Efficacy of Predicting Videofluoroscopic Results in Dysphagic Patients with Severe Cerebral Palsy Using the Mann Assessment of Swallowing Ability

Diagnostic Accuracy of Mann Assessment of Swallowing Ability for Predicting Dysphagia in Patients with Psychiatric Disorders

Dysphagia occurs in various diseases and constitutes a major concern in patients with psychiatric disorders. The Mann Assessment of Swallowing Ability (MASA) comprises 24 clinical parameters designed to identify swallowing disorders. One item in MASA, the "gag reflex", involves an unpleasant stimulus, which means that it is often omitted when the test is administered. The aims of this study were to determine the presence/absence of dysphagia in patients with psychiatric disorders using the MASA and determine its diagnostic accuracy when the gag reflex item was excluded in patients with psychiatric disorders. The study participants comprised patients admitted to a hospital psychiatric ward in whom dysphagia had been suspected based on oral intake status. The following items were determined: age, total MASA score (23 out of 24 items, giving a score out of 195 points), body mass index score, milligram equivalents of chlorpromazine, and the Food Intake Level Scale score. The patients were divided into two groups according to the presence or absence of swallowing problems as assessed by videoendoscopic or videofluoroscopic examination. The scores for each item investigated in the MASA, including the total score, were compared between the two groups. Receiver operating characteristic curve analysis was carried out to determine the optimum cut-off value. The total MASA score, which excluded the "gag reflex" item, was lower in the problematic swallowing group than in the non-problematic swallowing group. The MASA scores for cooperation, respiratory, dysphasia, tongue coordination, oral preparation, pharyngeal phase, and pharyngeal response tended to be lower in the problematic swallowing group. Furthermore, an optimum cut-off value of 169 points (sensitivity, 0.92; specificity, 0.68; likelihood ratio, 2.84) was identified. These results indicate that the cut-off MASA score is effective in screening for dysphagia, even when the "gag reflex" item is excluded.

Eating and Drinking Ability Classification System to detect aspiration risk in children with cerebral palsy: a validation study

This prospective study has two aims. The first aim is to assess the concurrent validity of the Eating and Drinking Ability Classification System (EDACS) as a means of identifying aspiration risk in children with cerebral palsy by using the Pediatric version of the Eating Assessment Tool (PEDI-EAT-10) as the reference test. The second aim is to investigate the relationship between the aspiration and non-aspiration groups using both the EDACS and the PEDI-EAT-10. Data were collected and analyzed from the EDACS and PEDI-EAT-10 using a convenience sample of 131 children with cerebral palsy and feeding problems (77 males, 54 females; median age 4.4 years [IQR 2.5 years]). Risk of aspiration was identified in 118 individuals using the PEDI-EAT-10 scores of ≥ 5 points. The EDACS proved to be a valid tool in identifying aspiration risk in children who are classified in EDACS levels III-V. There was a significant correlation between the EDACS and PEDI-EAT-10 (r_s = 0.597, p < 0.001). The EDACS had 78% (95% CI = 71-86%) sensitivity and 92% (95% CI = 88-97%) specificity in identifying aspiration risk a positive predictive value of 0.99, a negative predictive value of 0.32, a positive likelihood ratio of 9.75, and a negative likelihood ratio of 0.24.   Conclusion: The EDACS is a useful clinical tool to identify aspiration risk in children with cerebral palsy. Children in EDACS levels III to V are at risk of aspiration. As time permits, we recommend the use of both tools, the EDACS and the PEDI-EAT-10, when making decisions regarding referral for an instrumented swallowing study. What is Known: • Approximately 50% of children with cerebral palsy have dysphagia. • The Eating and Drinking Ability Classification System (EDACS) can be used to classify eating and drinking efficiency and safety in children with cerebral palsy. What is New: • Based on ROC analysis, EDACS demonstrates sensitivity of 78% and specificity of 92% in clinical identification of aspiration risk. • The combined use of the EDACS and the Pediatric version of the Eating Assessment Tool is recommended to make decisions about referral for an instrumented swallow study.

Dysphagia Characteristics of Patients Post SARS-CoV-2 During Inpatient Rehabilitation

OBJECTIVE

To investigate dysphagia in patients recovering from SARS-CoV-2 admitted to acute inpatient rehabilitation by summarizing clinical swallow evaluation and videofluoroscopic swallow study findings.

DESIGN

Retrospective cohort study.

SETTING

Urban inpatient rehabilitation hospital.

PARTICIPANTS

The first inpatients admitted with SARS-CoV-2 (N=40) who participated in a videofluoroscopic swallow study.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Patient characteristics upon admission (duration of intubation, tracheostomy status, comorbidities, videofluoroscopic swallow study (VFSS) completion at previous level of care); admission International Dysphagia Diet level (IDDSI); Mann Assessment of Swallowing Ability (MASA), Functional Oral Intake Scale (FOIS), dysphagia severity rating; penetration aspiration scale (PAS) rated during VFSS; and IDDSI level recommended after completion of VFSS.

RESULTS

Twenty percent of patients had been evaluated by videofluoroscopy in acute care. Nineteen of 37 (51%) individuals were upgraded to IDDSI level 7 regular diet with level 0 thin liquids and achieved a FOIS of 7 after the completion of the VFSS. Five individuals (13%) received a diet downgrade or remained on the same diet recommendations from their admission. Total numerical score (TNS) of less than 170 on the MASA predicted presence of aspiration in 27% of patients (6 of 22). Seventy-two percent of the sample (16 of 22) had a TNS less than 170 but did not demonstrate any instances of aspiration. The odds of patients having a PAS of 3 or greater increased by approximately 15% (odds ratio, 1.15; 95% confidence interval, 1.03-1.27; P=.013). Thus, with each additional day of intubation during acute care stay, there was a 15% greater likelihood of having airway invasion.

CONCLUSIONS

Instrumental swallow evaluations are imperative to diagnose and treat dysphagia in the post-coronavirus disease population. Because of the heterogeneity of this population, high incidence of prolonged intubation, and limitations of the clinical swallowing evaluation, instrumental assessments need to be performed on a more consistent basis as infection prevention protocols evolve.

Comparison of straw and cup for liquid swallowing in poststroke patients

The purposes of this study were to compare poststroke liquid swallowing methods by including a cup and a straw in videofluoroscopic swallowing studies (VFSS) and to test the hypothesis that increased aspiration would be observed with the cup compared to the straw. Eighty-five poststroke patients who had undergone VFSS using a spoon, cup, and straw were included. Penetration-aspiration scale and functional dysphagia scale (FDS) were used for assessment. These scores did not differ significantly between the cup and the straw. Higher FDS scores were found with the cup than with the straw in patients who had penetration/aspiration with both the cup and the straw and with the cup only. However, FDS scores did not differ significantly between the cup and the straw in patients who had penetration/aspiration with the straw only. Although advantages of the straw over the cup were clear, some patients showed penetration/aspiration only with the straw.

Assessment Across the Life Span: The Clinical Swallow Evaluation

Purpose This clinical focus article considers the roles of the clinical swallow examination (CSE) as a clinically meaningful assessment method used in both adult and pediatric populations. Method This clinical focus article explores the utility of the CSE across the life span. Specifically, components, reliability, standardized assessments, and limitations of the CSE within the adult and pediatric populations are highlighted. Conclusions The CSE remains a crucial assessment tool for the speech-language pathologist. The experienced clinician can make important judgments regarding patient safety and function. If the CSE is conducted mindfully and methodically, findings can help chart the course of care for individuals needing additional assessment and possibly intervention.

Reliability and Validity of the Eating and Drinking Ability Classification System in Adults with Cerebral Palsy

The Eating and Drinking Ability Classification System (EDACS) was developed to evaluate dysphagia in children with cerebral palsy (CP). This study aimed to investigate the interrater reliability and validity of the EDACS in adults with CP. This cross-sectional study included 117 community-dwelling adults (mean age, 37.9 ± 12.5 years) with a confirmed CP diagnosis. A swallowing occupational therapist (SwOT) conducted detailed interviews with participants and/or caregivers to classify the EDACS. Another SwOT and participants/caregivers evaluated the EDACS. Correlations were evaluated between the EDACS and Functional Oral Intake Scale (FOIS), Swallowing Quality of Life (SWAL-QOL), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification System (MACS). Interrater reliabilities between SwOTs (κ = 0.866, intraclass correlation coefficient (ICC) = 0.867), and between SwOT and participant/caregiver (κ = 0.884, ICC = 0.717) were reported. The EDACS correlated with the FOIS, SWAL-QOL, and MACS, although no significant correlation was found with the GMFCS. The EDACS of spastic-type showed better correlation than that of dyskinetic-type with the FOIS, MACS, and GMFCS. There was a significant correlation between the EDACS and the GMFCS in those aged ≤ 30 years, whereas there was no correlation in those aged ≥ 30 years. The EDACS is a reliable and valid tool for classifying eating and drinking ability in adults with CP. The correlation between the EDACS with gait or hand function was more prominent in individuals with spastic CP and in younger individuals. The EDACS is a valuable adjunct to comprehensive functional classification in adults with CP.