First Steps Towards Development of an Instrument for the Reproducible Quantification of Oropharyngeal Swallow Physiology in Bottle-Fed Children

Abstract

The incidence of feeding/swallowing impairments (deglutition disorders) in young children is rising and poses serious acute and long-term health consequences. Accurate detection and prompt intervention can lessen the impact of dysphagia-induced sequelae. Videofluoroscopic Swallow Studies (VFSSs) are used to make critical decisions for medically fragile children despite procedural variability and the lack of agreed upon measures for interpreting and reporting results. This investigation represents the first steps in the development of a novel tool for the quantification of oropharyngeal swallow physiology from full-length VFSS examinations in bottle-fed children. The Modified Barium Swallow Impairment Profile MBSImP™© served as the conceptual assessment model for development of components and operational score variants to characterize distinguishable VFSS observations. Twenty-four components of swallowing physiology were validated via expert consensus. Training materials included a library of 94 digitized video images comprised of distinct score variants for each component. Materials were disseminated to seven speech-language pathologists (SLPs) who participated in didactic and self-training sessions, and rated components. All SLPs achieved ≥80% reliability criterion after completing two or three training sessions. Agreement for 17 (71%) components was achieved after two sessions. Nutritive sucking/oral and airway-related components were most difficult to distinguish. Three sessions were required for 2 (33%) of the sucking/oral components and 4 (57%) of the airway-related components. These findings support the feasibility to standardize training and reliably score swallowing physiology using precise definitions and unambiguous visual images, and represent preliminary steps towards content validity and reliability of a standardized VFSS tool for bottle-fed children.

Incidence of aspiration in infants with single‐ventricle physiology following hybrid procedure

“…Additionally, two infants who did not aspirate during VFSS were placed unnecessarily on modified diets following the BSE. Currently, Lefton‐Greif and colleagues are working on standardization of VFSS for bottle‐fed infants. If BSE were standardized so that sensitivity and specificity were improved, we could reduce the need for instrumental assessment with VFSS.…”

Videofluoroscopy in Children

“…Na rozdiel od VFSS u dospelých, pri VFSS u detí neexistuje jednotný štandardný protokol na vyšetrenie, aj keď sa v súčasnosti realizujú rôzne štúdie, zamerané na štandardizáciu VFSS u detí (Henderson et al, 2016, Lefton-Greif et al, 2018. Najprv sa však podáva tekutina (1-2 hlty), odporúča sa začať 2-3 ml, čo zodpovedá objemu slín pri jednom typickom hlte.…”

“…Na našom pracovisku používame modifikáciu VFSS protokolu podľa Arvedson (Arvedson, 2016). V súčasnosti prebiehajú štúdie, ktoré sa snažia validovať kvantitatívne parametre VFSS u detí (Lefton-Greif et al, 2018). Stupeň penetrácie a aspirácie sa určuje podľa Rosenbekovej penetračno-aspiračnej škály (Rosenbek et al, 1996), v tabuľke č.…”

Swallowing Analyses of Neonates and Infants in Breastfeeding and Bottle-feeding: Impact on Videofluoroscopy Swallow Studies

“…7 8 The videofluoroscopy swallow study (VFSS) is considered the gold standard for the detection of swallowing dysfunction, even with procedural variability and lack of consensus regarding the measurements and analyses of the results. 9 10 11 12…”

“…Despite the relevance of the VFSS for the diagnosis of swallowing difficulties, only in recent decades there has been an increase in VFSSs among the population of neonates and infants. Safety procedures regarding radiation exposure and preliminary studies with temporal analyses were conducted based on the models established for the adult population 9 13 14 establishing standars for the infants and child population. However, in none of the studies the VFSS was performed during breastfeeding.…”