A timed test of swallowing capacity for neurological patients.

Abstract

A timed test of swallowing capacity has been designed for use in patients with neurogenic dysphagia. Swallowing speed (mlls) has been demonstrated to have high intra-and inter-rater and test-retest reliability, and to be essentially independent of flavour or temperature. "Guideline" normal values were established in individuals without a swallowing disorder: swallowing speed was less in females than males and declined in both groups with age. obtain an adequate view of laryngeal movement during each swallow so that the number of swallows can be counted. The time and number of swallows taken from the "go" signal to the last swallow recognised by return of the larynx to the rest position (as seen exteriorly by the movement of the thyroid cartilage) are noted. Any coughing during or after the test and the quality of the voice after the test is noted. The residual volume is measured in those in whom the test is abandoned so that in all cases speed (ml/s), and average volume/ swallow (ml) are calculated. Such a test is clearly inappropriate in patients with major dysphagia who are obviously aspirating.2) Reliability studies Intra-rater reliability was assessed by one examiner timing twice the videotaped record of the swallows undertaken by six normal subjects or patients in random order and with the stopwatch face obscured. Inter-rater reliability was examined by 6 observers observing videos of swallowing tests on five normal subjects or patients. The possibility of a learning effect was tested in 24 normal subjects by repeating the test in each subject 4 times over a 48 hour period: at the same time the effect of flavouring the drink was assessed by randomising the order of the 4 drinks-2 of which were water and two a flavoured drink. The effect of temperature on swallowing speed was studied by presenting water at three different temperatures (9°C, 19°C, 39°C) in random order to 6 normal subjects. Finally, swallowing speed was measured twice, at an interval of 1 to 37 days, in 38 neurological patients, of whom 24 had abnormal swallowing speeds (see below).3) Guideline normal ranges A swallowing test was undertaken in 101 "normal" subjects to establish a guideline range for swallowing speed. Individuals with clinically relevant medical or swallowing disorders were excluded.

A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke

“…Clinical assessment of swallowing was conducted by the first author or by an experienced speech-language pathologist from the rehabilitation facility and included an oro-motor assessment, mealtime observation [17], a timed 150ml water test [18,19] and an oral health assessment [20]. To be classified as non-dysphagic and therefore eligible for inclusion, participants needed a 'no abnormality detected' rating on the oro-motor and mealtime assessment according to the AusTOMS criteria [17] for dysphagia and aspiration and pass the water test according to the norms for age and gender.…”

Perceived changes to swallowing in people with Parkinson's disease

“…Using the WST cut-offs for normal-non-normal in (Nathadwarawala et al 1992) (i.e. <32.07 ml/sec males; <20.9 ml/sec females) all people with Parkinson's fell below in swallowing efficiency.…”

“…anti-parkinsonian therapy withheld and fasting since midnight -in order to obtain a direct comparison across subjects and clearer insight into the influence of underlying motor severity. Swallowing was assessed by a single research speech and language pathologist using a 150ml water swallow test (WST) (Nathadwarawala et al 1992), from which a measure of swallowing speed (millilitres/second) is derived. For participants who did not complete the full 150ml, swallowing speed was prorated on the basis of time taken for the amount drunk.…”

“…Questions were formulated based on this, as well as taking items from other questionnaires (Nathadwarawala et al 1992, Clarke et al 1998, Wallace et al 2000 that had shown strong associations with swallowing difficulties and matched descriptions by people with Parkinson's regarding changes which they experienced. .…”

Assessment of speech in neurological disorders: Development of a Swahili screening test

“…Hence we included as part of the screen the 150 ml water swallow test (Nathadwarawala, Nicklin, & Wiles, 1992) that has been shown to be valid and reliable at quantifying swallowing efficiency.…”