Ultrasound: Validity of a Pocket-Sized System in the Assessment of Swallowing

Winiker, Katharina; Burnip, Emma; Gozdzikowska, Kristin; Hernandez, Esther Guiu; Hammond, Rebecca; Macrae, Phoebe; Huckabee, Maggie‐Lee

doi:10.1007/s00455-020-10232-w

Cited by 13 publications

(24 citation statements)

References 14 publications

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“…measures. While this finding mirrors validity data of pocket-sized ultrasound in the assessment of healthy swallowing despite the use of slightly different measurement methods for thyrohyoid approximation (Winiker et al, 2021a), it does not align with published data of larger ultrasound equipment (Hsiao et al, 2012;Huang et al, 2009). Discrepancies may be explained by differences in image quality due to differing ultrasound technology.…”

Section: Discussioncontrasting

confidence: 65%

Swallowing assessment in patients with dysphagia: Validity and reliability of a pocket‐sized ultrasound system

Winiker

Hammond

Thomas

et al. 2022

Intl J Lang & Comm Disor

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Background The use of ultrasound as an adjunct to clinical swallowing evaluation provides quantitative physiological and morphological data. As a low‐risk procedure, ultrasound imaging can be performed outside of a medical setting. This is particularly important for patients living in rural areas with restricted access to a hospital. Technical advances have produced pocket‐sized ultrasound technology that is more affordable, and therefore within the fiscal reach of most allied health services. Aims To explore the validity and reliability of pocket‐sized ultrasound technology in dysphagia assessment. Methods & Procedures Data were acquired from 43 patients with dysphagia using the Clarius ultrasound device. Ultrasound and videofluoroscopic measures of hyoid and laryngeal displacement during liquid and puree swallowing were collected concurrently to quantify correlation and agreement between identical measures derived from the two instruments. Reliability of ultrasound was assessed for measures of hyoid and laryngeal displacement, tongue thickness, and size of the submental muscles in eight patients. Reliability was evaluated for the entire process of data acquisition including scanning and online measurement using an iPad in a clinical setting and for offline measurement on a computer screen to explore environmental influences on reliability. Outcomes & Results Results revealed poor correlation between the measures of interest across instruments. Reliability of the entire process of data acquisition in a clinical setting was insufficient while reliability was more promising for offline measurements. Conclusions & Implications The clinical use of pocket‐sized ultrasound devices, such as the Clarius system, for swallowing evaluation is not indicated at this time. Enhanced validity and reliability of the entire process of data acquisition are needed prior to clinical translation of such technology. WHAT THIS PAPER ADDS What is already known on the subject The use of ultrasound allows for radiation‐free, non‐invasive swallowing assessment. Some data suggest that ultrasound is valid and reliable in the evaluation of swallowing using standard‐sized equipment. Insufficient validity and reliability have been reported for pocket‐sized ultrasound technology in the assessment of healthy swallowing. What this paper adds to existing knowledge This research is the first to provide validity and reliability data of the pocket‐sized Clarius technology in the evaluation of swallowing in patients with dysphagia. Insufficient validity and reliability of online data acquisition in a clinical environment were found. Reliability for offline measurement was more promising. What are the potential or actual clinical implications of this work? The clinical use of pocket‐sized ultrasound devices, such as the Clarius system, for swallowing assessment is not indicated at this time.

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Section: Discussioncontrasting

confidence: 65%

Swallowing assessment in patients with dysphagia: Validity and reliability of a pocket‐sized ultrasound system

Winiker

Hammond

Thomas

et al. 2022

Intl J Lang & Comm Disor

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“…Further, reliable and valid assessment is related to assessment protocols and equipment selection; for example, reliability and validity may be impacted by the choice of US device. While there are some data to suggest that standard-sized US equipment may provide reliable and valid swallowing measures [ 5 , 12 , 16 ], this could not be confirmed for pocket-sized technology [ 24 , 60 ]. The method of data acquisition, such as the use of hand-held versus fixed transducers, may further affect reliability [ 61 , 62 ]; as might variability between different data collection settings, for example, data collected in the clinical versus research environment.…”

Section: Discussionmentioning

confidence: 99%

“…The emerging evidence that supports the use of US to detect bolus residue and aspiration may also extend its range of potential applications in the clinical setting [ 20 – 22 ]. Technological advances in US imaging quality [ 23 ], and increasing accessibility and portability of US devices [ 24 , 25 ], further support the rationale to determine the optimal approaches for effective implementation of US into clinical practice that are sustainable and evidence-based.…”

Section: Introductionmentioning

confidence: 99%

Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study

et al. 2022

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Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1–13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.

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“…In the current study, HxD max was calculated by the difference between the maximum and minimum Hx values extracted from the swallow region defined by when the bolus starts to approach the mouth until the completion of the swallow. While the position of the hyoid before the beginning of a swallow has been used in most previous studies as the resting position (e.g., Hsiao et al., 2012; Lee et al., 2016), Molfenter and Steele (2011) reported variability in how the rest frame is defined, including hyoid position before swallow (Vandaele et al., 1995), after swallow (Winiker et al., 2021) or the moment before bolus being propelled into the pharynx (Kim & McCullough, 2008). From observing the recorded data, it was noted that the lowest hyoid position was not always found before the swallow, especially when there is an anticipatory pre‐swallow raising of the hyoid position.…”

Section: Discussionmentioning

confidence: 99%

“…Hyoid displacement has previously been investigated as an indicator of the functioning of pharyngeal swallow in normal and disordered populations using VFSS (Kang et al., 2010; Paik et al., 2008). A recent study comparing hyoid excursion in ultrasound and videofluroscopic study of swallowing reported a strong correlation between the two instrumental measures during a dry and a liquid swallow, but not for a puree swallow (Winiker et al., 2021).…”

Section: Introductionmentioning

confidence: 99%

Automated assessment of hyoid movement during normal swallow using ultrasound

K-Y

Wrench

2022

Intl J Lang & Comm Disor

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Background The potential for using ultrasound by speech and language therapists (SLTs) as an adjunct clinical tool to assess swallowing function has received increased attention during the COVID‐19 pandemic, with a recent review highlighting the need for further research on normative data, objective measurement, elicitation protocol and training. The dynamic movement of the hyoid, visible in ultrasound, is crucial in facilitating bolus transition and protection of the airway during a swallow and has shown promise as a biomarker of swallowing function. Aims To examine the kinematics of the hyoid during a swallow using ultrasound imaging and to relate the patterns to the different stages of a normal swallow. To evaluate the accuracy and robustness of two different automatic hyoid tracking methods relative to manual hyoid position estimation. Methods & Procedures Ultrasound data recorded from 15 healthy participants swallowing a 10 ml water bolus delivered by cup or spoon were analysed. The movement of the hyoid was tracked using manually marked frame‐to‐frame positions, automated hyoid shadow tracking and deep neural net (DNN) tracking. Hyoid displacement along the horizontal image axis (HxD) was charted throughout a swallow, and the maximum horizontal displacement (HxD max) and maximum hyoid velocity (HxV max) along the same axis were automatically calculated. Outcomes & Results The HxD and HxV of 10 ml swallows are similar to values reported in the literature. The trajectory of the hyoid movement and its location at significant swallow event time points showed increased hyoid displacement towards the peak of the swallow. Using an interclass correlation coefficient, HxD max and HxV max values derived from the DNN tracker and shadow tracker are shown to be in high agreement and moderate agreement, respectively, when compared with values derived from manual tracking. Conclusions & Implications The similarity of the hyoid tracking results using ultrasound to previous reports based on different instrumental tools supports the possibility of using hyoid movement as a measure of swallowing function in ultrasound. The use of machine learning to automatically track the hyoid movement potentially provides a reliable and efficient way to quantify swallowing function. These findings contribute towards improving the clinical utility of ultrasound as a swallowing assessment tool. Further research on both normative and clinical populations is needed to validate hyoid movement metrics as a means of differentiating normal and abnormal swallows and to verify the reliability of automatic tracking. WHAT THIS PAPER ADDS What is already known on this subject There is growing interest in the use of ultrasound as an adjunct tool for assessing swallowing function. However, there is currently insufficient knowledge about the patterning and timing of lingual and hyoid movement in a typical swallow. We know that movement of the hyoid plays an essential role in bolus transition and airway protection. However, manual tracking of hyoi...

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Ultrasound: Validity of a Pocket-Sized System in the Assessment of Swallowing

Cited by 13 publications

References 14 publications

Swallowing assessment in patients with dysphagia: Validity and reliability of a pocket‐sized ultrasound system

Swallowing assessment in patients with dysphagia: Validity and reliability of a pocket‐sized ultrasound system

Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study

Automated assessment of hyoid movement during normal swallow using ultrasound

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