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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
Fiberoptic endoscopic evaluation of
swallowing (FEES) (continued)
FEESback sessions, 81
in neurogenic dysphagia, 369
supply kits, 67
training for clinicians, 82
Finger control speech, 284
Flexible endoscopic evaluation of
swallowing. See Fiberoptic
endoscopic evaluation of
swallowing (FEES)
Flexible endoscopic evaluation of
swallowing safety (FEESS), 65
Flexible endoscopy
as assessment tool, 65–81
assessment tasks, 71–80, 73–78
equipment for, 65–68
FEES vs fluoroscopy, 70–71
implications of findings, 80–81
limitations of, 69
patient preparation, 65–68
preliminary considerations, 65–68
supplies for, 65–68
certification requirements, 82
issues and concerns, 82–83
single-use endoscopes, 66
as therapeutic tool, 81–82
Flexible endoscopy with sensory testing
(FEEST), 65
Flexible laryngoscopy, 40–41
FLIP (functional lumen imaging probe)
tracings, 181, 182
Fluid needs, 295
Fluids, 209
Fluoroscopy
aspiration during, 134–135, 136
cinefluoroscopy, 431
dynamic swallow study (DSS),
101–120, 121–140, 141–174
esophageal evaluation with, 95
vs FEES, 70, 70–71, 71
limitations of, 102–104, 103
subjective impressions, 135, 136
video. See Videofluoroscopy
fMRI. See Magnetic resonance imaging,
functional
FOIS (Functional Oral Intake Scale), 53
Follow-up, 218–219
Following instructions, 56
Food(s), 54–55
impaired ability to manage, 35
nutrient-dense, 294
patient education materials, 322–323
refluxogenic, 432
texture continuum, 296, 297–299,
316–317
thickeners, 318–319
Food and Drug Administration (FDA),
253, 355–356
Food diary, 292, 330
Food frequency lists, 292
Food intake records, 292–293, 315
Food manipulation
apparent attempts to compensate for
difficulty in, 35
assessment of, 340
Food sticking, 34
Food swallow, 59. See also Swallowing
Forehead against resistance (FAR), 192
Fosamax (alendronate), 353
FSHD (facioscapulohumeral dystrophy),
382
Functional electrical stimulation (FES),
200, 207
Functional lumen imaging probe (FLIP)
systems, 355–356
Functional lumen imaging probe (FLIP)
tracings, 181, 182
Functional Oral Intake Scale (FOIS), 53
G
G-tubes (gastrostomy tubes), 302,
302–305, 306, 396–397
Gag reflex, 42, 56–57, 333, 334–337,
338–339
Gastric emptying, 181–183, 183
Gastroduodenal tubes (GD-tubes),
302–303
Gastroesophageal reflux (GER), 118,
183–184
Gastroesophageal reflux disease
(GERD), 349
definition of, 426
vs LPR, 426–427
medical therapies for, 263–266, 446–447
referrals for, 189
with spinal abnormalities, 446–447
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Gastroesophageal reflux disease (GERD)
esophagitis, 350, 350–351
Gastrointestinal reflux, 278
Gastrostomy
percutaneous endoscopic (PEG), 302,
302–303, 305–307
radiologically inserted (RIG), 305–307
Gastrostomy tubes (G-tubes), 302,
302–305, 306, 396–397
GD-tubes (gastroduodenal tubes),
302–303
Gender differences
in spatial measures, 167–168
in swallow gesture time, 157
in transit times, 151–152
Genioglossus muscles, 2–3, 5, 32, 47
Geniohyoid muscle, 14, 16, 18, 32, 47
GERD Impact Scale (GIS), 446–447
Global development, 332
Glossopharyngeal nerve (cranial nerve
IX), 8, 9, 56, 58, 405
impact of deficit on swallowing and
physical examination findings, 45
role during swallowing, 15, 19, 30
Glottal Enterprises, 238
Granuloma, vocal fold, 429, 430
Gravity
position strategies that exploit, 212–213
positioning and effects of, 128
Growth charts, 330–331
Growth standards, 330
Guided observation of swallowing in
the esophagus (GOOSE), 176–177,
177
Guillain-Barré syndrome, 366
Gums, 338
H
H2-receptor antagonists (blockers), 265,
431
Hamwi method, 294
Hard palate reconstruction, surgical, 400
Hawk-spit maneuver, 214–215
Head and neck cancer
chemoradiation therapy for, 397, 406,
406–415, 411–412, 414
postoperative radiation therapy for,
405–406
pretreatment evaluation, 394–395
surgery for, 397–405
Head and neck cancer database, 222,
223–225
Head and neck cancer patients, 393–424
dysphagia in, 394–395, 395, 405–406,
406, 406–407
gastrostomy tube placement, 396–397
preventive swallowing therapy
exercises for, 412
quality of life, 415–416
swallowing abnormalities, 408–415,
411–412
swallowing coordination, 413, 414
Head and neck physical examination,
42–43
Head tilting, 212–213
Heller myotomy, 357
Hiatal hernia, 96–97
example findings, 95
with solid food dysphagia, 350–351,
351
High-definition distal chip (“chip in the
tip”) endoscopes, 65–66
High-frequency rTMS, 252–253
High-resolution computed tomography,
178
High-resolution impedance planimetry,
181, 182
High-resolution manometry (HRM)
esophageal, 179, 179, 355–356
with impedance tracings (HRIM), 180,
181, 343
pharyngeal (HRPM), 180, 180, 369–370
pharyngoesophageal, 367
UES, 180, 180
High-resolution pharyngeal manometry
(HRPM), 180, 180
Histamine, 265
History
developmental, 329
medication, 37
nutritional, 292–293
past medical, 36, 36
pediatric feeding, 329
pediatric medical, 328–329
pediatric nutritional, 330–331
swallowing, 53–55
Hold position, 159–162, 161
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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
Household thickeners, 301, 320
HRM. See High-resolution manometry
Huckabee, Maggie-Lee, 246–249
Huntington’s chorea, 288
Huntington’s disease, 366, 377–378
Hydration
laboratory data, 292
suboptimal, 289
Hyoglossus muscles, 2–3, 5, 11, 32, 47
Hyoid bone, 13–14
Hyoid bone removal, 403, 404
Hyoid displacement
age, gender, and bolus size/
consistency differences in, 157,
167–168
DSS analysis, 125
H1, 149, 153–155, 165
H2, 149, 153–155, 165
H3, 149, 153–155, 165
maximum (Hmax), 159, 162, 165,
167–168
preparatory movements, 155
reduced, after chemoradiation
therapy, 410–412, 411–412
Hyoid/larynx elevation
after chemoradiotherapy, 411–412, 412
surgical, 269
Hyoid-to-larynx approximation, 163
age, gender, and bolus size/
consistency differences, 167–168
bolus size differences, 168
clinical implications, 170–171
at Hold (HLhold), 159, 163, 170–171
maximum (HLmax), 149, 159, 163,
165, 167–168
Hyolaryngeal complex, 273
Hypercontractile esophagus, 358–359
Hypernatremia, 289
Hyperplasia, 338
Hypersensitivity, oral, 333–338
Hypertonicity, 332
Hypoalbuminemia, 292
Hypoglossal nerve (cranial nerve XII), 57
course of, 5, 16
impact of deficit on swallowing and
physical examination findings,
40, 47
role during swallowing, 7–8, 11, 16,
18, 21, 32
Hypoglossal nerve palsy, 40
Hypoglossal nucleus, 21, 22, 24
Hypopharyngeal clearing, 132–133
Hypopharyngeal examination, 40–42
assessment tasks, 73–74, 74
DSS analysis, 131–137
Hypopharyngeal swallow actions,
122–123
Hypopharyngeal transit time, 131, 151
Hypopharyngeal tumors, 394–395
chemoradiation therapy for, 406–407
surgical treatment of, 397
Hypothyroidism, 360
Hypotonicity, 332
I
IAEA (International Atomic Energy
Association), 89
IBM (inclusion body myositis), 379–382,
381
Icing, 217–218
IDDSI (International Dysphagia Diet
Standardization Initiative), 92,
209–210, 300, 300–301
Ideal body weight (IBW), 290, 290
calculation, 294, 294
IEM (ineffective esophageal motility),
356, 359
Imaging, 177–178
Immune-mediated necrotizing
myopathy, 379–382
Impedance testing, 430
high-resolution planimetry, 181, 182
multichannel intraluminal, 180–181,
181, 430
IMRT (intensity-modulated radiation
therapy), 407–408
Inclusion body myositis (IBM), 379–382,
381
Indirect laryngoscopy, 40–41. See also
Flexible laryngoscopy
Indirect muscle stimulation, 199–200
Ineffective esophageal motility (IEM),
356, 359
Infants and young children. See also
Children
DSS protocol for, 112
feeding skills, 334, 334–335
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feeding skills assessment, 339–340,
343, 343–344
oral assessment, 333–339
special studies for, 189
videofluoroscopy in, 343, 343–344
Infectious esophagitis, 352, 352
Inferior pharyngeal constrictor muscle,
11–12, 15, 18, 31, 46
Inferior salivatory nucleus, 22
Inflammatory myopathy, 359, 381
Inflammatory myositis, 379–382, 381
Information management, 222, 223–225
Infraglottic edema, 429, 429
Inner arytenoid muscle, 32, 47
Inpatient care, 276–277
Instrumental assessment, pediatric,
342–344
Intensity-modulated radiation therapy
(IMRT), 407–408
Intensive care unit (ICU), 66, 302
Interincisal distance, 57
International Atomic Energy Association
(IAEA), 89
International Dysphagia Diet
Standardization Initiative
(IDDSI), 92, 209–210, 300,
300–301
Interneurons, 22, 23–24
Intubation, orotracheal, 279, 279
IOPI Medical, 198
Iowa Oral Performance Instrument
(IOPI), 193, 198–199, 203, 220
J
JAR (jaw lowering against resistance),
202, 220
Jaw
interincisal distance, 57
normative data in adults, 57
physical examination of, 56–58
Jaw lowering against resistance (JAR),
202, 220
Jaw movements, 340
Jaw range-of-motion exercises, 207, 220
Jaw thrust, 213, 215
Jejunal feeding, 307
Jejunostomy tubes (J-tubes), 302,
302–303, 305
K
Kendall™ Argyle™ Silicone Salem
Pump™ Tube (Tyco/Healthcare),
304
Kendall™ Entriflex™ Dual Port Feeding
Tube (Tyco/Healthcare), 304
Kendall™ Entriflex™ Dual Port Feeding
Tube with FLOWTHROUGH™
Stylet (Tyco/Healthcare), 305
Kendall™ Kangaroo™ (Tyco/
Healthcare), 304
KimberlyClark™ MIC™ Gastrostomy
Feeding Tube (Ballard Medical
Products), 306
Kwashiorkor, 332
Kyphosis, 440–441, 442
L
Laboratory data, 290–292
Laboratory studies, 225
Lansoprazole, 265–266
Laryngeal chambers and valves
assessment of, 76–79, 77–78
compensations of, 117
conceptual approach, 123
DSS analysis, 134–135
Laryngeal examination
flexible endoscopy assessment, 76–79,
77–78
hyoid-to-larynx approximation, 163
age, gender, and bolus size/
consistency differences, 167–168
bolus size differences, 168
clinical implications, 170–171
at Hold (HLhold), 159, 163,
170–171
maximum (HLmax), 149, 159, 163,
165, 167–168
physical, 42, 58–59
Laryngeal lift, 205
Laryngeal muscles, 16–17, 17, 32, 47
Laryngeal tumors, 394–395, 395
chemoradiation therapy for, 406–407
surgical treatment of, 397, 402–403
swallowing abnormalities after
chemoradiation therapy for,
409–410
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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
Laryngectomy
partial, 402–403
supraglottic, 402, 403
total, 403–405, 404
Laryngopharyngeal reflux (LPR),
425–438
definition and nomenclature, 425
diagnosis of, 427–428, 433
diagnostic studies, 430–431
epidemiology, 426
vs GERD, 426–427
pH monitoring in, 430
physical findings associated with,
428–429, 429–430
recommended lifestyle modifications
for, 431, 431
symptoms of, 427–428
treatment of, 431–433
Laryngoscopy, indirect or flexible, 40–41
Larynx
elevation of, 404
hyolaryngeal complex, 273
laminar airflow alteration during
auscultation of, 35
saliva swallow and laryngeal
management, 59
surgery that affects, 402–405
surgical elevation of, 269
upper vestibule, 16
Laser resection, endoscopic supraglottic,
402, 403
Leading complex, 18
Lee Silverman Voice Therapy (LSVT),
194–195, 205, 220–221
LES. See Lower esophageal sphincter
Levator veli palatini muscle, 6, 11, 31, 46
Lidocaine, 41
Lifestyle considerations, 293–294
Lifestyle recommendations, 431, 431
Linear nonthreshold theory (LNT), 89
Lingual nerve, 9, 10
Linguapalatal valve, 125–128, 130
compensations of, 115–116
posterior, 126–127
Lips, 57
Liquid alginate, 432
Liquid dysphagia, 301
Liquid swallow, 59. See also Swallowing
Liquids
cough with, 34
dysphagia for, 34
texture continuum, 296, 297–299,
316–317
thickened, 209
tips for thickening, 321
Living situation, 189
LNT (linear nonthreshold theory), 89
Localization of problem, 54
Lordosis, 440–441, 442
Lower esophageal sphincter (LES), 25,
96, 349
“bird’s beak” appearance, 356,
356–357
medications that relax, 353, 353
LPR. See Laryngopharyngeal reflux
LSVT (Lee Silverman Voice Therapy),
194–195, 205, 220–221
Lubrication, 107
Lung cancer, 274
Lusorian artery, 440, 441
Lymphoid hyperplasia, 429
M
Magnetic resonance imaging (MRI), 87,
178, 368
cine-MRI, 87–88
dynamic techniques, 87, 178
equipment for, 88
functional (fMRI), 20, 178
high-speed, 87
turboFLASH MRI, 87–88
Magnetoencephalography (MEG), 20
Malandraki, Georgia, 190
Malnutrition
definition of, 288–289
diagnostic criteria for, 289
mild, 290
moderate, 290
severe, 290
signs of, 332
Mandible tumors, 399–400, 400
Mandibular advancement, 215
Mandibular prosthesis, 216
Manometry, 109, 222
esophageal, 179, 179
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high-resolution impedance (HRIM),
180, 181, 343
pharyngeal, 180, 180
Manual therapy, 200
Marasmus, 332
Martin-Harris, Bonnie, 239–240
Masako maneuver, 193, 204, 220, 410
Massage, 200
Masseter muscle, 45
Mastication, muscles of, 9–10, 10, 30, 45,
57
Maximum hyoid-to-larynx
approximation (HLmax), 149,
159, 163, 165, 167–168
Maximum pharyngeal constriction
(PAmax), 149, 158–160, 163–164,
165
Maximum pharyngoesophageal
segment opening (PESmax), 149,
155–156, 158, 160, 164
age, gender, and bolus size/
consistency differences, 167–168
clinical implications, 168, 170
normative data, in adults, 143–144,
145
MBSImP infant version (BaByVFSSImP),
343–344
MD (muscular dystrophy), 382–385
MD Anderson Dysphagia Inventory
(MDADI), 378
Meals, 35
Measures, objective, 141–174, 165
Mechanical measures, 145
Mechanical stimulation, 217
Medical history, 293–294
in clinical swallow evaluation, 52–53
past, 36, 36
pediatric, 328–329
Medical Innovations, 306
Medical status, 189
Medical therapies, 263–266
Medication history, 37
Medications
change in routine ability to take, 35
neurogenic dysphagia due to, 378–379
pill or pill-induced esophagitis, 353,
353, 379
that cause dryness, 37, 378–379
that cause dysphagia, 353, 353
Medtronic SmartPill®, 183, 183
Meetings, weekly, 187
MEG. See Magnetoencephalography
Mendelsohn maneuver, 205–206, 215,
220, 412
Mental health status, 293
Mesencephalic nucleus, 22
MIC™ Gastro Enteric Feeding tube
(Medical Innovations), 306
Middle pharyngeal constrictor muscle,
11–12, 15, 18, 31, 46
Miles, Anna, 190
Mills, Madeline, 246–249
Minerals, 295–296
Mobility exercises, 191–199, 202–207
Modified barium swallow, 87. See also
Dynamic swallow study (DSS)
Monoclonal antibodies (mAbs), 379
Montreal Children’s Hospital Feeding
Scale, 328
Motility
assessment of, 178–184
esophageal motility disorders, 97,
355–356
ineffective esophageal motility (IEM),
356, 359
Motoneurons, 21–23, 22, 24
Motor neuron diseases (MNDs), 250,
365, 373–374, 374
Mouth
anterior floor
surgery that affects, 397–398
tumors of, 399–400, 400
assessment of, 338
MS (multiple sclerosis), 288, 365, 366,
375–376
Mucosal dryness, 128–129
Multichannel intraluminal impedance
testing, 180–181, 181, 430
Multidisciplinary Feeding Profile, 328
Multiple sclerosis (MS), 288, 365, 366,
375–376
Muscle stimulation, 199
direct, 200–201, 207, 220
indirect, 199–200
Muscle training, 195
Muscular dystrophy (MD), 382–385
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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
Myasthenia gravis, 366, 384–385
Mylohyoid muscle, 13–14, 14, 30, 45
Myofascial therapy, 200
Myotonic muscular dystrophy, 366,
382–384
N
NAM (necrotizing autoimmune
myositis), 379–382
Nasoduodenal (ND) tubes, 302, 302–303,
305
Nasogastric (NG) tubes, 302, 302–303,
304
Nasojejunal (NJ) tubes, 302, 302–303
Nasopharyngeal examination
DSS analysis, 127–131
physical, 41
National Center for Health Statistics, 330
National Council for Radiation
Protection (NCRP), 89
National Institutes of Health (NIH), 290,
295–296
National Institutes of Health Stroke
Scale, 369
National Outcomes Measurement
System (NOMS), 226
NCRP (National Council for Radiation
Protection), 89
ND (nasoduodenal) tubes, 302, 302–303,
305
Neck: palpation of, 42
Neck dissection, 408
Neck flexion (chin tuck), 212
Necrotizing autoimmune myositis
(NAM), 379–382
Neo-Synephrine (phenylephrine), 41, 67
Neonatal intensive care unit (NICU),
327, 329
Neonatal Oral-Motor Assessment Scale
(NOMAS), 331–332
Neoplasms, esophageal, 360
Neural control, 18–19
Neural stimulation, 199, 201
Neurogenic dysphagia, 365–391
in Alzheimer’s disease, 377–378
in amyotrophic lateral sclerosis,
373–374
assessment in, 366–367
after brain injury, 374–375
in cerebral palsy, 376–377
etiology, 365, 366
in inflammatory myositis, 379–382,
381
medication effects, 378–379
in multiple sclerosis, 375–376
in muscular dystrophy, 382–385
in Parkinson’s disease (PD), 371–373
after stroke, 367–371
Neuromodulation treatments, 250–262
Neuromuscular disease, 274
medical therapies for, 263
peripheral disorders, 379–385
Neuromuscular electrical stimulation
(NMES), 199–200, 206, 220
Neuroplasticity, 250
Newborns, 334. See also Infants and
young children
NG (nasogastric) tubes, 302, 302–303,
304
NIBS (noninvasive brain stimulation),
250–251, 255
NICU (neonatal intensive care unit), 327,
329
NIH (National Institutes of Health), 290,
295–296
Nizatidine, 265
NJ (nasojejunal) tubes, 302, 302–304, 305
NMES (neuromuscular electrical
stimulation), 199–200, 206, 220
NOMAS (Neonatal Oral-Motor
Assessment Scale), 331–332
Nomenclature, 425
NOMS (National Outcomes
Measurement System), 226
Noninvasive brain stimulation (NIBS),
250–251, 255
Nonoral feeding, 301–302
Nonsteroidal anti-inflammatory drugs,
353
Normative data, in adults, 142–145,
143–144
for interincisal distance, 57
for pharyngeal area, 73
NTS. See Nucleus tractus solitarius
Nucleus ambiguus, 21, 22, 25
Nucleus solitarius, 22
Nucleus tractus solitarius (NTS), 19, 23
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Nutrition, 287–323, 320–323
Nutritional assessment, 288–294, 290
Nutritional goals, 294–296
Nutritional history, 292–293, 330–331
Nutritional status, 330
Nutritional treatment plans, 296–301
O
Obesity, 290, 291
Objective measures, 147–157
in adults, 141–174, 165
evaluation with, 222
mechanical, 145
path to, 141–142
pros and cons, 145–147
Observation
of children, 331–332
clinical, 55–59
guided observation of swallowing in
the esophagus (GOOSE), 176–177,
177
Oculomotor nerve (cranial nerve III),
38–39
Oculomotor nucleus, 22
Oculopharyngeal muscular dystrophy
(OPMD), 366, 382–383
Odynophagia, 96
Omeprazole, 265–266
One-way valve speaking systems, 284
Onset of problem, 54
OPMD (oculopharyngeal muscular
dystrophy), 382–383
Optic nerve (cranial nerve II), 38–39
Oral cavity, 123
compensation of chambers and valves
in, 114–116
evaluation of
DSS, 114–115, 125–127
pediatric assessment, 338
physical examination, 39, 56–58
radiographic assessment, 102, 103
physiology of, 1–2
Oral cavity tumors, 394–395, 395, 397
Oral clearing, 126
Oral feeding, 276–277, 296–301
Oral hypersensitivity, 333–338
Oral-labial incompetence, 267
Oral-Motor/Feeding Rating Scale, 328
Oral preparation, 125–126
Oral reflexes
assessment of, 56–57, 333–339
pediatric, 333–339, 334–337
Oral secretions
excessive, 35
normal, 10
physical examination of, 58
questions to elicit description of
problem, 55
Oral sensory-motor assessment
pediatric, 333–339
physical examination, 58
Oral sphincter, 397
Oral transit time, 125–126
Orbicularis oris muscle, 2, 3, 11–12, 30,
45
Orientation techniques, 217
Oropharyngeal cancer, 394–395
chemoradiation therapy for, 406–407,
409–410, 411–412
preventive swallowing therapy
exercises in, 412
surgical treatment of, 397
swallowing abnormalities after
chemoradiation therapy for,
409–410, 411–412
Oropharyngeal chamber, 127–131
Oropharyngeal clearing, 128–130
Oropharyngeal dysphagia
in GERD, 264–265
in inflammatory myopathy, 381
neurogenic, 365, 381
Oropharyngeal structures
assessment of
DSS analysis, 127–131
DSS findings of interest, 93–94
flexible endoscopy, 73–74, 74
physical examination, 40
direct stimulation of, 217
physiology of, 1–2
swallow actions, 123
Oropharyngeal transit time, 127–128,
151
Oropharyngeal valves, 130–131
Orotracheal intubation, 279, 279
Osteophytectomy, surgical, 448
Osteophytes, 441–444, 443, 447–448
Outpatient care, 277
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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
Overall conditioning, 55
Overweight, 290, 291
P
Paediatric Assessment Scale for Severe
Feeding Problems, 328
Paediatric Eating Assessment Tool, 328
Palatal appliances, 216
Palatal muscles, 30–31, 45–46
Palatal obturators, 267, 400
Palatoglossus muscles, 3–7, 6
impact of deficit on swallowing and
physical examination findings, 46
innervation of, 5, 18
role during swallowing, 2–3, 14, 18, 31
Palatopharyngeus muscles, 6
impact of deficit on swallowing and
physical examination findings, 46
innervation of, 15, 18
role during swallowing, 14, 18, 31
Palmar grasp, 341
Palpation, of neck, 42
Pantoprazole, 265–266
Parasympathetic nervous system, 10
Parasympatholytic drugs, 37
Parasympathomimetic drugs, 37
Parent-Child Feeding Scale, 342
Parent-report instruments, 328
Parental Feeding Questionnaire, 328
Parenteral nutrition
peripheral (PPN), 301
total (TPN), 301–302
Parkinson’s disease (PD), 250, 360, 365,
366, 371–373
Parkinson’s syndrome, 288
Partial laryngectomy, 402–403
PAS (Penetration-Aspiration Scale), 80,
222, 226
PAS (Phonatory Aerodynamic System),
238
Past medical history, 36, 36
Patient education materials, 320–323
Patient history
medication history, 37
nutritional history, 292–293
past medical history, 36, 36
pediatric feeding history, 329
pediatric medical history, 328–329
pediatric nutritional history, 330–331
swallowing history, 53–55
Patient position. See Position(s)
Patient’s questions or complaints
chief complaint, 34–35
swallowing complaint, 52–53
Paxil, 37
PCR. See Pharyngeal constriction ratio
Pediatric clinical feeding assessment,
325–348
case history, 328
indications for, 327
team approach, 327
templates for pediatric feeding
history and clinical evaluation,
329
tools for, 327–328
Pediatric Eating Assessment Tool
(Pedi-EAT), 328
Pediatric Evaluation of Disability
Inventory (PEDI), 328
Pediatric feeding problems, 325, 326
Pediatric feeding skills development,
334–337
PEG (percutaneous endoscopic
gastrostomy), 302, 302–303,
305–307
PEJ (percutaneous endoscopic
jejunostomy), 302–303, 305
Pembrolizumab, 379
Penetration
barium radiographic evaluation of,
93–94
FEES vs fluoroscopy assessment of,
70, 70–71, 71
supraglottic, 134
Penetration-Aspiration Scale (PAS), 80,
222, 226
Pentax, 198
PENTAX Medical, 238
Peptic esophageal disease, 176
Percutaneous endoscopic gastrostomy
(PEG), 302, 302–303, 305–307
Percutaneous endoscopic jejunostomy
(PEJ), 302–303, 305
Performance bandwidth rules, 239
Performance feedback tools, 197–199
Peripheral neuromuscular disorders,
379–385
INDEX
https://t.me/medicina_free
473
Peripheral parenteral nutrition (PPN),
301
Peristalsis
disorders of, 357–359
pharyngeal, 136
secondary, 25
types seen, 96
Peroral endoscopic myotomy (POEM),
357
PES. See Pharyngeal electrical
stimulation; Pharyngoesophageal
segment
PET (positron emission tomography),
20, 408
pH monitoring, 430, 433
ambulatory testing, 183–184, 184
impedance testing with, 181, 430
Phagenyx treatment, 201
Pharyngeal chambers and valves
compensations of, 116–118
conceptual approach, 123
DSS analysis, 125
normative data, in adults, 73
positions that impact chamber shape
and function, 213
Pharyngeal constriction
at Hold (PAhold), 159–160, 163, 165,
166, 168
maximum (PAmax), 149, 158–160,
163–164, 165
reduced
after chemoradiation, 409
in head and neck cancer patients,
409–410
Pharyngeal constriction ratio (PCR), 76,
159–160, 163–164, 165
age differences, 167–168
clinical implications, 168–170
elevated, in inclusion body myositis,
381, 381
Pharyngeal constrictor muscles, 11–12
attachments to the larynx, 403, 404
impact of deficit on swallowing and
physical examination findings, 46
role during swallowing, 12, 15, 31
Pharyngeal electrical stimulation (PES),
250
application, 253
future work, 255
results/evidence for, 254–255
technology/mechanism, 252
Pharyngeal examination
barium radiographic evaluation,
87–99, 92–93
flexible endoscopy, 73–76, 74–76
manometry, 180, 180
physical examination, 42, 58–59
radiographic evaluation, 87, 102, 103
Pharyngeal manometry, 180, 180
Pharyngeal muscles, 30–31, 45–46
Pharyngeal peristalsis, 136
Pharyngeal plexus, 8, 8
impact of deficit on swallowing and
physical examination findings,
45–46
role during swallowing, 11, 15, 18–19,
30–31
Pharyngeal residue
expectoration of, 213
measures for quantifying, 164–167
Pharyngeal residue ratio (PRR), 166, 167
Pharyngeal shortening, 167
Pharyngeal squeeze maneuver, 75–76,
205, 220
Pharyngeal subdivisions, 122–123
Pharyngeal transit times, 151–152
Pharyngoesophageal segment (PES), 72
after chemoradiation therapy,
412–413, 414
compensations, 117–118
distension, 164
DSS analysis, 125, 135–137
maximum opening (PESmax), 149,
155–156, 158, 160, 164
age, gender, and bolus size/
consistency differences, 167–168
clinical implications, 168, 170
normative data, in adults, 143–144,
145
role during swallowing, 16–17
time of closing (Pcl), 150, 155–156
time of opening (Pop), 149, 155–156,
158, 165
age differences in, 157
bolus size/consistency differences,
157
Pharynx
anatomy and physiology of, 273–274
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