[Dysphagia] VFSS

[eripley at yahoo.com (Irene Campbell-Taylor)]

There seems to be a misunderstanding about VFSS and real meals. It's not that it's only a moment in time, it's that in NO WAY does it reflect what happens when a meal is being eaten. It doesn't matter how many trials you have of how many consistencies, it will never show what happens in real life. This has been shown repeatedly by Groher, Jones and Donner, Dua and others and is what leads to false positives as well as false negatives. As to what one does with the patient who coughs on thin liquids,.    At the risk of being repetitive, clysis is the usual answer to fluid maintenance in the rest of the world: See:
  Guidelines for the administration of subcutaneous fluids (hypodermoclysis) to adult patients in the community (Please note: in the community)
  http://www.leedspct.nhs.uk/archive/east/attachment/00000000abc3a292817efac1a68ba2a4/0000000077869cd00183e189f3a5caad/PL+010+SUBCUT+Fluids+Guideline.pdf_
  _AND___
  _____http://www.leedspct.nhs.uk/archive/northeast/attachment/00000000edcf3591017443e65dddbba8/000000006f897f618d249b47cf5e73f0/PL010+Sc+Guideline.pdf________________________________________________________
  Age and Ageing 2005; 34: 215?217 
  Hypodermoclysis?a victim of historical prejudice
  PRANOY BARUA, BIMAL K. BHOWMICK
  Abstract
  Hypodermoclysis (HDC) had fallen into disrepute after adverse clinical incidents that were obviously the result of improper use of an ingenious technique. HDC has clear advantages over alternative parenteral routes. It has stood the rigor of scientific
  scrutiny but failed to regain its past glory. This is possibly because of our ignorance and inability to detach ourselves from an age-old prejudice. This is an attempt to demystify some of the myths that surround it. The hope is that older people are not denied an element of health care that they are perhaps most well suited to.
  _____AND one of the guidelines I cited yesterday:
  GUIDELINE TITLE
  Dehydration and fluid maintenance.
  BIBLIOGRAPHIC SOURCE(S)
  American Medical Directors Association (AMDA). Dehydration and fluid maintenance. Columbia (MD): American Medical Directors Association (AMDA); 2001. 28 p. [15 references
  GUIDELINE OBJECTIVE(S)
  To improve the quality of care delivered to patients in long-term care facilities 
  To guide the identification and management of dehydration and fluid/electrolyte imbalance in older adults residing in the long-term care settings 
  To present approaches that attempt to minimize the occurrence of dehydration and fluid/electrolyte imbalance
  Management of specific deficits and imbalances, as indicated, such as fluid and electrolyte replacements or fluid restrictions. Fluid replacement may be by various routes, including oral, hypodermoclysis, nasogastric or gastrostomy tube or intravenous 
   
  AND re VFSS and meals:
   Dua KS; Ren J; Bardan E; Xie P; Shaker R. Coordination  of deglutitive glottal function and pharyngeal bolus transit during normal eating.Gastroenterology, 112:73-83  1997
  AND
  Groher M. The detection of aspiration. Dysphagia, 9; 147. 1994
  Martin-Harris ; Logemann et al. The clinical utility of the modified barium swallow. Dysphagia 15; 2000. 136. 
  JonesB, Donner M. Normal and abnormal swallowing, Springer 1999.
   


Dr I Campbell-Taylor
Clinical Neuroscientist
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