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Deglutition and its disorders. Anatomy, physiology, clinical diagnosis, and management
  1. J A WILSON

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Deglutition and its disorders. Anatomy, physiology, clinical diagnosis, and management. Edited by Perlman AL, Schulze-Delrieu KS. (Pp 522; illustrated; £49.95.) Singular Publishing Group, 1997. ISBN 9781565 936218.

The act of swallowing has been described as the most complex reflex which can be reproduced by the stimulation of a peripheral nerve. Such complexity is also encountered in the aetiology, pathogenesis, investigation, and management of deglutition disorders. The senior editor of this comprehensive multi author review, Adrienne Perlman, is a speech and language therapist, now based in Champaign, Illinois, with an outstanding personal record of innovative research in the field of swallowing. Her contributors include most of the principal prominent names in North American dysphagia research, whether internists, neurologists, radiologists or, of course, speech and language therapists. Few readers are likely to approach this volume with important questions about dysphagia which would not, at least in part, be answered by in this comprehensive text. As a reference book, it has very few competitors. Thus any library which is required to carry the journal Dysphagia will find this text frequently consulted. Overall, the line diagrams are well chosen and the radiographic images clear. Some of the endoscopic photographs inevitable lose a little in black and white reproduction.

For many practising speech and language therapists the benchmark chapter will be the one on videoendoscopic assessment of swallowing. It is written by the North American leaders in the field, but has certain limitations for therapists practising in countries, such as the United Kingdom, where the technique has yet to be fully integrated into the repertoire of the speech and language therapist. The interpretative section is outstanding, but the equipment section rather suggests that a very substantial investment is required to set up a good system. What many Europeans need is a message that the method can be initiated with very little new capital outlay, and the more sophisticated set-ups, with videotimers, videoprinters and the like graduated to over a period of time.

Some of the individual chapters cover topics which are not often identified in a pure dysphagia context—for example, the chapter on swallowing and feeding in paediatric patients. Others reflect Dr Perlman’s specialist interests—for example, the use of electromyography in the diagnosis of deglutition disorders. The inclusion of these superspecialist topics is, however, entirely justified because it is only someone with this superspecialist interest in dysphagia who is likely to make a personal purchase of this volume.

The great range of health care professionals interested in dysphagia (reflected in the multidisciplinary authorship list) will come to this text with different expertise. This justifies the inclusion of basic information within each section included in the text. For example, those who are radiologists will find the radiology sections oversimplified but the non-radiologists may find the introductory information invaluable. Four to six multiple choice questions are included at the end of each of the 16 chapters. A comprehensive glossary is also included. Deglutition and its disorderstherefore attempts to offer a complete dysphagia education, based on minimal prior knowledge of the relevant concepts. Such a goal may well find a niche market in the United Kingdom, where, at the present time, dysphagia work load comprises a huge proportion of clinical speech and language therapy time. Most speech therapy degree courses do not include a significant amount of dysphagia instruction at the undergraduate level and postgraduate experience is often based on practical experience supplemented by ad hoc clinical courses. Thus, this book may well improve the understanding of clinical practice of the group of professionals who bear the brunt of clinical decision making in dysphagic patients in the United Kingdom today. Every speech and language therapy department seeing dysphagic patients should have a copy of this volume on its shelf.

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