Oral perception of liquid volume changes with age.

Bolus volume has been widely studied, and research has demonstrated a variety of physiological impacts on swallowing and swallowing disorders. Oral perception of bolus volume has not, to our knowledge, been investigated in association with normal ageing processes. Research suggests many sensory changes with age, some within the oral cavity, and changes in swallowing function with age have been defined. The role of perception in oropharyngeal deglutition with age requires further investigation. The purpose of this study was to establish the psychophysical relationship between liquid volume and oral perception and examine changes with age. Healthy young and older adults were prospectively assessed using a magnitude estimation task differentiating five volumes of water delivered randomly to the oral cavity. Results suggest a fourfold increase in liquid volume is required by older participants to perceive an approximate twofold increase in the perception of volume compared with younger healthy adults. Sensory receptors in the oral cavity provide a feedback loop that modulates the swallowing motor response so that it is optimal for the size and consistency of the bolus. Changes in perception of bolus volume with age are consistent with other perceptual changes and may provide valuable information regarding sensorineural rehabilitation strategies in the future.

Utility of clinical swallowing examination measures for detecting aspiration post-stroke.

The purpose of this investigation was to determine the utility of clinical swallowing examination (CSE) measures for detecting aspiration as defined by videofluoroscopic swallowing examination (VFSE). This study, involving 165 participants, is a follow-up to a previously published investigation of 60 participants. Findings are compared with that investigation as well as with other research on CSEs. The results suggest that clinicians can make an accurate judgment of the occurrence of aspiration in most post-stroke patients. However, ruling out aspiration when it is absent appears more problematic. More work needs to be done if data collected from non-instrumented examinations are to be strongly predictive of the presence and absence of aspiration on VFSE. At present, there are no data to suggest that CSEs can be used to quantify aspiration or make adequate recommendations regarding patient care.

Sensitivity and specificity of clinical/bedside examination signs for detecting aspiration in adults subsequent to stroke.

UNLABELLED: While detecting the presence of aspiration is only one aspect of a noninstrumented examination of swallowing function, it is an important component due to its potential health status consequences. The purpose of this investigation was to investigate the sensitivity and specificity of clinical/bedside examination signs for predicting aspiration on videofluoroscopic examination of swallowing. Sixty consecutive, acute stroke patients were investigated with clinical/bedside and videofluoroscopic exams. Clinical signs consisted of history, oral motor/speech praxis, voice, and trial swallow ratings. Results confirm that more work needs to be done if data collected from noninstrumented examinations are to be strongly predictive of aspiration on VFSE. However, comparisons of the current results with previous investigations provides a promising framework for future research. EDUCATIONAL OBJECTIVES: (1) To understand the use of sensitivity and specificity in detecting disease; (2) To understand the current evidence regarding clinical signs of aspiration.

Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures.

Interjudge reliability for videofluoroscopic (VFS) swallowing evaluations has been investigated, and results have, for the most part, indicated that reliability is poor. While previous studies are well-designed investigations of interjudge reliability, few reports of intrajudge reliability are available for VFS measures derived from frame-by-frame analysis that clinicians typically employ. The purpose of this study was to examine the inter- and intrajudge reliability of VFS examination measures commonly used to assess swallowing functions. No training to criteria occurred. VFS examinations were conducted on 20 patients who had suffered a stroke within six weeks and had no structural abnormalities or tracheostomies. Three clinical judges served as subjects and rated the VFS examinations from videotape using frame-by-frame analysis. A clinician's repeated review of measures employed in the 20 examinations indicated high intrajudge reliability for a number of measures, suggesting that an experienced clinician may employ consistent standards for rating certain VFS measures across patients and time. These standards appear to vary among clinicians and yield unacceptable interjudge reliability. The need to train clinicians to criteria to improve interjudge reliability is discussed.

Inter- and intrajudge reliability of a clinical examination of swallowing in adults.

This study investigates inter- and intrajudge reliability of a clinical examination of swallowing in adults. Several investigations have sought correlations between clinical indicators of dysphagia and the actual presence of dysphagia as determined by videofluoroscopy. Whereas some investigations have reported interjudge reliability for the videofluoroscopic measures employed, none have reported reliability for clinical measures. Without established reliability for rating clinical measures, conclusions drawn regarding the utility of a measure for detecting aspiration can be called into question. Results of the present study indicate that fewer than 50% of the measures clinicians typically employ are rated with sufficient inter- and intrajudge reliability. Measures of vocal quality and oral motor function were rated more reliably than were history measures or measures taken during trial swallows. There is a need to define more clearly the measures employed in clinical examinations and to be consistent in reporting reliability for clinical measures of swallowing function in future research.

Bacterial endocarditis in pregnancy: successful surgical correction.

Bacterial endocarditis, an extremely rare and serious complication during pregnancy, is almost always fatal to the fetus. This paper describes successful aortic valve replacement in a woman who was 22 weeks' pregnant. She had acute bacterial endocarditis with aortic insufficiency and severe congestive heart failure. At term, she was delivered of a live infant. We believe this is the first case of a fetus surviving such a complication.