
POEM (peroral endoscopic myotomy),
357
Polymyositis (PM), 359, 379–382
Polypharmacy, 378
Position(s)
clinical examination or observation of,
55–56
and DSS, 105–106
and effects of gravity, 128
reference “Hold” position, 159–162,
161
strategies that exploit gravity, 128
that impact pharyngeal chamber
shape and function, 213
Trendelenburg position, 97
Positron emission tomography (PET),
20, 408
Posterior cricoarytenoid muscle, 32, 47
Posterior cricoid plication, 94
Posterior cricoid (PC) region, 94
Postoperative dysphagia, 445, 445–446
Postoperative radiation therapy,
405–406, 406
Postpolio syndrome, 374
Postswallow measure, 166
Postural compensations, 211–213
Posture
clinical examination or observation of,
55–56
for DSS, 106
Potassium, slow-releasing, 353
PPIs (proton pump inhibitors), 265–266,
351, 431–433
PPN (peripheral parenteral nutrition),
301
Pre-motoneurons, 23–24
Prealbumin, 290–292
Prefeeding preparation, 217
Presbyphagia, 368
Preswallowing activity, 23–24
Preventive therapy exercises, 412
Primary lateral sclerosis, 374
Progressive bulbar palsy, 374
Progressive dysphagia, 379
Progressive muscular atrophy, 374
Prosthetic appliances, 216, 400
Protein requirements, 294–295
Protein status, visceral, 290
Proton pump inhibitors (PPIs), 265–266,
351, 431–433
Prozac, 37
PRR (pharyngeal residue ratio), 166, 167
Pseudoachalasia, 356
Pseudoepiglottis, 403–404
Pseudosulcus vocalis, 429, 429
Psychosocial interactional feeding
assessment, 341–342
Pterygoid muscles, 18, 30, 45
Pulmonary disease, 274
Pulmonary risk factors, 274
Pulse oximetry, 50
Puree foods, 296, 297–299, 316–317
Pureed diet, 301
Pyriform fossa tumors, 406–407
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475
Q
Quality of life, 415–416
R
Rabeprazole, 265–266
RACs (repetitive anterograde
contractions), 181
Radiation esophagitis, 353–354
Radiation exposure and safety, 88–91
dose comparisons, 89–90, 90
videofluoroscopy swallowing study
dose, 89–90, 90, 90–91
Radiation therapy
chemoradiation
for head and neck cancer, 397, 406,
406–408
risk factors for permanent
dysphagia after, 394
swallowing physiology after,
408–409
for head and neck cancer, 405–406,
406, 407–408
intensity-modulated (IMRT), 407–408
postoperative, 405–406, 406
Radiography
barium radiographic evaluation, 87–99
esophageal examination, 87–99, 102,
103
pharyngeal examination, 87–99, 102,
103
rapid sequence digital, 88
Radiologically inserted gastrostomy
(RIG), 305–307
Ranitidine, 265
Rankin Scale, 369
Rapid sequence digital radiography, 88
Readiness for feeding, 331–332
Recordkeeping
clinical, 222
database, 222, 223–225
recording food intakes, 315
Recurrent laryngeal nerve, 16–17, 17, 32,
47
Reference “Hold” position, 159–162, 161
Referrals, 189
Reflux
antireflux regimens, 265, 431–432
esophageal, 431
gastroesophageal. See
Gastroesophageal reflux (GER)
gastrointestinal, 278
laryngopharyngeal, 425–438
medications that promote, 353, 353
precautions against, 265, 277–278
recommended lifestyle modifications
for, 431, 431
Reflux symptom index (RSI), 428
Refluxogenic foods, 432
Reinke’s edema, 428–429, 429
Repetitive anterograde contractions
(RACs), 181
Repetitive retrograde contractions
(RRCs), 181
Repetitive transcranial magnetic
stimulation (rTMS), 201, 250–255
Residue
FEES vs fluoroscopy of, 70, 70–71, 71
measures of, 164–167
pharyngeal residue ratio (PRR), 166,
167
Resistance training, 192–193
chin tuck against resistance (CTAR),
192, 202
jaw lowering against resistance (JAR),
202
swallow against laryngeal resistance
(SLAR), 192–193, 202
Swallow Resistance Exercise Device
(sRED), 192–193
tongue press exercises, 193, 203
Resonance, 58
Respiration, 35
Respiratory-swallow training (RST), 204,
220–221, 237–245
Retromolar trigone tumors, 399–400, 400
Revised NOMAS, 331–332
Right subclavian artery, aberrant, 440,
441
Rituximab therapy, 384–385
Robotic surgery, transoral (TORS), 399,
401–402
Rooting reflex, 333, 334, 338
Rotary grind, 340
RRCs (repetitive retrograde
contractions), 181
RSI (reflux symptom index), 428
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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
RST (respiratory-swallow training), 204,
220, 237–245
Russell-Silver syndrome, 331
S
Safety, radiation, 88–91
Saliva swallow, 59
Salivation, 10
Schatzki’s rings, 96, 97, 354, 354
Schedule for Oral Motor Assessment
(SOMA), 328
Scintigraphy, 177–178
SCJ (squamocolumnar junction), 96
Scleroderma (systemic sclerosis), 359
Scoliosis, 440, 442
Screening tests, 49–50
Screening Tool of Feeding Problems,
328
Secondary esophageal peristalsis, 25
Secretions
excessive, 35
normal, 10
physical examination of, 58
questions to elicit description of, 55
Selective stimulation, 216–218
Self-assessment tools, 226
Self-feeding
clinical examination or observation
of, 56
pediatric assessment of, 340–341
sEMG (surface electromyography),
246–249
Senequan, 37
Sensory cueing, 217
Sensory-motor assessment, oral,
333–339
Sensory neurons, 22, 24
Sensory testing, flexible endoscopy with
(FEEST), 65
Shaker exercise, 192, 202
indications for, 220
preventive, 412
Silent aspiration, 94, 275
in Parkinson’s disease, 372
pediatric, 342, 342
after stroke, 368–369
Single-use flexible endoscopes, 66
Sjögren’s syndrome, 266, 359–360
Skull base tumors, 405
SLAR (swallow against laryngeal
resistance), 192–193, 202, 220
SLN. See Superior laryngeal nerve
SLPs (speech-language pathologists), 82,
89, 91–92
SMA (spinal muscular atrophy), 374, 382
SmartBar, 183
SmartPill® (Medtronic), 183, 183
Social changes, 35
Social environment, 54, 189, 293
Soft diets, 301
Soft foods, 316–317
Soft palate (velum)
muscles of, 3–7, 6, 13
physical examination of, 57–58
surgical reconstruction of, 400
treatment of defects, 267
Solid food dysphagia, 34
esophageal phase, 350, 350–351, 351,
352, 352
from hiatal hernia, 351, 351
from infectious esophagitis, 352, 352
most common causes, 349, 349
SOMA (Schedule for Oral Motor
Assessment), 328
Sonography. See Ultrasound
Spatial measures
age, gender, and bolus size/
consistency differences in,
167–168
clinical implications, 168–171
Speaking systems, 284
Speaking valves, 284
Speech, finger control, 284
Speech-language pathologists (SLPs), 82,
89, 91–92
Spinal abnormalities, 439–451
anatomic considerations, 440–446
medical management of, 446–447
surgical management of, 447–448
swallowing strategies for, 447
Spinal accessory muscles, 22
Spinal muscular atrophy (SMA), 374,
382
Spinal surgery, 444–446
Spinal trigeminal nucleus, 22
Spot films, 95
Squamocolumnar junction (SCJ), 96
sRED (Swallow Resistance Exercise
Device), 192–193
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477
Stimulation techniques
direct muscle stimulation, 200–201,
207, 220
direct stimulation of oral-pharyngeal
structures, 217
indirect muscle stimulation, 199–200
mechanical stimulation, 217
repetitive TMS (rTMS), 201, 250–255
selective stimulation, 216–218
transcranial DCS (tDCS), 201, 250–251,
253–255
transcranial magnetic stimulation
(TMS), 20, 218, 250–251
Strength training, 191–199, 201, 202–207
Biofeedback in Strength and Skill
Training (BiSSkiT), 246–248
expiratory muscle strength training
(EMST), 193–194, 204, 220–221
indications and exercises, 220–221
tongue-strengthening exercises, 193,
203, 220, 410
Stretching exercises, 207, 220
Strictures
esophageal, 97
diagnosis of, 270
example findings, 95, 137, 138
surgical treatment of, 269–270
in head and neck cancer patients, 395,
406
Styloglossus muscles, 3–7, 5
impact of deficit on swallowing and
physical examination findings, 47
innervation of, 5, 18
role during swallowing, 2–3, 11, 14,
18, 32
Stylohyoid muscle, 14, 18
Stylopharyngeus muscle, 15, 30, 45
Suck reflex, 333, 334, 338
Super supraglottic maneuver, 214–215
Superior laryngeal nerve (SLN), 16–17,
17, 19, 47, 444
Superior pharyngeal constrictor muscle,
11–12, 12–14, 18, 31, 46
Superior salivatory nucleus, 22
Supplies
FEES kits, 67
for flexible endoscopy, 65–68
Supraglottic laryngectomy, 402, 403
Supraglottic maneuver, 214–215
Supraglottic penetration, 134
Suprahyoid muscles, 14, 30, 45
Supranuclear palsy, 366
Surface electromyography (sEMG),
246–249
Surgery
for dysphagia, 266–270
endoscopic, 402, 403
for head and neck cancer, 397–405,
399, 403, 406
postoperative radiation therapy,
405–406, 406
spinal, 444–446
for spinal abnormalities, 447–448
tongue base, 398–399, 399
transoral robotic (TORS), 399, 401–402
Survey tools, 226
SWALCARE (swallowing quality of
care) survey tool, 226
Swallow against laryngeal resistance
(SLAR), 192–193, 202, 220
Swallow evaluation
assessment tasks, 79–80
clinical, 49–61, 62–63
dynamic swallow study (DSS),
101–120, 121–140, 141–174
guided observation of swallowing in
the esophagus (GOOSE), 176–177,
177
liquid and/or food swallow, 59
saliva swallow, 59
screening tests, 49–50
with videofluoroscopy
radiation dose, 89–90, 90, 90–91
recommended frame rates, 88
water swallow tests, 49–50
Swallow gestures, 115
coordination with bolus movement,
125
exercises for improving, 191–199, 201,
202–207
timing, 148, 149–150, 153, 165
age, gender, and bolus size/
consistency differences in, 157
vs bolus transit time, 123–124, 124,
154, 157–159
after chemoradiotherapy, 413, 414
clinical implications, 157
durations, 156–157
dyscoordinated, 154
prolonged but coordinated, 154
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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
Swallow reflex, 333, 334, 339–341
Swallow Resistance Exercise Device
(sRED), 192–193
Swallowing
cough during or after, 35
effortful swallow, 206, 213–214, 220,
410
esophageal phase, 24–25, 349
neural control of, 18–19
observations of the patient during, 35
oral phase
anatomy and physiology of, 10–14
direct physical evaluation of, 56–58
oropharyngeal phase, 14, 18–20, 24
pharyngeal phase
airway protection during, 273–274
anatomy and physiology of, 13, 13,
14–24, 15
physiology
after chemoradiation, 408–415,
411–412
normal, 1–44, 274
preparatory phase, 2–10, 7
strategies for spinal abnormalities, 447
therapeutic strategies, 81
Swallowing complaint
chief complaint, 34–35
in clinical swallow evaluation, 52–53
Swallowing exercise programs, 192
Swallowing history, 53–55
Swallowing Signals Lab, 198
Swallowtail (software), 145
SWALQOL (swallowing quality of life)
survey tool, 226
Symmetrel, 37
Syndesmophytes, 442
Systemic lupus erythematosus, 359
Systemic sclerosis (scleroderma), 359
T
Taste changes, 34
TBE (timed barium esophagogram), 355
Team approach, 226–227, 307–310, 327
Team review, 187–189, 188
Teamwork, 118
Telehealth, 453
Telemetry, wireless pH, 184, 184
Telepractice, 344
Temperature, 55
Temporalis muscle, 45
Tensor veli palatini muscle, 6, 30, 45
Terminology, 425
Tetracyclines, 353
Texture continuum, 296, 297–299,
316–317
TheraBite (Atos Medical), 199, 207, 220
Therapeutic swallowing strategies, 81
Thermal stimulation, 217–218
Thick liquids, 296, 297–299, 320–323
Thickened liquids, 209, 301, 316–317
Thickeners, 301, 318–319, 320–323
Thin liquid dysphagia, 301
Thoracic scoliosis, 440–441, 442
Throat clear, volitional, 58–59
Thyroarytenoid muscle, 32, 47
Thyrohyoid muscles, 16, 32, 47
Tilting
head, 212–213
upper body, 212
Timed barium esophagogram (TBE), 355
Timing measures, 148–152, 149–150. See
also Transit times
Tissue stimulation, 200
TMS. See Transcranial magnetic
stimulation
TNE. See Transnasal esophagoscopy
Tofranil, 37
Tongue base
after chemoradiation, 409–410
resection of, 398–399, 399
retraction of, 128
Tongue bulk defects, 267, 398
Tongue elevation, 340
Tongue examination, 39–40, 57
Tongue hold or Masako maneuver, 193,
204, 220, 410
Tongue lateralization, 340
Tongue muscles
extrinsic, 2–3, 5
impact of deficit on swallowing and
physical examination findings, 47
role during swallowing, 2–3, 14, 18, 32
Tongue-pharynx constriction, 81
Tongue press exercises, 193, 203
Tongue protrusion reflex, 333, 334, 338
Tongue-strengthening exercises, 193,
203, 220, 410
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479
Tongue surgery, 267, 398–399, 399
Tongue tumors, 398–399
Toronto Bedside Swallowing Test
(TOR-BSST), 50
TORS (transoral robotic surgery), 399,
401–402
Total laryngectomy, 403–405, 404
Total parenteral nutrition (TPN),
301–302
Total pharyngeal transit time, 151
TPN (total parenteral nutrition), 301–302
Tracheostomy, 278–283
Tracheostomy tubes, 274, 283–284
cuffed, 279, 280, 282, 282, 283
fenestrated, 283–284, 284
position relative to other aerodigestive
tract structures, 278, 278–279
risk factors for aspiration, 275–276
uncuffed/cuffless, 280–282, 281, 282,
282, 283
Traction diverticulum, 444, 445
Training for clinicians, 82
Transcranial direct current stimulation
(tDCS), 201, 250–251, 253–255
Transcranial magnetic stimulation
(TMS), 20, 218, 250–251
repetitive (rTMS), 201, 250–255
Transit times
age, gender, and bolus size/
consistency differences in,
151–152
bolus, 148, 149–150, 153, 165
dyscoordinated, 154
prolonged, 128, 152, 154
vs swallow gesture time, 123–124,
124, 154, 157–159
time of arrival at the sphincter
(BP1), 149, 151, 158, 165
time of clearance of the sphincter
(BP2), 149, 151, 158, 165
hypopharyngeal, 131, 151
oral, 125–126
oropharyngeal, 127–128, 151
pharyngeal, 151–152
Transnasal esophagoscopy (TNE),
175–176, 176
Transoral robotic surgery (TORS), 399,
401–402
Transverse tongue response, 57
Traumatic brain injury (TBI), 374–375
Treatment
behavioral approaches, 190–199
bolus manipulation, 208
DSS probes, 113
evaluation of, 222–226
exercise programs, 191–199, 201,
202–207
facilitative devices, 215–218
facilitative maneuvers, 213–215
with flexible endoscopy, 81–82
follow-up, 218–221
implementation of, 218–221
medical therapies, 263–266
muscle stimulation, 199
direct, 200–201, 207
indirect, 199–200
neural stimulation, 199, 201
neuromodulation treatments, 250–262
nutritional treatment plans, 296–301
pretreatment evaluation, 394–395
preventive exercises, 412
respiratory-swallow training (RST),
237–245
surgical therapies, 266–270
therapeutic swallowing strategies, 81
Treatment planning, 187–189, 188,
189–190
Trendelenburg position, 97
Tricyclic antidepressants, 37
Trigeminal motor nucleus, 22, 24
Trigeminal nerve (cranial nerve V), 8–9,
9, 9–10, 56–57
branches, 16, 30
impact of deficit on swallowing and
physical examination findings,
38–39, 45
role during swallowing, 14, 18–19, 30
sensory nuclei, 22
Trochlear nerve (cranial nerve IV),
38–39
Trochlear nucleus, 22
True vocal folds, 16
Tumors, 97
TurboFLASH MRI, 87–88
24-hour recall, 292
Tyco/Healthcare
Kendall™ Argyle™ Silicone Salem
Pump™ Tube, 304
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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
Tyco/Healthcare (continued)
Kendall™ Entriflex™ Dual Port
Feeding Tube, 304
Kendall™ Entriflex™ Dual
Port Feeding Tube with
FLOWTHROUGH™ Stylet, 305
Kendall™ Kangaroo™, 304
U
UES. See Upper esophageal sphincter
Ultrasound, 87, 177, 343
Underweight, 290
University of Auckland Swallowing
Research Laboratory, 343
University of California–Davis Health
System, 320–323
University of California–Davis Medical
Center, 62–63
University of Queensland, 344
University of Utah, 264
Upper body tilting, 212
Upper esophageal sphincter (UES), 17,
268
after chemoradiation therapy,
411–412, 412–413, 414
in multiple sclerosis, 375
Upper esophageal sphincter HRM, 180,
180
Upper vestibule, 16
U.S. Department of Agriculture (USDA),
293
Usual body weight (UBW), 290, 290
V
Vagus nerve (cranial nerve X), 58, 405,
444
branches, 8, 8
impact of deficit on swallowing and
physical examination findings,
46–47
role during swallowing, 13, 15–16,
18–19, 31–32
Vallecula, 403–404
Valsalva maneuver, 97
Valves, 115. See also Chambers and
valves
hypopharyngeal, 134–137
laryngeal
compensations of, 117
DSS analysis, 134–135
linguapalatal
compensations of, 115–116
DSS analysis, 128
oral, 114–116
oropharyngeal, 130–131
pharyngeal, 116–118
pharyngoesophageal
compensations of, 117–118
DSS analysis, 135–137
velopharyngeal
assessment of, 72–73, 73
compensations of, 116–117
Variability, 54–55
VEED. See Videoendoscopic evaluation
of dysphagia
Velopharyngeal port, 72–73, 73
Velopharyngeal valve, 129–130
assessment of, 72–73, 73
compensations of, 116–117
Velum. See Soft palate
Ventilator-associated pneumonias
(VAPs), 276
Ventral swallowing group (VSG), 23–24
Ventricular vocal folds, 16
Vertical munch, 340
Vestibular nuclei, 22
Video radiography, 87
Videoendoscopic evaluation of
dysphagia (VEED), 65
Videofluoromanometry, 88
Videofluoroscopy, 88
BaByVFSSImP (MBSImP infant
version), 343–344
pediatric, 343, 343–344
swallowing study (VFSS). See also
Dynamic swallow study (DSS)
radiation dose, 89–90, 90, 90–91
recommended frame rates, 88
Virtual lesions, 251
Visceral protein status, 290
Viscosity, 209
food continuum of, 296, 297–299
steady-state, 209
Vitamin A deficiency, 332
Vitamins, 295–296
Vocal fold granulomas, 429, 430
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481
Vocal fold paralysis, 17, 267–268
Vocal folds, 16–17
Vocal quality
changes while eating, 35
evaluation of, 58
Volitional movements
assessment of, 57–59
cough or throat clear, 58–59
Volume-Viscosity Swallow Test (VVST),
49–50
VSG. See Ventral swallowing group
VVST (Volume-Viscosity Swallow Test),
49–50
W
Water siphon test, 97
Water swallow tests, 49–50
Water Swallowing Speed Test (WSST),
376
Weekly team meetings, 187
Weight loss, 35
evaluation of, 289, 289
questions to elicit description of, 54
Weight status, 290, 291
Weight-to-length ratio, 330
Wet or gurgling sound, 35
Whiteout strategy, 104
WHO (World Health Organization), 448
Whole-gut transit monitoring, 183, 183
Wireless capsule monitoring, 183, 183
Wireless pH telemetry, 184, 184
World Health Organization (WHO), 330
WSST (Water Swallowing Speed Test),
376
X
Xerophthalmia, 332
Xerostomia, 55, 129, 359–360
in head and neck cancer patients, 405
medical therapies for, 266
Y
Yale Pharyngeal Residue Severity Scale,
80
Z
Zenker’s diverticulum, 168, 183–184, 268
surgical correction of, 269
visualization of, 92–93, 93, 104
Zoloft, 37
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