Dysphagia Assessment and Treatment Planning A TEAM APPROACH Fourth Edition Dysphagia Assessment and Treatment Planning A TEAM APPROACH Fourth Edition Rebecca Leonard, PhD Katherine A. Kendall, MD 5521 Ruffin Road San Diego, CA 92123 e-mail: [email protected] website: http://www.pluralpublishing.com Copyright 2019 © by Plural Publishing, Inc. Typeset in 10.5/13 Palatino by Flanagan’s Publishing Services, Inc. Printed in Korea by Four Colour Print Group All rights, including that of translation, reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, including photocopying, recording, taping, Web distribution, or information storage and retrieval systems without the prior written consent of the publisher. For permission to use material from this text, contact us by Telephone: (866) 758-7251 Fax: (888) 758-7255 e-mail: [email protected] Every attempt has been made to contact the copyright holders for material originally printed in another source. If any have been inadvertently overlooked, the publishers will gladly make the necessary arrangements at the first opportunity. Library of Congress Cataloging-in-Publication Data Names: Leonard, Rebecca, editor. | Kendall, Katherine (Staff physician), editor. Title: Dysphagia assessment and treatment planning : a team approach / [edited by] Rebecca Leonard, Katherine A. Kendall. Description: Fourth edition. | San Diego : Plural Publishing, [2019] | Includes bibliographical references and index. Identifiers: LCCN 2017046023| ISBN 9781635500097 (alk. paper) | ISBN 1635500095 (alk. paper) Subjects: | MESH: Deglutition Disorders — diagnosis | Deglutition Disorders — therapy | Patient Care Planning | Patient Care Team Classification: LCC RC815.2 | NLM WI 258 | DDC 616.3/23 — dc23 LC record available at https://lccn.loc.gov/2017046023 Contents Introduction vii Multimedia List xi Acknowledgments xii Contributors xiii 1 Anatomy and Physiology of Deglutition 1 Katherine A. Kendall 2 Head and Neck Physical Exam 27 Katherine A. Kendall 3 Clinical Swallow Evaluation 37 Susan J. Goodrich and Alice I. Walker 4 Endoscopy in Assessing and Treating Dysphagia 53 Rebecca Leonard 5 Radiographic Evaluation of the Pharynx and Esophagus 73 Jacqui Allen 6 Dynamic Fluoroscopic Swallow Study: Swallow Evaluation with 85 Videofluoroscopy Susan McKenzie and Rebecca Leonard 7 DSS: A Systematic Approach to Analysis and Interpretation 105 Susan McKenzie and Rebecca Leonard 8 Dynamic Swallow Study: Objective Measures and Normative 125 Data in Adults Rebecca Leonard 9 Other Technologies in Dysphagia Assessment 157 Maggie A. Kuhn 10 The Treatment Plan 169 Rebecca Leonard and Katherine A. Kendall v vi DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH 11 Nursing Evaluation and Care of the Dysphagic Patient 221 Ann E. F. Sievers 12 Nutritional Concerns and Assessment in Dysphagia 243 Beverly Lorens and Katherine A. Kendall 13 Pediatric Clinical Feeding Assessment 279 Anna Miles 14 Esophageal Phase Dysphagia 299 Peter C. Belafsky and Catherine J. Rees Lintzenich 15 Neurogenic Dysphagia 309 Jacqui Allen 16 Dysphagia in Head and Neck Cancer Patients 327 Katherine A. Kendall 17 Laryngopharyngeal Reflux 355 Catherine J. Rees Lintzenich and Peter C. Belafsky 18 Spinal Abnormalities in Dysphagia 369 Derrick R. Randall Index 379 Introduction Dysphagia Assessment and Treatment Plan- of educational material, as opposed to ning: A Team Approach is now in its fourth a static resource. edition, which speaks to our continu- Some information in the new edition ing emphasis on a multidisciplinary ap- represents updates on material previ- proach to dysphagia, but also, to the will- ously presented. In a few cases — for ingness of original, new and extended example, head and neck anatomy (Chap- “team” members to be involved in this ter 1) and the clinical head and neck project. We very much appreciate every- examination (Chapter 2) — information one’s contributions! previously presented has not changed, The organization of the book has though some edits to the existing changed, with chapters concerned with text have been made. Similarly, our assessment techniques coming first, and approach to endoscopy (Chapter 4) material addressing special populations remains the same, though new pos- comprising the latter portion of the text. sibilities for quantifying what have This reflects what is likely a more typi- previously been only subjective obser- cal approach to dysphagia in graduate vations are mentioned. Improvements courses concerned with the topic, and in endoscopic equipment have also one that we hope complements teach- continued, contributing primarily to ing of the subject matter. Also new are improved diagnostic capabilities, but PowerPoint slides accompanying each also enhancing the differentiation of chapter hosted on a PluralPlus compan- observations critical to oral-pharyn- ion website. The slides are intended to geal dysphagia. Clinical evaluation of highlight each chapter’s major points, swallowing (Chapter 3), incorporating with supplemental content then added both bedside and actual clinical evalu- as desired by individual instructors. ations, is quite comprehensive and has We are also including materials on the undergone minimal updating, as well. website that can be used to comple- In other cases, substantial changes are ment chapter content. These have been obvious in the material. developed by Dr. Barkmeier-Kraemer, For example, the pediatrics chap- first author of the text’s accompanying ter (Ch. 13) has been written by Anna workbook, for a graduate dysphagia Miles, Ph.D., a speech-language pathol- course that utilized the text. Our plan is ogist from New Zealand who works in to continue to update and add to these both medical and academic settings. materials over the course of the next Dr. Miles has expanded this chapter to few years, thereby allowing the book address specific problems and needs to be a more dynamic, evolving source not only of infants, which was a primary vii viii DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH focus of earlier chapters, but rather, the patients, and is once again the subject of entire spectrum of childhood. This is an an entire chapter (Chapter 17). A chapter excellent addition to the book, one that devoted to the esophagus (Chapter 14) provides both practical and data-based addresses both esophageal diseases and evidence for assessing and treating dys- their treatments, and diagnostic tools phagia in infants and children. used to evaluate them. Other tools used A brand-new addition to the book is to evaluate dysphagia, with descrip- Chapter 18 by Dr. Derrick Randall, who tions of their use and updates on their completed a laryngology fellowship at emergence, are addressed in Chapter 9, UC Davis and is now practicing at the “Other Technologies in Dysphagia As- University of Calgary, Alberta, Can- sessment.” This chapter, authored by ada. Dr. Randall’s chapter addresses Dr. Maggie Kuhn, laryngologist from dysphagia associated with alterations UC Davis, provides an excellent over- to the spine as a consequence of either view of tools, including ultrasound and disease or surgery. His information functional MRI, for which continued not only is current, but also provides exploration has demonstrated unique practical information to students and potential in the assessment of dyspha- clinicians who are, or will be, seeing gia. Material presented will be infor- these patients in clinical practice. In our mative for those just being introduced own setting at UC Davis, this popula- to dysphagia, as well as to those with tion is substantial, and we believe this substantial experience in the field. SLP is likely to be true of many settings, in deglutologists who are expanding their particular those in which outpatients practices to include instrumental tech- are evaluated and treated. We felt we niques such as manometry and perhaps should address this population in the other esophageal assessments, will find current edition, and Dr. Randall’s chap- this information of particular interest. ter nicely fulfills this need. “GOOSE” (guided observation of swal- Chapters dealing with nursing lowing in the esophagus), for example, (Chapter 11) and nutrition (Chapter 12) is described in the chapter as the esoph- retain much of the information previ- ageal equivalent of FEES for the upper ously presented but have been updated aerodigestive tract. to incorporate the latest recommenda- As with previous editions, informa- tions in nursing care and dietary con- tion dedicated to fluoroscopic evalu- siderations for patients experiencing ation, or the dynamic swallow study dysphagia. Similarly, chapters address- (DSS), is emphasized (Chapters 6–8, 15). ing special populations, including neu- In part, this is due to the fact that fluo- rogenic disease (Chapter 15) and head roscopy continues to be a major diag- and neck cancer (Chapter 16), provide nostic tool in patients with dysphagia. details regarding the unique features of Advances in MRI (magnetic resonance these pathologies, as well as incorpo- imaging) have emerged in the last few rating the latest information regarding years — for example, it now has the dysphagia and approaches to treatment potential to capture data in “real-time.” pertinent to each group. This, in addition to its excellent soft tis- Gastroesophageal reflux continues sue definition and non-invasiveness, to be a major