Overview

With a fresh, integrative approach that lays a strong conceptual foundation for dysphagia evaluation and treatment, Dysphagia is the culmination of what clinicians, graduate students, and professors have been seeking in a comprehensive swallowing and swallowing disorders instructional book. The authors translate very complex information to clinically practical information with direct application.

The text covers the neural and functional anatomical underpinnings of swallowing and its disorders. The neural mechanisms are directly related to the targeted swallowing function (not just a muscle group as in the traditional approach). This novel approach teaches clinicians to carefully evaluate the potential etiology of the functional disorder – a skill that is highly regarded by instructors, clinicians, and physicians.

The entire spectrum of dysphagia (mouth to stomach)is covered and the authors highlight the importance of interaction of integrative behavioral systems that must be considered in evaluation and treatment (i.e., respiration, cardiopulmonary, cognitive, speech, voice, etc). Also discussed is the influence of condition on swallowing function such as, sleep/wakefulness, varied medical, systemic and surgical etiologies. Overall, this text aims to prepare students and clinicians to approach the swallowing disorder based on the physiologic targets involved in bolus preparation, propulsion, airway protection, and bolus clearance regardless of the etiology.

State of the art evaluation and treatment methods are detailed and illustrated with emphasis on how to select the methods based on the patient population, setting, and specific questions that needed to be addressed. Methods for concise and clear reporting of testing results are included to permit standardized comparison of findings across clinics and clinical laboratories.

Instructors struggle with training students/clinicians to integrate all aspects of a patient’s case when designing appropriate treatment plans. Treatment, therefore, is strategically imbedded into the evaluation section. Following an introduction to the treatment approaches (compensatory, physiotherapeutic), treatment modalities (biofeedback, sensory stimulation, etc.), and comparative evidence regarding their utility, treatments are paired with the specific physiologic swallowing impairments/targets.

In summary, Dysphagia is a swallowing and swallowing disorders (dysphagia) text fresh in its approach to learning, based on years of teaching and clinical experience, discussions with colleagues, and a passion to train new and experienced clinicians in the evaluation and rehabilitation of this challenging and exciting area of clinical practice.

Audience

Primary Subject: Speech and Language Pathology / Swallowing
Secondary Subject: Speech and Language Pathology / Textbooks
Audience Level: Professional/Textbook - Desk Copy

Introduction

• The spectrum of the dysphagia
• Condition versus disease
• State of the art in assessment and treatment
• The focus on aspiration and why you think it is sometimes not appropriate or pertinent
• Nutrition and quality of life as important and neglected aspects of swallowing disorders

Normal Swallowing and its Neural Control
Physiologic Components of Adult Swallowing Function

• Bolus Transport and Phase Models
  Functional Anatomy and Physiology
  • Oropharyngeal Mechanisms
  • The Esophagus
  • Breathing and swallowing coordination
  • Swallowing during sleep in adults and infants

Neural Control Mechanisms
Central Control: Development, Initiation, Modulation, Modification

• Cortical Centers
• Brain Stem CPG
• Peripheral Mechanisms
• Integrated Sensori-motor control: respiration, phonation, cardiovascular
• Is swallowing a reflex?

Control
Central Control: Development, Initiation, Modulation, Modification

• Cortical Centers
• Brain Stem CPG
• Peripheral Mechanisms
• Integrated Sensori-motor control: respiration, phonation, cardiovascular

Swallowing Disorders
Adult Swallowing Impairments

• Anticipation and Planning
• Bolus Preparation
• Containment
• Airway Protection

Patient Populations - Adult

• • Neurologic Diseases and Conditions
  • Head and Neck Cancer
  • Head and Neck Trauma
  • Pulmonary/Airway
  • Systemic Disease
  • Connective Tissue Disease
  • Idiopathic
  • Mechanical

Patient Populations – Children

• • Neurologic Diseases and Conditions
  • Head and Neck Cancer
  • Head and Neck Trauma
  • Pulmonary/Airway
  • Systemic Disease
  • Connective Tissue Disease
  • Idiopathic
  • Mechanical

Assessment
Patient History

• Clinical Symptoms
  • Health related
  • Nutrition related
  • Ingestion related
  • Pain
  • Discomfort

Non-instrumental Clinical Assessment

• • Clinical Signs
  • Cognitive-Communicative
  • Psychosocial
  • Sensory
  • Motor

Instrumental Clinical Assessment

• • Videofluorography
  • Flexible Fiberoptic Endoscopy
  • Electromyography
  • Manometry
  • Multi-channel Intraluminal Impedance
  • phMetry
  • Scinitigraphy
  • Ultrasound
  • Auscultation
  • Integrated Physiologic Recordings

Special Considerations in Pediatric Assessment

Treatment
Functional Targets for Swallowing Treatment

• Would airway protection and bolus transport be considered functional targets?
• Sensation and Pleasure
• Sensation and Initiation
• Sensation and Airway Protection
• Excercises: Range, Strength, Coordination
• Cross-system Interaction
• Compensation
• Feedback Tools

Special Considerations in Pediatric Feeding and Swallowing Treatment

Outcomes for Swallowing Intervention: Patient Centered

• Goals
• Nutrition
• Health Status
• Quality of Life
• Ethical Considerations
• Cultural Issues

Operations
Reporting
Patient – Family Communication
Interdisciplinary Communication
Documentation
Problem Oriented Approach

• Team Integration
• In-house
• Out-of-house

Interdisciplinary Approach

• Scope of Practice
• Medical Specialties
• Interdisciplinary Roles
• Referral Patterns

Swallowing Management Programs

• Patient Populations
• Referral Mechanisms
• Staff Support
• Staffing
• Training
• Competency Measurement
• Reimbursement
• Student Practicum

About The Authors

Bonnie Martin-Harris, PhD, CCC-SLP, BRS-S

Dr. Bonnie Martin-Harris is Professor of Otolaryngology-Head and Neck Surgery and Director of Medical University of South Carolina’s Evelyn Trammell Institute for Voice and Swallowing, Charleston. She is also Director of the Doctoral Program in Health and Rehabilitation Science in the Department of Health Sciences and Research. Dr. Martin-Harris is a past President, Dysphagia Research Society and serves on the editorial board of the Dysphagia Journal. She is past Chair of the Specialty Board on Swallowing and Swallowing Disorders.

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David McFarland, PhD

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