VFSS


 * Videofluoroscopy Swallowing Study (VFSS) ** [[image:MBS-150x150.jpg align="right" caption="(5:f)"]]

Videofluoroscopy swallowing study (VFSS) is the most common clinical method for instrumental swallowing assessment for the oropharyngeal and pharyngeal phases of the swallow (Peruzzi, Logemann, Currie, & Moen, 2001).

It is a qualitative, dynamic, radiological study of all stages of the swallow that is easily accessible in hospitals. VFSS allows for accurate measurement of the timing of swallow events, the opening capacity of the upper esophageal sphincter (UES), and detection and contributory causes of aspiration (Shaw et al., 2003).

However, a significant limitation of videofluoroscopy is its inability to quantify residual in the oral and pharyngeal cavities because this is a two-dimensional image of three-dimensional cavities (Cicero & Murdoch, 2006). It is a costly procedure which exposes the patient to radiation which is of particular concern for patients already recieving radiation therapy. It is often difficult to visualise airway closure and it may not be representative of true abilities as it is a strange environment for several swallows only.

There are specific procedures to follow when conducting a VFSS. The lateral plane should begin at the lips and go down to the level of the seventh cervical vertebrae (Cicero & Murdoch, 2006). It is easiest to see the focal fold function and symmetry of the swallow in the AP view. It is important to tell the patient that the barium will not be absorbed by the body and will pass through the system.
 * Procedure **

The VFSS can be discontinued at any time however even if aspiration occurs, if position, maneovre, change to diet texture or viscoscity are being trialed, the clinician may decide to continue. If the modifications minimize aspiration the benefits may outweigh the risks (Cicero & Murdoch, 2006).

There is a variety of ways of interpreting VFSS such as descriptions of dysfunction, binary ratings, i.e., and/or the use of rating scales to describe the degree of impairment (Peruzzi, Logemann, Currie, & Moen, 2001). Computer software has been developed to make temporal, distance, and biomechanical measures of swallowing physiology.
 * Interpretation **

Many of these measures are time-consuming and are not used regularily in clinical practice (Cicero & Murdoch, 2006). The interpretations of the measures above often remain subjective as there is no universal consensus of an ‘‘unsafe’’ swallow.

One tool that attempts to make the interpretation more objective is Huckabee's NZIMES [|tool]

Below is a link to knowledge and skills needed by SLT’s for conducting a VFSS from the American Speech-Language-Hearing Association. (2004).

Knowledge and Skills Needed by Speech-Language Pathologists Performing Videofluoroscopic Swallowing Studies [Knowledge and Skills]. Also available from [|ASHA]



Below are published tools that can be used to assess severity that do not require further training. There is a link to an abstract for a journal article providing more detail on the validity and reliability of the tool.
 * Tools **

Modified Barium Swallow Impairment Tool (MBSImp) [|article]

Rosenbeck Penetration-Aspiration Scale [|article]

Videofluoroscopic Dysphagia Scale [|article]

Additional Assessments to Consider