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barium is observed, and the clinician instructs the patient how to improve the swallow. Valuable
information about the integrity of the swallow is obtained in addition to the patient’s success in
modifying deficient aspects of it. Be hav iors that can reduce or eliminate barium aspiration include
turning the patient’s head to the affected side for vocal cord paralysis and positioning the body to
maximize the effects of gravity during the swallow. Sometimes patients can reduce or eliminate
aspiration by dry swallows, in which they repeatedly swallow without placing additional barium in
their mouths. For some patients, forcefully producing a vowel at the conclusion of the swallow and
before inhalation can help clear the air passages. When these and other be hav iors are completed
during the video swallow study, the clinician can determine their success and incorporate them
in dysphagia therapy.
As mentioned earlier, procedures such as clinical/bedside screening can produce false positives
and false negatives. Some patients are anxious about the video swallow study and do not perform
optimally; for other patients, the procedure creates artificial situations providing unnatural
results. In addition, patients’ neuromuscular abilities are rarely constant and static; some patients
have progressive disorders, and others achieve spontaneous recovery. Because of this variability,
the clinician should be cautious in interpreting the results of the clinical/bedside examination and
instrumental tests of dysphagia. These procedures are not exact, nor are they always reliable and
valid. Repeated clinical/bedside and instrumental dysphagia evaluations are often required.
Nasogastric, Gastric, and Tracheotomy Tubes
A nasogastric (NG) tube is placed through the patient’s nose into the stomach. It is a temporary
way of providing the patient with nutritional supplements and liquids. Patients sometimes receive
dysphagia therapy while the NG tube is in place. Although there are no research studies about
the effects of an NG tube on the patient’s swallow, it prob ably creates a foreign body sensation
and interferes with swallowing movements. Some patients require gastrotomy, the creation of an
opening directly into the stomach (Dirckx, 2001). A gastric tube is placed directly into the stomach
in patients with dysphagia who have a poor prognosis, and nutritional supplements and liquid are
given by bypassing the oral- pharyngeal- esophageal route.
A tracheotomy tube is placed in the patient’s neck below the vocal cords. It provides a direct
opening that allows air to enter the lungs and bypass the larynx and upper air passageways,
and is used for patients whose respiration is compromised. When the tracheotomy tube’s cuff, a
balloon- like device surrounding the lower part of the tube, is inf lated, food and liquid are usually
prevented from entering the lungs. Some tracheotomy tubes are fenestrated (i.e., have win dows cut
into them), allowing the patient to produce voice. Tracheotomy tubes reduce laryngeal elevation
and can interfere with the swallow.
Dysphagia in Geriatric and Pediatric Populations
The very old and very young are often high- risk populations for dysphagia and related
complications. In el derly patients with dementia, dysphagia can be difficult to diagnose and treat.
Because of dementia- related symptoms such as memory loss, agitation, impulsiveness, generalized
intellectual deficits, and so forth, these patients pres ent special challenges during clinical/bedside
and instrumental diagnosis, and they may be unable to participate fully in dysphagia therapies.
According to Cefalu (1999), high- risk patients with dementia suspected of having dysphagia
include those with significant weight loss or feeding difficulties, those requiring assistance with
feeding, those significantly below ideal body weight, and those with concurrent depression or a
history of cerebrovascular accidents.
Children with dysphagia are seen by speech- language pathologists in medical and educational
settings. In young children, dysphagia diagnosis and treatment are complicated by their anatomical
differences. The size, dimension, and movement differences of the oral- laryngeal structures in