Bayesian hierarchical profile regression for binary covariates.

Dysphagia, a common result of other medical conditions, is caused by malfunctions in swallowing physiology resulting in difficulty eating and drinking. The Modified Barium Swallow Study (MBSS), the most commonly used diagnostic tool for evaluating dysphagia, can be assessed using the Modified Barium Swallow Impairment Profile (MBSImP™). The MBSImP assessment tool consists of a hierarchical grouped data structure with multiple domains, a set of components within each domain which characterize specific swallowing physiologies, and a set of tasks scored on a discrete scale within each component. We lack sophisticated approaches to extract patterns of physiologic swallowing impairment from the MBSImP task scores within a component while still recognizing the nested structure of components within a domain. We propose a Bayesian hierarchical profile regression model, which uses a Bayesian profile regression model in conjunction with a hierarchical Dirichlet process mixture model to (1) cluster subjects into impairment profile patterns while respecting the hierarchical grouped data structure of the MBSImP, and (2) simultaneously determine associations between latent profile cluster membership for all components and the outcome of dysphagia severity. We apply our approach to a cohort of patients referred for an MBSS and assessed using the MBSImP. Our research results can be used to inform appropriate intervention strategies, and provide tools for clinicians to make better multidimensional management and treatment decisions for patients with dysphagia.

Criterion (Concurrent) Validity and Clinical Utility of the Tongueometer Device.

PURPOSE: Tongue manometry (i.e., tongue pressure measurement) is a commonly used assessment for patients with suspected oral-motor involvement in swallowing disorders. Availability of lingual manometry has changed in recent years, with the introduction of the Tongueometer device being a more affordable tongue manometry system. The purpose of this study was to test concurrent (criterion) validity of the Tongueometer compared to the current standard reference device, the Iowa Oral Performance Instrument (IOPI). METHOD: Adults without dysphagia were recruited for participation in this study. Standard lingual measurements (swallowing-related pressures, maximum isometric pressure [MIP], and maximum isometric endurance) were recorded, with the bulb anteriorly placed, with both devices, in a randomized order. The Bland-Altman method was used to determine concurrent (criterion) validity of these measurements compared to the clinical standard IOPI device. A recently available suggested corrective value by Curtis et al. (2023) was also applied, with comparisons made between devices both with and without the Curtis correction. RESULTS: The final sample included 70 adult participants aged 20-89 years (Mage = 52.3 years). Measures with the Tongueometer device were significantly lower when compared with the same measures taken using the IOPI (p < .01) for all measures including MIP, endurance, and swallow pressures. The correction suggested by Curtis and colleagues did not ameliorate these differences. CONCLUSIONS: The Tongueometer lingual measurements were consistently lower compared to the IOPI. Clinical use of values taken with the Tongueometer device should be compared to normative data published for each specific device. Available features of each device (e.g., display, bulb texture, technology/application) should be considered when selecting which device to use with an individual patient.

Impact of Reducing Fluoroscopy Pulse Rate on Adult Modified Barium Swallow Studies.

Modified Barium Swallow Studies (MBSS) are a critical part of the evaluation, treatment planning, and outcome assessment for persons with swallowing disorders. Since MBSSs use ionizing radiation with associated cancer risks, many clinicians have reduced radiation exposure by reducing the fluoroscopic pulse rate. However, by reducing pulse rate, we also decrease the temporal resolution of MBSSs which has been shown in pilot studies to significantly reduce diagnostic accuracy. Two hundred MBSSs from patients routinely undergoing MBSS as standard of care conducted at 30 pulses per second (pps) using the Modified Barium Swallow Study Impairment Profile (MBSImP™) standardized administration protocol were selected. A stratified sampling method ensured that a full range of swallowing impairments (etiology, type, and severity) was represented. Recordings were down sampled from 30 pps to 15, 7.5, and 4 pps. MBSSs were rated using the MBSImP components and Penetration-Aspiration Scale (PAS) score for each swallow. Percent agreement was calculated across raters for MBSImP and PAS scores by bolus type and volume. The Least-Squares Method was used for hypothesis testing. Statistically significant and clinically meaningful changes in scores of swallowing physiology and penetration/aspiration occurred when reducing pulse rate below 30pps. These changes were evident across bolus types and volumes. Given the impact on diagnostic accuracy and the low radiation risks to adults undergoing MBSSs, reducing pulse rate to 15pps or below is not aligned with the As Low As Reasonably Achievable (ALARA) principle and should not be used as a viable method to reduce radiation exposure from MBSSs.

Quantifying Oropharyngeal Swallowing Impairment in Response to Bolus Viscosity.

PURPOSE: The purpose of this study was to test the feasibility for quantifying changes in oropharyngeal swallowing impairment in response to alteration in bolus viscosity using a reliable and valid method of observational measurement-the Modified Barium Swallow Impairment Profile (MBSImP). METHOD: This retrospective analysis included a heterogeneous cohort of 119 patients with suspected dysphagia that underwent a videofluoroscopic swallowing study as part of clinical care. Using consensus scoring, two expert clinicians assigned MBSImP scores to components related to oropharyngeal swallowing function between two bolus viscosities (thin liquid and pudding): epiglottic movement, laryngeal elevation, anterior hyoid excursion, tongue base retraction, pharyngeal stripping wave, and pharyngoesophageal segment opening (PESO). Comparisons between the two bolus viscosities were investigated for each component. RESULTS: Higher (worse) scores were observed in the thin-liquid trial compared with the pudding trial for the following MBSImP components: anterior hyoid excursion (p = .03), epiglottic movement (p < .001), pharyngeal stripping wave (p < .001), and PESO (p = .002). Lower (better) scores were observed in the liquid trial compared with the pudding trial for one component-tongue base retraction (Component 15) only (p < .001). CONCLUSION: These findings provide further evidence for positive influences of viscosity on the swallow mechanism, including influences of sensory feedback on the sensorimotor swallow program.

Respiratory-Swallow Coordination in Individuals with Parkinson's Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Swallowing impairment, including altered physiology and aspiration, occur across the progression of Parkinson's disease (PD). The phase of respiration during which a swallow is initiated has been linked to swallowing impairment and aspiration in cohorts with dysphagia following stroke and head and neck cancer treatment, but has been understudied in PD. If similar findings are shown in individuals with PD, the implications for swallowing assessment and treatment are significant. OBJECTIVE: The aim of this systematic review and meta-analysis of literature was to examine respiratory-swallow coordination measures and potential implications on swallowing physiology in individuals with PD. METHODS: An extensive search of 7 databases (PubMed, EMBASE, Central, Web of Science, ProQuest Dissertations & Theses, Scopus, and CINAHL) with predetermined search terms was conducted. Inclusion criteria were individuals with PD and the use of objective evaluations of respiratory-swallow coordination. RESULTS: Of the 13,760 articles identified, 11 met the inclusion criteria. This review supports the presence of atypical respiratory swallow patterning, respiratory pause duration and lung volume at swallow initiation in individuals with PD. The meta-analysis estimated an occurrence of 60% of non-expiration-expiration and 40% of expiration-expiration respiratory phase patterns surrounding swallowing. CONCLUSION: Although this systematic review supports the occurrence of atypical respiratory-swallow coordination in individuals with PD, the evidence is limited by the variability in the methods of data acquisition, analysis, and reporting. Future research examining the impact of respiratory swallow coordination on swallowing impairment and airway protection using consistent, comparable, and reproducible methods and metrics in individuals with PD is warranted.

The Impact of Cervical Spinal Disease on Pharyngeal Swallowing Function.

PURPOSE: Spinal pathology is very common with advancing age and can cause dysphagia; however, it is unclear how frequently these pathologies affect swallowing function. This study evaluates how cervical spinal pathology may impact swallowing function in dysphagic individuals observed during videofluoroscopic swallowing studies (VFSSs). METHOD: A retrospective case-control study was performed on 100 individuals with dysphagia as well as age-/gender-matched healthy controls (HCs) with available VFSS. Spinal anatomy of patients was classified into two predetermined categories, and a consensus decision of whether spinal pathology influenced swallowing physiology was made. Validated swallow metrics, including Modified Barium Swallow Impairment Profile (MBSImP) component scores, Penetration-Aspiration Scale (PAS) maximum scores, and 10-item Eating Assessment Tool (EAT-10) scores, were compared between the spine-associated dysphagia (SAD), non-SAD (NSAD), and HC groups using Kruskal-Wallis one-way analysis of variance. RESULTS: Most patients with dysphagia had spinal pathology. Spinal pathology was judged to be the primary etiology of dysphagia in 16.9% of patients with abnormal spine pathology. Median EAT-10 scores were statistically different among the three groups, with the NSAD group scoring the highest and the HC group scoring the lowest. Similarly, median PAS scores were significantly different between dysphagic groups and HCs. Median MBSImP Oral Total scores were significantly different only between the NSAD group and HCs, whereas Pharyngeal Total score was not significantly different among the groups. CONCLUSIONS: Spinal pathology is commonly observed during VFSS and can contribute to dysphagia, resulting in worse swallowing-related outcomes when compared with HCs. Patients judged to have SAD tended to have better outcomes than patients with dysphagia from other etiologies, perhaps due to the progressive nature of spinal disease that allows for compensatory swallowing physiology over time.

Stakeholder Perspectives on Radiation Use and Interdisciplinary Collaboration in Adult Modified Barium Swallow Studies.

The Modified Barium Swallow Study (MBSS) is a videofluoroscopic examination of the anatomy and physiology involved in swallowing. Like other fluoroscopic examinations, the MBSS uses ionizing radiation with related radiation risks. Thus, the procedures and protocols related to MBSSs must balance the benefit of the diagnostic information gained with the risk of radiation exposure. This requires complex decision-making for any given clinician but becomes complicated due to the interprofessional nature of conducting MBSSs, namely the direct involvement of both the speech-language pathologist and radiologist with indirect involvement of the medical physicist and the referring physician. This editorial provides the perspectives of the various stakeholder groups related to radiation use in adult MBSSs, identifies barriers to conducting MBSSs in an evidence-based manner, and suggests areas for improvement.

Cross-System Integration of Respiration and Deglutition: Function, Treatment, and Future Directions.

Swallowing occurs preferentially in the expiratory phase of the quiet breathing cycle and at mid-to-low tidal volume. This coordinative pattern imparts important biomechanical advantages to swallowing and airway protection and facilitate laryngeal elevation, laryngeal vestibular and vocal fold closure, and cricopharyngeal sphincter opening. This preferred coordinative relationship between breathing and swallowing is impaired in a variety of patient populations, including head and neck cancer survivors with dysphagia. We developed a training protocol to re-establish more optimal phasing of swallowing with breathing in these patients with striking outcomes, including reduced swallowing physiological impairments and improved airway protection. This motivated us to continue to refine and expand this training protocol and develop new assistive technologies for swallowing monitoring outside of the lab. In this review, we highlight the origins of our optimal respiratory-swallowing coordination hypothesis, describe the biomechanical advantages it provides, carefully describe our training protocol and findings, and chart a course for the next phase of this work. Our overall goal is to harness technology combined with carefully constructed learning paradigms to improve the lives of patients with impaired respiratory-swallowing coordination consequent to a variety of pathologies including head and neck cancer and degenerative neurological conditions such as Parkinson's disease.

Relating Physiologic Swallowing Impairment, Functional Swallowing Ability, and Swallow-Specific Quality of Life.

Many studies include functional swallowing ability and quality of life information to indicate a response to a specific swallowing intervention or to describe the natural history of dysphagia across diseases and conditions. Study results are difficult to interpret because the association between these factors and actual swallowing impairment is not understood. We set out to test the associations between components of physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life using standardized and validated measurement tools: Modified Barium Swallow Impairment Profile (MBSImP), Functional Oral Intake Scale (FOIS), Eating Assessment Tool (EAT-10), and Dysphagia Handicap Index (DHI). We specifically aimed to understand which factors may contribute to the overall relationships between these measurement tools when analyzed using total scores and item-level scores. This study included a heterogeneous cohort of 273 outpatients who underwent a modified barium swallow study (MBSS). We found significant correlations between MBSImP total scores and FOIS scores and DHI total scores, but not between MBSImP total scores and EAT-10 total scores. Significant correlations were also found between MBSImP item-level component scores and FOIS scores, EAT-10 total scores, and DHI total scores. Detailed item-level analyses revealed the MBSImP components of bolus transport/lingual motion, oral residue, and tongue base retraction were correlated with EAT-10 item-level scores and DHI item-level scores. The clinically modest associations between physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life reveal different factors that uniquely contribute to patients' overall dysphagic profile, emphasizing the clinical impact of a comprehensive swallowing assessment.

Determining Swallowing Biomechanics Underlying Modified Barium Swallow Impairment Profile Scoring Using Computational Analysis of Swallowing Mechanics.

PURPOSE: The elements of impaired swallowing biomechanics are visually assessed and scored by clinicians using a standardized and validated tool for assessing type and severity of physiological impairments using the Modified Barium Swallow Impairment Profile (MBSImP). However, the functional anatomical correlates that underly noted impairments using MBSImP scoring have not been measured. The purpose of this study was to determine whether differences in MBSImP component scores represent differences in underlying swallowing mechanics as measured by computational analysis of swallowing mechanics (CASM) to better define underlying mechanisms of impairment. METHOD: A retrospective analysis of modified barium swallow studies from physician-referred adult patients with dysphagia was scored using the MBSImP for laryngeal elevation, anterior hyoid excursion, epiglottic movement, pharyngoesophageal segment opening, and tongue base retraction. A canonical variate analysis (CVA) was performed to determine the movement of anatomical landmarks associated with MBSImP component scores using the CASM method. Mahalanobis distances (D) were then used to detect differences among MBSImP scores for each component assessed. RESULTS: CVA showed significant differences (p < .0001) in Mahalanobis distance (D > 1) between MBSImP component scores of 0-1, 0-2, 0-3, or 0-4, as applicable, depending on the component. Discriminant function analyses revealed concomitant increase/worsening in MBSImP score with changes in anatomical positioning of structures. CONCLUSIONS: Ratings of swallowing impairment and physiology using the MBSImP have distinct biomechanical correlates with anatomical movements of swallowing. These data further demonstrate how swallowing mechanics are highly interrelated. Understanding these linkages between anatomical and physiological movement within impaired swallowing biomechanics is essential in more specific characterization and treatment of dysphagia. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20816788.

Soft skin-interfaced mechano-acoustic sensors for real-time monitoring and patient feedback on respiratory and swallowing biomechanics.

Swallowing is a complex neuromuscular activity regulated by the autonomic nervous system. Millions of adults suffer from dysphagia (impaired or difficulty swallowing), including patients with neurological disorders, head and neck cancer, gastrointestinal diseases, and respiratory disorders. Therapeutic treatments for dysphagia include interventions by speech-language pathologists designed to improve the physiology of the swallowing mechanism by training patients to initiate swallows with sufficient frequency and during the expiratory phase of the breathing cycle. These therapeutic treatments require bulky, expensive equipment to synchronously record swallows and respirations, confined to use in clinical settings. This paper introduces a wireless, wearable technology that enables continuous, mechanoacoustic tracking of respiratory activities and swallows through movements and vibratory processes monitored at the skin surface. Validation studies in healthy adults (n = 67) and patients with dysphagia (n = 4) establish measurement equivalency to existing clinical standard equipment. Additional studies using a differential mode of operation reveal similar performance even during routine daily activities and vigorous exercise. A graphical user interface with real-time data analytics and a separate, optional wireless module support both visual and haptic forms of feedback to facilitate the treatment of patients with dysphagia.

Structural Validity, Internal Consistency, and Rater Reliability of the Modified Barium Swallow Impairment Profile: Breaking Ground on a 52,726-Patient, Clinical Data Set.

PURPOSE: The purpose of this study was to extend the assessment of the psychometric properties of the Modified Barium Swallow Impairment Profile (MBSImP). Here, we re-examined structural validity and internal consistency using a large clinical-registry data set and formally examined rater reliability in a smaller data set. METHOD: This study consists of a retrospective structural validity and internal consistency analysis of MBSImP using a large data set (N = 52,726) drawn from the MBSImP Swallowing Data Registry and a prospective study of the interrater and intrarater reliability of a subset of studies (N = 50) rated by four MBSImP-trained speech-language pathologists. Structural validity was assessed via exploratory factor analysis. Internal consistency was measured using Cronbach's alpha for each of the multicomponent MBSImP domains, namely, the oral and pharyngeal domains. Interrater reliability and intrarater reliability were measured using the intraclass correlation coefficient (ICC). RESULTS: The exploratory factor analysis showed a two-factor solution with factors precisely corresponding to the scale's oral and pharyngeal domains, consistent with findings from the initial study. Component 17, that is, the esophageal domain, did not load onto either factor. Internal consistency was good for both the oral and pharyngeal domains (αoral = .81, αpharyngeal = .87). Interrater reliability was found to be good with ICCinterrater = .78 (95% confidence interval [CI; .76, .80]). Intrarater reliability was good for each rater, ICCRater-1 = .82 (95% CI [.77, .86]), ICCRater-2 = .83 (95% CI [.79, .87]), ICCRater-3 = .87 (95% CI [.83, .90]), and ICCRater-4 = .87 (95% CI [.83, .90]). CONCLUSIONS: This study leverages a large-scale, clinical data set to provide strong, generalizable evidence that the MBSImP assessment method has excellent structural validity and internal consistency. In addition, the results show that MBSImP-trained speech-language pathologists can demonstrate good interrater and intrarater reliability.

Scoring the Penetration-Aspiration Scale (PAS) in Two Conditions: A Reliability Study.

A widely applied metric for identifying airway invasion events is the Penetration-Aspiration Scale (PAS). PAS scores are often included as primary outcome measures in clinical interventional studies, applied to characterize airway protection in a particular disease, used to establish a normal referent for control group comparisons without dysphagia, and as determinants or predictors of clinical outcomes. Despite the widespread use of the PAS, there is variability in scoring condition. One common method used in research studies includes rater scores applied to each single swallow that occurred during a modified barium swallow study (MBSS) of the same patient. A second common method includes raters scoring single swallow segments that have been spliced from full MBSS from different patients. These single swallow segments are then randomly distributed and the rater is blinded to all swallows that occurred during that patient MBSS. The potential effects of different scoring conditions on rater reliability and score accuracy have not been studied and may have high relevance for the conclusion drawn from the result. The primary aim of this investigation is to determine the impact of two scoring conditions on rater reliability and score accuracy: 1. Contextual, unblinded scoring condition and 2. Randomized, blinded condition. Results of the present study show that no statistically significant differences in PAS rater reliability and score accuracy were found between the two scoring conditions. If findings from this pilot study are reproduced in larger sample sizes, the time and intensity involved in splicing and randomizing MBSS for scoring may not be necessary.

Radiation Effective Doses to Adults Undergoing Modified Barium Swallow Studies.

Modified Barium Swallow Studies (MBSSs) are important tests to aid the diagnosis of swallowing impairment and guide treatment planning. Since MBSSs use ionizing radiation, it is important to understand the radiation exposure associated with the exam. This study reports the average radiation dose in routine clinical MBSSs, to aid the evidence-based decision-making of clinical providers and patients. We examined the MBSSs of 200 consecutive adult patients undergoing clinically indicated exams and used kilovoltage (kV) and Kerma Area Product to calculate the effective dose. While 100% of patients underwent the exam in the lateral projection, 72% were imaged in the upper posterior-anterior (PA) projection and approximately 25% were imaged in the middle and lower PA projection. Average kVs were 63 kV, 77 kV, 78.3 kV, and 94.3 kV, for the lateral, upper, middle, and lower PA projections, respectively. The average effective dose per exam was 0.32 ± 0.23 mSv. These results categorize a typical adult MBSS as a low dose examination. This value serves as a general estimate for adults undergoing MBSSs and can be used to compare other sources of radiation (environmental and medical) to help clinicians and patients assess the risks of conducting an MBSS. The distinction of MBSS as a low dose exam will assuage most clinician's fears, allowing them to utilize this tool to gather clinically significant information about swallow function. However, as an X-ray exam that uses ionizing radiation, the principles of ALARA and radiation safety must still be applied.

Advanced Machine Learning Tools to Monitor Biomarkers of Dysphagia: A Wearable Sensor Proof-of-Concept Study.

INTRODUCTION: Difficulty swallowing (dysphagia) occurs frequently in patients with neurological disorders and can lead to aspiration, choking, and malnutrition. Dysphagia is typically diagnosed using costly, invasive imaging procedures or subjective, qualitative bedside examinations. Wearable sensors are a promising alternative to noninvasively and objectively measure physiological signals relevant to swallowing. An ongoing challenge with this approach is consolidating these complex signals into sensitive, clinically meaningful metrics of swallowing performance. To address this gap, we propose 2 novel, digital monitoring tools to evaluate swallows using wearable sensor data and machine learning. METHODS: Biometric swallowing and respiration signals from wearable, mechano-acoustic sensors were compared between patients with poststroke dysphagia and nondysphagic controls while swallowing foods and liquids of different consistencies, in accordance with the Mann Assessment of Swallowing Ability (MASA). Two machine learning approaches were developed to (1) classify the severity of impairment for each swallow, with model confidence ratings for transparent clinical decision support, and (2) compute a similarity measure of each swallow to nondysphagic performance. Task-specific models were trained using swallow kinematics and respiratory features from 505 swallows (321 from patients and 184 from controls). RESULTS: These models provide sensitive metrics to gauge impairment on a per-swallow basis. Both approaches demonstrate intrasubject swallow variability and patient-specific changes which were not captured by the MASA alone. Sensor measures encoding respiratory-swallow coordination were important features relating to dysphagia presence and severity. Puree swallows exhibited greater differences from controls than saliva swallows or liquid sips (p < 0.037). DISCUSSION: Developing interpretable tools is critical to optimize the clinical utility of novel, sensor-based measurement techniques. The proof-of-concept models proposed here provide concrete, communicable evidence to track dysphagia recovery over time. With refined training schemes and real-world validation, these tools can be deployed to automatically measure and monitor swallowing in the clinic and community for patients across the impairment spectrum.

Translation into Brazilian Portuguese and Cultural Adaptation of the Component Scores Definition from the Modified Barium Swallow Impairment Profile (MBSImPTM). / Tradução para o português brasileiro e adaptação cultural da Definição de Pontuações de Componentes (Component Scores Definition) pertencentes ao Modified Barium Swallow Impairment Profile ­ MBSImP(™).

PURPOSE: Translate into Brazilian Portuguese and culturally adapt the component scores definition from the Modified Barium Swallow Impairment Profile - MBSImP videofluoroscopy protocol. METHODS: This study was conducted based on international guidelines for creation, translation and transcultural adaptation according to domestic publications for the validation of international speech-language pathology tests. A specialist committee was convened with two otorhinolaryngologists and three speech-language pathologists familiar with videofluoroscopy examinations. Translation into Brazilian Portuguese was carried out by two otorhinolaryngologists with subsequent back translation performed independently by two U.S.-born translators. The final Brazilian Portuguese version was written by speech-language pathologists after revision of translations and back translations resolved semantic, idiomatic, conceptual, linguistic and contextual inconsistencies. This version was tested by committee members, who assessed subjects with no disease, with head and neck cancer and with mild cognitive impairment. RESULTS: Translation of the component scores definition from MBSImP was performed independently and translators agreed on a final version. The MBSImP protocol was renamed "Martin-Harris scale for swallowing videofluoroscopy". Some terms were adapted for the final Brazilian Portuguese version. Use of the translated protocol did not reveal any deviations from the original. CONCLUSION: Translation of the MBSImP fragment into Brazilian Portuguese was consistent with the original version. Approval from specialist committee members refined the protocol adaptation, allowing precise concepts to be accurately translated.

OBJETIVO: Traduzir para o português brasileiro e adaptar culturalmente a definição dos componentes e pontuação (Component Scores Definition) pertencentes ao protocolo para videofluoroscopia Modified Barium Swallow Impairment ­ MBSImPTM. MÉTODO: Esse estudo foi desenvolvido com base nas recomendações internacionais para elaboração, tradução e adaptação transcultural em consonância com publicações nacionais para validação de testes internacionais em Fonoaudiologia. Foi formado um comitê de especialistas, composto por dois médicos otorrinolaringologistas e três fonoaudiólogas conhecedoras do exame de videofluoroscopia. A tradução para o português brasileiro foi realizada por dois otorrinolaringologistas com retrotradução de forma independente por dois nativos norte-americanos. A versão final em português brasileiro foi elaborada pelas fonoaudiólogas certificadas após a revisão das traduções e das retrotraduções com resolução de discrepâncias semânticas, idiomáticas, conceituais, linguísticas e contextuais. Essa versão foi testada pelas fonoaudiólogas membros do Comitê, que avaliaram indivíduos saudáveis, com Câncer de Cabeça e Pescoço e Comprometimento Cognitivo Leve. RESULTADOS: A tradução da definição dos componentes e pontuação do MBSImP foi realizada de forma independente e os tradutores chegaram a um consenso para a versão final. O protocolo original Modified Barium Swallow Impairment, foi traduzido para "Escala Martin-Harris para videofluoroscopia da deglutição". Na versão final em português brasileiro alguns termos foram adaptados. A aplicação do protocolo traduzido não apresentou discrepâncias em relação ao protocolo original. CONCLUSÃO: A tradução do excerto do protocolo MBSImP para o português brasileiro foi compatível com a versão original. A certificação de membros do comitê favoreceu a adaptação do material, permitindo a adaptação conceitual.

Respiratory-swallow coordination and swallowing impairment in head and neck cancer.

BACKGROUND: The aim of the study was to determine the link between frequency of optimal respiratory-swallow coordination, swallowing impairment, and airway invasion in head and neck cancer (HNC) patients. METHOD: A cross-sectional study of a heterogeneous group of HNC patients (49), precancer (N = 30) or postcancer treatment (N = 29), participated in a single Modified Barium Swallow Study (MBSS) with synchronized respiratory data. RESULTS: Spearman correlation coefficients revealed significant negative correlations between optimal respiratory-swallow phase pattern and objective measures of swallowing impairment: penetration-aspiration scale max, pharyngeal total, and oral total scores with Spearman correlation coefficients of -0.53 (z .001), -0.50 (P < .001), and -0.43 (P = .002), respectively. Optimal respiratory-swallow pattern was significantly decreased (P = .03) in patients after cancer treatment compared with another patient group before cancer treatment. CONCLUSION: These findings indicate that as the percentage of optimal respiratory-swallow phase patterns increase, swallowing impairment decreases in the HNC patient population.

Characterization of dysphagia following anterior cervical spine surgery.

BACKGROUND: Post-operative dysphagia is one of the most common complications of anterior cervical spine surgery (ACSS). OBJECTIVE: Examine post-operative structural and physiologic swallowing changes in patients with dysphagia following ACSS as compared with healthy age and gender matched controls. METHODS: Videofluoroscopic swallow studies of adults with dysphagia after ACSS were retrospectively reviewed. Seventy-five patients were divided into early (≤2 months) and late (> 2 months) post-surgical groups. Modified Barium Swallow Impairment Profile (MBSImP), Penetration-Aspiration Scale (PAS) scores, and pharyngeal wall thickness (PWT) metrics were compared. RESULTS: Significant differences were identified for all parameters between the control and early post-operative group. MBSImP Pharyngeal Total (PT) scores were greater in the early group (Interquartile Range (IQR) = 9-14, median = 12) versus controls (4-7, 5, P < 0.001) and late group (0.75-7.25, 2, P < 0.001). The early group had significantly higher maximum PAS scores (IQR = 3-8, median = 7) than both the control group (1-2, 1, P < 0.001) and late post-operative group (1-1.25, 1, P < 0.001). PWT was significantly greater in the early (IQR = 11.12-17.33 mm, median = 14.32 mm) and late groups (5.31-13.01, 9.15 mm) than controls (3.81-5.41, 4.68 mm, P < 0.001). CONCLUSION: Dysphagic complaints can persist more than two months following ACSS, but often do not correlate with validated physiologic swallowing dysfunction on VFSS. Future studies should focus on applications of newer technology to elucidate relevant deficits.

Radiation exposure in modified barium swallow studies.

PURPOSE OF REVIEW: The modified barium swallow study (MBSS) is an X-ray examination of swallowing used to detect the presence and type impairment, aspiration risk, and to develop intervention plans. In this review, we will cover the use of ionizing radiation in MBSSs and review recent literature concerning radiation exposure and cancer risks to patients undergoing MBSSs. Lastly, we will discuss the clinical implications of these findings. RECENT FINDINGS: Recent literature confirms that the MBSS is a low-dose examination and that reducing pulse rate negatively impacts diagnostic accuracy. Importantly, cancer risks to adults undergoing MBSSs were also reported to be low. SUMMARY: An adult undergoing MBSS using a standardized, valid protocol, like the Modified Barium Swallow Impairment Profile (MBSImP), has low-radiation exposure and very low associated cancer risks. MBSSs should be used whenever relevant to adult patient care without undue concern regarding radiation exposure. Children also have low radiation exposure from MBSSs; however, cancer risks from that exposure remain unknown. Best practices in radiation safety must always be followed. Reducing pulse rates in the adult or pediatric population to reduce radiation exposure is not a valid strategy because of the resulting reduction in diagnostic accuracy.