Videofluoroscopic evaluation in the assessment of swallowing disorders in paediatric and adult populations

Videofluoroscopic swallow studies (VFSS) are often considered the 'gold sta ndard' technique to assess dysphagia. Despite this status, unanimous agreem ent has not been reached regarding the protocol for this procedure. Review of the literature reveals two main schools of thought. The first advocates a uniform, standardised protocol used with all patients. The second argues for functional, tailor-made studies, which aim to elicit a sample of swallo wing representative of typical feeding patterns. This paper reviews the lit erature on VFSS methodology and evaluates the applicability of protocols to the paediatric population. Broadly speaking, adult protocols tend towards uniform procedures, whereas paediatric studies aim to be more individualise d and tailor-made. Clinical recommendations based upon VFSS are examined in the light of validity and reliability issues. The need for standardisation of the VFSS procedure is highlighted. The question is raised whether it is possible to achieve uniformity and consistency between clinicians and stil l perform patient-centered, tailor-made VFSSs, which are truly representati ve of a patient's swallow function. It is revealed that dysphagia specialis ts should achieve greater consistency in the VFSS procedure before claiming to be implementing a 'gold standard' technique.