, Volume 8, Issue 3, pp 209–214 | Cite as

A protocol for the videofluorographic swallowing study

  • Jeffrey B. Palmer
  • Keith V. Kuhlemeier
  • Donna C. Tippett
  • C. Lynch


This paper presents a detailed protocol for performing the videofluorographic swallowing study (VFSS), and describes how it evolved from its antecedents. The objectives of the VFSS are both diagnostic and therapeutic. Preparing for the VFSS is described, including the equipment, food preparation, and a brief discussion of the clinical evaluation. The detailed description of the VFSS procedure covers the position of the patient, the foods presented, the views obtained, modifications of feeding and swallowing that are commonly employed, the standardized set of observations, and reporting the results. Criteria for deviating from the protocol or aborting the study are presented. The VFSS does not necessarily end when a patient aspirates. Indeed, the complete evaluation of aspiration, and the effects of maneuvers designed to reduce it, is a major purpose of the VFSS. Modifications of feeding and swallowing are tested empirically during the study. The modifications include therapeutic and compensatory techniques that may improve the safety and efficiency of swallowing. A rationale for deciding which modifications to test in a given patient is discussed. The protocol has been used successfully in more than 350 patients. It has improved the efficiency and quality of our videofluorographic examinations.

Key words

Radiology Videofluoroscopy Rehabilitation Deglutition Deglutition disorders Aspiration 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Logemann JA:Evaluation and Treatment of Swallowing Disorders. San Diego: College-Hill Press, 1983Google Scholar
  2. 2.
    Gelfand DW, Richter JE (eds.):Dysphagia: Diagnosis and Treatment. New York: Igaku-Shoin, 1989Google Scholar
  3. 3.
    Linden PL, Siebens AA: Dysphagia: predicting laryngeal penetration.Arch Phys Med Rehab 64:281–284, 1983Google Scholar
  4. 4.
    Horner J, Massey EW: Silent aspiration following stroke.Neurology 38:317–319, 1988Google Scholar
  5. 5.
    Logemann JA:Manual for the Videofluorographic Study of Swallowing. Boston: College-Hill Press, 1986Google Scholar
  6. 6.
    Siebens AA, Linden PL: Dynamic imaging for swallowing reeducation.Gastrointest Radiol 10:251–253, 1985Google Scholar
  7. 7.
    Linden P: Videofluoroscopy in the rehabilitation of swallowing dysfunction.Dysphagia 3:189–191, 1989Google Scholar
  8. 8.
    Robbins JA, Sufit R, Rosenbek J, Levine RL: A modification of the modified barium swallow.Dysphagia 2:83–86, 1987Google Scholar
  9. 9.
    Curtis DJ: Radiologic examinations of the oropharyngeal region. In: Gelfand DW, Richter JE (eds.):Dysphagia: Diagnosis and Treatment. New York: Igaku-Shoin, 1989, pp 31–43Google Scholar
  10. 10.
    Ekberg O: Radiographic evaluation of swallowing. In: Groher ME (ed.):Dysphagia: Diagnosis and Management, 2nd ed. Boston: Butterworth-Heinemann, 1992, pp 163–195Google Scholar
  11. 11.
    Palmer JB, DuChane AS: Rehabilitation of dysphagia due to cerebrovascular disease.Phys Med Rehab Clin North Am 2:529–546, 1991Google Scholar
  12. 12.
    Siebens H, Trupe E, Siebens A, Cook F, Ansben S, Hanauer R, Oster G: Correlates and consequences of eating dependency in institutionalized elderly.J Am Geriatr Soc 34:192–198, 1986Google Scholar
  13. 13.
    Martin BJW, Corlew MM: The incidence of communication disorders in dysphagic patients.J Speech Hear Disord 55:28–32, 1990Google Scholar
  14. 14.
    Tippett DC, Palmer JB, Linden P: Management of dysphagia in a patient with closed head injury.Dysphagia 1:221–226, 1987Google Scholar
  15. 15.
    Siebens AA: Rehabilitation for swallowing impairment. In: Kottke FJ, Lehmann IF (eds.):Krusen's Handbook of Physical Medicine and Rehabilitation, 4th ed. Philadelphia: WB Saunders, 1990, pp 765–777Google Scholar
  16. 16.
    Palmer JB, DuChane AS, Donner MW: The role of radiology in the rehabilitation of swallowing. In: Jones B, Donner MW (eds.):Normal and Abnormal Swallowing: Imaging in Diagno sis and Therapy. New York: Springer-Verlag, 1991, pp 215–225Google Scholar
  17. 17.
    Palmer JB, Rudin NJ, Lara G, Crompton AW: Coordination of mastication and swallowing.Dysphagia 7:187–200, 1992Google Scholar
  18. 18.
    Silver KH, Palmer JB, Kuhlemeier KV: Timing of swallow onset during eating and drinking (abstract).Arch Phys Med Rehabil 73:979, 1992Google Scholar
  19. 19.
    Beck TJ, Gayler BW: Radiation in video-recorded fluoroscopy. In: Jones B, Donner MW (eds.):Normal and Abnormal Swallowing: Imaging in Diagnosis and Therapy. New York: Springer-Verlag, 1991, pp 1–6Google Scholar
  20. 20.
    Ekberg O: Posture of the head and pharyngeal swallow.Acta Radiol Diagn 27:691–696, 1986Google Scholar
  21. 21.
    Logemann JA, Kahrilas PJ, Kobara M, Vakil NB: The benefit of head rotation on pharyngoesophageal dysphagia.Arch Phys Med Rehabil 70:767–771, 1989Google Scholar
  22. 22.
    Kahrilas PJ, Logemann JA, Krugler C, Flanagan E: Volitional augmentation of upper esophageal sphincter opening during swallowing.Am J Physiol 260 (Gastrointest Liver Physiol 23): G450-G456, 1991Google Scholar
  23. 23.
    Coster S, Schwarz W: Rheology and the swallow-safe bolus.Dysphagia 1:113–118, 1987Google Scholar
  24. 24.
    Dantas RO, Kern MK, Massey BT, Dodds WJ, Kahrilas PJ, Brasseur JG, Cook IJ, Lang IM: Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing.Am J Physiol 258:G675-G681, 1990Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1993

Authors and Affiliations

  • Jeffrey B. Palmer
    • 1
  • Keith V. Kuhlemeier
    • 1
  • Donna C. Tippett
    • 2
  • C. Lynch
    • 2
  1. 1.Departments of Rehabilitation Medicine and Otolaryngology-Head and Neck Surgery and the Johns Hopkins Swallowing CenterGood Samaritan HospitalBaltimore
  2. 2.Departments of Speech-Language Pathology and Rehabilitation MedicineGood Samaritan HospitalBaltimoreUSA

Personalised recommendations