The development and use of an 8-point, equal-appearing interval scale to describe penetration and aspiration events are described. Scores are determined primarily by the depth to which material passes in the airway and by whether or not material entering the airway is expelled. Intra- and interjudge reliability have been established. Clinical and scientific uses of the scale are discussed.

Advances in the measurement of swallowing physiologic parameters have been clinician-driven, as has the development of intervention techniques to modify swallowing pathophysiology. However, a critical element to determining the success of such efforts will be established by the patients themselves. We conceptualized, developed, and validated the SWAL-QOL, a 93-item quality-of-life and quality-of-care outcomes tool for dysphagia researchers and clinicians. With 93 items, the SWAL-QOL was too long for practical and routine use in clinical research and practice. We used an array of psychometric techniques to reduce the 93-item instrument into two patient-centered outcomes tools: (1) the SWAL-QOL, a 44-item tool that assesses ten quality-of-life concepts, and (2) the SWAL-CARE, a 15-item tool that assesses quality of care and patient satisfaction. All scales exhibit excellent internal-consistency reliability and short-term reproducibility. The scales differentiate normal swallowers from patients with oropharyngeal dysphagia and are sensitive to differences in the severity of dysphagia as clinically defined. It is intended that the standardization and publication of the SWAL-QOL and the SWAL-CARE will facilitate their use in clinical research and clinical practice to better understand treatment effectiveness as a critical step toward improving patients' quality of life and quality of care.

Objective: Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement. Methods:This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration-aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images.

The measurement of intelligibility in dysarthric individuals is a major concern in clinical assessment and management and in research on dysarthria. The measurement objective is complicated by the fact that intelligibility is not an absolute quantity but rather a relative quantity that depends on variables such as test material, personnel, training, test procedures, and state of the speaker. This paper reviews scaling procedures and item identification tests as they have been applied to dysarthric speech. Based in part on previous studies of speech of the hearing impaired, a profile has been designed to direct research on the acoustic or physiologic correlates of dysarthric intelligibility impairment. In addition, a word intelligibility test is proposed for use with dysarthric speakers. This test is designed to examine 19 acoustic-phonetic contrasts that are likely to (a) be sensitive to dysarthric impairment and (b) contribute significantly to speech intelligibility. Preliminary data from a sample of subjects with amyotrophic lateral sclerosis are presented to illustrate the use of this test in the phonetic interpretation of intelligibility impairment.

2016-10-17T18:53:41