Boulevard, St. Paul, MN 55103, phone (612) 232-2358, fax (612) 23 2-2268. St~mmcnt yth~ Problem: In the past J;c;iLl;, thc literature on swallow dysfunction has expanded to include research regarding aspiration, silent aspiration, and varying compensatory techniques and dietary changes to avoid aspiration. There is presently a dearth of research regarding aspiration of roods and liquids and the relationship to aspiration pneumonia. The issue uf causality of aspiration pneumonia and medical complicatic,ns therein is of major concern to physicians and swaHow professionals working with swal!nw dysfunction.MechoJ oJ Smoh':Using a randomizeJ-o JI1[fol prospective design, this one year study examined two groups of stroke patients with previously identified thin liquid aspiration. The m)ntrt)1 group ( 10 patients) rccciBml thickened liquids onty. The study group (10 patients) had aH tiquids thickened in the same manner, hut were ,ill

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Epiglottic movement patterns of 500 consecutive patients with varying etiologies were recorded during routine video¯uoroscopic swallow evaluations. Seven distinct, commonly repeated, abnormal epiglottic patterns were identi®ed. A multifactorial analysis of these seven abnormal epiglottic movement patterns was completed. Findings indicate that each of these seven distinct movement patterns have varying rates and amounts of aspiration. A description of each epiglottic movement pattern is given in conjunction with information regarding aspiration and other variables associated with the swallow process. A universal nomenclature is oered regarding these subtle abnormal epiglottic movement patterns to increase a verbal commonality in our descriptions of epiglottic function as it aects aspiration.

Objective: Following the publication of the DePippo et al. research, many physicians are beginning to use the 3-oz water screen as a replacement for videofluoroscopic swallow evaluations. Decisions regarding oral intake are being made using the cough reflex as the sole indicator of aspiration. We replicated this procedure in one hundred patients scheduled for videofluoroscopic evaluation to determine its reliability as a screening method.Design: As part of routine videofluoroscopic swallow evaluations over a four-month period, we identified one hundred consecutive patients tested with the 3-oz water screen. Setting:The videofluoroscopic evaluations were conducted in an acute hospital setting and a rehabilitation hospital.Participants: All patients had observed or suspected swallow difficulty that indicated the need for videofluoroscopic swallow evaluation. Half of the patients were evaluated at the acute hospital, the remaining at the rehabilitation hospital. Males comprised 52%. The mean age was 75.2 years (± 11.3), range 27 to 95. The diagnosis ofCVA (left, bilateral, or right) had been made in 50% of the patients. Main Outcome Measures:Determine the proportion of patients who coughed on the 3-oz screen and aspirated on the videofluoroscopic swallow evaluation.Results: Fifty-four patients aspirated. Of these, only nineteen (35%) coughed, leaving thirty-five, or 65%, who were not identified by this screening method. Using the Fisher Exact Test, a statistically significant difference (p < 0.005) was identified between those patients who were identified by the 3-oz water screen and those who were identified by videofluoroscopic evaluation. Conclusions:The 3-oz water screen utilizing the cough reflex as the sole indicator of aspiration is not a replacement for the precision and accuracy of a videofluoroscopic evaluation.

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