A bedside swallowing screen for the identification of post-extubation dysphagia on the intensive care unit - validation of the Gugging Swallowing Screen (GUSS)-ICU.

PURPOSE: Screening for dysphagia at the intensive care unit (ICU) soon after extubation can prevent aspiration, pneumonia, lower mortality, and shorten re-feeding interval. This study aimed to modify the Gugging Swallowing Screen (GUSS), which was developed for acute stroke patients, and to validate it for extubated patients in the ICU. METHODS: In this prospective study, forty-five patients who had been intubated for at least 24 h were recruited consecutively at the earliest 24 h after extubation. The modified GUSS-ICU was performed twice by two speech and language therapists independently. Concurrently, gold standard the flexible endoscopic evaluation of swallowing (FEES) was performed by an otorhinolaryngologist. Measurements were conducted within a three-hour period; all testers were blinded to each other's results. RESULTS: According to FEES, 36 of 45 (80%) participants were diagnosed with dysphagia; 13 of those were severe, 12 moderate, and 11 mild. Compared to FEES, the GUSS-ICU predicted dysphagia well (area under the curve for the initial rater pair: 0.923, 95% CI 0.832-1.000 and 0.923, 95% CI 0.836 -1.000 for the second rater pair). The sensitivity was 91.7% (95% CI 77.5-98.3%) and 94.4% (95% CI 81.3-99.3%); the specificity was 88.9% (51.8-99.7%) and 66.7% (29.9-92.5%); the positive predictive values were 97.1% (83.8-99.5%) and 91.9% (81.7-96.6%), and the negative predictive values were 72.7% (46.8-89%) and 75% (41.9-92.6%) for the first and second rater pairs, respectively. Dysphagia severity classification according to FEES and GUSS-ICU correlated strongly (Spearman's rho: 0.61 for rater 1 and 0.60 for rater 2, p < 0.001). Agreement by all testers was good (Krippendorffs Alpha: 0.73). The interrater reliability showed good agreement (Cohen`s Kappa: 0.84, p < 0.001). CONCLUSION: The GUSS-ICU is a simple, reliable, and valid multi-consistency bedside swallowing screen to identify post-extubation dysphagia at the ICU. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04532398,31/08/2020.

Cervical spine kinematics during machine-based and live scrummaging.

The aim of this study was to compare cervical spine kinematics in rugby union front row players during machine-based and "live" scrummaging. Cervical spine kinematics was measured via electromagnetic tracking of sensors attached to the head and thorax. Joint angles were extracted from each trial at two time points ("bind" prior to engagement and instant of impact) for comparison between scrummaging conditions. The effect of scrummaging condition on kinematics was evaluated using a mixed effects model and estimations were based on a Bayesian framework. With differences ranging from 38° to 50°, the results show that the cervical spine is consistently more flexed when scrummaging against opponents than against a scrum machine. In contrast, there are little differences in the excursion of lateral-flexion (range 5-8°) and axial rotation (7°) between the two conditions. The findings from this study provide clear information on motion patterns in different scrum formations, and suggest that the current design of scrum machines may not promote the same pattern of movement that occurs in live scrums. The results highlight that findings from previous studies that have investigated kinematics during machine-based scrummaging may not be generalisable to a competitive scrummaging context.

Reliability and validity of a smartphone-based application for the quantification of the sit-to-stand movement in healthy seniors.

INTRODUCTION: Recently, it has been demonstrated that biomechanical parameters measured with accelerometers during everyday activities might provide early information about mobility in seniors. The use of smartphones has been suggested for this purpose. The aim of this study was to develop and validate a smartphone-based application for the quantification of the sit-to-stand movement (STS) in healthy seniors. METHODS: Sixteen healthy seniors performed the STS with a smartphone first attached to the lower back and then to the sternum. The subjects' vertical ground reaction forces (VGRF) and vertical acceleration (VAcc) were recorded simultaneously using two force plates (reference standard) and the smartphone, respectively. VAcc data were converted to force; power was then calculated based on both force-time curves. Subsequently, the total movement duration (Ttotal), peak force (Fmax), rate of force development (RFD) and peak power (Pmax) were determined. Relative (intraclass correlation coefficient [ICC]) and absolute (standard error of measurement [SEM]) reliability were also calculated. For the variables showing strong reliability (ICC≥0.75), Pearson correlation coefficients (r) between VGRF- and VAcc-derived data and one-sample T-tests for the mean differences were carried out. RESULTS: In the sternal configuration, all variables showed strong reliability (range: 0.86-0.93), except the smartphone-derived parameter RFD (ICC=0.43). Fmax and Ttotal were found to be highly valid (r=0.86 and 0.98, respectively). CONCLUSION: The results showed that the smartphone-based application can be used as a reliable and valid tool for the quantification of the STS in healthy seniors if the proposed protocol is followed.