Certificate Program
Foundations of Best Practice in Videofluoroscopy (VFSS)
This seven-part series of courses provides clinicians with essential foundational knowledge regarding best practices in videofluoroscopic swallowing studies.
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About this Certificate Program
Videofluoroscopic swallow studies are a key assessment method for dysphagia. In this seven-part series, Professor Catriona Steele guides clinicians through the fundamentals required for best practice in VFSS. This begins with indications for VFSS, followed by exploration of different protocols. Modules on contrast media and technical aspects of VFSS (like frame rate) will equip the learner to set up VFSS examinations for optimal diagnostic accuracy. Professor Steele then guides the learner through analysis of swallowing safety (penetration and aspiration) and efficiency (residue). The series concludes with a case-based illustration of the use of VFSS to guide intervention selection and to measure treatment outcomes.
Target audience
This course is intended for clinicians who provide oropharyngeal swallowing assessments in inpatient or outpatient settings for people suspected to have dysphagia. Most commonly, dysphagia is considered to fall in the scope of practice for speech-language pathologists. However, there are some jurisdictions where other professionals are involved in dysphagia practice (including occupational therapists). Some of those clinicians may find this content suitable for their professional development.
Goals & objectives
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Define oropharyngeal dysphagia and the two key aspects of swallowing dysfunction that can be evaluated during VFSS (i.e., swallowing safety and swallowing efficiency)
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Design a standard VFSS protocol, incorporating VFSS tasks that are most likely to reveal impairment in swallowing safety and efficiency
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Explain the difference between on- and off-label use of contrast media for VFSS and the impact of concentration on barium opacity
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Recognize the relationship between frame rate and diagnostic accuracy, highlighting how information may be lost when fluoroscopy frame rate is lowered
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Identify Penetration-Aspiration Scale scores and residue severity measurements that represent clinical concern
What’s included in the Certificate Program
Accredited Online Courses*
6 hours of online video lectures and patient demonstrations.
Interactive Learning Assessments
Case-based quizzes to evaluate and improve clinical reasoning.
HEP and Patient Education
HEP and patient education resources to use with your patients.
Certificate Program overview
Section 1
Videofluoroscopy 7 ItemsVideofluoroscopy Part 1: Indicators for the Exam Course
Chapter 1: Dysphagia: Definitions and Prevalence
The word dysphagia means “difficulty swallowing,” but different people have different operational definitions for the clinical condition of dysphagia. We will propose a definition of oropharyngeal dysphagia based on the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) and discuss what is known about the prevalence of dysphagia as a feature of different clinical conditions.
Chapter 2: What Is a Videofluoroscopy, and What Questions Can It Answer?
The videofluoroscopy is a dynamic X-ray procedure that allows direct visualization of bolus flow and swallowing physiology. We will review the questions that can be answered about swallowing function and impairment using videofluoroscopy as well as questions that cannot be answered using this procedure.
Chapter 3: Developing Your VFSS Questions
We will use a case study format to identify priority questions regarding patient swallowing that can be answered by a VFSS.
Videofluoroscopy Part 2: How to Design the Exam Course
Chapter 1: VFSS Protocols: A Historical Perspective
We will discuss protocols for VFSS developed by early leaders in the field, including Drs. Jeri Logemann, Jeffrey Palmer, Bronwyn Jones, and Olle Ekberg. Through this review, we will discuss variations in swallowing behavior and VFSS exam results that may be attributable to protocol choices, such as task instructions, repetitions, volume and bolus administration choices, etc.
Chapter 2: More Recent Development of Standard VFSS Protocols
We will discuss three recently developed standard protocols for VFSS: MBSImP, DIGEST, and the Steele Swallowing Lab protocol.
Chapter 3: Optimizing Your VFSS Protocol
We will review studies that suggest which tasks are most likely to reveal impairments in swallowing safety and efficiency.
Videofluoroscopy Part 3: Contrast Media Course
Chapter 1: Contrast Media for VFSS
We will describe how contrast agents work and what the desirable properties of a contrast agent are for VFSS. We will discuss the difference between on-label and off-label use of barium.
Chapter 2: Barium Concentration: How Does It Impact What We See on Videofluoroscopy?
We will discuss how altering the concentration of barium through methods like dilution can alter what you see on the exam and how this may influence VFSS exam results.
Chapter 3: How Should I Choose Barium Products and Prepare Barium for VFSS?
We will discuss why it is important to understand manufacturer recommendations for preparing barium for use in VFSS and how off-label practices may influence the exam in undesirable ways.
Videofluoroscopy Part 4: Equipment and Pulse Rate Course
Chapter 1: How Does Fluoroscopy Work?
We will review how fluoroscopic images are generated and explain the difference between continuous fluoroscopy and pulsed fluoroscopy.
Chapter 2: What Is the Impact of Lower Pulse Rates on Diagnostic Information?
In this chapter, we will explore the trade-off between fluoroscopy pulse rate and diagnostic information. We will illustrate how reducing pulse rate impacts the information that is available to the clinician.
Chapter 3: The Relationship Between Pulse Rate and Radiation Dose
In this chapter, we will explore the trade-off between pulse rate and radiation dose. We will discuss the ALARA principle and explore issues of examination length (and associated radiation dose) related to pulse rate. We will provide a list of points that clinicians can present to colleagues in radiology when determining optimal settings and protocols for VFSS in their facilities.
Videofluoroscopy Part 5: Evaluation of Swallowing Safety Course
Chapter 1: Introduction to the 8-Point Penetration-Aspiration Scale
Although the Penetration-Aspiration Scale (PAS) is widely used, clinicians may be unfamiliar with its properties. In this chapter, we will describe the scale and its development and discuss its properties. We will explain why decimal places have no meaning on the scale.
Chapter 2: More About the Penetration-Aspiration Scale: Which Scores Are Normal, and Which Ones Are Rare?
In this chapter, we will discuss which scores on the 8-point Penetration-Aspiration Scale are expected in healthy people and which scores are rarely seen in both healthy people and patients with dysphagia.
Chapter 3: How Variable Is Penetration/Aspiration?
Individuals who demonstrate penetration or aspiration do not necessarily do so consistently across repeated boluses of the same texture. In this chapter, we will explore what is known about the frequency and variability of penetration-aspiration events within individual patients with dysphagia and discuss the implications of this information for summarizing the results of an assessment in terms of swallowing safety.
Videofluoroscopy Part 6: Evaluation of Swallowing Efficiency Course
Chapter 1: What Is Pharyngeal Residue?
In this chapter, we will explain what pharyngeal residue is and where it may be located.
Chapter 2: Visuoperceptual Approaches to Measuring Residue Severity
In this chapter, we will discuss several different visuoperceptual approaches to describing residue severity. These include both bolus-derived and space-derived measures. We will discuss the reliability of these measures as reported in the literature.
Chapter 3: Quantitative Pixel-Based Methods of Measuring Residue
In this chapter, we will describe and illustrate pixel-based measurement of residue severity. We will discuss different approaches to normalizing these measures to anatomical reference scalars and lead participants through a measurement activity.
Videofluoroscopy Part 7: Using Videofluoroscopy for Treatment Planning Course
Chapter 1: Videofluoroscopy as a Tool for Measuring Treatment Effect
In this chapter, we will explore the difference between compensatory and rehabilitative interventions for dysphagia and describe how videofluoroscopy can be used as a tool for measuring treatment effect.
Chapter 2: Use of the Chin-Down Posture in Videofluoroscopy
The chin-down posture is an example of a commonly used intervention for dysphagia. In this chapter, we will use a case study methodology to illustrate how videofluoroscopy can be used to determine the impact of the chin-down posture and decide when it should be recommended for a patient.
Chapter 3: Measuring the Effect of Thickened Liquids on Swallowing Safety and Efficiency
Thickened liquids are one of the most common interventions recommended for managing penetration/aspiration in people with dysphagia. However, there is controversy about the effectiveness of this intervention. In this chapter, we will discuss the physiological mechanism behind thin liquid aspiration and the rationale for considering thicker liquids as a compensatory intervention. We will discuss evidence from a videofluoroscopy demonstrating the effect of thickening on swallowing safety and describe how a clinician can use videofluoroscopy to determine whether thickened liquids are likely to be helpful in a particular patient.
Chapter 4: Measuring the Effect of the Effortful Swallow on Swallowing Safety and Efficiency
The effortful swallow is an example of a commonly used intervention for dysphagia. In this chapter, we will illustrate how videofluoroscopy can be used to measure outcomes of using the effortful swallow.
Instructors
Catriona Steele
PhD, CCC-SLP, S-LP(C), Reg. CASLPO, ASHA Fellow
CEU approved
6
total hours*
of accredited coursework.
Medbridge accredits each course individually so you can earn CEUs as you progress.
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Browse PlansFrequently asked questions
Everything you need to know about Certificate Programs.
Accreditation Hours
Each course is individually accredited and exact hours will vary by state and discipline. Check each course for specific accreditation for your license.
When do I get my certificate?
You will receive accredited certificates of completion for each course as you complete them. Once you have completed the entire Certificate Program you will receive your certificate for the program.
Do I get CEU credit?
Each course is individually accredited. Please check each course for your state and discipline. You can receive CEU credit after each course is completed.
Do I have to complete the courses in order?
It is not required that you complete the courses in order. Each Certificate Program's content is built to be completed sequentially but it is not forced to be completed this way.
How long do I have access to the Certificate Program?
You will have access to this Certificate Program for as long as you are a subscriber. Your initial subscription will last for one year from the date you purchase.
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