Application of fiberoptic endoscopic examination of swallowing combined with dye test in silent aspiration after stroke / 中国康复理论与实践

ObjectiveTo explore the diagnostic value of fiberoptic endoscopic examination of swallowing (FEES) combined with dye test in patients with post-stroke dysphagia and silent aspiration. MethodsFrom December, 2021 to June, 2022, 50 stroke patients in the Rehabilitation Department of Xuzhou Central Hospital were selected. They were assessed with FEES and videofluoroscopic swallowing study (VFSS), and compared. ResultsThe detection rate of aspiration was higher with FEES than with VFSS (χ2 = 7.000, P < 0.05), and especially for liquid food (χ2 = 4.000, P < 0.05). There was a good consistency when consuming paste food (κ = 0.941, P < 0.001) and solid food (κ = 0.779, P < 0.001). There was a good consistency in the food residue site between two methods (κ = 0.818, P < 0.001), as well as for all the three food types (κ ≥ 0.862, P < 0.001). There was no significant difference in the scores of Penetration Aspiration Scale of three food types between two methods (Z < 0.667, P > 0.05). ConclusionFEES combined with dye test can be used for evaluating silent aspiration after stroke.

Hallazgos de videofluoroscopía en niños de 3 a 6 años con parálisis cerebral / Videofluoroscopic findings in children from 3 to 6 years old with cerebral palsy

Introducción: Los trastornos de la alimentación y deglución (TAD) acompañan frecuentemente a la parálisis cerebral (PC). Su diagnóstico oportuno previene numerosas complicaciones. La evaluación clínica es el primer acercamiento a los TAD, pero resulta insuficiente para identificar situaciones de riesgo (penetración laríngea o aspiración). Para ello, es necesaria una evaluación instrumental como la videofluoroscopía (VFC). Objetivo: Describir y cuantificar los hallazgos de VFC en un grupo de niños con PC, entre 3 años y 6 años 11 meses, GMFCS I-V. Pacientes y Métodos: Se practicó una VFC a 50 pacientes con PC, previa determinación del nivel Gross Motor Functional Classification System (GMFCS) e inexistencia de contraindicaciones para dicho examen. Además, se determinaron signos de incompetencia e inseguridad deglutoria, consistencias toleradas y requerimientos de posicionamiento, para facilitar el procedimiento. Resultados: Población predominantemente masculina, edad promedio de 5 años, 78% GMFCS III-V. Hasta el 94% tuvo una o más alteraciones videofluoroscópicas en alguna etapa del examen. El 28% no presentó capacidad de masticación, siendo todos GMFCS V. En eficacia deglutoria la alteración más frecuente fue el residuo vallecular (86%). En seguridad deglutoria fue el derrame posterior en la fase oral (68%). El 26% tuvo aspiración traqueal silente. En la fase esofágica, el 30% presentó tránsito esofágico lento y el 8% reflujo gastroesofágico. Conclusión: La VFC identificó alteraciones potencialmente riesgosas en todos los niveles GMFCS en niños portadores de PC, algunas de ellas silentes, incluso en casos de compromiso motor leve.

Introduction: Cerebral palsy (CP) is frequently accompanied by feeding and swallowing disorders (FSD). An early diagnosis of FSD prevents numerous complications. Clinical assessment stands as the first approach to FSD, although it is insufficient to identify risk factors (laryngeal penetration and aspiration). For this purpose, a videofluoroscopic (VFC) evaluation is required. Objective: To describe and quantify VFC findings in a group of children with CP, aged 3 to 6 years, GMFCS I to V. Patients and Methods: 50 patients underwent a VFC after their Gross Motor Functional Classification System (GMFCS) level was determined and no contraindications for the exam were identified. In addition, the researchers conducted an assessment to establish the presence of signs of unsafe and incompetent swallowing, food consistency tolerance, and mealtime positioning requirements, in order to allow a more comfortable VFC procedure. Results: There was male predominance, average age of 5 years, 78% GMFCS III-V. Up to 94% had one or more VFC alterations at some point of the exam. 28% had no chewing ability, being all the cases GMFCS V. Considering the deglutition efficacy, the commonest alteration was residue in the vallecula (86%), while the most frequent for swallowing safety was posterior spillage in the oral phase (68%). 26% presented silent tracheal aspiration. In the esophageal phase the findings were poor esophageal transit (30%) and gastroesophageal reflux (8%). Conclusions: VFC identified potentially risks in every GMFCS level of children with CP. Some of the VFC alterations are silent, even in mild motor impairment cases.

Effects of Orogastric Tubes on the Videofluoroscopic Swallowing Study Findings in Infants / 대한연하장애학회지

OBJECTIVE: An orogastric tube is used frequently in infants because infants are obligate nose breathers and nasogastric tubes can cause partial nasal obstruction. This study examined whether the presence of an orogastric tube could affect the swallowing parameters assessed by a videofluoroscopic swallowing study in infants with dysphagia caused by a variety of reasons. METHODS: Tests were conducted in 15 infants aged less than 150 days after birth who used an orogastric tube due to dysphagia. Two tests were conducted. The first was conducted with an orogastric tube inserted. Subsequently, the orogastric tube was removed with a 5-minute break before the second test. Skilled physiatrists then analyzed the recorded video. The number of sucks required for one swallow, abnormalities of the pharyngeal phase, and penetration-aspiration scales were evaluated. RESULTS: After removing the orogastric tube, the number of sucks required for one swallow reduced significantly (2.50±1.73 vs. 3.45±2.54, P=0.04). On the other hand, no statistical significance was observed in the results of the pharyngeal phase and penetration-aspiration scale (5.60±3.16 vs. 5.9±3.81, P=0.41) with and without the orogastric tube. CONCLUSION: These findings showed that the insertion or non-insertion of an orogastric tube might not affect the swallowing abnormalities in the pharyngeal phase and the risk of aspiration. In addition, an orogastric tube may have a negative effect on the swallowing function in the oral phase.

Clinical Factors Associated with Videofluoroscopic Swallowing Study Findings in Stroke Patients / 대한연하장애학회지

OBJECTIVE: To examine the clinical factors and brain lesion locations related to the patterns of dysphagia in stroke patients in a rehabilitation hospital. METHODS: The medical records of 116 stroke patients who underwent a videofluoroscopic swallowing study (VFSS) between January 2010 and January 2015 in a rehabilitation hospital were reviewed retrospectively. The swallowing-related parameters were assessed using a VFSS. The brain lesion locations were classified as the cortex, basal ganglia, thalamus, midbrain, pons, medulla, cerebellum, and others (subarachnoid or intraventricular hemorrhage). The ambulation ability was assessed using functional ambulation categories (FACs). The independence in the activities of daily living and the degree of cognitive impairment were assessed using the Korean versions of the modified Barthel index (K-MBI) and Mini-Mental State Examination (K-MMSE), respectively. After adjusting for the potential confounding factors in multivariate analysis, the odds ratios and confidence intervals of the stroke brain lesions were calculated and the clinical factors for predicting the VFSS findings were determined. RESULTS: Among the 116 patients, 35 (27%) had an impaired oral stage and 58 (50%) had aspiration. The impaired oral stage was associated significantly with the onset time, basal ganglia stroke, dietary and fluid intake methods at the time of the VFSS, symptoms of dysphagia, FACs, K-MBI, and K-MMSE. Aspiration was correlated with a pontine stroke, methods of dietary and fluid intakes at the time of the VFSS, symptoms of dysphagia, FACs, and K-MBI. Multivariate analysis showed that the pontine stroke and methods of dietary and fluid intake at the time of VFSS predicted aspiration after adjusting for the potential confounding factors. In subgroup analysis of the diet type, the liquid and semisolid aspirations were correlated with the dietary and fluid intake methods and pontine stroke, respectively. CONCLUSION: Patients with a pons lesion stroke, who are on a modified diet (fluid thickening and tube feeding), have higher risks of aspiration. This provides evidence for precise clinical reasoning in this specific patient group.

Predictors of Long Term Prognosis of Dysphagia in Tonsil Cancer Patients / 대한연하장애학회지

OBJECTIVE: To evaluate the factors affecting long-term prognosis for dysphagia in tonsil cancer patients, after treatment. METHOD: This was a retrospective study of subjects who underwent a videofluoroscopic swallowing study (VFSS) following treatment for stage 3 or 4 tonsil cancer. Data including sex, age, cancer characteristics, and methods of cancer treatment were collected. To evaluate the swallowing-related outcome, we collected data including findings regarding the last VFSS, method of feeding, and history of aspiration pneumonia requiring in-patient care. We evaluated the correlation between these data and the characteristics of cancer and treatment methods. RESULT: Among 32 subjects included in this study, eight had aspiration or penetration confirmed by the last VFSS. There were no significant differences in swallowing-related factors according to the presence of aspiration or penetration in the last VFSS. Patients who underwent curative tonsillectomy retained more residues on the last VFSS than those who did not. CONCLUSION: Among subjects with tonsil cancer, history of curative tonsillectomy was correlated with more pharyngeal residue. However, other cancer- or treatment-related factors did not affect the outcome of swallowing.

Frequency and Characteristics of Videofluoroscopic Swallow Study in Patients with Aspiration Pneumonia / 대한연하장애학회지

OBJECTIVE: This study was conducted to identify the frequency of videofluoroscopic swallow study (VFSS) and characteristics of VFSS findings in the patients diagnosed with aspiration pneumonia. METHOD: We retrospectively reviewed the medical records of 2,885 patients who has been diagnosed with aspiration pneumonia either clinically or radiographically. Overall, 811 patients could not be examined because of medical problems. The rest of the subjects were divided into two groups according to the presence of neurologic deficit. The findings of VFSS were scored using the Penetration-Aspiration Scale (PAS) and Pharyngeal Residue Grade (PRG), and data were analyzed based on descriptive statistics, the χ² test, t-test, ANCOVA and logistic regression. RESULT: A total of 1,267 subjects (43.9%) underwent VFSS. Among patients who could be examined, 61.1% were tested. Only 26.7% of subjects without neurologic deficit underwent VFSS, while 56.5% of the subjects in the other group underwent the procedure. The PAS and PRG scores did not differ significantly between groups. About 32.7% of the findings showed silent aspiration (PAS 8), which difficult to detect by bedside screening tests. CONCLUSION: Subjects with neurologic deficit showed significantly higher test rates than the others. There were no significant differences in VFSS findings between groups. Dysphagia should be evaluated in patients with aspiration pneumonia using precise tools, such as VFSS and fiberoptic endoscopic evaluation of swallowing (FEES), regardless of presence of neurological deficit.

Relationship between location of cerebral infarction and features of videofluoroscopic swallowing / 中华物理医学与康复杂志

Objective To explore whether the pattern of dysphagia verified using videofluoroscopic swallowing study (VFSS) was associated with the Iocation of the infarction in stroke patients.Methods Ninety-two patients with dysphagia (admitted between January 2015 and August 2016) who had first onset of cerebral infarction confirmed by magnetic resonance imaging were included in this study.They were divided into a unilateral brainstem group (n =29),a left hemisphere (cortex + white matter) group (n =37) and a right hemisphere (cortex + white matter) group (n=26) according to the location of the stroke.All subjects were evaluated using VFSS,and the oral transit time (OTT),triggering of pharyngeal swallowing (TPS),presence of residue in the vallecular and pyriform sinus,penetration,aspiration,cough reaction and upper esophageal sphincter (UES) opening were recorded and compared among the three groups.Results There were no significant differences among the three groups in OTT (X2 =0.712,P=0.918),TPS (1.564,P =0.458),penetration (X2 =5.615,P=0.060) and cough reaction (X2 =5.882,P=0.053).The unilateral brainstem group had significantly more residue in the vallecular and pyriform sinus than the left hemisphere group (X2=6.508,P=0.011).Aspiration was significantly more frequently found in the unilateral brainstem group than in the left hemisphere group (X2=7.803,P =0.005).The unilateral brainstem group was more likely to have insufficient UES opening than the left hemisphere (X2=29.555,P＜0.001) and right hemisphere groups (X2=24.630,P＜0.001).Conclusions Unilateral brainstem stroke is more likely to cause dysphagia than the unilateral cerebral hemisphere stroke,characterized by the abnormal residue in the vallecular and pyriform sinus,aspiration and the degree of UES opening.No significant differences were found in the dysphagia between stroke survivors with stroke in right and left hemispheres.

Acoustic Voice Analysis in Patients with Penetration/Aspiration Via Videofluoroscopic Swallowing Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The present study aimed to investigate the effects of penetration/aspiration (P/A) on voice acoustic parameters. SUBJECTS AND METHOD: Twenty-seven patients were analyzed with the videofluoroscopic swallowing study (VFSS) and then divided into two groups based on the modified Penetration and Aspiration Scale results. Ten patients (5 males and 5 females) were included in the Non-P/A group, and 17 patients (12 males and 5 females) in the P/A group. Stroke was the major cause of swallowing disorders. Three sustained /a/ vowels recorded in pre- and post-VFSS were analyzed. Mann-Whitney U-test was used to compare acoustic values before and after VFSS, and the receiver operating characteristics (ROC) curve with combination of significant parameters was also conducted. RESULTS: Among acoustic parameters, the length of analyzed sample (p=0.010), number of segments computed (p=0.018), total number detected pitch periods (p=0.017), and second formant (p=0.013) in pre- and post-VFSS were significantly different between Non-P/A and P/A groups. In the P/A group after VFSS, the means of these significant parameters decreased. According to ROC combined with four significant parameters, the probability of predicting P/A condition was 84% (p=0.005), the sensitivity was 80%, and the specificity was 80%. CONCLUSION: Voice acoustic analysis can reflect voice changes by penetration/aspiration and the combination of significant parameters can also detect swallowing disorders. Therefore, voice analysis can be a reliable screening tool for patients with swallowing disorders.

Development of a Dysphagia Screening Test for Preterm Infants (DST-PI)

OBJECTIVE: To explore both the early prediction and diagnosis of dysphagia in preterm infants as an important developmental aspect as well as the prevention of respiratory complications, we developed the simple and-easy-to-apply Dysphagia Screening Test for Preterm Infants (DST-PI) to predict supraglottic penetration and subglottic aspiration. METHODS: Fifty-two infants were enrolled in a videofluoroscopic swallowing study (VFSS) due to clinical suspicions of dysphagia. Thirteen items related to supraglottic penetration or subglottic aspiration were initially selected from previous studies for the DST-PI. Finally, 7 items were determined by linear logistic regression analysis. Cutoff values, sensitivity, specificity, and the area under the ROC curve (AUC) of the DST-PI for predicting supraglottic penetration or subglottic aspiration were calculated using a ROC curve. For inter-rater reliability, the kappa coefficient was calculated. RESULTS: Seven items were selected: ‘gestational age,’‘history of apnea,’‘history of cyanosis during feeding,’‘swallowing pattern,’‘coughs during or after feeding,’‘decreased oxygen saturation within 3 minutes of feeding,’ and ‘voice change after feeding.’ The Spearman correlation coefficient between the DST-PI and the penetration-aspiration scale (PAS) was 0.807 (p<0.001). The sensitivity and specificity at different cutoff values for detecting supraglottic penetration and subglottic aspiration were 96.6% and 76.9% at 3.25, and 88.9% and 75.8% at 6.25, respectively. CONCLUSION: The DST-PI is a valid and reliable dysphagia screening test for supraglottic penetration or subglottic aspiration in preterm infants that is easy to apply in a clinical context.

Relationship between sialorrhea and dysphagia in Chinese patients with Parkinson′s disease / 中华神经科杂志

Objective To explore the prevalence of sialorrhea and its clinical correlation with dysphagia in Chinese patients with Parkinson′s disease ( PD ).Methods One hundred and sixteen consecutive patients with a clinical diagnosis of PD were selected.Demographic data included sex , age, years of education, age at onset of PD, clinical genotype, disease duration, treatment, Hoehn and Yahr (H&Y) stage.Sialorrhea was assessed using the Unified Parkinson′s Disease Rating Scale (UPDRS) Ⅱitem number 6.All patients were studied with videofluoroscopic study of swallowing ( VFSS).Results The prevalence rate of sialorrhea in PD was 59.5% (69/116, 95% CI 50.6%-68.4%).Males were more likely to develop sialorrhea than females (47/70 vs 22/46,χ2 =4.298, P=0.038).PD patients′sialorrhea correlated with oral dysphagia:with food leaking from the mouth ( liquid r=0.229, P=0.014; juice r=0.197, P=0.034;pudding viscosities r=0.231, P=0.013;solid food r=0.255, P=0.006), with more than 1 ml of oral food residues (liquid r=0.319, P<0.01;solid food r=0.185, P=0.047), with delay in food transfer to the root of the tongue (liquid r=0.279, P=0.002; juice r=0.209, P=0.024), and delayed swallow transfer ( pudding viscosities r=0.257, P=0.005).Sialorrhea score was not related to H&Y stage, clinical course and levodopa equivalent doses (LED).The prevalence rate of dysphagia in PD was 87.1%(95% CI 81.0% -93.2%).Liquid was more likely to cause pharyngeal dysphagia ( P=0.03).With the increase in H&Y stage , so did the oral and pharyngeal stages of dysphagia.Late and mid-course was more likely to develop oral and pharyngeal dysphagia than those with early clinical course .Conclusions Sialorrhea and dysphagia are common non-motor symptoms in PD patients.Sialorrhea is more prevalent in males and correlates with oral phase of dysphagia.Liquid is more likely to cause pharyngeal dysphagia.With increase in H&Y stage , so did oral and pharyngeal dysphagia.Even though late clinical course is more likely to develop oral and pharyngeal dysphagia than early clinical course , the comparison between late and intermediate clinical courses does not reach statistical significance .

A Prospective Comparison between Bedside Swallowing Screening Test and Videofluoroscopic Swallowing Study in Post-Stroke Dysphagia

To reveal test discrepancies between early bedside swallowing screening test (BSST) and standard videofluoroscopic swallowing study (VFSS) and thereby to achieve an evaluation standard for post-stroke dysphagia which prevent aspiration pneumonia or unnecessary diet restrictions. Consecutive 252 first-ever stroke patients admitted to stroke unit of 1 tertiary university hospital from May 2009 to May 2010. BSST was performed within 3 days after onset and VFSS within 2 weeks after BSST. The findings between BSST and VFSS were compared. BSST and VFSS were performed in 186 patients. Of the 116 patients who passed BSST, aspiration was newly detected in VFSS in 16 patients (14%). Diet recommendation was changed in 95 of the 186 patients (51%) after VFSS, with 28% (n = 52) being changed to a more conservative level compared to the recommendation based on initial BSST. The data support the need for reassessment using VFSS even when BSST is performed in the acute stage of stroke.

Diagnosis of Spasmodic Dysphonia Manifested by Swallowing Difficulty in Videofluoroscopic Swallowing Study

Spasmodic dysphonia is defined as a focal laryngeal disorder characterized by dystonic spasms of the vocal cord during speech. We described a case of a 22-year-old male patient who presented complaining of idiopathic difficulty swallowing that suddenly developed 6 months ago. The patient also reported pharyngolaryngeal pain, throat discomfort, dyspnea, and voice change. Because laryngoscopy found no specific problems, an electrodiagnostic study and videofluoroscopic swallowing study (VFSS) were performed to find the cause of dysphagia. The VFSS revealed continuous twitch-like involuntary movement of the laryngeal muscle around the vocal folds. Then, he was diagnosed with spasmodic dysphonia by VFSS, auditory-perceptual voice analysis, and physical examination. So, we report the first case of spasmodic dysphonia accompanied with difficulty swallowing that was confirmed by VFSS.

Adding Endoscopist-Directed Flexible Endoscopic Evaluation of Swallowing to the Videofluoroscopic Swallowing Study Increased the Detection Rates of Penetration, Aspiration, and Pharyngeal Residue

BACKGROUND/AIMS: Currently, the videofluoroscopic swallowing study (VFSS) is the standard tool for evaluating dysphagia. We evaluated whether the addition of endoscopist-directed flexible endoscopic evaluation of swallowing (FEES) to VFSS could improve the detection rates of penetration, aspiration, and pharyngeal residue, compared the diagnostic efficacy between VFSS and endoscopist-directed FEES and assessed the adverse events of the FEES. METHODS: In single tertiary referral center, a retrospective analysis of prospectively collected data was conducted. Fifty consecutive patients suspected of oropharyngeal dysphagia were enrolled in this study between January 2012 and July 2012. RESULTS: The agreement in the detection of penetration and aspiration between VFSS and FEES of viscous food (kappa=0.34; 95% confidence interval [CI], 0.15 to 0.53) and liquid food (kappa=0.22; 95% CI, 0.02 to 0.42) was "fair." The agreement in the detection of pharyngeal residue between the two tests was "substantial" with viscous food (kappa=0.63; 95% CI, 0.41 to 0.94) and "fair" with liquid food (kappa=0.37; 95% CI, 0.10 to 0.63). Adding FEES to VFSS significantly increased the detection rates of penetration, aspiration, and pharyngeal residue. No severe adverse events were noted during FEES, except for two cases of epistaxis, which stopped spontaneously without requiring any packing. CONCLUSIONS: This study demonstrated that the addition of endoscopist-directed FEES to VFSS increased the detection rates of penetration, aspiration, and pharyngeal residue.

Dysphagia in Tongue Cancer Patients

OBJECTIVE: To identify risk factors for dysphagia in tongue cancer patients. Dysphagia is a common complication of surgery, radiotherapy, and chemotherapy in tongue cancer patients. Previous studies have attempted to identify risk factors for dysphagia in patients with head and neck cancer, but no studies have focused specifically on tongue cancer patients. METHODS: This study was conducted on 133 patients who were diagnosed with tongue cancer and who underwent a videofluoroscopy swallowing study (VFSS) between January 2007 and June 2012 at the Asan Medical Center. Data collected from the VFSS were analyzed retrospectively. Patients with aspiration were identified. RESULTS: Patients showed a higher incidence of inadequate tongue control, inadequate chewing, delayed oral transit time, aspiration or penetration, vallecular pouch and pyriform residue, and inadequate laryngeal elevation after surgery. Moreover, male gender, extensive tumor resection, a higher node stage, and more extensive lymph node dissection were major risk factors for aspiration in tongue cancer patients. CONCLUSION: Tongue cancer patients have difficulties in the pharyngeal phase as well as the oral phase of swallowing. These difficulties can worsen after tongue cancer surgery. Gender, the extent of tumor resection, and lymph node metastasis affect swallowing in tongue cancer patients. Physicians should take these risk factors into account when administering swallowing therapy to tongue cancer patients.

A Questionnaire Survey about the Use and Preparation of Test Foods for Videofluoroscopic Swallowing Examinations / The Japanese Journal of Rehabilitation Medicine

Objective : To understand how test foods used in videofluoroscopic swallowing examinations (VF) are prepared and used. Methods : A survey was conducted using participants in a workshop organized by the Japanese Association of Rehabilitation Medicine (October 27, 2012). Results : Among 129 participants, the survey collection rate was 48.8 %. The percentage who had conducted VF was 66.7 %. The test foods used were thickened liquid 97.6 %, jelly 92.9 %, and test foods other than liquid, thickened liquid or jelly were used by 64.3 %. A little less than 20 % answered that the test foods did not always or possibly did not always have the same physical property and texture. The contrast agents used in test foods were barium sulfate 50.0 %, amidotrizoic acid (Gastrografin^®) 33.3 % and iodinated contrast agent for angiography 7.1 %. Conclusions : In addition to thickened liquid and jelly, many solid test foods were also used. The uniformity and safety of these test foods and their properties need to be examined and considered in their preparation.

Dysphagia Testing with VF and VE : Understanding the Clinical Condition / The Japanese Journal of Rehabilitation Medicine

It is difficult to make dysphagia assessments in actual meal settings. Therefore, instrument-based evaluations are necessary, and videofluoroscopic examinations (VF) and video-endoscopic examinations (VE) of swallowing are typically performed for this purpose. Much information can be obtained by understanding the respective advantages and disadvantages of VF and VE and combining them for evaluations, making them useful for both assessment and treatment. Essentially, VF is contrast radiography using a fluoroscope. It uses test food containing a contrast agent that allows the flow of the food from the mouth to the pharynx and esophagus accompanying swallowing movements to be observed in real time to determine whether there is aspiration or food remaining in the pharynx. The images are taken mainly from the frontal and lateral views under fluoroscopy. VE is a test that involves direct fiberscopic observation of things such as glottal closure, saliva and secretions, and food boluses or other substances remaining in the pharynx. Assessment includes evaluation of vocal cord paralysis, redness and swelling of the arytenoid region, and whether there is saliva aspiration into the larynx. Next, the swallowing function is assessed using actual food. The body posture used in the test is the individual's regular posture when eating and a safe, proper posture with a low risk of aspiration. Today, VF and VE are essential tools for assessing and treating dysphagia. It is hoped that many practitioners will acquire the skills to administer and make use of these tests in the rehabilitation of patients with eating and swallowing disorders.

Comparison of Swallowing Functions Between Brain Tumor and Stroke Patients

OBJECTIVE: To compare the swallowing functions according to the lesion locations between brain tumor and stroke patients. METHODS: Forty brain tumor patients and the same number of age-, lesion-, and functional status-matching stroke patients were enrolled in this study. Before beginning the swallowing therapy, swallowing function was evaluated in all subjects by videofluoroscopic swallowing study. Brain lesions were classified as either supratentorial or in-fratentorial. We evaluated the following: the American Speech-Language-Hearing Association (ASHA) National Outcome Measurement System (NOMS) swallowing scale, clinical dysphagia scale, functional dysphagia scale (FDS), penetration-aspiration scale (PAS), oral transit time, pharyngeal transit time, the presence of vallecular pouch residue, pyriform sinus residue, laryngopharyngeal incoordination, premature spillage, a decreased swal-lowing reflex, pneumonia, and the feeding method at discharge. RESULTS: The incidence of dysphagia was similar in brain tumor and stroke patients. There were no differences in the results of the various swallowing scales and other parameters between the two groups. When compared brain tumor patients with supratentorial lesions, brain tumor patients with infratentorial lesions showed higher propor-tion of dysphagia (p=0.01), residue (p<0.01), FDS (p<0.01), PAS (p<0.01), and lower ASHA NOMS (p=0.02) at initial evaluation. However, there was no significant difference for the swallowing functions between benign and malig-nant brain tumor patients. CONCLUSION: Swallowing function of brain tumor patients was not different from that of stroke patients according to matching age, location of lesion, and functional status. Similar to the stroke patients, brain tumor patients with infratentorial lesions present poor swallowing functions. However, the type of brain tumor as malignancy does not influence swallowing functions.

Food and Liquid Swallowing Difficulty in Stroke Patients : A Study based on the Findings of Food Tests, a Modified Water Swallowing Test and Videofluoroscopic Examination of Swallowing / The Japanese Journal of Rehabilitation Medicine

We compared food and water swallowing tests to investigate the reliability of the tests to exclude aspiration following acute stroke. Subjects were 155 patients with cerebral strokes aged between 20.98 years (66.6±12.9 years) and for whom videofluoroscopic examination of swallowing (VF) was performed for swallowing difficulty or suspected swallowing difficulty. Food tests (FTs) using jelly and rice porridge, and a modified water swallowing test (MWST) were evaluated during VF. The results showed fewer occurrences of choking, cough, wet voice and aspiration during the FTs than in the MWST. The sensitivity and specificity of the FTs for aspiration ranged from 80.0% to 83.3% and 25.5% to 41.3%, respectively. The MWST gave a sensitivity of 58.0% and a specificity of 72.4% for aspiration. There were more incidences of silent aspiration in the MWST than in the FTs. However, the validity of the FTs and their positive predictive value were lower than for the MWST. Choking and cough had a significant relation to aspiration in both tests. We recommend that we need to use each of these tests with an understanding of their characteristics and limitations in order to obtain correct findings in stroke patient swallowing assessments.

The Use of Radionuclide Salivagram and Videofluoroscopic Swallow Study in the Evaluation of Aspiration Pneumonia in Children / 대한소아소화기영양학회지

PURPOSE: To compare the abilities of radionuclide salivagrams (RS) and videofluoroscopic swallow studies (VFSS) to diagnose aspiration in children with aspiration pneumonia. METHODS: The records of children who were referred to the Asan Medical Center between April, 2006 and April, 2012 and who underwent both VFSS and RS to evaluate their recurrent aspiration pneumonia were reviewed (n=67). The aspiration positivity rates of the two tests were determined. The agreement between the tests was assessed by using the kappa statistic. RESULTS: VFSS was more frequently positive (n=26, 39%) than RS (n=23, 34%) (p=0.68). In the 11 children who repeat two test, Repeated examination increased positive rate in each tests (n=11), repeated RS (54%, p=1) is more frequent positive than repeated VFSS (46%, p=0.37). If a cumulative positive test had been defined as at least one positive result, the positive rate of two test was 56% (p<0.05). There was a fair agreement between RS and VFSS (kappa=0.26). CONCLUSION: The RS and VFSS positivity rates in children with aspiration pneumonia were similar but there was fair agreement between the two tests. This result suggests that these investigations to demonstrate aspiration are not interchangeable but complementary.

The Effect of Bedside Exercise Program on Stroke Patients with Dysphagia

OBJECTIVE: To examine the effects of a bedside exercise program on the recovery of swallowing after a stroke. METHOD: Fifty stroke patients with dysphagia (<6 months post-stroke) were enrolled and classified into two groups, the experimental (25 subjects) and control groups (25 subjects). The control group was treated with conventional swallowing therapy. The experimental group received additional bedside exercise training, which consisted of oral, pharyngeal, laryngeal, and respiratory exercises, 1 hour per day for 2 months, and they were instructed regarding this program through the nursing intervention. All patients were assessed for their swallowing function by Videofluoroscopic Swallowing Study (VFSS), using the New VFSS scale, the level of functional oral intake, the frequency of dysphagia complications, the presence (or not) of tube feeding, the mood state and quality of life before the treatment and at 2 months after the treatment. RESULTS: After 2 months of treatment, the experimental group showed a significant improvement in the swallowing function at the oral phase in the New VFSS Scale than that of the control group (p<0.05). Further, they also showed less depressive mood and better quality of life than the control group. However, there was no significant change in the incidence of dysphagia complication and the presence (or not) of tube feeding between the two groups. CONCLUSION: Bedside exercise program showed an improvement of swallowing function and exhibited a positive secondary effect, such as mood state and quality of life, on subacute stroke patients with dysphagia. For improvement of rehabilitation results on subacute stroke patients with dysphagia, this study suggests that additional intensive bedside exercise would be necessary.