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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

  • Define oropharyngeal dysphagia and the two key aspects of swallowing dysfunction that can be evaluated during VFSS (i.e., swallowing safety and swallowing efficiency)
  • Design a standard VFSS protocol, incorporating VFSS tasks that are most likely to reveal impairment in swallowing safety and efficiency
  • Explain the difference between on- and off-label use of contrast media for VFSS and the impact of concentration on barium opacity
  • Recognize the relationship between frame rate and diagnostic accuracy, highlighting how information may be lost when fluoroscopy frame rate is lowered
  • 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.

Patient Education
HEP and Patient Education

HEP and patient education resources to use with your patients.

Section 1: Videofluoroscopy

7 Chapters

Videofluoroscopy Part 1: Indicators for the Examkeyboard_arrow_down

  • Dysphagia: Definitions and PrevalenceChapter 1

    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.

  • What Is a Videofluoroscopy, and What Questions Can It Answer?Chapter 2

    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.

  • Developing Your VFSS QuestionsChapter 3

    We will use a case study format to identify priority questions regarding patient swallowing that can be answered by a VFSS.

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Videofluoroscopy Part 2: How to Design the Examkeyboard_arrow_down


Videofluoroscopy Part 3: Contrast Mediakeyboard_arrow_down


Videofluoroscopy Part 4: Equipment and Pulse Ratekeyboard_arrow_down


Videofluoroscopy Part 5: Evaluation of Swallowing Safetykeyboard_arrow_down


Videofluoroscopy Part 6: Evaluation of Swallowing Efficiencykeyboard_arrow_down


Videofluoroscopy Part 7: Using Videofluoroscopy for Treatment Planningkeyboard_arrow_down

  • Videofluoroscopy as a Tool for Measuring Treatment EffectChapter 1

    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.

  • Use of the Chin-Down Posture in VideofluoroscopyChapter 2

    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.

  • Measuring the Effect of Thickened Liquids on Swallowing Safety and EfficiencyChapter 3

    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.

  • Measuring the Effect of the Effortful Swallow on Swallowing Safety and EfficiencyChapter 4

    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.

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Catriona Steele


CEU Approved

6 total hours* of accredited coursework.
MedBridge accredits each course individually so you can earn CEUs as you progress.

      Our clinic could not be happier with MedBridge.

Amy Lee, MPT, OCS
Physical Therapy Central

       MedBridge has allowed us to create a culture of learning that we were previously unable to attain with traditional coursework.

Zach Steele, PT, DPT, OCS
Outpatient Physical Therapy & Rehabilitation Services

    MedBridge has created a cost-effective and quality platform that is the future of online education.

Grant R. Koster, PT, ATC, FACHE
Vice President of Clinical Operations, Athletico Physical Therapy

Frequently Asked Questions

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.

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.

*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.

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.

Sample Certificate

Sample Certificate

Complete this series to receive your certificate.

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Certificate Program
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