It is important for clinicians to be aware of alternative instrumental assessments that might provide similar information without involving the risks of radiation. This module will review a number of alternative instrumental procedures that can provide information about swallowing function, including the strengths and limitations of these alternatives, to assist clinicians in making the best choice when recommending additional assessment procedures for a patient with dysphagia. At the end of this module, the clinician learner will be able to:

1. Describe the differences between videofluoroscopy and FEES
2. Discuss the limitations of FEES with respect to the white-out period
3. Identify the limitations of cervical auscultation and pulse oximetry with respect to identifying aspiration
4. Describe the expected pattern of respiratory-swallow phasing seen in a nasal cannula signal
5. Understand how to measure maximum isometric or swallowing pressures using the Iowa Oral Performance Instrument
6. Describe the elements of swallowing that can or cannot be seen on an ultrasound recording
7. Explain why norms do not exist for the amplitude of submental muscle contraction during swallowing, measured using surface electromyography
8. Describe the features of swallowing that can be seen in a high resolution manometry heat map image

About Instructor

Professor Catriona M. Steele is a clinician scientist working in the area of swallowing and swallowing disorders. She has a background as a medical speech-language pathologist, and is Director of the Swallowing Rehabilitation Research Laboratory (www.steeleswallowinglab.ca) at KITE, the research arm of the Toronto Rehabilitation Institute – University Health Network. Dr. Steele is a Professor in the Department of Speech-Language Pathology at the University of Toronto. Professor Steele holds research funding from the National Institutes of Health (USA) as well as several active industry contracts. She is an associate editor for the Dysphagia journal and a member of the editorial board for the Journal of Texture Studies. She is also a member of the Board of Directors for the International Dysphagia Diet Standardisation Initiative (www.iddsi.org).