title: Search for compensation postures with videofluoromanometric investigation in dysphagic patients affected by amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  This study was undertaken to verify the effectiveness of compensatory postures, suggested on the basis of the type of dysphagia identified at videofluoromanometric (VFM) investigation to ensure safe oropharyngeal transit.
  
  
  METHODS
  Eighty-one patients with amyotrophic lateral sclerosis (ALS) underwent speech therapy assessment and VFM investigation of the swallowing process. In the event of altered transit, penetration or aspiration of contrast material into the airways, compensation postures for correction of the swallowing disorder were suggested and verified during VFM examination.
  
  
  RESULTS
  In 37 patients, contrast agent transport was preserved and safe; in 19, we observed penetration of the contrast agent into the laryngeal inlet without aspiration; in 24, there was aspiration (four preswallowing, eight intraswallowing, nine postswallowing, three mixed), whereas in one patient no transit was seen. Penetration without aspiration was resolved by coughing or throat clearing; aspiration was resolved in 13 patients by assuming the chin-tuck posture and in six by rotating the head; in five patients, it was not resolved. A hyperextended head posture proved to be effective to resolve lack of transit.
  
  
  CONCLUSIONS
  By correlating morphological with functional data, VFM enables one not only to precisely characterise the dysphagic disorder but also to identify the most appropriate compensation posture for each patient and verify its effectiveness.
authors.affiliation: Sezione di Radiologia, Dipartimento Magrassi-Lanzara, Seconda Università di Napoli, Naples, Italy. antoniosolazzo@hotmail.it
authors.forename: A
authors.initials: A
authors.lastname: Solazzo
authors.forename: L
authors.initials: L
authors.lastname: Del Vecchio
authors.forename: A
authors.initials: A
authors.lastname: Reginelli
authors.forename: L
authors.initials: L
authors.lastname: Monaco
authors.forename: A
authors.initials: A
authors.lastname: Sagnelli
authors.forename: M
authors.initials: M
authors.lastname: Monsorrò
authors.forename: N
authors.initials: N
authors.lastname: Di Martino
authors.forename: G
authors.initials: G
authors.lastname: Tedeschi
authors.forename: R
authors.initials: R
authors.lastname: Grassi
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008365:Manometry / Q000379:methods; D010779:Photofluorography / Q000379:methods; D011015:Pneumonia, Aspiration / Q000517:prevention & control; D011187:Posture; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013070:Speech Therapy; D014741:Video Recording