Bedside diagnosis of dysphagia: A systematic review

Abstract

Background Dysphagia is associated with aspiration, pneumonia and malnutrition, but remains challenging to identify at the bedside. A variety of exam protocols and maneuvers are commonly used, but the efficacy of these maneuvers is highly variable. Methods We conducted a comprehensive search of seven databases, including MEDLINE, EMBASE and Scopus, from each database’s earliest inception through June 5th, 2013. Studies reporting diagnostic performance of a bedside examination maneuver compared to a reference gold standard (videofluoroscopic swallow study [VFSS] or flexible endoscopic evaluation of swallowing with sensory testing [FEEST]) were included for analysis. From each study, data were abstracted based on the type of diagnostic method and reference standard study population and inclusion/exclusion characteristics, design and prediction of aspiration. Results The search strategy identified 38 articles meeting inclusion criteria. Overall, most bedside examinations lacked sufficient sensitivity to be used for screening purposes across all patient populations examined. Individual studies found dysphonia assessments, abnormal pharyngeal sensation assessments, dual axis accelerometry, and one description of water swallow testing to be sensitive tools, but none were reported as consistently sensitive. A preponderance of identified studies was in post-stroke adults, limiting the generalizability of results. Conclusions No bedside screening protocol has been shown to provide adequate predictive value for presence of aspiration. Several individual exam maneuvers demonstrated reasonable sensitivity, but reproducibility and consistency of these protocols was not established. More research is needed to design an optimal protocol for dysphagia detection.

Lingual and Jaw Kinematic Abnormalities Precede Speech and Swallowing Impairments in ALS

“…We expect this work will help to guide physiologically based therapeutic exercises aimed at prolonging swallowing function in this population. Additionally, kinematic assessment of bulbar function during the swallow may help identify critical markers of bulbar decline, which will improve the management of risks associated with dysphagia [38, 39] and improve timing of the implementation of diet modifications and non-oral feedings [38, 39]. …”

Screening Accuracy for Aspiration Using Bedside Water Swallow Tests

“…14,[17][18][19][20]71,74,75 This review focuses on a single method, the WST, and controlled for the heterogeneity in the literature using appropriate statistical analyses. Despite these methods, the variability of our results is similar to previous reviews, strongly suggesting that robust statistical methods cannot correct for limitations in experimental methods.…”

Morbidade hospitalar por acidente vascular encefálico e cobertura fonoaudiológica no Estado da Paraíba, Brasil

“…During the hospital stay, the team begin the specialized care, in order to encourage deinstitutionalization and avoid or minimize potential complications of stroke (6) . The speech-language therapy in these cases can help reduce hospital costs (21) . The results of this study showed that there was progress in the integration of the speech-language therapist in the public hospital services in Paraiba, between 2010 and 2014, as the total number of speech-language therapists associated to these sites almost doubled during the study period.…”