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. Treatment Planning 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. American Telemedicine Association 2002 ConferenceAmerican Telemedicine Association 2002 Conference

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