Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4464_Библиотеки_им_академика_М_И_Перельмана.pdf
132 CLINICAL MANAGEMENT OF SWALLOWING DISORDERS
TABLE 5–5. Critical Components of the Clinical
Case History
The clinician should be prepared to answer the following
questions as a result of conducting a thorough case
history:
1. Is the patient currently eating by mouth or relying on
nonoral feeding?
2. Is there a history of aspiration pneumonia?
3. Was the patient recently hospitalized? If so, for what
reasons?
4. Does the patient have other associated medical
conditions (including past surgery and trauma)?
5. Is the patient thriving or maintaining general health
and nutrition status based on the current diet and
method of eating? Any significant weight loss
recently?
6. What are the patient’s main concerns and
expectations?
7. Any environmental support upon discharge from
hospital (eg, meal preparation, feeding assistance,
training support)?
The clinician should be prepared to answer the following
questions as a result of completing a clinical swallow
examination:
TABLE 5–6. Common Clinical Findings in Dysphagic
Patients
General Health Status
• Weight loss
• Bronchorrhea
• Fluctuating low fever
• Pulmonary infiltrates
• Increased or insufficient oral or pharyngeal
secretions
• Edentulous (lacking teeth)
• Drooling
• Ineffective cough
Behaviors or Observations During Mealtimes
• Resistance to eating or drinking
• Increased time to consume meal
• Changes in taste
• Difficulty in swallowing foods of specific texture
• Complaints of food stuck in throat
• Oral residue
• Multiple swallow patterns
• Coughing or choking during or after swallow
• Wet vocal quality during or after mealtime
1. Is there a risk of aspiration given the present
nutritional status and diet?
2. What is the anatomical and functional status of the
oral mechanism?
3. Should the patient be referred for further evaluation of
their swallowing based on the information gleaned at
the CSE?
4. Is the patient cognitively capable of participating in
instrumental testing and rehabilitation?
5. What changes in the treatment plan should be
anticipated or planned given the outcome of the CSE?
as a team. For those patients with a weak or breathy
voice, a consultation with an otolaryngologist is recommended. The otolaryngologist may perform an
examination of the larynx and vocal folds using a
flexible endoscope.
Cognitive Assessment
Knowing the general cognitive level of the patient
can help clinicians adjust the assessment procedures
and make appropriate recommendations for intervention and environmental adjustments. A cognitive
assessment may be informal or conducted using one
of the validated screening tools. Informal assessment may involve asking questions related to time
and place orientation, ability to follow simple commands, and general attention and alert level while
the clinician was obtaining the case history. MiniMental State Exam (MMSE) and Montreal Cognitive Assessment (MoCA) are 2 commonly used and
validated cognitive screening tests that may also be
used by SLP. The MMSE takes around 8 minutes to
complete, while the MoCA takes around 12 minutes
to complete.
Oral, Pharyngeal, and
Laryngeal Examination
A thorough examination of the oral, laryngeal, and
pharyngeal structures should include an assessment of lip closure, tongue strength and mobility,
5. CLINICAL EVALUATION OF SWALLOWING DISORDERS 133
facial symmetry, voice quality, and volitional cough
strength. Table 5–7, modified from Daniels et al,
52
provides a comprehensive orderly approach to
the oropharyngeal examination. Clinicians, even
those with extensive experience in oral examination, may profit from this structure, as it provides
an orderly approach to assessing muscular function related to the cranial nerves most important for
swallowing.
Prior to the oropharyngeal examination, the
clinician should have a general knowledge of
the patient’s characteristics that may interfere
with parts of the examination. These include the
following:
n Airway
n Cognition/alertness/endurance
n Ability to follow instructions
n Body tone/size/posture/positioning
n Self-feeding potential
Oral Examination
2. Sensation. Assess by light touch of lips,
tongue, and buccal cavity.
3. Structural anatomy. Look for abnormalities of
lips and oral cavity.
4. Range and coordination of movement
n
Jaw — ability to open and close the jaw
n
Lips — labial closure and compression at rest
and during swallowing
n
Tongue — anterior lingual movement may
be assessed by having the patient extend,
lateralize, elevate, and depress the tip and
by having the patient sweep the tongue
from front to back along the roof of the
mouth
n
Velum — movement of the velum, or soft
palate, may be assessed by having the
patient open the mouth and then observing
palatal movement during production of a
sustained /a/ sound
5. Secretions. Note location and amount.
6. Articulation. Screen with sentences or words
containing tongue tip and posterior tongue
consonants (p, t, b, d, th, k, g).
7. Resonance. Note presence of hypernasal
quality.
The oral examination should include assessment of
the range of motion, strength, and sensory function
of all oral structures. Prominent atrophy and fas-
ciculation of the tongue not related to any previous
medical conditions should raise the possibility of
amyotrophic lateral sclerosis.
1. Reflexes and responses
n
The gag reflex includes a head and jaw
extension, rhythmical tongue protrusions,
and pharyngeal contractions in response to
stimulation at the posterior part of the oral
cavity. Recent literature suggests that the
gag reflex may not be important for normal
swallowing to occur.
n
The bite reflex is clamping of the teeth
or up and down movement of the jaw in
response to stimulation of the gum, molar,
or other dental surfaces.
n
The transverse tongue response is a lateral
movement in response to tactile stimulation
at the lateral border of the tongue.
Pharyngeal and Laryngeal Examinations
1. Vocal quality/changes — listen to patient
talking before and after swallowing. Is there a
difference in voice quality?
2. Pitch control/range — a voice without pitch
changes may be indicative of sensory paralysis. Is the pitch of the voice appropriate, and
does the patient have variation in their pitch
range?
3. Breathing — is the patient experiencing
labored breathing or is there an audible noise
associated with inhalation or exhalation?
4. Volitional cough/throat clear — lack of the
ability to cough may suggest poor vocal fold
closure. Can the patient produce a normal
cough and clearing of the throat?
5. Saliva swallow: laryngeal management — does
the patient continue to feel saliva or mucous
in the throat? This may sometimes be a sign
of reflux or a more serious problem called
Zenker diverticulum.
134 CLINICAL MANAGEMENT OF SWALLOWING DISORDERS
TABLE 5–7. The Oropharyngeal Examination for the Clinical Swallow Examination
Name _________________________________ Date ____________________
Diagnosis ______________________________
Mandible (CN V)
Symmetry on Extension __________ Strength __________________
Lips (CN VII)
Symmetry: Rest ________________ Retraction _________________ Protrusion
Strength _______________________
Nonspeech Coordination: Repetitive Movement ___________________ Alternating Movement
Speech Coordination: Repetitive (/p,w/) _________________________ Alternating (/p-w/)
Tongue (CN XII)
Symmetry: Rest ________________ Protrusion _________________ Lateralization
Elevation Yes/No Lateralization Yes/No Fasciculations Yes/No
Strength
Nonspeech Coordination: Repetitive Movement ___________________ Alternating Movement
Alternating Movement (/p^t^k^/)
Multisyllabic Word Repetition (tip top, baseball player, several, caterpillar, emphasize)
Conversation: (speech, voice, coordination characteristics)
Laryngeal Function: Isolated Movement (/i-i-i/ on one breath)
Alternating Movement (/u-i/)
Buccofacial Apraxia: “Blow out the candle” _______________________ “Lick an ice cream cone”
“Lick milk off your top lip” ________ “Sip through a straw” __________ “Kiss a baby”
Velum (CN IX, X XI)
Symmetry: Rest ______________________________ Elevation
Coordination: Repetitive Movement (/a/)
Appearance of Hard Palate
Dentition
Reflexes (CN IX, X, XI)
Gag (Abnormal: Yes/No)
Swallow (Cough: Yes/No)
Voice Change (Yes/No)
Additional Information
c/o Facial Numbness or Tingling: Yes/No ______ Light Touch
Dysphonia: Yes/No (mild, moderate, severe)
Dysarthria: Yes/No (mild, moderate, severe)
Breath Support
Resonance
Volitional Cough (Abnormal: Yes/No)
_____________________________________ ___________________________
Clinician Date
a
Adapted with permission from Daniels, McAdam, Brailey, and Foundas.
52
5. CLINICAL EVALUATION OF SWALLOWING DISORDERS 135
6. Laryngeal elevation — lack of laryngeal
elevation usually suggests a nerve injury
at the laryngeal level. Place your finger on
the thyroid cartilage. Do you feel the larynx
elevate when the patient is asked to swallow?
Trial Swallows
Based on the patient’s input, family input, medical
records, and the severity of the problem, clinicians
will decide whether to proceed to trial swallows. The
final portion of the CSE consists of trial swallows of
water and different food textures. This can be combined with the measurement of oxygen saturation
or auscultation. The clinician should be consistent
in the amount of water to be swallowed. The majority of reports suggest that it is appropriate to begin
with a 5-mL bolus.
can advance to 10- and 20-mL boluses. The fluid
consistencies may be thickened or thinned according to the patient’s performance. A selection of food
textures should also be tested to determine if diet
modification may be necessary for the patient. The
patient’s chewing ability should also be assessed
during trial swallows of different textures; referral to
a dentist may be necessary if chewing difficulties are
related to the jaw and dentition. Laryngeal elevation,
identified by palpation of the thyroid prominence,
should be monitored for each swallow. After each
swallow, the patient is asked to sustain the /a/ vowel
for a few seconds or count from 1 to 5 to determine
if there is wet hoarseness or other drainage in voice
quality. Daniels and her associates
wet hoarseness and a weak cough are 2 signs of
increased risk for aspiration. If aspiration is suspected, the patient should be referred for further
instrumental swallow evaluation. Table 5–8 shows a
list of signs and symptoms that may be observable
during trial swallows.
Cervical Auscultation
Cervical auscultation refers to placing a stethoscope
gently on the lateral aspect of the larynx to listen to
“swallowing sounds” and respiration. Cervical auscultation assesses swallowing-respiration coordination and detection of aspiration and penetration.
27
Depending on the results, one
17
suggest that
53,54
TABLE 5–8. Signs and Symptoms That May Be
Observable During Trial Swallows
The clinician should observe for the following signs
and symptoms while the patient tries foods of different
textures and drinks of different consistencies.
Limited arm movement needing feeding assistance
Poor lips seal with food and drinks leaking from mouth
Poor bolus control
Chewing difficulties
Prolonged oral phase
Nasal regurgitation
No swallow reflex
Incoordination of swallowing reflex
Reduced laryngeal elevation
Cough (before swallow)
Cough (during swallowing)
Cough (after swallow)
Throat clearing
Double/multiple swallows
Gurgly voice after swallow
Shortness of breath
Oral residue after swallow
The sensitivity of using cervical auscultation to
detect aspiration is approximately 85%, with specificity ranging from 56% to 71% across studies.
55
interrater reliability was considered to be poor to
fair across studies. It is suggested that cervical auscultation should only be used in conjunction with
other swallowing tests, instead of using this technique as a screening test to detect aspiration.
Trial Swallows With Pulse Oximetry
Pulse oximetry refers to the monitoring of peripheral blood oxygen saturation level while conducting
trial swallows.
56,57
It aims to identify aspiration based
on the principle that aspiration of food or liquids
will lead to hypoxia and desaturation. Conflicting
results have been reported in the literature. Some
studies have reported that the use of pulse oximetry during trial swallows achieved excellent sensitivity and good specificity for detecting aspiration.
However, a number of other studies reported poor
sensitivity and specificity and found no additional
The
58
136 CLINICAL MANAGEMENT OF SWALLOWING DISORDERS
value in the use of oximetry during clinical swallow
examination.
59,60
Mann Assessment of Swallowing Ability
A noninvasive assessment protocol for quantifying
the severity of swallowing impairment was developed by Mann.
61
This protocol, called the Mann
Assessment of Swallowing Ability (MASA), is a comprehensive clinical examination of oropharyngeal
dysphagia consisting of 24 items. The MASA is one
clinical measure of dysphagia that has demonstrated
strong reliability and has been validated against videofluoroscopic and videoendoscopic swallowing
examinations in several populations. It provides a
numerical score reflecting the severity of dysphagia symptoms and is sensitive to change in patient
performance over time. The 24 items in the MASA
combine to provide a total score and cutoff criteria
for dysphagia and aspiration severity. It is considered simple to use and score.
Functional Oral Intake Scale
The Functional Oral Intake Scale (FOIS) is a validated and reliable scale to describe the current
mode and type of diet intake.
62,63
The scale has
been validated with different populations, including adults with traumatic brain injury, stroke, head
and neck cancer, neurological and neuromuscular
disorders, and children with dysphagia.
64–66
It has
been translated to different languages, including
Chinese, German, Italian, and Persian.
67–70
The current functional diet is described on a 7-point ordinal
scale. Table5–9 shows the descriptors for each level.
Silent Aspiration and the Clinical
Swallow Examination
Silent aspiration is the penetration of food, liquid,
or saliva to the subglottic area without the elicitation of a cough.
The clinician must always be aware of the possibility of silent aspiration. It has been estimated
that the occurrence of silent aspiration may be as
high as 40% in patients with dysphagia, and it is
not generally identifiable during the CSE. However,
TABLE 5–9. Functional Oral Intake Scale
Level 1 Nothing by mouth
Level 2 Tube dependent with minimal attempts of food
or liquid
Level 3 Tube dependent with consistent oral intake of
food or liquid
Level 4 Total oral diet of a single consistency
Level 5 Total oral diet with multiple consistencies
but requiring special preparation or
compensations
Level 6 Total oral diet with multiple consistencies
without special preparation but with specific
food limitations
Level 7 Total oral diet with no restrictions
Adapted from Crary et al.
62
a history of pneumonia, a weak or absent cough,
changes in body temperature after eating, and a
voice that has a “wet hoarse” quality suggest the
possibility of silent aspiration. Additionally, the use
of sensory testing provides an objective test of sensory awareness that may be the best indicator that
the patient is a silent aspirator.
71,72
SUMMARY
Normal swallowing consists of a series of wellcoordinated neuromuscular movements beginning
with placement of a bolus in the mouth. From that
point, bolus transport and bolus awareness become
an integrated neural process. Although originally
thought to be a serial processing pattern, we now
know that the 4 phases of swallowing (described in
detail in Chapter 1) overlap considerably in a parallel processing paradigm. This chapter pointed out
the importance of the clinical assessment and case
history to guide further evaluation of the swallowing complaints. Depending on the types of patient
complaints and by using self-assessment techniques
and case history information, tests may be selected
by one or more specialists involved in the patient’s
care. It should be noted that the diagnosis of swal-
5. CLINICAL EVALUATION OF SWALLOWING DISORDERS 137
lowing disorders extends into many disciplines
and that there is no single gold standard test for all
swallow complaints. Different disciplines may opt
for specific tests based on their initial evaluations.
There has been significant growth in new screening
and diagnostic clinical tools for dysphagia over the
past decade. Some of them remain experimental or
may be extremely costly to use on a regular basis.
Nonetheless, clinicians should be aware of all of
the possible tests for identifying the basis of the
swallowing disorder and how the tests may aid in
treating the problem.
DISCUSSION QUESTIONS
1. Which screening and self-assessment tool
would you use for a patient with (a) physical
disability, (b) myasthenia gravis, (c) pain, and
(d) stroke? Why?
2. If a patient cannot cooperate during the clini-
cal swallow evaluation, what alternatives does
the clinician have to assess patient’s readiness
to swallow?
STUDY QUESTIONS
1. Patient self-assessment in the management of
swallowing disorders has limitations related to
A. The number of tests now available
B. The lack of construct validation of scales or
charts now being used
C. The cognitive condition of the patient
when asked to complete the assessment
D. The length of assessment scales
2. In conducting various clinical screenings of
swallowing function, a false-positive test
A. Is better because it will suggest
conservative treatment procedures
B. Indicates the patient is having problems
that the patient really does not have
C. Suggests that feeding or oral eating should
be stopped due to aspiration
D. Requires another test to verify the results
3. The prerequisites of conducting an oropharyngeal examination are that the
A. Patient has self-reported swallowing
problems
B. Clinician is aware of patient’s
characteristics that may interfere with the
examination
C. Swallowing problems are because of
neurological deficits
D. Patient is on nonoral feeding
REFERENCES
1. Threats TT. Use of the ICF in dysphagia management.
Semin Speech Lang. 2007;28(04):323–333.
2. Scarinci N, Worrall L, Hickson L. The ICF and third-party
disability: its application to spouses of older people
with hearing impairment. Disabil Rehabil. 2003;25(31):
2088–2100.
3. Zipoli RP, Kennedy M. Am J Speech Lang Pathol. 2005;
12(3):208–220.
4. American Speech-Language-Hearing Association. Pre-
ferred practice patterns for the profession of speechlanguage pathology [Preferred Practice Patterns]. 2004.
Accessed August 8, 2024. http://www.asha.org/policy/
PP2004-00191/
5. Virvidaki IE, Nasios G, Kosmidou M, Giannopoulos S,
Milionis H. Swallowing and aspiration risk: a critical
review of noninstrumental bedside screening tests. J Clin
Neurol. 2018;14(3):265–274.
6. Smithard DG, O’Neill PA, Park C, et al. Can bedside
assessment reliably exclude aspiration following acute
stroke? Age Ageing. 1998;27(2):99–106.
7. Smithard DG, ONeill PA, England RE, et al. The natu-
ral history of dysphagia following a stroke. Dysphagia.
1997;12(4):188–193.
8. Ramsey DJ, Smithard DG, Kalra L. Early assessments of
dysphagia and aspiration risk in acute stroke patients.
Stroke. 2003;34(5):1252–1257.
9. Perry L. Screening swallowing function of patients with
acute stroke. Part one: identification, implementation and
initial evaluation of a screening tool for use by nurses. J
Clin Nurs. 2001;10(4):463–473.
10. Perry L. Screening swallowing function of patients with
acute stroke. Part two: detailed evaluation of the tool
used by nurses. J Clin Nurs. 2001;10(4):474–481.
11. Trapl M, Enderle P, Nowotny M, et al. Dysphagia bedside
screening for acute-stroke patients The Gugging Swallowing Screen. Stroke. 2007;38(11):2948–2952.
12. Edmiaston J, Connor LT, Loehr L, Nassief A. Validation of
a dysphagia screening tool in acute stroke patients. Am
J Crit Care. 2010;19(4):357–364.
138 CLINICAL MANAGEMENT OF SWALLOWING DISORDERS
13. Martino R, Silver F, Teasell R, et al. The Toronto Bedside
Swallowing Screening Test (TOR-BSST): development
and validation of a dysphagia screening tool for patients
with stroke. Stroke. 2009;40(2):555–561.
14. Antonios N, Carnaby-Mann G, Crary M, et al. Analysis of
a physician tool for evaluating dysphagia on an inpatient
stroke unit: the Modified Mann Assessment of Swallowing Ability. J Stroke Cerebrovasc Dis. 2010;19(1):49–57.
15. Suiter DM, Leder SB. Clinical utility of the 3-ounce Water
Swallow Test. Dysphagia. 2007;23(3):244–250.
16. DePippo KL, Holas MA, Reding MJ. Validation of the 3-oz
water swallow test for aspiration following stroke. Arch
Neurol. 1992;49(12):1259.
17. Daniels SK, Anderson JA, Willson PC. Valid items for
screening dysphagia risk in patients with stroke: a systematic review. Stroke. 2012;43(3):892–897.
18. Suiter DM, Sloggy J, Leder SB. Validation of the Yale
Swallow Protocol: a prospective double-blinded videofluoroscopic study. Dysphagia. 2014;29(2):199–203.
19. Ward M, Skelley-Ashford M, Brown K, Ashford J, Suiter
D. Validation of the Yale Swallow Protocol in post-acute
care: a prospective, double-blind, multirater study. Am J
Speech Lang Pathol. 2020;29(4):1937–1943.
20. DePippo KL, Holas MA, Reding MJ. The Burke dysphagia screening test: validation of its use in patients with
stroke. Arch Phys Med Rehabil. 1994;75(12):1284–1286.
21. Cichero JA, Heaton S, Bassett L. Triaging dysphagia:
nurse screening for dysphagia in an acute hospital. J
Clin Nurs. 2009;18(11):1649–1659.
22. O’Neil-Pirozzi MT, Lisiecki JD, Jack Momose KD, Connors JJ, Milliner PM. Simultaneous modified barium swallow and blue dye tests: a determination of the accuracy
of Blue Dye Test aspiration findings. Dysphagia. 2003;
18(1):32–38.
23. Belafsky PC, Blumenfeld L, Lepage A, Nahrstedt K. The
accuracy of the modified Evan’s blue dye test in predicting aspiration. Laryngoscope. 2003;113(11):1969–1972.
24. McCullough G, Wertz R, Rosenbek J. Sensitivity and specificity of clinical/bedside examination signs for detecting
aspiration in adults subsequent to stroke. J Commun
Disord. 2001;34(1):55–72.
25. Peruzzi WT, Logemann JA, Currie D, Moen SG. Assessment
of aspiration in patients with tracheostomies: comparison of the bedside colored dye assessment with videofluoroscopic examination. Respir Care. 2001;46(3):243–247.
26. Carrau RL, Murry T, Howell RJ. Comprehensive Manage-
ment of Swallowing Disorders. Plural Publishing; 2016.
27. Timmerman AA, Speyer R, Heijnen BJ, Klijn-Zwijnenberg
IR. Psychometric characteristics of health-related qualityof-life questionnaires in oropharyngeal dysphagia. Dys-
phagia. 2014;29(2):183–198.
28. McHorney CA, Bricker DE, Kramer AE, et al. The SWALQOL outcomes tool for oropharyngeal dysphagia in
adults: I. Conceptual foundation and item development.
Dysphagia. 2000;15(3):115–121.
29. McHorney CA, Bricker DE, Robbins J, Kramer AE, Rosenbek JC, Chignell KA. The SWAL-QOL outcomes tool for
oropharyngeal dysphagiain adults: II. Item reduction and
preliminary scaling. Dysphagia. 2000;15(3):122–133.
30. McHorney CA, Robbins J, Lomax K, et al. The SWALQOL and SWAL-CARE outcomes tool for oropharyngeal
dysphagia in adults: III. Documentation of reliability and
validity. Dysphagia. 2002;17(2):97–114.
31. Lovell SJ, Wong HB, Loh KS, Ngo R, Wilson JA. Impact
of dysphagia on quality‐of‐life in nasopharyngeal carcinoma. Head Neck. 2005;27(10):864–872.
32. dos Santos Queija D, Portas JG, Dedivitis RA, Lehn CN,
Barros APB. Swallowing and quality of life after total
laryngectomy and pharyngolaryngectomy. Braz J Oto-
rhinolaryngol. 2009;75(4):556–564.
33. McHorney AC, Robbins J, Lomax K, et al. The SWALQOL and SWAL-CARE outcomes tool for oropharyngeal
dysphagia in adults: III. Documentation of reliability and
validity. Dysphagia.17(2):97–114.
34. Bogaardt HCA, Speyer R, Baijens LWJ, Fokkens WJ.
Cross-cultural adaptation and validation of the Dutch
version of SWAL-QOL. Dysphagia. 2008;24(1):66–70.
35. Khaldoun E, Woisard V, Verin É. Validation in French
of the SWAL-QOL scale in patients with oropharyngeal
dysphagia. Gastroenterol Clin Biol. 2009;33(3):167–
171.
36. Finizia C, Rudberg I, Bergqvist H, Rydén A. A crosssectional validation study of the Swedish version of
SWAL-QOL. Dysphagia. 2011;27(3):325–335.
37. Lam PM, Lai CKY. The validation of the Chinese version
of the Swallow Quality-of-Life Questionnaire (SWALQOL) using exploratory and confirmatory factor analysis. Dysphagia. 2010;26(2):117–124.
38. Bandeira AKC, Azevedo EH, Vartanian JG, Nishimoto IN,
Kowalski LP, Carrara-de Angelis E. Quality of life related
to swallowing after tongue cancer treatment. Dysphagia.
2008;23(2):183–192.
39. Robbins J, Kays SA, Gangnon RE, et al. The effects of
lingual exercise in stroke patients with dysphagia. Arch
Phys Med Rehabil. 2007;88(2):150–158.
40. Troche MS, Okun MS, Rosenbek JC, et al. Aspiration
and swallowing in Parkinson disease and rehabilitation
with EMST: a randomized trial. Neurology. 2010;75(21):
1912–1919.
41. Keage M, Delatycki M, Corben L, Vogel A. A systematic
review of self-reported swallowing assessments in progressive neurological disorders. Dysphagia. 2014;30(1):
27–46.
42. Chen AY, Frankowski R, Bishop-Leone J, et al. The development and validation of a dysphagia-specific qualityof-life questionnaire for patients with head and neck
cancer: the MD Anderson dysphagia inventory. Arch
Otolaryngol Head Neck Surg. 2001;127(7):870–876.
43. Schindler A, Borghi E, Tiddia C, Ginocchio D, Felisati G,
Ottaviani F. Adaptation and validation of the Italian MD
Anderson dysphagia inventory (MDADI). Rev Laryngol
Otol Rhinol (Bord). 2007;129(2):97–100.
44. Carlsson S, Rydén A, Rudberg I, Bove M, Bergquist H,
Finizia C. Validation of the Swedish M. D. Anderson Dys-
5. CLINICAL EVALUATION OF SWALLOWING DISORDERS 139
phagia Inventory (MDADI) in patients with head and
neck cancer and neurologic swallowing disturbances.
Dysphagia. 2011;27(3):361–369.
45. Kwon C-H, Kim YH, Park JH, Oh B-M, Han TR. Validity
and reliability of the Korean version of the MD Anderson
Dysphagia Inventory for head and neck cancer patients.
Ann Rehabil Med. 2013;37(4):479–487.
46. Speyer R, Heijnen BJ, Baijens LW, et al. Quality of life
in oncological patients with oropharyngeal dysphagia:
validity and reliability of the Dutch version of the MD
Anderson Dysphagia Inventory and the Deglutition
Handicap Index. Dysphagia. 2011;26(4):407–414.
47. Belafsky PC, Mouadeb DA, Rees CJ, et al. Validity and
reliability of the Eating Assessment Tool (EAT-10). Ann
Otol Rhinol Laryngol. 2008;117(12):919–924.
48. Silbergleit AK, Schultz L, Jacobson BH, Beardsley T, Johnson AF. The Dysphagia Handicap Index: development
and validation. Dysphagia. 2011;27(1):46–52.
49. Dwivedi RC, Rose SS, Roe JWG, et al. Validation of the Sydney Swallow Questionnaire (SSQ) in a cohort of head and
neck cancer patients. Oral Oncol. 2010;46(4):e10–e14.
50. Woisard V, Lepage B. The “Deglutition Handicap Index” a
self-administrated dysphagia-specific quality of life questionnaire: temporal reliability. Rev Laryngol Otol Rhinol
(Bord). 2010;131(1):19–22.
51. Ridner SH, Rhoten BA, Niermann KJ, Murphy BA, Dietrich MS. Vanderbilt head and neck symptom survey, version 2.0: clinical and research utility for identification of
symptom clusters and changes in symptoms over time.
Oral Oncol. 2018;83:25–31.
52. Daniels SK, McAdam CP, Brailey K, Foundas AL. Clinical
assessment of swallowing and prediction of dysphagia
severity. Am J Speech Lang Pathol. 1997;6(4):17–24.
53. Borr C, Hielscher-Fastabend M, Lücking A. Reliability and
validity of cervical auscultation. Dysphagia. 2007;22(3):
225–234.
54. Leslie P, Drinnan MJ, Finn P, Ford GA, Wilson JA. Reliability and validity of cervical auscultation: a controlled comparison using videofluoroscopy. Dysphagia. 2004;19(4):
231–240.
55. Lagarde ML, Kamalski DM, van den Engel-Hoek L. The
reliability and validity of cervical auscultation in the
diagnosis of dysphagia: a systematic review. Clin Reha-
bil. 2016;30(2):199–207.
56. Collins MJ, Bakheit A. Does pulse oximetry reliably
detect aspiration in dysphagic stroke patients? Stroke.
1997;28(9):1773–1775.
57. Smith HA, Lee SH, O’Neill PA, Connolly MJ. The combination of bedside swallowing assessment and oxygen
saturation monitoring of swallowing in acute stroke: a
safe and humane screening tool. Age Ageing. 2000;29(6):
495–499.
58. Lim SH, Lieu P, Phua S, et al. Accuracy of bedside clinical
methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of
aspiration in acute stroke patients. Dysphagia. 2001;
16(1):1–6.
59. Kolb G, Bröker M. State of the art in aspiration assessment and the idea of a new non invasive predictive test
for the risk of aspiration in stroke. J Nutr Health Aging.
2009; 13(5):429–433.
60. Ramsey DJC, Smithard DG, Kalra L. Can pulse oximetry
or a bedside swallowing assessment be used to detect
aspiration after stroke? Stroke. 2006;37(12):2984–2988.
61. Mann G. The Mann Assessment of Swallowing Ability:
MASA. Delmar Thompson Learning; 2002:5–39.
62. Crary MA, Mann GDC, Groher ME. Initial psychometric
assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):
1516–1520.
63. Mortensen J, Pedersen AR, Nielsen JF, Kothari M. Construct and content validity of the Functional Oral Intake
Scale; analyses from a cohort of patients with acquired
brain injury. Brain Injury. 2020;34(9):1257–1263.
64. Umemoto G, Fujioka S, Arahata H, et al. Relationship
between tongue pressure and functional oral intake scale
diet type in patients with neurological and neuromuscular disorders. Clin Neurol Neurosurg. 2020;198:106196.
65. Hansen TS, Engberg AW, Larsen K. Functional oral intake
and time to reach unrestricted dieting for patients with
traumatic brain injury. Arch Phys Med Rehabil. 2008;
89(8):1556–1562.
66. Yi YG, Shin H-I. Psychometrics of the functional oral
intake scale for children with dysphagia. J Pediatr Gas-
troenterol Nutr. 2020;71(5):686–691.
67. Bakhtiyari J, Tohidast SA, Mansuri B, Azimi H, Ebadi A.
The Persian version of the Functional Oral Intake Scale
(FOIS-P): a validation study on stroke patients with dysphagia. Logoped Phoniatr Vocol. 2022;47(2):133–138.
68. Zhou H, Zhu Y, Zhang X. Validation of the Chinese version of the Functional Oral Intake Scale (FOIS) score in
the assessment of acute stroke patients with dysphagia.
Stud Health Technol Inform. 2017;245:1195–1199.
69. Hamzic S, Braun T, Juenemann M, et al. Validation of the
German version of Functional Oral Intake Scale (FOIS-G)
for flexible endoscopic evaluation of swallowing (FEES).
Dysphagia. 2021;36(1):130–139.
70. Ninfa A, Pizzorni N, Eplite A, Moltisanti C, Schindler A.
Validation of the Italian version of the Functional Oral
Intake Scale (FOIS-It) against fiberoptic endoscopic evaluation of swallowing and nutritional status. Dysphagia.
2022;37(1):137–147.
71. Splaingard M, Hutchins B, Sulton L, Chaudhuri G. Aspiration in rehabilitation patients: videofluoroscopy vs bedside clinical assessment. Arch Phys Med Rehabil. 1988;
69(8):637–640.
72. Aviv JE, Martin JH, Debell M, Keen MS, Blitzer A. Air
pulse quantification of supraglottic and pharyngeal sensation: a new technique. Ann Otol Rhinol Laryngol. 1993;
102(10):777–780.
Instrumental Evaluation
of Swallowing Disorders
CHAPTER OUTLINE
Introduction
Flexible Endoscopic Evaluation of Swallowing
Measurement Scales for Flexible Endoscopic
Evaluation of Swallowing
Modified Barium Swallow
Modified Barium Swallow Test Observations
Radiation Safety During Modified Barium Swallow
Measurement Scales for Modified Barium
Swallow
Modified Barium Swallow, Flexible Endoscopic
Evaluation of Swallowing, and Silent Aspiration
Manometry and High-Resolution Manometry
Tongue Pressure/Strength Measurement
Other Instrumental Tests Associated With
Swallowing Disorders
Ultrasound
Electromyography
Magnetic Resonance Imaging
Functional Magnetic Resonance Imaging
Positron Emission Tomography
Esophagram (Barium Swallow)/Upper
Gastrointestinal Series
Computed Tomography
Esophagoscopy
Scintigraphy
Esophageal pH Monitoring
Summary
Discussion Questions
Study Questions
References
Chapter
6
141