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Telefluoroscopy in Dysphagia Management

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

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  1. Telefluoroscopy in Dysphagia Management James L. Coyle Communication Science and Disorders University of Pittsburgh

  2. Speech Language Pathology • Diagnose and Treat • Communication Disorders • Motor Speech Disorders • Language Disorders • Cognitive Disorders • Voice Disorders • Swallowing Disorders

  3. 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

  4. 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

  5. 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.

  6. Diagnosis • Videofluoroscopic Diagnosis • Speech Pathologist • Radiologist • Solid Food, Liquid • Dynamic Assessment • Video, Digital Recording • Diagnosis • Therapy Planning

  7. Swallowing Disorders • Biomechanical Analysis • Food is misdirected by biomechanical errors • And enters the lungs • Pneumonia, choking • Nutritional Compromise • Social Disadvantages • Dehydration • Medication Administration

  8. Swallowing Disorders • Examiner Experience Varies • Rural Settings • Unusual Diagnoses • Unfamiliar Populations

  9. Swallowing Disorders • Treatment Planning May Vary • Diet Modification • Behavioral Maneuvers • Enteral Tube Feeding

  10. 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

  11. Telefluoroscopic Examination

  12. Telefluoro-scopic Examination • 3 Phases • Remote Expert Analysis • Remote Therapy Planning

  13. Biomechanical Analysis

  14. Imaging Interpretation • Advantages • Structural Abnormalities • Image Enhancement • Experience of Expert • Improve Precision • Remote Training

  15. TreatmentPlanning Diet Modification Compensatory Strategies Rehabilitation Referral

  16. Telemedicine and Dysphagia • Remote Home Monitoring • Follow Up • Modification of Plans without Clinic Visits

  17. Telefluoroscopy • Goals: Reduce Dysphagia Related Morbidity • ...in rural settings • ...for those without transportation • ...to reduce healthcare costs • ...and to improve access to expert clinicians

  18. 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.

  19. Telefluoroscopy in Dysphagia Management James L. Coyle, M.A., CCC-SLP Communication Science and Disorders University of Pittsburgh jcoyle+@pitt.edu

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