Evaluation Guide For Vocal Variety Pdf CreatorExpunging Grades in Middle School; FCPS 2015-16 District Profile; FCPS 2015-2016 Optional Course Guide; FCPS 2015-2016 Standard Course Guide; FCPS Graduation Requirements Information; FCPS Handbook for High School Grading. For many years, videofluoroscopy was considered the gold standard for studies on swallowing disorders, and only recently has its role been challenged, due primarily to the widespread use of videoendoscopy in the evaluation of. How to go about defining, studying, and explaining emotions. The last 100 years, psychologists have offered a variety of definitions, each focussing on different manifestations or components of the emotion. Rhinology & Laryngology 119(7):460-467. Vocal Function Exercises for Presbylaryngis: A Multidimensional Assessment of Treatment Outcomes Cara Sauder. ClassZone Book Finder. Follow these simple steps to find online resources for your book. Using other people’s research or ideas without giving them due credit is plagiarism. Role of videofluoroscopy in evaluation of neurologic dysphagia. Acta Otorhinolaryngol Ital. Dec; 2. 7(6): 3. 06–3. Rugiu SOC ORL, Azienda Universitaria Ospedaliera, P. S. ta Maria della Misericordia 1, 3. MCPS CURRICULUM 2.0 7 IN CURRICULUM 2.0, GRADE 1, specific critical and creative thinking and academic success skills are identified for each marking period. These skills are explicitly taught through the concepts and topics. What's Changing in AP Learn more about new courses and courses undergoing changes over the next few years. Udine, Italy, Fax: +3. Email: ti. orebil@anyloyram. Conference. Round Table 9. National Congress Italian Society of Otorhinolaryngology and Cervico- Facial Surgery (S. I. O. Albeit, videofluoroscopy still maintains its key role in this area and, in particular, in studies on dysphagia of neurological origin, on account not only of the possibility, with this procedure, to achieve complete and dynamic evaluation of all phases of deglutition, but also the high sensitivity and specificity in revealing the presence of inhalation. Evaluation Guide For Vocal Variety Pdf PrinterAim of the present investigation was to analyse the technical procedure of videofluoroscopy and the principal indications in the study of dysphagia of neurological origin, in the attempt to reveal the advantages and disadvantages occurring in this examination, also with respect to other methods adopted in the evaluation of dyphagia. In conclusion, at present, no instrumental examination can be defined as ideal for the study of swallowing, but it can be seen that, with each of these procedures, the information forthcoming is actually complementary, thus achieving the aim to proceed as correctly and rapidly as possible, with the management of patients with dysphagia. Keywords: Swallowing, Dysphagia, Aspiration, Videofluoroscopy, Fiberoptic endoscopy. Riassunto. La videofluoroscopia . Solo recentemente il suo ruolo . La videofluoroscopia mantiene comunque il suo ruolo chiave in questo campo ed in particolare nello studio della disfagia di origine neurologica, grazie soprattutto alla possibilit. In questo lavoro saranno analizzate le modalit. In conclusione attualmente nessun esame strumentale pu. It is a frequently encountered problem with a marked social impact, if taking into consideration that it has been estimated that, in 2. United States of America, 1. This is a deficit that follows the course of the initial disorder, thus, in some cases, it presents with an acute onset and a seemingly favourable course, as in the case of stroke and traumatic brain injury, whilst in others, the course is chronic and progressively presents a more serious behaviour, as in the neurodegenerative diseases. In both cases, dysphagia is associated with an increase in the risk of aspiration pneumonia, malnutrition and dehydration, which lead to an increase in morbidity and mortality of the patients affected, as well as a deterioration in quality of life and a marked increase in public health spending. Rapid diagnosis and management of the swallowing disorder is, therefore, mandatory and should be aimed at: early identification of those patients with dysphagia presenting risk of aspiration; exclusion of the presence of structural alterations of the organs involved in swallowing; characterization of the alteration of the swallowing mechanism responsible for the dysphagia; indication needs to suspend oral feeling and to adopt other alternatives for feeding, which in most cases is performed by means of percutaneous endoscopic gastrostomy (PEG), or, on the other hand, defining the right time to recommence oral feeding; programming of the specific therapeutic strategy, which includes the choice of the type of food to be given and/or planning of the rehabilitative logopaedic treatment. Videofluoroscopy (VFS) or modified barium swallow has, for the last ten years, been considered the instrumental examination of choice in the study of swallowing, in addition to clinical history and bedside assessment. Study of swallowing using cineradiography, was first proposed, in 1. Donner & Siegel, who recognized its usefulness in the study of dysphagia caused by neuromotor disorders 2. This technique has since been re- elaborated and improved, in particular by Logemann, which greatly contributed to further knowledge regarding the physiopathology of swallowing, with fundamental repercussions on the diagnosis and treatment of dysphagia 3. The examination, which consists in recording fluoroscopic images which appear on the monitor during intake by the patient of a radio- opaque bolus, enables a precise evaluation to be made, not only of the morphological features but also, and above all, the dynamics of the swallowing act, including its three phases: oral, pharyngeal and oesophageal. Even if, over the years, various instrumental investigations have been used alongside VFS, first of which videoendoscopy, but also oro- pharyngeal scintigraphy, echography, manometry which have been widely used in studies on swallowing, VFS still maintains a determinant role in achieving more detailed diagnostic data concerning swallowing disorders 5. In the present report, based upon an analysis of the more recent literature, attention will be focused not only on the technical procedures used in this investigation, including the indications, in particular, in dysphagia of neurological origin, but also the advantages and limits, also compared to other instrumental examinations currently available for the specialist. Technical procedure. VFS is a radiological investigation based upon the recording of fluoroscopic images appearing on the monitor of an X- ray machine, whilst the patient is swallowing a radio- opaque bolus. The equipment required to perform the investigation comprises a fluoroscopic tube large enough to include images of the oral cavity, pharynx, larynx, and upper oesophagus, as well as a high resolution video recording system. The possibility to be able to see the recorded images at any time during the course of the examination is fundamental considering that the swallowing action occurs in an extremely short time (approximately 2 seconds), thus making immediate analysis very difficult. Compared to cineradiography, which consists in a simple cinematographic recording on tape, VFS presents a series of advantages represented by less exposure to radiation and the possibility to see the recorded images again immediately, even while the examination is still being performed. The disadvantage consists, on the other hand, in the less frequent acquisition of the images with VFS compared to cinematography, 2. The examination is performed by a radiologist, preferably in the presence of a phoniatric specialist and/or logopaedist. VFS should be performed with the patient in a standing or sitting position, not only on account of the way in which the equipment is set up but also in order to place the patient in as close as possible to a physiological position for the swallowing act. The examination generally begins with the latero- lateral view, which allows identification of the reference points, namely, the cervical rachis, the prevertebral soft tissues, the tongue base, the hyoid bone and the larynx. These structures can be studied either at rest or whilst performing a dry swallow. The next phase consists in administering a series of radio- opaque boluses, to the patient, represented by preparations of varying consistency opacified with contrast media and, if possible, made to taste pleasant in order to encourage the patient to take them. In theory, when performing this examination it is worthwhile attempting, as far as possible, to follow a standardized procedure as far as concerns the type of bolus given (rheological characteristics and quantity) which will be useful when comparing and repeating future examinations; albeit, due to the wide variety of clinical cases studied this cannot always be applied and it is, therefore, necessary to use personalised procedures. Usually, the examination begins with the administration of barium of liquid consistency, but sometimes it is better to begin using the consistency which is easier for the patient to swallow and which offers greater safety margins as far as concerns the risk of inhalation; usually this consists of a semi- solid consistency. The quantity administered begins with 5 or 1. In those cases in which there is strong suspicion of the presence of inhalation, it is advisable to begin with the administration of the minimum quantity of boluses, for example 2 ml, in order to avoid the risk of inhalation of greater quantities of the contrast medium, particularly in the absence of a valid cough. If no signs of inhalation are observed, the examination is continued with the administration of boluses of variable consistency: liquid, semi- liquid and solid. For the latter, a biscuit or piece of toasted bread can be used, or as an alternative a “Marshmallow”, a sweet characterized by the elastic jelly- like consistency, dipped in barium. Currently available, on the market, are specific “ready for use” preparations, all containing the same concentration of sulphate barium, but varying in consistency and which have been made palatable (Varibar, E- Z- EM, Westbury, NY, USA). Use of these products offers the advantage of greater standardization of the tested consistencies as well as a better guarantee of reproducibility of the examination. Furthermore, Varibar is formulated with a concentration of barium which minimally coats mucosal surfaces, which, theoretically, results in a more accurate diagnosis of the oral and/or pharyngeal stasis 7. As already pointed out, first of all, registration in a latero- lateral position is necessary: this plane offers the possibility to evaluate the passing of the bolus from the oral cavity towards the pharynx and subsequent passing into the oesophagus by way of the upper oesophageal sphincter (UES), analysing the movements of the mandible, tongue, velum palati, pharyngeal wall, hyoid bone, epiglottis.
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