The dysphagia diagnostic procedure as a treatment efficacy trial.

In all of these case reports, the patient's swallow function and the effect of therapy procedures on this function could be observed and measured from the videofluoroscopic assessment. In some cases, effects could be measured using other imaging procedures. The effects of each swallow therapy procedure can be measured by examining specific physiologic elements of the swallow. Table 3 presents the various therapy procedures and appropriate efficacy measures for each. In some cases, introduction of therapy procedures into the diagnostic evaluation can immediately enable the patient to begin eating. In other cases, evaluation of the effectiveness of the therapy procedure can validate its appropriateness for use with a patient in building the neuromuscular control necessary to return to oral intake. Not all therapy procedures can be introduced into the diagnostic setting, however, since they do not all result in immediate effects. For example, range of motion exercises for the lips, tongue, and/or jaw do not have an immediate effect, but typically show an effect after 2 to 3 wks. However, the clinician can still quantify the effects of range of motion exercises by measuring the patient's structural movement at each therapy session. When a second assessment is completed, change in range of motion of the target structure can be assessed by comparing the first and second studies. Introducing treatment techniques into the diagnostic swallowing assessment requires the clinician to read the results of the radiographic study or other imaging procedure immediately and identify the physiologic dysfunction so that appropriate therapy procedures can be selected and introduced. Because videofluoroscopy involves X-ray exposure to the patient, all possible treatment techniques cannot be attempted while in X-ray. Rather, the clinician must select those techniques believed to be most appropriate for that patient's anatomy and swallow physiology. When effective techniques are identified, the videotape of the diagnostic procedure can be used as an educational tool with the patient and his or her family, nurses, physicians, and others to educate and counsel them regarding the rationale for use of particular procedures with the patient, including introduction of particular posture, diets, etc. This type of visual evidence often improves patient and family compliance with therapy recommendations.