Visual Analysis of Swallowing Efficiency and Safety (VASES): A Standardized Approach to Rating Pharyngeal Residue, Penetration, and Aspiration During FEES.

The primary aim of this study was to describe the development of the Visual Analysis of Swallowing Efficiency and Safety (VASES)-a standardized method to rate pharyngeal residue, penetration, and aspiration during FEES. As a secondary aim, we explored the feasibility of training novices to interpret FEES using VASES. Literature review and consensus panel discussions were used to develop standardized rules for VASES. A training protocol was developed and criterion ratings were established. Twenty-five novice raters completed VASES training and pre-/post-training assessments. Statistical analyses were used to examine pre- to post-training differences in the accuracy, reliability, and time to rate each video clip using VASES. Four sets of VASES rules were developed, including 'what', 'where', 'when', and 'how' to rate FEES. Large, significant post-training improvements in rating accuracy were observed across all seven VASES outcome measures (Cohen's d range 0.74-1.59). Additionally, inter-rater reliability increased for four of the seven outcome measures, and the amount of time to rate each video clip decreased from 2.6 min pre-training to 1.5 min post-training. VASES is a standardized FEES rating method used to enhance the subjective analysis of pharyngeal residue, penetration, and aspiration. It can be feasibly taught to novice raters with a high level of success and may be an effective method to analyze swallowing safety and efficiency in clinical and research practices. Future research is needed to test the validity of VASES by examining its relationship with other validated FEES rating scales.

Detection of Aspiration, Penetration, and Pharyngeal Residue During Flexible Endoscopic Evaluation of Swallowing (FEES): Comparing the Effects of Color, Coating, and Opacity.

The aim of this study was to assess the effects of color, coating, and opacity on the detection of aspiration, penetration, and residue during flexible endoscopic evaluations of swallowing (FEES). Thirty dysphagic adults underwent FEES while swallowing five 5 mL thin liquid boluses (1 × each, randomized): white water, blue water, white milk, blue milk, and barium water. To assess the effects of color, blue milk was compared to white milk. To assess the effects of coating, barium, white water, and white milk were compared to each other. To assess the effects of opacity, blue milk was compared to blue water. Videos were blindly analyzed and judged for the presence of pharyngeal residue, penetration, and aspiration. Repeated measures analyses were used to assess differences in the frequency of detection across bolus types. Pharyngeal residue was detected more frequently for liquids that were blue, had a coating effect, or were opaque (p < 0.05) when compared to liquids that were white, did not have a coating effect, or were translucent, respectively. Penetration and aspiration were detected more frequently for liquids that had a coating effect (p < 0.05), but not for liquids that were colored blue or opaque (p > 0.05). Coating appears to be the most important factor detecting thin liquid residue, penetration, and aspiration during FEES. Given these findings, standardized use of boluses that possess a coating effect (e.g., white-dyed water or barium) is highly recommended to enhance the sensitivity of identifying impairments in swallowing safety and efficiency during FEES.

Respiratory-Swallow Coordination Training Improves Swallowing Safety and Efficiency in a Person With Anoxic Brain Injury.

Purpose The aim of this study was to assess the effects of respiratory-swallow coordination training (RSCT) on respiratory-swallow coordination (RSC), swallowing safety (penetration/aspiration), and swallowing efficiency (pharyngeal residue) in a person with anoxic brain injury. Method A 68-year-old man with anoxic brain injury, tachypnea, and severe dysphagia was recruited to participate in a prospective AABAA single-subject experimental design. RSC, swallowing safety, and swallowing efficiency were measured at each assessment using respiratory inductive plethysmography and flexible endoscopic evaluations of swallowing. Data were analyzed descriptively using Cohen's d effect size. Outcome measures were compared pre-RSCT to post-RSCT, and pre-RSCT to a 1-month retention assessment. Results Improvements in RSC were observed immediately post-RSCT (d = 0.60). These improvements were maintained upon retention assessment 1 month later (d = 0.60). Additionally, improvements in swallowing safety (d = 1.73), efficiency (d = 1.73), and overall dysphagia severity (d = 1.73) were observed immediately post-RSCT and were maintained upon retention assessment 1 month later (d = 1.73). Conclusions Clinically meaningful improvements in RSC were observed following four sessions of RSCT, which were subsequently associated with large improvements in swallowing safety and efficiency. RSCT may be an efficacious, clinically feasible skill-based exercise for people with anoxic brain injury, suboptimal RSC, and dysphagia. Future work is needed to expand these findings in a larger cohort of people with dysphagia.