Reconsidering the value of the modified Evan's blue dye test: a comment on Thompson-Henry and Braddock (1995)
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Barium Sulfate↗
Biomedical subjects
D C Tippett
Publications and source records attributed to D C Tippett.
A protocol for the videofluorographic swallowing study.
This paper presents a detailed protocol for performing the videofluorographic swallowing study (VFSS), and describes how it evolved from its antecedents. The objectives of the VFSS are both diagnostic and therapeutic. Preparing for the VFSS is described, including the equipment, food preparation, and a brief discussion of the clinical evaluation. The detailed description of the VFSS procedure covers the position of the patient, the foods presented, the views obtained, modifications of feeding and swallowing that are commonly employed, the standardized set of observations, and reporting the results. Criteria for deviating from the protocol or aborting the study are presented. The VFSS does not necessarily end when a patient aspirates. Indeed, the complete evaluation of aspiration, and the effects of maneuvers designed to reduce it, is a major purpose of the VFSS. Modifications of feeding and swallowing are tested empirically during the study. The modifications include therapeutic and compensatory techniques that may improve the safety and efficiency of swallowing. A rationale for deciding which modifications to test in a given patient is discussed. The protocol has been used successfully in more than 350 patients. It has improved the efficiency and quality of our videofluorographic examinations.
Barium Sulfate↗
Dysphagia and expiratory air flow.
Expiratory air flow preserves the freedom of the upper airway from foodway contamination in patients with dysphagia. Valving the tracheostomy cannula, "quad coughing," the Heimlich maneuver, the "supraglottic swallow," and coupling to a ventilator each has a place among the measures used for treating aspiration.
Deglutition Disorders↗
Synchronous positive and negative myoclonus due to pontine hemorrhage.
We report a case of synchronous positive and negative myoclonus following pontine hemorrhage. Constant synchronous jerking of the eyes, tongue, face, mandible, larynx, pharynx, and diaphragms persisted during sleep. Jerking of limb muscles occurred during volitional activities, but not at rest. Inability to sustain glottic adduction during phonation contributed to severe dysarthria. Electromyography (EMG) revealed positive myoclonus of the branchial musculature with synchronous negative myoclonus in a generalized distribution. Treatment with trazodone reduced the ocular myoclonus but worsened the dysphagia. We suggest that a single neural rhythm generator may produce both positive and negative myoclonus.
Adult↗
Using ventilators for speaking and swallowing.
An inflated cuff, although commonly thought to be required for the ventilator-dependent patient with a tracheostomy cannula, precludes speaking and has adverse implications for swallowing. Clinical trials with five ventilator-dependent, cognitively intact individuals with glottic control document that a deflated cuff is compatible with ventilation, preserves oral communication, and restores safe alimentation by mouth.
Adult↗