Dysphagia Assessment and Treatment Planning—A Team Approach

Brewer, Kelly; Leonard, Leonard; Kendall,

doi:10.1044/sasd9.1.9

Cited by 13 publications

(16 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Swallowing safety (i.e., airway invasion) and swallowing efficiency during MBSS were quantified using the median Penetration Aspiration Scale (PAS) 29,30 and norm‐referenced measures of timing and displacement for laryngeal closure and related airway protection events via Swallowtail 2.0 software (BellDev Medical, Arlington Heights, IL), respectively. Established quantitative measures of laryngeal kinematics (i.e., timing and displacement) as well as total pharyngeal transit time (TPT) (i.e., duration the bolus is adjacent to the larynx) were conducted 31–39 (Table II). Specifically, quantifiable laryngeal kinematics included the start of arytenoid approximation to the epiglottis (AEs), the time to reach laryngeal vestibule closure in comparison to hyoid burst (LVCrt) or in comparison to the depth of the head of the bolus (BP1AEcl), and the extent of approximation of the larynx to the hyoid bone (HL) 31–39 .…”

Section: Methodsmentioning

confidence: 99%

Voluntary Cough Testing as a Clinical Indicator of Airway Protection in Cervical Spinal Cord Injury

et al. 2022

View full text Add to dashboard Cite

Objective Voluntary cough testing (VCT) may be useful for determining aspiration risk in neurogenic dysphagia; however, has yet to be investigated in traumatic cervical spinal cord injury (tCSCI). The study explored if VCT may elucidate swallowing safety and kinematics related to airway protection in tCSCI survivors. Methods Ten inpatients, 13–73 days post‐tCSCI (7 incomplete injuries), completed VCT and a modified barium swallowing study that was analyzed via the Penetration Aspiration Scale (PAS) and norm‐referenced measures of swallowing events related to airway protection. Spearman rho correlations explored relations among cough airflow, median PAS, and airway protection. Mann–Whitney U tests explored group differences based on clinical airway invasion (PAS > 2) and receiver operating characteristic statistics probed the sensitivity/specificity of VCT measures. Results Safe (PAS > 2) and unsafe swallowers differed by cough volume acceleration (CVA) for the total sample and by inspiratory duration for incomplete injuries (p = 0.03, r > 0.7). A cut‐off value of 24.8 L/s for CVA predicted airway invasion (AUC = 0.917, p = 0.03) with sensitivity = 100%/specificity = 75%. CVA correlated with delayed laryngeal vestibule closure during swallowing for both the total sample and for incomplete injuries (rs > 0.6, p < 0.05). Blunted peak flow and prolonged cough phases were associated with disordered laryngeal kinematics and prolonged bolus transit during swallowing (p < 0.05). Conclusions Reduced CVA, blunted peak flow, and prolonged cough phases reflected PAS and disrupted mechanisms of airway protection in tCSCI survivors, demonstrating promise for VCT as a clinical assessment for post‐tCSCI dysphagia. Level of Evidence 3 Laryngoscope, 133:1434–1441, 2023

show abstract

Section: Methodsmentioning

confidence: 99%

Voluntary Cough Testing as a Clinical Indicator of Airway Protection in Cervical Spinal Cord Injury

et al. 2022

View full text Add to dashboard Cite

show abstract

“…After BSE, all patients were evaluated by a phoniatrician and submitted to FEES according to a protocol in use at our centre 3 . Endoscopic evaluation was performed with a Storz endoscope (model 11101RP2, 30 cm long, 3.5 mm in diameter) and recorded with a workstation (Richard Wolf GmbH, Knittlingen, Germany).…”

Section: Methodsmentioning

confidence: 99%

“…In dysfunctional or pathological conditions, material pooling or residue can invade the respiratory tract, upwards and/or downwards, leading to respiratory or nutritional complications (ineffective / inefficient swallow or dysphagia), respectively 2 . Several conditions, acting as morbidity or comorbidities, can affect the quality of life (QOL) of dysphagic patients, offering a wide variety of events that are able to influence each other in guiding the clinical options adopted by the multidisciplinary team (MDT) that manages the patient 3 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Correlations between bedside and instrumental endoscopic parameters in determining severity of dysphagia: an integrated clinical evaluation of safety and efficiency

Farneti

Genovese

2020

Acta Otorhinolaryngol Ital

View full text Add to dashboard Cite

SUMMARY Interaction between bedside and endoscopic parameters is of great interest in the management of patients with swallowing disorders. Our aim is to document if and how bedside parameters correlate with severity using endoscopic assessment. 556 consecutive patients (318 M/238 F, mean age 65.56 ± 10.36 years, range 18-91), were evaluated in our Swallowing Centre during 2008. All underwent bedside evaluation and fiberoptic endoscopic evaluation of swallowing (FEES), considering the pooling score (p-score) and the pooling sensation, collaboration and age score (p-SCA score) to express criteria of clinical severity of dysphagia. The correlation between the two tests (Spearman correlation coefficient) and their agreement to classify severity (Cohen’s kappa) was defined. After dichotomisation (cut-off: no risk/any kind of risk of aspiration), values of sensitivity and specificity were obtained after comparison with FEES results (gold standard). A close and significant correlation between the p-score and p-SCA score was found (rho = 0.88; p < 0.001). The agreement among scores in attributing the categories of risk is moderate (Cohen’s Kappa = 0.46; p < 0.001).The p-score had a sensitivity of 96% and specificity of 60%, while the p-SCA score has a sensitivity of 98% and specificity of 40%. Our results suggest that including even a few parameter from bedside evaluation to an endoscopic score, the level of severity expressed by the latter, decreases. The evaluation of patients with swallowing disorders should consider as many elements as possible, deriving from non-instrumental and instrumental evaluation (integrated clinical evaluation).

show abstract

“…Importantly, validation of the MBSImP has been conducted with the use of Varibar, allowing for consistent information to be obtained in the same manner both within and between patients, clinicians, and settings. Measures of penetration/aspiration (penetration-aspiration scale), swallow efficiency combined with airway invasion (Dynamic Imaging Grade of Swallowing Toxicity), and kinematic and temporal measures may also be included (Brewer et al, 2000;Hutcheson et al, 2017;Martin-Harris & Jones, 2008;Molfenter & Steele, 2014;Rosenbek et al, 1996;Steele et al, 2019). Importantly, these standardization methods permit contributions to big data initiatives (Garand et al, 2018;MBSImP, 2020).…”

Section: Performing An Mbssmentioning

confidence: 99%

The Modified Barium Swallow Study for Oropharyngeal Dysphagia: Recommendations From an Interdisciplinary Expert Panel

et al. 2021

View full text Add to dashboard Cite

Purpose Dysphagia occurs as a component of a wide variety of diseases and conditions. When unrecognized or poorly managed, dysphagia can result in malnutrition, volume depletion, and reduced quality of life, as well as aspiration, pneumonia, and death. This document focuses specifically on oropharyngeal dysphagia. The modified barium swallow study (MBSS) is a fluoroscopic motion study used to evaluate oropharyngeal anatomy and swallowing physiology in real time. It is typically performed by a speech-language pathologist together with a radiologist and often assisted by a radiologic technologist. Because oropharyngeal dysphagia has such a varied presentation, the guidance to diagnose and treat oropharyngeal dysphagia in the United States falls under the purview of several professional societies and organizations. However, a thorough review of available practice guidelines and appropriateness criteria issued to date reveals a deficit of up-to-date, comprehensive, evidence-based information on the diagnosis and evaluation of oropharyngeal dysphagia. Specifically, a lack of quality guidance on the ordering, performance, and reporting of the MBSS has hindered efforts to improve standardization and ensure quality continuity of care. Method In 2019, a group with expertise in oropharyngeal dysphagia (speech-language pathologists, radiologists, and referring physicians) convened with the goal of specifying a core set of expert recommendations/best practices to achieve a high-quality MBSS. Results Here, we present the results of the participants' discussions and provide consensus recommendations regarding ordering, performing, and reporting an MBSS. Conclusion The overarching goal of this summary is to emphasize the need for and encourage the development of MBSS practice guidelines to support clinicians and patients.

show abstract

Dysphagia Assessment and Treatment Planning—A Team Approach

Cited by 13 publications

References 0 publications

Voluntary Cough Testing as a Clinical Indicator of Airway Protection in Cervical Spinal Cord Injury

Voluntary Cough Testing as a Clinical Indicator of Airway Protection in Cervical Spinal Cord Injury

Correlations between bedside and instrumental endoscopic parameters in determining severity of dysphagia: an integrated clinical evaluation of safety and efficiency

The Modified Barium Swallow Study for Oropharyngeal Dysphagia: Recommendations From an Interdisciplinary Expert Panel

Contact Info

Product

Resources

About