The dysphagia diagnostic procedure as a treatment efficacy trial.

Clinics in communication disorders Pub Date : 1993-01-01
J A Logemann
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Abstract

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.

吞咽困难诊断程序作为治疗效果试验。
在所有这些病例报告中,患者的吞咽功能和治疗方法对吞咽功能的影响都可以通过透视评估来观察和测量。在某些情况下,可以使用其他成像程序来测量效果。每个吞咽治疗程序的效果可以通过检查吞咽的特定生理因素来衡量。表3给出了各种治疗方法和相应的疗效指标。在某些情况下,在诊断评估中引入治疗程序可以立即使患者开始进食。在其他情况下,对治疗程序有效性的评估可以验证其是否适合用于建立恢复口服摄入所必需的神经肌肉控制的患者。然而,并非所有的治疗方法都可以引入诊断环境,因为它们并不都能产生立竿见影的效果。例如,嘴唇、舌头和/或下巴的活动范围练习不会立即产生效果,但通常在2至3周后显示效果。然而,临床医生仍然可以通过在每次治疗过程中测量患者的结构运动来量化活动范围练习的效果。当第二次评估完成后,可以通过比较第一次和第二次研究来评估目标结构的运动范围变化。将治疗技术引入到诊断性吞咽评估中,要求临床医生立即阅读放射学研究或其他影像学检查结果,识别生理功能障碍,以便选择和引入适当的治疗方法。由于x线透视涉及到病人的x射线暴露,所有可能的治疗技术都不能在x射线下尝试。相反,临床医生必须选择那些被认为最适合患者解剖和吞咽生理的技术。当确定了有效的技术时,诊断过程的录像带可以作为对患者及其家属、护士、医生和其他人的教育工具,以教育和咨询他们对患者使用特定程序的基本原理,包括介绍特定的姿势、饮食等。这种类型的视觉证据经常提高患者和家属对治疗建议的依从性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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