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Messina F, Rocca S, Manca B, Scarponi L, Ninfa A, Schindler A, Pizzorni N. Pharyngeal Residue Scoring in Fiberoptic Endoscopic Evaluation of Swallowing: Reliability Comparison and Applicability Among Different Scales. Dysphagia 2024; 39:872-880. [PMID: 38329538 PMCID: PMC11449967 DOI: 10.1007/s00455-024-10669-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024]
Abstract
Several scales to assess pharyngeal residue in Fiberoptic Endoscopic Evaluation of Swallowing (FEES) are currently available. The study aimed to compare the reliability and the applicability in real clinical practice among four rating scales: the Pooling Score (P-SCORE), the Boston Residue and Clearance Scale (BRACS), the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), and the Residue Ordinal Rating Scale (RORS). Twenty-five FEES videos were evaluated four times, once for each scale, by four speech and language pathologists. To test intra-rater reliability, the same raters re-assessed the videos two weeks apart. To test the applicability, raters recorded the time required to complete each assessment and the perceived difficulty/ease on a visual-analog scale (VAS). The intra-rater and the inter-rater reliability were calculated with Cohen's weighted Kappa and the Fleiss weighted Kappa, respectively. Time and perceived difficulty/ease scores were compared. The intra-rater reliability analysis showed almost perfect agreement for YPRSRS (k = 0.91) and RORS (k = 0.83) and substantial agreement for P-SCORE (k = 0.76) and BRACS (k = 0.74). Pairwise comparison showed no significant differences among the scales. The inter-rater reliability for the YPRSRS (k = 0.78) was significantly higher than P-SCORE (k = 0.52, p < 0.001), BRACS (k = 0.56, p < 0.001), and RORS (k = 0.65, p = 0.005). The BRACS required the longest time (p < 0.001) and was perceived as the most difficult scale (p < 0.001). The RORS was perceived as the easiest scale (p < 0.05). In conclusion, the YPRSRS showed the highest reliability, while raters perceived the RORS as the easiest to score. These results will allow clinicians to consciously choose which scale to use in clinical practice.
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Affiliation(s)
- Federica Messina
- Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, 20157, Milan, Italy
| | - Sara Rocca
- Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, 20157, Milan, Italy.
| | - Beatrice Manca
- Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, 20157, Milan, Italy
| | - Letizia Scarponi
- Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, 20157, Milan, Italy
| | - Aurora Ninfa
- Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, 20157, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, 20157, Milan, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, 20157, Milan, Italy
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Venite RS, Pernambuco L, Silva RGD, Onofri SMM. Translation and cross-cultural adaptation of the Yale Pharyngeal Residue Severity Rating Scale into Brazilian Portuguese. Braz J Otorhinolaryngol 2024; 90:101470. [PMID: 39059321 PMCID: PMC11327458 DOI: 10.1016/j.bjorl.2024.101470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/20/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE To report the process of translation and cross-cultural adaptation of theYale Pharyngeal Residue Severity Rating Scale into Brazilian Portuguese. METHODS Methodological study approved by the Ethics Committee of the Institution (nº 5.166.256). The English original scale was translated into Brazilian Portuguese following suggested in the literature guidelines and recommendations after authorization from the authors of the original instrument, and involved the following reported steps of (1) Translation, (2) Synthesis of translations, (3) Determination of the applicability of the translated version 4) Back-translation, (5) Synthesis of the back-translated versions, and (6) Final synthesis. The translations and back-translations were performed by two bilingual translators. The research committee constituted three specialists who considered whether the linguistic, semantics, conceptual, idiomatic, and contextual equivalence of the translations and back-translations were. In Step 3, the raters consisted of three Speech-Language Pathologists and five ENT physicians divided into two subgroups (less than 5 years of professional expertise, and more than 5 years of professional expertise). RESULTS Step 1 was carried out properly by the translators, in Step 2 the translated version was prepared after minor adjustments. In Step 3, the raters reported that they found no difficulties in applying the scale. The Cronbach's Alpha coefficient was 0.995, demonstrating high internal consistency of the instrument, and the analysis of the Intraclass Correlation Coefficient (ICC) among the eight raters was 0.994 with a confidence interval between 0.990 and 0.998, demonstrating excellent agreement, regardless of experience. The research committee judged the last to be adequate and not to require adjustments. CONCLUSION The Brazilian Portuguese version of theYale Pharyngeal Residue Severity Rating Scale is presented in this study. This is a methodological study - No level of evidence.
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Affiliation(s)
- Roberta Seabra Venite
- Universidade Estadual Paulista (Unesp), Faculdade de Filosofia e Ciências, Marília, SP, Brazil
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Burdick RJ, Dallal-York J, Shapira-Galitz Y. Flexible Endoscopic Evaluation of Swallowing: A Proposed Checklist. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-10. [PMID: 39151055 DOI: 10.1044/2023_ajslp-22-00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
PURPOSE Flexible endoscopic evaluation of swallowing (FEES) is not only a well-recognized and ubiquitous tool in dysphagia research but also possesses features that make the assessment vulnerable to shortcomings in transparency and rigor in published literature. Therefore, FEES was considered an important addition to the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS), a multisite collective effort to establish a tool for the critical appraisal of reporting in all forms of dysphagia and swallowing-related research on human subjects. METHOD From the FRONTIERS collective, a team of three clinician researchers completed a review of FEES-related literature to determine all components crucial for generalizable and reproducible reporting of FEES research. These components were developed and refined through an iterative process. RESULTS This review culminated in a 26-item series of "yes/no" questions, forming the FEES section of FRONTIERS. These questions are grouped into the following five components: (a) Equipment, (b) Rater(s), (c) Rating Process, (d) Outcome Metrics, and (e) Miscellaneous Factors. CONCLUSION The results of this review support that FEES possesses unique characteristics to other aspects of dysphagia research and is consequently a crucial addition to FRONTIERS to ensure that clinical researchers have access to critical appraisal of FEES-related research inquiry.
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Affiliation(s)
- Ryan J Burdick
- Swallowing & Salivary Bioscience Lab, Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison
| | - Justine Dallal-York
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral SciencesTeachers College, Columbia University, New York City, NY
| | - Yael Shapira-Galitz
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hebrew University of Jerusalem, Rehovot, Israel
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Yee J, Smaoui S, Rogus-Pulia N. Exercise-Based Dysphagia Treatment: A Proposed Checklist. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1-11. [PMID: 39151063 PMCID: PMC11427736 DOI: 10.1044/2024_ajslp-22-00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/28/2023] [Accepted: 05/08/2024] [Indexed: 08/18/2024]
Abstract
PURPOSE Oropharyngeal swallowing exercise-based interventions are frequently utilized to target physiologic mechanisms with the goal of improving swallowing function. However, study replicability and evidence synthesis regarding effects of interventions are limited due to inconsistent reporting on factors known to influence treatment delivery. In order to promote consistency of reporting factors associated with replicability, the authors constructed a set of preferred parameters focused on dysphagia as part of the initial version of the larger tool (Framework for RigOr aNd Transparency In REseaRch on Swallowing or FRONTIERS). METHOD Thirty-eight initial questions were assembled by the authors as part of the treatment subsection. Questions were then reviewed by individuals in the FRONTIERS collaborative who have expertise in research, clinical practice, or both. RESULT Twenty-four questions were removed following review, reducing the final set of treatment-focused questions to 14 questions. CONCLUSIONS The revised set of questions provides users of the exercise-based treatment section of the FRONTIERS checklist with an initial checklist to promote transparency and rigor to improve study replicability and evidence synthesis. We intend for this treatment section of FRONTIERS to undergo further refinement following commentary and feedback.
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Affiliation(s)
- Joanne Yee
- William S. Middleton Memorial Veterans Affairs Hospital, Geriatric Research Education and Clinical Center, Madison, WI
- Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin–Madison
- School of Medicine and Public Health, University of Wisconsin–Madison
| | - Sana Smaoui
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Nicole Rogus-Pulia
- William S. Middleton Memorial Veterans Affairs Hospital, Geriatric Research Education and Clinical Center, Madison, WI
- Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin–Madison
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Labeit B, Lapa S, Muhle P, Suntrup-Krueger S, Claus I, Gandor F, Ahring S, Oelenberg S, Dziewas R, Warnecke T. Validation of the DIGEST-FEES as a Global Outcome Measure for Pharyngeal Dysphagia in Parkinson's Disease. Dysphagia 2024; 39:697-704. [PMID: 38135841 PMCID: PMC11239722 DOI: 10.1007/s00455-023-10650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
Flexible Endoscopic Evaluation of Swallowing (FEES) is one of two diagnostic gold standards for pharyngeal dysphagia in Parkinson's disease (PD), however, validated global outcome measures at the patient level are widely lacking. The Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) represents such an outcome measure but has been validated primarily for head and neck cancer collectives. The objective of this study was, therefore, to investigate the validity of the DIGEST-FEES in patients with PD. Content validity was evaluated with a modified Delphi expert survey. Subsequently, 66 FEES videos in PD patients were scored with the DIGEST-FEES. Criterion validity was determined using Spearman's correlation coefficient between the DIGEST-FEES and the Penetration-Aspiration Scale (PAS), the Yale-Residue-Rating-Scale, the Functional-Oral-Intake-Scale (FOIS), and the swallowing-related Unified-Parkinson-Disease-Rating-Scale (UPDRS) items. Inter-rater reliability was determined using 10 randomly selected FEES-videos examined by a second rater. As a result, the overall DIGEST-FEES-rating exhibited significant correlations with the Yale-Valleculae-Residue-Scale (r = 0.84; p < 0.001), the Yale-Pyriform-Sinus-Residue-Scale (r = 0.70; p < 0.001), the FOIS (r = - 0.55, p < 0.001), and the UPDRS-Swallowing-Item-Score (r = 0.42, p < 0.001). Further, the DIGEST-FEES-safety subscore correlated with the PAS (r = 0.63, p < 0.001). Inter-rater reliability was high for the overall DIGEST-FEES rating (quadratic weighted kappa of 0.82). Therefore, DIGEST-FEES is a valid and reliable score to evaluate overall pharyngeal dysphagia severity in PD. Nevertheless, the modified Delphi survey identified domains where DIGEST-FEES may need to be specifically adapted to PD or neurological collectives in the future.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Sriramya Lapa
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Inga Claus
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Florin Gandor
- Movement Disorders Clinic, Beelitz-Heilstätten, Germany
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Sigrid Ahring
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Stephan Oelenberg
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck - Academic Teaching Hospital of the WWU Muenster, Osnabrueck, Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck - Academic Teaching Hospital of the WWU Muenster, Osnabrueck, Germany
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Sutton S, Lim L, Servino K, To H, Wang L, McCoy Y, Bice EM, Galek KE. Normal values for swallow events during endoscopic evaluation of swallowing: a preliminary study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08782-y. [PMID: 39001914 DOI: 10.1007/s00405-024-08782-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/04/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE The current investigation aimed to establish preliminary normative data for endoscopic swallow studies (FEES). The investigators collected data for three timing measures (time to whiteout, duration of whiteout, and total swallow time), three swallowing outcomes (safety, efficiency, and number of swallows per bolus), and one physiologic event (glottal response), for both healthy young and older adults using two liquid volumes, one pureed bolus and a solid bolus. METHODS Blinded raters retrospectively analyzed 65 randomly selected, deidentified videos of endoscopic swallowing examinations from a pool of 163 young and older adults with typical swallowing abilities. Timing measures and analysis of airway invasion, amount of residue, number of swallows, and glottal response were obtained. RESULTS Preliminary means and quartiles were established for healthy adults in two age groups (young and old), for time to whiteout (WO), number of swallows per bolus, glottal response, Yale Residue Rating Scale Scores, Penetration-Aspiration Scale scores, duration of WO, and total swallow duration. Differences were found between the older and younger groups. CONCLUSION The current study represents a preliminary attempt to provide quantitative and normative values for FEES. These data represent reference values to which other bolus presentations and populations can be compared. The data represents proof of concept and merits additional investigation. IRB ID 1756246-2: Approved 2022/06/06. CLINICAL TRIAL REGISTRATION Study does not meet criteria. DATA REPOSITORY: https://doi.org/10.6084/m9.figshare.25800025 .
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Affiliation(s)
- Sarah Sutton
- BS University of Nevada, Reno School of Medicine, North Virginia Street, MS 0152, Reno, NV, 89557, USA
| | - Lauren Lim
- BS University of Nevada, Reno School of Medicine, North Virginia Street, MS 0152, Reno, NV, 89557, USA
| | - Kendahl Servino
- BS University of Nevada, Reno School of Medicine, North Virginia Street, MS 0152, Reno, NV, 89557, USA
| | - Hao To
- BS University of Nevada, Reno School of Medicine, North Virginia Street, MS 0152, Reno, NV, 89557, USA
| | - Lingchen Wang
- Reno School of Medicine, Department of Public Health, University of Nevada, Reno, NV, USA
| | - Yvette McCoy
- MS, Moravian University College of Health School of Rehabilitative Science, Moravian, PA, USA
| | - Ed M Bice
- IOPI Medical, LLC, Clinical consulting, Woodinville, WA, USA
| | - Kristine E Galek
- University of Nevada, Reno School of Medicine, Speech Pathology and Audiology, Reno, NV , USA.
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Burdick R, Peña-Chávez R, Namasivayam-MacDonald A, Rogus-Pulia N. Deglutologist Practices and Perceptions of the Penetration-Aspiration Scale: A Survey Study. Dysphagia 2024; 39:522-533. [PMID: 38267756 DOI: 10.1007/s00455-023-10637-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/26/2023] [Indexed: 01/26/2024]
Abstract
Successful dysphagia management requires accurate, succinct diagnosis and characterization of swallowing safety impairments. However, the Penetration-Aspiration Scale (PAS) remains the only available tool developed exclusively for assessment of airway protection. To best support efforts to advance the field's understanding of swallowing safety, it is crucial to understand current clinician practice patterns, perceptions, and accuracy regarding the PAS. A 46-item survey was developed and distributed to deglutologists internationally examining: (1) Demographics; (2) Scale Practices; (3) Swallowing Safety Priorities; (4) Scale Perceptions; and (5) Accuracy. The first four sections consisted of questionnaires. In the optional fifth section, respondents were asked to score five videos of swallows collected via videofluoroscopy and previously PAS-scored by two trained raters. In total, 335 responses were analyzed. The majority of respondents self-reported PAS training (84%); 90% of untrained respondents were receptive to training. Respondents reported using the PAS "always" (40%) or "frequently" (29%), and that the PAS carries "a great deal of" weight in assessment (40%). Reported application of the PAS was heterogeneous, with the most common approach being "single worst score per unique presentation" (45%). Most respondents (64%) prioritized a parameter not captured by the PAS. Untrained respondents were significantly more confident with PAS ratings than trained respondents (X2 = 7.47; p = 0.006). Of 1460 PAS ratings provided, 364 of them were accurate (25%) when compared to ratings by trained lab members. Results of this survey reflect ubiquitous use of the PAS, unmet needs for assessment of swallowing safety, low accuracy despite generally high confidence, and heterogenous training that does not correspond to confidence. This emphasizes the need for additional training in clinical application of the PAS as well as development of novel metrics to optimize assessments of swallowing safety.
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Affiliation(s)
- Ryan Burdick
- Department of Medicine, Division of Geriatrics and Gerontology, Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705-2281, USA
- Geriatric Research Education and Clinical Center (GRECC), William S Middleton Veterans Hospital, Madison, USA
| | - Rodolfo Peña-Chávez
- Department of Medicine, Division of Geriatrics and Gerontology, Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705-2281, USA
- Geriatric Research Education and Clinical Center (GRECC), William S Middleton Veterans Hospital, Madison, USA
- Facultad de Ciencias de La Salud y de los Alimentos, Departamento de Ciencias de La Rehabilitacion en Salud, Universidad del Bío-Bío, Concepción, Chile
| | - Ashwini Namasivayam-MacDonald
- Department of Communication Sciences and Disorders, McMaster University, Togo Salmon Hall 331, 1280 Main Street West, Hamilton, Ontario, Canada
| | - Nicole Rogus-Pulia
- Department of Medicine, Division of Geriatrics and Gerontology, Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705-2281, USA.
- Geriatric Research Education and Clinical Center (GRECC), William S Middleton Veterans Hospital, Madison, USA.
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Seifelnasr A, Ding P, Si X, Biondi A, Xi J. Oropharyngeal swallowing hydrodynamics of thin and mildly thick liquids in an anatomically accurate throat-epiglottis model. Sci Rep 2024; 14:11945. [PMID: 38789468 PMCID: PMC11126673 DOI: 10.1038/s41598-024-60422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Understanding the mechanisms underlying dysphagia is crucial in devising effective, etiology-centered interventions. However, current clinical assessment and treatment of dysphagia are still more symptom-focused due to our limited understanding of the sophisticated symptom-etiology associations causing swallowing disorders. This study aimed to elucidate the mechanisms giving rise to penetration flows into the laryngeal vestibule that results in aspirations with varying symptoms. Methods: Anatomically accurate, transparent throat models were prepared with a 45° down flapped epiglottis to simulate the instant of laryngeal closure during swallowing. Fluid bolus dynamics were visualized with fluorescent dye from lateral, rear, front, and endoscopic directions to capture key hydrodynamic features leading to aspiration. Three influencing factors, fluid consistency, liquid dispensing site, and dispensing speed, were systemically evaluated on their roles in liquid aspirations. Results: Three aspiration mechanisms were identified, with liquid bolus entering the airway through (a) the interarytenoid notch (notch overflow), (b) cuneiform tubercle recesses (recess overflow), and (c) off-edge flow underneath the epiglottis (off-edge capillary flow). Of the three factors considered, liquid viscosity has the most significant impact on aspiration rate, followed by the liquid dispensing site and the dispensing speed. Water had one order of magnitude higher aspiration risks than 1% w/v methyl cellulose solution, a mildly thick liquid. Anterior dispensing had higher chances for aspiration than posterior oropharyngeal dispensing for both liquids and dispensing speeds considered. The effects of dispending speed varied. A lower speed increased aspiration for anterior-dispensed liquids due to increased off-edge capillary flows, while it significantly reduced aspiration for posterior-dispensed liquids due to reduced notch overflows. Visualizing swallowing hydrodynamics from multiple orientations facilitates detailed site-specific inspections of aspiration mechanisms.
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Affiliation(s)
- Amr Seifelnasr
- Department of Biomedical Engineering, University of Massachusetts, 1 University Ave., Falmouth Hall 302I, Lowell, MA, 01854, USA
| | - Peng Ding
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine, 9501 Euclid Ave, Cleveland, OH, 44195, USA
| | - Xiuhua Si
- Department of Mechanical Engineering, California Baptist University, 8432 Magnolia Ave, Riverside, CA, 92504, USA
| | - Andres Biondi
- Department of Electrical and Computer Engineering, University of Massachusetts, 1 University Ave., Lowell, MA, 01854, USA
| | - Jinxiang Xi
- Department of Biomedical Engineering, University of Massachusetts, 1 University Ave., Falmouth Hall 302I, Lowell, MA, 01854, USA.
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Curtis JA, Tabor Gray L, Arrese L, Borders JC, Starmer H. Characterizing the Validity of Using VASES to Derive DIGEST-FEES Grades. Folia Phoniatr Logop 2024:1-10. [PMID: 38631299 DOI: 10.1159/000538935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/14/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Visual Analysis of Swallowing Efficiency and Safety (VASES) and Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) are two complimentary methods for assessing swallowing during FEES. Whereas VASES is intended to facilitate trial-level ratings of pharyngeal residue, penetration, and aspiration, DIGEST-FEES is intended to facilitate protocol-level impairment grades of swallowing safety and efficiency. The aim of this study was to assess the validity of using VASES to derive DIGEST-FEES impairment grades. METHODS DIGEST-FEES grades were blindly analyzed from 50 FEES - first using the original DIGEST-FEES grading method (n = 50) and then again using a VASES-derived DIGEST-FEES grading method (n = 50). Weighted Kappa (κw) and absolute agreement (%) were used to assess the relationship between the original DIGEST-FEES grades and VASES-derived DIGEST-FEES grades. Spearman's correlations assessed the relationship between VASES-derived DIGEST-FEES grades with measures of construct validity. RESULTS Substantial agreement (κw = 0.76-0.83) was observed between the original and VASES-derived grading methods, with 60-62% of all DIGEST-FEES grades matching exactly, and 92-100% of DIGEST-FEES grades within one grade of each other. Furthermore, the strength of the relationships between VASES-derived DIGEST-FEES grades and measures of construct validity (r = 0.34-0.78) were similar to the strength of the relationships between original DIGEST-FEES grades and the same measures of construct validity (r = 0.34-0.83). CONCLUSION Findings from this study demonstrate substantial agreement between original and VASES-derived DIGEST-FEES grades. Using VASES to derive DIGEST-FEES also appears to maintain the same level of construct validity established with the original DIGEST-FEES. Therefore, clinicians and researchers may consider using VASES to increase the transparency and standardization of DIGEST-FEES ratings. Future research should seek to replicate these findings and explore the simultaneous use of VASES and DIGEST-FEES in a greater sampling of raters and across other patient populations.
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Affiliation(s)
- James A Curtis
- Aerodigestive Innovations Research Lab (AIR), Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Lauren Tabor Gray
- Dr. Kiran C. Patel College of Allopathic Medicine, Center for Collaborative Research, NOVA Southeastern University, Fort Lauderdale, Florida, USA
| | - Loni Arrese
- Department of Speech and Hearing Science, Ohio State University, Columbus, Ohio, USA
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Heather Starmer
- HOPES Lab, Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, California, USA
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Garcia R. What School-Based Speech-Language Pathologists Need to Know About Pediatric Swallowing and Feeding Development and Disorders. Lang Speech Hear Serv Sch 2024; 55:458-468. [PMID: 38241673 DOI: 10.1044/2023_lshss-23-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
PURPOSE School-based speech-language pathologists are at the frontline for treating children with pediatric feeding disorders (PFDs). Often, speech-language pathologists are the primary allied health professionals who are charged with maximizing safety, supporting nutrition and neurodevelopmental growth. Due to the increasing need for assessment and treatment of PFDs in schools, it is fundamental that PFDs and dysphagia are detected, differentially diagnosed, and addressed to support developing children. This tutorial addresses the anatomy, physiology, and development of functional feeding and swallowing patterns across the spectrum of childhood for both PFDs and dysphagia. METHOD A clinical expert review of the anatomy, physiology, and development of functional feeding and swallowing patterns in children across the spectrum of childhood will be completed. CONCLUSIONS The aim of this tutorial is to support school-based speech-language pathologists in their understanding of the anatomy and physiology of feeding and swallowing. School-based speech-language pathologists should complete this tutorial with an increased understanding and breadth of knowledge related to typical anatomy and physiology versus atypical or disordered presentations. This tutorial would support school-based speech-language pathologists in determining whether a child presents with characteristics of oropharyngeal dysphagia and/or a PFD.
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Affiliation(s)
- Raquel Garcia
- Nova Southeastern University, Fort Lauderdale, FL
- Joe DiMaggio Children's Hospital, Hollywood, FL
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Perluk T, Abu Bandora E, Freund O, Jacob T, Friedman Regev I, Kleinhendler E, Shteinberg M, Bar-Shai A, Oestriecher-Kedem Y. Asymptomatic Dysphagia and Aspiration in Patients with Idiopathic Bronchiectasis. Lung 2024; 202:189-195. [PMID: 38499811 PMCID: PMC11009759 DOI: 10.1007/s00408-024-00683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Although considered contributors to idiopathic bronchiectasis (IB), neither dysphagia nor silent aspiration have been systematically evaluated in IB patients. We aimed to explore the prevalence of asymptomatic dysphagia and silent aspiration in IB patients and to identify parameters predictive of their presence. METHODS This prospective cohort study included IB patients from our Pulmonary Institute without prior history of dysphagia and without prior dysphagia workup. Swallowing function was assessed by the Eating Assessment Tool (EAT-10) questionnaire and by the Fiberoptic Endoscopic Evaluation of Swallowing (FEES) test. RESULTS Forty-seven patients (31 females, mean age 67 ± 16 years) were recruited. An EAT-10 score ≥ 3 (risk for swallowing problems) was present in 21 patients (44.6%). Forty-two patients (89.3%) had at least one abnormal swallowing parameter in the FEES test. Six patients (12.7%) had a penetration aspiration score (PAS) in the FEES of at least 6, indicating aspiration. An EAT-10 score of 3 was found to be the ideal cutoff to predict aspiration in the FEES, with a good level of accuracy (area under the curve = 0.78, 95% CI 0.629-0.932, p = 0.03) and sensitivity of 83%. This cutoff also showed a trend towards a more severe disease using the FACED (forced expiratory volume, age, colonization with pseudomonas, extension of lung involvement, dyspnea) score (p = 0.05). CONCLUSION Dysphagia is prevalent in IB and may be undiagnosed if not specifically sought. We recommend screening all patients with IB for dysphagia by the EAT-10 questionnaire and referring all those with a score of ≥ 3 to formal swallowing assessment.
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Affiliation(s)
- Tal Perluk
- Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, School of Medicine, Tel-Aviv University, 6 Weizman St., 6423906, Tel Aviv-Yafo, Israel.
| | - Eiman Abu Bandora
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, School of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Ophir Freund
- Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, School of Medicine, Tel-Aviv University, 6 Weizman St., 6423906, Tel Aviv-Yafo, Israel
| | - Tommy Jacob
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, School of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Inbal Friedman Regev
- Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, School of Medicine, Tel-Aviv University, 6 Weizman St., 6423906, Tel Aviv-Yafo, Israel
| | - Eyal Kleinhendler
- Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, School of Medicine, Tel-Aviv University, 6 Weizman St., 6423906, Tel Aviv-Yafo, Israel
| | - Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
- The B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Bar-Shai
- Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, School of Medicine, Tel-Aviv University, 6 Weizman St., 6423906, Tel Aviv-Yafo, Israel
| | - Yael Oestriecher-Kedem
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, School of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv-Yafo, Israel
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12
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Costa BOI, Machado LS, Augusto MM, Magalhães DDD, Alves TC, Pernambuco L. Training to Analyze Functional Parameters with Fiberoptic Endoscopic Evaluation of Swallowing: A Scoping Review. Dysphagia 2024; 39:198-207. [PMID: 37592140 DOI: 10.1007/s00455-023-10614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
Analyzing fiberoptic endoscopic evaluation of swallowing (FEES) is challenging and requires training to ensure the proficiency of health professionals and improve reliability. This scoping review aims to identify and map the available evidence on training health professionals to analyze FEES functional parameters. The method proposed by the Joanna Briggs Institute and the PRISMA-ScR guidelines were followed. The search was performed in MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, CINAHL databases, and in the gray literature. Two blinded independent reviewers screened articles by title and abstract. Then, they read the full text of the included reports, considering the eligibility criteria. Data were extracted using a standardized form. Six studies met the established eligibility criteria, published between 2009 and 2022, with few participants. All these studies addressed training as part of the process to validate a rating scale. No standardized criteria were observed regarding the selection of experts and participants, training structure, and outcome measures to assess participants' competence. The reviewed literature indicates that training must be developed to equip students and health professionals who treat dysphagia, enabling them to analyze the functional parameters of the FEES, considering variables that may influence the participants' performance.
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Affiliation(s)
- Bianca O I Costa
- Graduate Program in Decision and Health Models (PPGMDS/UFPB), Universidade Federal da Paraíba (UFPB), Campus I s/n, Conj. Pres. Castelo Branco III, João Pessoa, PB, 58050-585, Brazil
| | - Liliane S Machado
- Graduate Program in Decision and Health Models (PPGMDS/UFPB), Universidade Federal da Paraíba (UFPB), Campus I s/n, Conj. Pres. Castelo Branco III, João Pessoa, PB, 58050-585, Brazil
| | - Milena M Augusto
- Technological Innovation in Health Laboratory (LAIS/UFRN), Universidade Federal do Rio Grande do Norte (UFRN), Av. Nilo Peçanha, 650, Petrópolis, Natal, RN, 59012-300, Brazil
| | - Desiré D D Magalhães
- Graduate Program in Decision and Health Models (PPGMDS/UFPB), Universidade Federal da Paraíba (UFPB), Campus I s/n, Conj. Pres. Castelo Branco III, João Pessoa, PB, 58050-585, Brazil
| | - Thaís Coelho Alves
- Dysphagia Research and Rehabilitation Laboratory (LADis/UNESP), Universidade Estadual Paulista (UNESP), Campus I 737, Av. Hygino Muzzi Filho, Marília, SP, 17.525-900, Brazil
| | - Leandro Pernambuco
- Graduate Program in Decision and Health Models (PPGMDS/UFPB), Universidade Federal da Paraíba (UFPB), Campus I s/n, Conj. Pres. Castelo Branco III, João Pessoa, PB, 58050-585, Brazil.
- Department of Speech, Language and Hearing Sciences, Universidade Federal da Paraíba (UFPB), Campus I s/n, Conj. Pres. Castelo Branco III, João Pessoa, PB, 58051-900, Brazil.
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13
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Vergara J, Miles A, Lopes de Moraes J, Chone CT. Contribution of Wireless Wi-Fi Intraoral Cameras to the Assessment of Swallowing Safety and Efficiency. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:821-836. [PMID: 38437030 DOI: 10.1044/2023_jslhr-23-00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Clinical evaluation of swallowing provides important clinical information but is limited in detecting penetration, aspiration, and pharyngeal residue in patients with suspected dysphagia. Although this is an old problem, there remains limited access to low-cost methods to evaluate swallowing safety and efficiency. PURPOSE The purpose of this technical report is to describe the experience of a single center that recently began using a wireless Wi-Fi intraoral camera for transoral endoscopic procedures as an adjunct to clinical swallowing evaluation. We describe the theoretical structure of this new clinical evaluation proposal. We present descriptive findings on its diagnostic performance in relation to videofluoroscopic swallowing study as the gold standard in a cohort of seven patients with dysphagia following head and neck cancer. We provide quantitative data on intra- and interrater reliability. Furthermore, this report discusses how this technology can be applied in the clinical practice of professionals who treat patients with dysphagia and provides directions for future research. CONCLUSIONS This preliminary retrospective study suggests that intraoral cameras can reveal the accumulated oropharyngeal secretions and postswallow pharyngolaryngeal residue in patients with suspected dysphagia. Future large-scale studies focusing on validating and exploring this contemporary low-cost technology as part of a clinical swallowing evaluation are warranted.
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Affiliation(s)
- José Vergara
- Department of Surgery, Head and Neck Surgery, University of Campinas, São Paulo, Brazil
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, New Zealand
| | - Juliana Lopes de Moraes
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
| | - Carlos Takahiro Chone
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
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Doruk C, Çaytemel B, Şahin E, Kara H, Samancı B, Abay SN, Bilgiç B, Hanağası H, Başaran B, Enver N, Rameau A. Evaluation of Post-Swallow Residue with Visual Analysis of Swallowing Efficiency and Safety in Patients with Idiopathic Parkinson's Disease. EAR, NOSE & THROAT JOURNAL 2023:1455613231210976. [PMID: 38050868 DOI: 10.1177/01455613231210976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Objectives: Dysphagia is common in idiopathic Parkinson's disease (IPD) and is associated with impairments in both swallowing safety and swallowing efficiency. The goals of this study were to define post-swallow residue patterns in people with IPD and describe pathophysiological endoscopic findings affecting residue accumulation. Methods: This was a prospective single-blinded cross-sectional cohort study of patients with the diagnosis of IPD recruited from a Movement Disorder Clinic. Clinical variables included patient age, cognitive function, and measures of disease severity, and laryngoscopic examinations with a flexible endoscopic evaluation of swallowing (FEES) were completed for each patient. Visual Analysis of Swallowing Efficiency and Safety (VASES) was used to analyze FEES. Post-swallow residue outcomes and non-residue endoscopic outcomes including the Bowing index, Penetration Aspiration Scale (PAS) score, premature leakage, and build-up phenomenon were evaluated. Multiple regression models were used to evaluate factors affecting the residue at different anatomic levels. Results: Overall 53 patients completed the study. The multiple regression analyses showed a relation between (1) the presence of residue at the level of oropharynx and epiglottis with premature leakage, (2) the presence of residue at the level of the laryngeal vestibule and vocal folds with build-up phenomenon, and (3) the presence of residue at the level of the hypopharynx, laryngeal vestibule, and subglottis with airway invasion. Conclusion: Residue pattern during FEES is associated with specific swallow dysfunctions in IPD. Using residue localization and quantification may be a helpful tool in assessing the impact of targeted swallowing interventions in patients with IPD and dysphagia.
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Affiliation(s)
- Can Doruk
- Istanbul Faculty of Medical, Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul, Turkey
- Division of Laryngology, Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical School, New York, NY, USA
| | - Berkay Çaytemel
- Istanbul Faculty of Medical, Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Erdi Şahin
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Hakan Kara
- Istanbul Faculty of Medical, Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Bedia Samancı
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Sevinç Nisa Abay
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
- Işık University, Istanbul, Turkey
| | - Başar Bilgiç
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Haşmet Hanağası
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Bora Başaran
- Istanbul Faculty of Medical, Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul, Turkey
| | - Necati Enver
- Department of Otolaryngology, Head and Neck Surgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Anais Rameau
- Department of Otolaryngology-Head & Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medicine, New York, NY, USA
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15
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Curtis JA, Borders JC, Dakin AE, Troche MS. Auditory-Perceptual Assessments of Cough: Characterizing Rater Reliability and the Effects of a Standardized Training Protocol. Folia Phoniatr Logop 2023; 76:77-90. [PMID: 37544291 DOI: 10.1159/000533372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Auditory-perceptual assessments of cough are commonly used by speech-language pathologists working with people with swallowing disorders with emerging evidence beginning to demonstrate their validity; however, their reliability among novice clinicians is unknown. Therefore, the primary aim of this study was to characterize the reliability of auditory-perceptual assessments of cough among a group of novice clinicians. As a secondary aim, we assessed the effects of a standardized training protocol on the reliability of auditory-perceptual assessments of cough. METHODS Twelve novice clinicians blindly rated ten auditory-perceptual cough descriptors for 120 cough audio clips. Standardized training was then completed by the group of clinicians. The same cough audio clips were then re-randomized and blindly rated. Reliability was analyzed pre- and post-training within each clinician (intra-rater), between each unique pair of raters (dyad-level inter-rater), and for the entire group of raters (group-level inter-rater) using intraclass correlation coefficients and Cohen's Kappa. RESULTS Pre-training reliability was greatest for measures of strength, effectiveness, and normality and lowest when judging the type of expiratory maneuver (cough, throat clear, huff, other). The measures that improved the most with training were ratings of perceived crispness, amount of voicing, and type of expiratory maneuver. Intra-rater reliability coefficients ranged from 0.580 to 0.903 pre-training and 0.756-0.904 post-training. Dyad-level inter-rater reliability coefficients ranged from 0.295 to 0.745 pre-training and 0.450-0.804 post-training. Group-level inter-rater reliability coefficients ranged from 0.454 to 0.919 pre-training and 0.558-0.948 post-training. CONCLUSION Reliability of auditory-perceptual assessments varied across perceptual cough descriptors, but all appeared within the range of what has been historically reported for auditory-perceptual assessments of voice and visual-perceptual assessments of swallowing and cough airflow. Reliability improved for most cough descriptors following 30-60 min of standardized training. Future research is needed to examine the validity of auditory-perceptual assessments of cough by assessing the relationship between perceptual cough descriptors and instrumental measures of cough effectiveness to better understand the role of perceptual assessments in clinical practice.
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Affiliation(s)
- James A Curtis
- Department of Otolaryngology-Head and Neck Surgery, Aerodigestive Innovations Research Lab (AIR), Weill Cornell Medical College, New York, New York, USA
- Department of Biobehavioral Sciences, Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York, New York, USA
| | - James C Borders
- Department of Biobehavioral Sciences, Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York, New York, USA
| | - Avery E Dakin
- Department of Biobehavioral Sciences, Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York, New York, USA
| | - Michelle S Troche
- Department of Biobehavioral Sciences, Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York, New York, USA
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Curtis JA, Borders JC, Dakin AE, Troche MS. Normative Reference Values for FEES and VASES: Preliminary Data From 39 Nondysphagic, Community-Dwelling Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-18. [PMID: 37343540 DOI: 10.1044/2023_jslhr-23-00132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
PURPOSE The aim of this study was to establish preliminary reference values for the Visual Analysis of Swallowing Efficiency and Safety (VASES)-a standardized rating methodology used to evaluate swallowing safety and efficiency for flexible endoscopic evaluation of swallowing (FEES). METHOD FEES were completed in nondysphagic, community-dwelling adults using a standardized protocol of 15 swallowing trials that varied by bolus size, consistency, contrast agent, and swallowing instructions. FEES were blindly analyzed using VASES. Primary outcome measures included bolus location at swallow onset, Penetration-Aspiration Scale (PAS) scores, and percentage-based residue ratings for six anatomic landmarks. Secondary outcome measures included sip size, bite size, and number of swallows. RESULTS Thirty-nine healthy adults completed the study, yielding an analysis of 584 swallows. Swallows were initiated with the bolus in the pharynx for 41.8% of trials. PAS 1 was the most common score, accounting for 75.3% of trials, followed by PAS 3, which accounted for 18.8% of trials. When residue was present (> 0%), the amount was relatively small across all anatomic landmarks, with median residue ratings of 2.0% (oropharynx), 1.5% (hypopharynx), 3.0% (epiglottis), 3.0% (laryngeal vestibule), and 3.5% (vocal folds). Five events of aspiration were observed, which were characterized by subglottic residue ratings of 1%, 3%, 10%, 24%, and 90%. The average sip size of self-selected volume cup sips of water was 19.8 ml, and the average bite size of a 3.0-g saltine cracker was 1.33 g. Moreover, 78% of the trials in this study protocol (except 90-ml trials) were completed in a single swallow. DISCUSSION The results from this study provide preliminary norms for VASES that could be used as a reference when assessing functional swallowing outcomes during FEES. While this is an important first step in establishing norms for FEES and VASES, clinicians and researchers should be mindful that the normative reference values from this study are from a relatively small study sample (N = 39), with most people below the age of 60 years (n = 30). Future research should expand on these norms by including a greater number of people across the age continuum and with greater racial, ethnic, and gender diversity. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23504325.
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Affiliation(s)
- James A Curtis
- Aerodigestive Innovations Research Lab, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York City, NY
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY
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A Primer on Hypotussic Cough: Mechanisms and Assessment. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023. [DOI: 10.1007/s40136-023-00446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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18
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Troche MS, Curtis JA, Sevitz JS, Dakin AE, Perry SE, Borders JC, Grande AA, Mou Y, Vanegas-Arroyave N, Hegland KW. Rehabilitating Cough Dysfunction in Parkinson's Disease: A Randomized Controlled Trial. Mov Disord 2023; 38:201-211. [PMID: 36345090 DOI: 10.1002/mds.29268] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Disorders of airway protection (cough and swallowing) are pervasive in Parkinson's disease (PD) resulting in a high incidence of aspiration pneumonia and death. However, there are no randomized controlled trials comparing strength and skill-based approaches to improve airway protection in PD. OBJECTIVES The aim of this study was to compare expiratory muscle strength training (EMST) and sensorimotor training for airway protection (smTAP) to improve cough-related outcomes in people with PD. METHODS Participants with PD and dysphagia were recruited for this prospective phase II randomized-blinded controlled clinical trial. Participants completed baseline assessment, 5 weeks of EMST or smTAP, and a post-training assessment. Primary outcome measures included maximum expiratory pressure (MEP) and voluntary cough peak expiratory flow rate (PEFR). Mixed effects models were used to assess the effects of EMST and smTAP on outcomes. RESULTS A total of 65 participants received either EMST (n = 34) or smTAP (n = 31). MEP improved from pre- to post-treatment for smTAP (P < 0.001, d = 0.19) and EMST (P < 0.001, d = 0.53). Voluntary PEFR increased from pre- to post-treatment for smTAP (P < 0.001, d = 0.19) and EMST (P < 0.001, d = 0.06). Moreover, reflex cough PEFR (P < 0.001, d = 0.64), reflex cough expired volume (P < 0.001, d = 0.74), and urge to cough (P = 0.018, OR = 2.70) improved for the smTAP group but not for the EMST group. CONCLUSIONS This clinical trial confirmed the efficacy of smTAP to improve reflex and voluntary cough function, above and beyond EMST, the current gold standard. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA.,Division of Movement Disorders, Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Sarah E Perry
- University of Canterbury Rose Centre for Stroke Recovery and Research at St. George's Medical Centre, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | | | - Yuhan Mou
- Laboratory for the Study of Upper Airway Dysfunction, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, USA
| | | | - Karen W Hegland
- Laboratory for the Study of Upper Airway Dysfunction, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, USA.,Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
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Curtis JA, Borders JC, Dakin AE, Troche MS. The Role of Aspiration Amount on Airway Protective Responses in People with Neurogenic Dysphagia. Dysphagia 2022:10.1007/s00455-022-10546-x. [DOI: 10.1007/s00455-022-10546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
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20
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The Relationship Between Lingual Strength and Functional Swallowing Outcomes in Parkinson’s Disease. Dysphagia 2022:10.1007/s00455-022-10543-0. [DOI: 10.1007/s00455-022-10543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
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21
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Konradi J, Zajber M, Betz U, Drees P, Gerken A, Meine H. AI-Based Detection of Aspiration for Video-Endoscopy with Visual Aids in Meaningful Frames to Interpret the Model Outcome. SENSORS (BASEL, SWITZERLAND) 2022; 22:9468. [PMID: 36502169 PMCID: PMC9736280 DOI: 10.3390/s22239468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Disorders of swallowing often lead to pneumonia when material enters the airways (aspiration). Flexible Endoscopic Evaluation of Swallowing (FEES) plays a key role in the diagnostics of aspiration but is prone to human errors. An AI-based tool could facilitate this process. Recent non-endoscopic/non-radiologic attempts to detect aspiration using machine-learning approaches have led to unsatisfying accuracy and show black-box characteristics. Hence, for clinical users it is difficult to trust in these model decisions. Our aim is to introduce an explainable artificial intelligence (XAI) approach to detect aspiration in FEES. Our approach is to teach the AI about the relevant anatomical structures, such as the vocal cords and the glottis, based on 92 annotated FEES videos. Simultaneously, it is trained to detect boluses that pass the glottis and become aspirated. During testing, the AI successfully recognized the glottis and the vocal cords but could not yet achieve satisfying aspiration detection quality. While detection performance must be optimized, our architecture results in a final model that explains its assessment by locating meaningful frames with relevant aspiration events and by highlighting suspected boluses. In contrast to comparable AI tools, our framework is verifiable and interpretable and, therefore, accountable for clinical users.
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Affiliation(s)
- Jürgen Konradi
- Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Milla Zajber
- Department for Health Care & Nursing, Catholic University of Applied Sciences, 55122 Mainz, Germany
| | - Ulrich Betz
- Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Philipp Drees
- Department of Orthopedics and Trauma Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Annika Gerken
- Fraunhofer Institute for Digital Medicine MEVIS, 28359 Bremen, Germany
| | - Hans Meine
- Fraunhofer Institute for Digital Medicine MEVIS, 28359 Bremen, Germany
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Rocca S, Pizzorni N, Valenza N, Negri L, Schindler A. Reliability and Construct Validity of the Yale Pharyngeal Residue Severity Rating Scale: Performance on Videos and Effect of Bolus Consistency. Diagnostics (Basel) 2022; 12:diagnostics12081897. [PMID: 36010247 PMCID: PMC9406605 DOI: 10.3390/diagnostics12081897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/30/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
The Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) provides an image-based assessment of pharyngeal residue in the fiberoptic endoscopic evaluation of swallowing (FEES). Its performance was investigated only in FEES frames. This study analyzed the reliability and construct validity of the YPRSRS in FEES videos and the influence of bolus consistency. Thirty pairs of FEES videos and frames, 8 thin liquids (<50 mPa·s), 11 pureed (2583.3 mPa·s at 50 s−1, 697.87 mPa·s at 300 s−1), and 11 solid food; were assessed by 29 clinicians using the YPRSRS; 14 raters re-assessed materials at least 15 days from the first evaluation. Construct validity and intra-rater reliability were assessed using weighted Cohen’s Kappa. Inter-rater reliability was assessed using weighted Fleiss Kappa. Construct validity and inter-rater reliability were almost perfect or excellent for frames (0.82 ≤ k ≤ 0.89) and substantial or intermediate to good for videos (0.67 ≤ k ≤ 0.79). Intra-rater reliability was almost perfect for both frames and videos (k ≥ 0.84). Concerning bolus consistency, thin liquids had significantly lower values of construct validity, intra-, and inter-rater reliability than pureed and solid food. Construct validity and inter-rater reliability were significantly lower for solid food than for pureed food. The YPRSRS showed satisfactory reliability and construct validity also in FEES videos. Reliability was significantly influenced by bolus consistency.
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Affiliation(s)
- Sara Rocca
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- Correspondence: ; Tel.: +39-02-3043526
| | - Nadia Valenza
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Luca Negri
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
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Costa BOID, Machado LDS, Augusto MM, Alves TC, Pernambuco L. Treinamento para análise de parâmetros da videoendoscopia da deglutição: um protocolo de revisão de escopo. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/202224111021s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: apresentar um protocolo de revisão de escopo para identificar e mapear as evidências disponíveis sobre treinamento para a análise de parâmetros da videoendoscopia da deglutição. Métodos: o protocolo seguirá o método proposto pelo Joanna Briggs Institute e as diretrizes PRISMA-P para relato de protocolos de revisão. A busca será feita na MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, CINAHL e literatura cinzenta. Uma estratégia de busca foi desenvolvida para a MEDLINE, que será adaptada para cada base de dados. Dois revisores independentes rastrearão os artigos pelo título e resumo. Em seguida, farão a leitura do texto completo dos artigos incluídos, considerando os critérios de elegibilidade. Os dados serão extraídos com um formulário padronizado. Os resultados serão apresentados em fluxograma e resumo narrativo, seguindo as diretrizes do PRISMA-ScR. Revisão da literatura: há escassez de pesquisas que descrevam métodos de treinamento perceptivo-visual para analisar parâmetros da VED e dados inconsistentes para orientar a tomada de decisão clínica. Esta revisão fornecerá informações abrangentes sobre o desenvolvimento de treinamento para esse tipo de análise. Conclusão: este protocolo de revisão de escopo apresentará o estado geral das pesquisas sobre o tema e identificará as lacunas existentes na base de evidências.
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Costa BOID, Machado LDS, Augusto MM, Alves TC, Pernambuco L. Training for fiberoptic endoscopic evaluation of swallowing parameter analysis: a scoping review protocol. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/202224111021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to present a scoping review protocol to identify and map available evidence on training for fiberoptic endoscopic evaluation of swallowing parameter analysis. Methods: the protocol follows the method proposed by the Joanna Briggs Institute and the PRISMA-P guidelines for review protocol reports. The survey will be made in MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, CINAHL, and grey literature. A search strategy has been developed for MEDLINE, which will be adapted for each database. Two independent reviewers will screen the articles by title and abstract. Then, they will read the full text of the included articles, considering the eligibility criteria. The data will be extracted with a standardized form. The results will be presented in a flowchart and narrative summary, following the PRISMA-ScR guidelines. Literature Review: there is a scarcity of research describing visual-perceptual training methods to analyze FEES parameters and inconsistent data to guide clinical decision-making. This review will provide comprehensive information on developing training for this type of analysis. Conclusion: this scoping review protocol will present the overall state of research on the topic and identify existing gaps in the base of evidence.
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Allen JE, Clunie G, Ma JKY, Coffey M, Winiker K, Richmond S, Lowell SY, Volkmer A. Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study. Dysphagia 2022; 37:1586-1598. [PMID: 35201387 PMCID: PMC8867131 DOI: 10.1007/s00455-022-10413-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022]
Abstract
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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Affiliation(s)
- Jodi E. Allen
- The National Hospital for Neurology and Neurosurgery, Therapy & Rehabilitation Services, 2nd Floor 8-11 Queen Square, London, WC1N 3BG UK
| | - Gemma Clunie
- SLT Department, Imperial College Healthcare Trust, Charing Cross Hospital, London, UK
| | - Joan K.-Y. Ma
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, UK
| | - Margaret Coffey
- SLT Department, Imperial College Healthcare Trust, Charing Cross Hospital, London, UK
| | - Katharina Winiker
- Swiss University of Speech and Language Sciences SHLR, Seminarstrasse 27, 9400 Rorschach, Switzerland
| | - Sally Richmond
- Imaging Department, University College London Hospitals, London, UK
| | - Soren Y. Lowell
- Communication Sciences & Disorders Department, Syracuse University, Syracuse, NY USA
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
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