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

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


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


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


Examiner Experience VariesExaminer Experience Varies– Rural SettingsRural Settings– Unusual DiagnosesUnusual Diagnoses– Unfamiliar PopulationsUnfamiliar Populations


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

Telefluoroscopic ExaminationTelefluoroscopic Examination

Telefluoro-Telefluoro-scopic scopic ExaminationExamination

3 Phases3 Phases

Remote Remote Expert Expert AnalysisAnalysis

Remote Remote Therapy Therapy PlanningPlanning

Biomechanical AnalysisBiomechanical Analysis

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

[email protected]

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