Management of Adult Neurogenic Dysphagia (1999).  Maggie Lee Huckabee & Cathy A. Pelletier. Singular Publishing Group, Inc., 401 West A St., Suite 325, San Diego, CA 92101-7904. 350 pages, $62.95. Reviewed by Kathleen L. Bulloch, Anaheim, CA.

This softbound text is one volume in the dysphagia series. "Chapter One: Issues in Dysphagia Management" presents the philosophical approach taken by the authors in developing the text. The framework for intervention draws parallels between the skills needed by a speech-language pathologist and those developed by an athletic coach. Suggestions for critiquing new research in this ever-changing area of practice are also included.

"Chapter Two: Framework for Intervention" discusses a framework based on developing the skills of an athletic coach. Clinicians must acquire vital skills to diagnose and then develop appropriate intervention plans for their patients. Suggestions on how to determine intervention options and evaluate their functional outcomes are discussed.

"Chapter Three: Rehabilitation of Dysphagia" provides definitions, supporting research, and techniques for swallowing rehabilitation. Maneuvers are presented based on the physiologic abnormality that is considered to address, rather than the symptom.

"Chapter Four: Biofeedback Modalities" and "Chapter Five: Other Biofeedback Modalities: Endoscopy, Ultrasound, Auscultation, and Oximetry" outline the role of biofeedback modalities as an adjunct to swallowing rehabilitation. These chapters address the theoretical and technical underpinnings of surface electromyography biofeedback and several other techniques.

"Chapter Six: Compensatory Interventions for Dysphagia" provides a definition and tutorial on compensatory management of dysphagia. Instructions for the techniques, including coaching techniques, and examples of short-term objectives are included.

"Chapter Seven: Malnutrition and Dehydration in Dysphagia" discusses the nutrient and hydration requirements in the elderly and define the terms nutrition, malnutrition, and dehydration. The role of the speech-language pathologist is discussed with relation to this aspect of dysphagia.

"Chapter Eight: Nonoral Nutrition" describes the various types of nonoral nutrition approaches available to patients with dysphagia. The rationale and ethics of enteral feeding, especially with chronically ill elderly, are discussed.

"Chapter Nine: Oral Nutrition Interventions for Dysphagia" discusses the terminology and management issues involved in diet modification as an intervention option for oropharyngael dysphagia.

"Chapter Ten: Special Issues of Feeding Dependency" describes the many management issues surrounding caregivers who feed patients and what role clinicians can play in implementing proper feeding techniques with patients.

"Chapter Eleven: Surgical Management of Dysphagia of Neurogenic Origin" describes selected surgical managements. Knowing what is possible from surgery gives the management team the maximum possible number of options, especially for persons whose dysphagia does not improve with other treatment or time.

"Chapter Twelve: Legal and Reimbursement Issues of Documentation" discusses how to document dysphagia services to meet the rigorous standards set for reimbursement and to provide legal protection to the clinician.

"Chapter Thirteen: The Patient's Perspective" includes a patient's personal experience with dysphagia. The patient's perspective can offer a rich source of ideas about dysphagia management.

Appendix A, B, and C include the American Speech-Language-Hearing Association Code of Ethics, Statement of Practices and Procedures of the Board of Ethics, and the Medicare Intermediary Manual Part 3-Claims Process. References and Index are included in the final portion of the text.

This text is a comprehensive treatment of dysphagia management. It is recommended for speech-language pathologists with present or future responsibility for treating adults with impaired swallowing. Clinicians will learn what to do, why to do it, and with how much confidence in this ever-changing field. The charts, illustrations, and photographs are very helpful in clarifying the text.

The authors have been successful in creating a resource that provides practicing clinicians with a comprehensive guide of what is known and what we hope to know about how to manage adults with neurogenic dysphagia. The chapter written from the patient's perspective on what it feels like to have dysphagia and to undergo treatment for dysphagia was most enlightening. This book serves as a valuable reference for treatment planning, clinical management, and dialogues regarding ethical dilemmas in service delivery to the patient with neurogenic dysphagia.