Skip to main content
SpringerLink
Log in

Clinical Evaluation of Dysphagia

  • Chapter
  • First Online:
Dysphagia Evaluation and Treatment

Abstract

Clinical evaluation, both instrumental and noninstrumental, plays an important role in the swallowing assessment of the patients with dysphagia. The gathered information from thorough evaluation contributes the presence of dysphagia, dysphagia severity level, rehabilitation planning, and both the problem and the potential solution. The dysphagia screening, clinical and instrumental assessment, and new perspectives in advanced swallowing assessment will be described in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Donovan NJ, Daniels SK, Edmiaston J, Weinhardt J, Summers D, Mitchell PH. Dysphagia screening: state of the art: invitational conference proceeding from the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. Stroke. 2013;44(4):e24–31. doi:10.1161/STR.0b013e3182877f57.

    Article  PubMed  Google Scholar 

  2. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36(12):2756–63.

    Article  PubMed  Google Scholar 

  3. Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal dysphagia screening protocols prevent pneumonia. Stroke. 2005;36(9):1972–6.

    Article  PubMed  Google Scholar 

  4. Martino R, Pron G, Diamant N. Screening for oropharyngeal dysphagia in stroke: insufficient evidence for guidelines. Dysphagia. 2000;15(1):19–30.

    Article  CAS  PubMed  Google Scholar 

  5. Lakshminarayan K, Tsai AW, Tong X, Vazquez G, Peacock JM, George MG, et al. Utility of dysphagia screening results in predicting poststroke pneumonia. Stroke. 2010;41(12):2849–54. doi:10.1161/STROKEAHA.110.597039.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Daniels SK, Anderson JA, Willson PC. Valid items for screening dysphagia risk in patients with stroke: a systematic review. Stroke. 2012;43(3):892–7. doi:10.1161/STROKEAHA.111.640946.

    Article  PubMed  Google Scholar 

  7. Baba M, Saitoh E, Takeda S, Onogi K. Swallowing evaluation for accommodation of oral feeding. Sogo Rehabil. 2002;30:1309–16. (Japanese).

    Google Scholar 

  8. Kertscher B, Speyer R, Palmieri M, Plant C. Bedside screening to detect oropharyngeal dysphagia in patients with neurological disorders: an updated systematic review. Dysphagia. 2014;29(2):204–12. doi:10.1007/s00455-013-9490-9.

    Article  PubMed  Google Scholar 

  9. Martino R, Flowers HL, Shaw SM, Diamant NE. A systematic review of current clinical and instrumental swallowing assessment methods. Curr Phys Med Rehabil Rep. 2013;1:267–79. doi:10.1007/s40141-013-0033-y.

  10. Poorjavad M, Jalaie S. Systemic review on highly qualified screening tests for swallowing disorders following stroke: validity and reliability issues. J Res Med Sci. 2014;19(8):776–85.

    PubMed  PubMed Central  Google Scholar 

  11. Oguchi K, Saitoh E, Mizuno M, Baba M, Okui M, Suzuki M. The repetitive saliva swallowing test (RSST) as a screening test of functional dysphagia (1) normal values of RSST. Jpn J Rehabil Med. 2000;37:375–82. (Japanese).

    Google Scholar 

  12. Oguchi K, Saitoh E, Baba M, Kusudo S, Tanaka T, Onogi K. The repetitive saliva swallowing test (RSST) as a screening test of functional dysphagia (2) Validity of RSST. Jpn J Rehabil Med. 2000;37:383–8. (Japanese).

    Google Scholar 

  13. Tohara H, Saitoh E, Mays KA, Kuhlemeier K, Palmer JB. Three tests for predicting aspiration without videofluorography. Dysphagia. 2003;18(2):126–34.

    Article  PubMed  Google Scholar 

  14. Saitoh E. Grant for Ministry of Welfare (Comprehensive Gerontologic Science) Comprehensive study of treatment and management for dysphagia. Report of Grant for Ministry of Welfare. 2009;1999:1–18.

    Google Scholar 

  15. Kubota T, Mishima H, Hanada M, Minami I, Kojima Y. Paralytic dysphagia in cerebrovascular disorder – screening tests and their clinical application. Sogo Rehabil. 1982;10:271–6. (Japanese).

    Google Scholar 

  16. Horiguchi S, Suzuki Y. Screening tests in evaluating swallowing function. Jpn Med Assoc J. 2011;54(1):31–4.

    Google Scholar 

  17. Takeda S, Saitoh E, Matsuo K, Baba M, Fujii W, Palmer JB. Influence of chewing on food transport and swallowing. Jpn J Rehabil Med. 2002;39(6):322–30.

    Article  Google Scholar 

  18. Ozaki K, Kagaya H, Yokoyama M, Saitoh E, Okada S, González-Fernández M, et al. The risk of penetration or aspiration during videofluoroscopic examination of swallowing varies depending on food types. Tohoku J Exp Med. 2010;220(1):41–6.

    Article  PubMed  Google Scholar 

  19. The government revision of medical fee. The fourth version of VF standard procedure (detail version). Jpn J Dysphagia Rehabil. 2014;18(2):166–86. https://www.jsdr.or.jp/wp-content/uploads/file/doc/VF18-2-p166-186.pdf. (Japanese).

  20. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8.

    Article  CAS  PubMed  Google Scholar 

  21. Wright RER, Boyd CS, Workman A. Radiation doses to patients during pharyngeal videofluoroscopy. Dysphagia. 1998;13:113–5.

    Article  CAS  PubMed  Google Scholar 

  22. Crawley MT, Savage P, Oakley F. Patient and operator dose during fluoroscopic examination of swallow mechanism. Br J Radiol. 2004;77:654–6.

    Article  CAS  PubMed  Google Scholar 

  23. Zammit-Maempel I, Chapple CL, Leslie P. Radiation dose in videofluoroscopic swallow studies. Dysphagia. 2007;22:13–5.

    Article  PubMed  Google Scholar 

  24. Kanamori D, Kagaya H, Fujii N, Inamoto Y, Nakayama E, Suzuki S, et al. Examination of the distance measurement error and exposed dose when using a 320-row area detector CT: a comparison with videofluoroscopic examination of swallowing. Jpn J Compr Rehabil Sci. 2011;2:18–23.

    Google Scholar 

  25. Langmore S. Endoscopic evaluation and treatment of swallowing disorders. 2nd ed. New York: Thieme; 2001.

    Google Scholar 

  26. Wu CH, Hsiao TY, Chen JC, Chang YC, Lee SY. Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluoroscopic technique. Laryngoscope. 1997;107(3):396–401.

    Article  CAS  PubMed  Google Scholar 

  27. Hiss SG, Postma GN. Fiberoptic endoscopic evaluation of swallowing. Laryngoscope. 2003;113(8):1386–93.

    Article  PubMed  Google Scholar 

  28. Aviv JE, Kaplan ST, Thompson JE, Spitzer J, Diamond B, Close LG. The safety of flexible endoscopic evaluation of swallowing with sensory testing: an analysis of 500 consecutive evaluations. Dysphagia. 2000;15:39–44.

    Article  CAS  PubMed  Google Scholar 

  29. Warnecke T, Teismann I, Oslenber S, Hamacher C, Ringelstein EB, Schabitz WR, et al. The safety of fiberoptic endoscopic evaluation of swallowing in acute stroke patients. Stroke. 2009;40(2):482–6. doi:10.1161/STROKEAHA.108.520775.

    Article  PubMed  Google Scholar 

  30. Toda F, Kagaya H, Baba M, Shibata S, Ozeki Y, Kanamori D, et al. Effect of swallowing rounds on the outcome of dysphagic patients. Jpn J Compr Rehabil Sci. 2015;6:50–5.

    Google Scholar 

  31. Sellars C, Bowie L, Bagg J, Sweeney MP, Miller H, Tilston J, et al. Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke. 2007;38(8):2284–91.

    Article  PubMed  Google Scholar 

  32. Armstrong JR, Mosher BD. Aspiration pneumonia after stroke: intervention and prevention. Neurohospitalist. 2011;1(2):85–93. doi:10.1177/1941875210395775.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Almeida SR, Bahia MM, Lima FO, Paschoal IA, Cardoso TA, Li LM. Predictors of pneumonia in acute stroke in patients in an emergency unit. Arq Neuropsiquiatr. 2015;73(5):415–9. doi:10.1590/0004-282X20150046.

    Article  PubMed  Google Scholar 

  34. Fujii N, Inamoto Y, Saitoh E, Baba M, Okada S, Yoshioka S, et al. Evaluation of swallowing using 320-detector-row multislice CT. Part I: single- and multiphase volume scanning for three-dimensional morphological and kinematic analysis. Dysphagia. 2011;26(2):99–107. doi:10.1007/s00455-009-9268-2.

    Article  PubMed  Google Scholar 

  35. Inamoto Y, Fujii N, Saitoh E, Baba M, Okada S, Katada K, et al. Evaluation of swallowing using 320-detector-row multislice CT. Part II: kinematic analysis of laryngeal closure during normal swallowing. Dysphagia. 2011;26(3):209–17. doi:10.1007/s00455-010-9276-2.

    Article  PubMed  Google Scholar 

  36. Inamoto Y, Saitoh E, Okada S, Kagaya H, Shibata S, Ota K, et al. The effect of bolus viscosity on laryngeal closure in swallowing: kinematic analysis using 320-row area detector CT. Dysphagia. 2013;28(1):33–42.

    Article  PubMed  Google Scholar 

  37. Inamoto Y. Swallowing disorder - Kinematic analysis and understanding of dysphagia pathophysiology using swallowing CT. Innervation. 2014;29(5):73–6.

    Google Scholar 

  38. Inamoto Y, Saitoh E. Novel swallowing evaluation using swallowing CT. Jon J Rehabil Med. 2015;52:36–41.

    Google Scholar 

  39. Okada T, Aoyagi Y, Inamoto Y, Saitoh E, Kagaya H, Shibata S, et al. Dynamic change in hyoid muscle length associated with trajectory of hyoid bone during swallowing: analysis using 320-row area detector computed tomography. J Appl Physiol. 2013;115:1138–45. doi:10.1152/japplphysiol.00467.2013.

    Article  PubMed  Google Scholar 

  40. Shibata S, Kagaya H, Inamoto Y, Saitoh E, Okada S, Ota K, et al. Swallowing maneuver analysis using 320-row area detector computed tomography (320-ADCT). Jpn J Compr Rehabil Sci. 2011;2:54–62.

    Google Scholar 

  41. Nakayama E, Kagaya H, Saitoh E, Inamoto Y, Hashimoto S, Fujii N, et al. Changes in pyriform sinus morphology in the head rotated position as assessed by 320-row area detector CT . Dysphagia. 2013;28(2):199–204. doi:10.1007/s00455-012-9430-0.

  42. Schepp SK, Tirschwell DL, Miller RM, Longstreth WT Jr. Swallowing screens after acute stroke: a systematic review. Stroke. 2012;43(3):869–71. doi:10.1161/STROKEAHA.111.638254.

    Article  PubMed  Google Scholar 

  43. Martino R, Silver F, Teasell R, Bayley M, Nicholson G, Streiner DL, et al. The Toronto Bedside Swallowing Screening Test (TOR-BSST): development and validation of a dysphagia screening tool for patients with stroke. Stroke. 2009;40(2):555–61. doi:10.1161/STROKEAHA.107.510370.

    Article  PubMed  Google Scholar 

  44. SCORE (Stroke Canada Optimization of Rehabilitation through Evidence) evidence-based recommendations for the upper and lower extremities and risk assessment post-stroke 2007. Ottawa: Canadian Stroke Network; 2007. http://www.canadianstrokenetwork.ca/eng/tools/downloads/SCORE_EBR_Aug2307.pdf. Accessed 19 Oct 2015.

  45. Edmiaston J, Connor LT, Loehr L, Nassief A. Validation of a dysphagia screening tool in acute stroke patients. Am J Crit Care. 2010;19(4):357–64. doi:10.4037/ajcc2009961.

    Article  PubMed  Google Scholar 

  46. Edmiaston J, Connor LT, Ford AL. SWALLOW-3D, a simple 2-minute bedside screening test, detects dysphagia in acute stroke patients with high sensitivity when validated against video-fluoroscopy (abstract). Stroke. 2011;42:e352.

    Google Scholar 

  47. Clavé P, Arreola V, Romea M, Medina L, Palomera E, Serra-Prat M. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr. 2008;27(6):806–15. doi:10.1016/j.clnu.2008.06.011.

    Article  PubMed  Google Scholar 

  48. Suiter DM, Leder SB. Clinical utility of the 3-ounce water swallow test. Dysphagia. 2008;23(3):244–50.

    Article  PubMed  Google Scholar 

  49. Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, et al. Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke. 2007;38(11):2948–52.

    Article  PubMed  Google Scholar 

  50. DePippo KL, Holas MA, Reding MJ. The Burke dysphagia screening test: validation of its use in patients with stroke. Arch Phys Med Rehabil. 1994;75(12):1284–6.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan

    Kannit Pongpipatpaiboon, Yoichiro Aoyagi, Seiko Shibata & Hitoshi Kagaya

  2. Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Yoko Inamoto

  3. Department of Dentistry, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan

    Koichiro Matsuo

Authors
  1. Kannit Pongpipatpaiboon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoko Inamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoichiro Aoyagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seiko Shibata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hitoshi Kagaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koichiro Matsuo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoko Inamoto .

Editor information

Editors and Affiliations

  1. Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan

    Eiichi Saitoh

  2. Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan

    Kannit Pongpipatpaiboon

  3. Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan

    Yoko Inamoto

  4. Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan

    Hitoshi Kagaya

Appendix

Appendix

1.1 Other Available Dysphagia Screening Tools

These time- and cost-effective tools are used to identify patients at high risk of dysphagia who therefore require further assessment. Two recent systematic reviews [8, 42] of dysphagia impairment identified the following two validated and reliable screening tools based on sufficient sample sizes and accepted psychometric criteria for clinical use in stroke survivors:

  1. 1.

    Toronto Bedside Swallowing Screening Test (TOR-BSST©)

  2. 2.

    Barnes Jewish Hospital Stroke Dysphagia Screen

1.1.1 TOR-BSST© [4, 43, 44]

The TOR-BSST© is a stable and accurate dysphagia screening tool for patients with stroke . It is one of the highest-ranking dysphagia screening tools and is quick and easy to perform, taking less than 10 min to administer and score [42]. The TOR-BSST© can be administered by any healthcare professional (e.g., nurse , dietician ) who has received training by an SLHT using a standardized training program. The test consists of three sections: the first two sections involve an oral examination (tongue movement and voice quality), and the third section involves a series of water swallow tests. A patient who has failed any section of the test stops the screening and is referred to an SLHT for further evaluation.

The TOR-BSST© has demonstrated high validity; the sensitivity of the trial swallow using water and the negative predictive value were 96.35% and 93.30%, respectively, in the acute setting and 80.00% and 89.50%, respectively, in the rehabilitation setting. The inter-rater reliability for administration was excellent, with an intraclass correlation coefficient of 0.92 (95% confidence interval, 0.85–0.96). However, the TOR-BSST© is copyrighted and must be purchased before administration. Its purchase includes online training and information on how to implement the screening protocol, which may be desirable for some facilities.

1.1.2 Barnes Jewish Hospital Stroke Dysphagia Screen [45, 46]

The Barnes Jewish Hospital Stroke Dysphagia Screen is a simple 2-min bedside screening test for acute stroke patients. It involves measurement of the level of consciousness , assessment of several items that indicate the presence of dysarthria (asymmetry or weakness in the facial, lingual, and palatal regions), and performance of a 3-oz water swallow test. This test showed high sensitivity (95%) using VF for concurrent validity, a high negative predictive value (94%), and moderate specificity (68%).

Martino et al. [9] performed another systematic review of bedside screening tools with which to detect oropharyngeal dysphagia in patients with neurological disorders. The authors identified two clinical screening tools that met the methodological quality assessment requirements (validity, reliability, and generalizability) and had high sensitivity with moderate specificity:

  1. 1.

    Volume-Viscosity Swallowing Test

  2. 2.

    TOR-BSST©, described above

1.1.3 Volume-Viscosity Swallowing Test [47]

The Volume-Viscosity Swallowing Test was designed to identify clinical signs of impaired swallowing efficacy and safety. This test is also used to select the appropriate bolus volume and viscosity with which to achieve the highest safety and efficacy of deglutition by testing three viscosities (nectar, liquid, and pudding ).

Many other screening methods administered in different settings are available for clinical use, including the 3-oz water swallow test described by Suiter and Leder [48], the Gugging Swallowing Screen described by Trapl et al. [49], the Burke Dysphagia Screening Test described by DePippo et al. [50], and others.

As in bedside screening, protocols may vary among bedside tests with different goals and among different clinical settings, number of trial swallows, chosen cutoff points for aspiration or penetration , or bolus consistencies and volumes tested. At present, no guideline or consensus exists with respect to the most effective protocol in any screening procedure.

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Singapore Pte Ltd.

About this chapter

Cite this chapter

Pongpipatpaiboon, K., Inamoto, Y., Aoyagi, Y., Shibata, S., Kagaya, H., Matsuo, K. (2018). Clinical Evaluation of Dysphagia. In: Saitoh, E., Pongpipatpaiboon, K., Inamoto, Y., Kagaya, H. (eds) Dysphagia Evaluation and Treatment. Springer, Singapore. https://doi.org/10.1007/978-981-10-5032-9_5

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-5032-9_5

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-5031-2

  • Online ISBN: 978-981-10-5032-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation