Skip to main content
SpringerLink
Log in

Establishment of a Multi-parameter Evaluation Model for Risk of Aspiration in Dysphagia: A Pilot Study

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

It’s difficult for clinical bedside evaluations to accurately determine the occurrence of aspiration in patients. Although VFSS and FEES are the gold standards for clinical diagnosis of dysphagia, which are mainly used to evaluate people at high risk of dysphagia found by bedside screening, the operation is complicated and time-consuming. The aim of this pilot study was to present an objective measure based on a multi-parameter approach to screen for aspiration risk in patients with dysphagia. Objective evaluation techniques based on speech parameters were used to assess the oral motor function, vocal cord function, and voice changes before and after swallowing in 32 patients with dysphagia (16 low-risk aspiration group, 16 high-risk aspiration group). Student’s t test combined with stepwise logistic regression were used to determine the optimal index. The best model consists of three parameters, and the equation is: logit(P) = − 3.824 − (0.504 × maximum phonation time) + (0.008 × second formant frequency of /u/) − 0.085 × (fundamental frequency difference before and after swallowing). An additional eight patients with dysphagia were randomly selected as the validation group of the model. When applied to validation, this model can accurately identify the risk of aspiration in 87.5% of patients, and the sensitivity is as high as 100%. Therefore, it has certain clinical practical value that may help clinicians to assess the risk of aspiration in patients with dysphagia, especially for silent aspiration.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Clavé P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12(5):259–70.

    Google Scholar 

  2. Martin-Harris B, Jones B. The videofluorographic swallowing study. Phys Med Rehabil Clin N Am. 2008;19(4):769–85.

    Google Scholar 

  3. Swan K, et al. Psychometric properties of visuoperceptual measures of videofluoroscopic and fibre-endoscopic evaluations of swallowing: a systematic review. Dysphagia. 2019;34(1):2–33. https://doi.org/10.1007/s00455-018-9918-3.

    Article  Google Scholar 

  4. Boaden E, et al. Clinical practice guidelines for videofluoroscopic swallowing studies: a systematic review. Radiography (London 1995). 2020;26(2):154–62. https://doi.org/10.1016/j.radi.2019.10.011.

    Article  CAS  Google Scholar 

  5. Benjapornlert P, et al. The prevalence and findings of fibre-optic endoscopic evaluation of swallowing in hospitalised patients with dysphagia. J Oral Rehab. 2020;47(8):983–8. https://doi.org/10.1111/joor.13026.

    Article  Google Scholar 

  6. Olesen MD, et al. Prevalence of signs of dysphagia and associated risk factors in geriatric patients admitted to an acute medical unit. Clin Nutr ESPEN. 2021;41:208–16. https://doi.org/10.1016/j.clnesp.2020.12.020.

    Article  Google Scholar 

  7. McAllister S, et al. Implications of variability in clinical bedside swallowing assessment practices by speech language pathologists. Dysphagia. 2016;31(5):650–62. https://doi.org/10.1007/s00455-016-9724-8.

    Article  Google Scholar 

  8. Okun MS, et al. Decreased cough sensitivity and aspiration in Parkinson disease. Chest. 2014;146(5):1294–9.

    Google Scholar 

  9. Osawa A, Maeshima S, Tanahashi N. Water-swallowing test: screening for aspiration in stroke patients. Cerebrovasc Dis. 2013;35(3):276–81.

    Google Scholar 

  10. Ahmed S, et al. Three ounce water swallow test versus fiberoptic endoscopic evaluation of swallowing for evaluation of laryngeal aspiration. QJM. 2020. https://doi.org/10.1093/qjmed/hcaa047.019.

    Article  Google Scholar 

  11. Garon BR, Sierzant T, Ormiston C. Silent aspiration: results of 2,000 video fluoroscopic evaluations. J Neurosci Nurs. 2009;41(4):186–7.

    Google Scholar 

  12. Miles A, et al. Comparison of cough reflex test against instrumental assessment of aspiration. Physiology Behavior. 2013;118(1):25–31.

    CAS  Google Scholar 

  13. Ji YL, et al. Usefulness of the simplified cough test in evaluating cough reflex sensitivity as a screening test for silent aspiration. Ann Rehabil Med. 2014;38(4):476–84.

    Google Scholar 

  14. Steele CM, Cichero J. Physiological factors related to aspiration risk: a systematic review. Dysphagia. 2014;29(3):295–304.

    Google Scholar 

  15. Leder SB, Espinosa JF. Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. Dysphagia. 2002;17(3):214–8.

    Google Scholar 

  16. Kagi G, et al. Prolonged impairment of deglutition in supratentorial ischaemic stroke: the predictive value of Parramatta Hospitals’ assessment of Dysphagia. Swiss Med Wkly. 2016;146:w14355–w14355. https://doi.org/10.4414/smw.2016.14355.

    Article  Google Scholar 

  17. Sakai K, et al. An examination of factors related to aspiration and silent aspiration in older adults requiring long-term care in rural Japan. J Oral Rehab. 2016. https://doi.org/10.1111/joor.12349.

    Article  Google Scholar 

  18. Tiina I, et al. Risk factors for laryngeal penetration-aspiration in patients with acute traumatic cervical spinal cord injury. Spine J. 2018. https://doi.org/10.1016/j.spinee.2017.06.033.

    Article  Google Scholar 

  19. Linden P, et al. The probability of correctly predicting subglottic penetration from clinical observations. Dysphagia. 1993;8(3):170–9. https://doi.org/10.1007/BF01354535.

    Article  CAS  Google Scholar 

  20. McCullough GH, et al. Utility of clinical swallowing examination measures for detecting aspiration post-stroke. J Speech Lang Hearing Res. 2005;48(6):1280–93. https://doi.org/10.1044/1092-4388(2005/089).

    Article  CAS  Google Scholar 

  21. Power ML, et al. Predicting aspiration after hemispheric stroke from timing measures of oropharyngeal bolus flow and laryngeal closure. Dysphagia. 2009;24(3):257–64. https://doi.org/10.1007/s00455-008-9198-4.

    Article  Google Scholar 

  22. Daniels SK, et al. Rapid aspiration screening for suspected stroke: part 1: development and validation. Arch Phys Med Rehab. 2016;97(9):1440–8. https://doi.org/10.1016/j.apmr.2016.03.025.

    Article  Google Scholar 

  23. Festic E, Soto JS, Pitre LA, et al. Novel bedside phonetic evaluation to identify dysphagia and aspiration risk. Chest. 2016;149(3):649–59.

    Google Scholar 

  24. Park EJ, et al. Correlations between swallowing function and acoustic vowel space in stroke patients with dysarthria. Neuro Rehab (Reading, Mass). 2019;45(4):463–9. https://doi.org/10.3233/NRE-192904.

    Article  Google Scholar 

  25. Theyyar RA, et al. Reduced maximum pitch elevation predicts silent aspiration of small liquid volumes in stroke patients. Front Neurol. 2017;8:436.

    Google Scholar 

  26. McKenna VS, et al. A systematic review of isometric lingual strength-training programs in adults with and without dysphagia. Am J Speech Lang Pathol. 2017;26(2):524–39. https://doi.org/10.1044/2016_AJSLP-15-0051.

    Article  Google Scholar 

  27. Miyata E, et al. Early voice therapy for unilateral vocal fold paralysis improves subglottal pressure and glottal closure. Am J Otolaryngol. 2020;41(6):102727–102727. https://doi.org/10.1016/j.amjoto.2020.102727.

    Article  Google Scholar 

  28. Di Pede C, et al. Dysphagia in the elderly: focus on rehabilitation strategies. Aging Clin Exp Res. 2016;28(4):607–17. https://doi.org/10.1007/s40520-015-0481-6.

    Article  Google Scholar 

  29. Fang TJ, et al. The role of glottal gap in predicting aspiration in patients with unilateral vocal paralysis. Clin Otolaryngol Allied Sci. 2004;29(6):709–12. https://doi.org/10.1111/j.1365-2273.2004.00876.x.

    Article  CAS  Google Scholar 

  30. Piccirillo JF, Painter C, Haiduk A, et al. Assessment of two objective voice function indices. Annal Otol Rhinol Laryngol. 1998;107(5):396–400. https://doi.org/10.1177/000348949810700506.

    CAS  Google Scholar 

  31. Wuyts FL, Bodt MSD, Molenberghs G, et al. The dysphonia severity index: An objective measure of vocal quality based on a multiparameter approach. J Speech Lang Hear Res. 2000;43(3):796–809. https://doi.org/10.1044/jslhr.4303.796.

    CAS  Google Scholar 

  32. Ryu JS, Park SR, Choi KH. Prediction of laryngeal aspiration using voice analysis. Am J Phys Med Rehab. 2004;83(10):753–7.

    Google Scholar 

Download references

Acknowledgements

The author wishes to express her deep gratitude to the participants who have contributed their time and energy to this study. We sincerely thank all institutions for their efforts and cooperation in this study.

Author information

Authors and Affiliations

  1. Department of Rehabilitation Sciences, Faculty of Education, East China Normal University, North Zhongshan Road, Putuo District, Shanghai, 200062, China

    Jing Song MD, Qin Wan PhD & Yongli Wang PhD

  2. Rehabilitation Medicine Department, The First People’s Hospital of Foshan, North 81 Lingnan Avenue, Chancheng District, Foshan City, 528000, Guangdong Province, China

    Jing Song MD & Huichang Zhou BS

Authors
  1. Jing Song MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qin Wan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yongli Wang PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Huichang Zhou BS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qin Wan PhD.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Song, J., Wan, Q., Wang, Y. et al. Establishment of a Multi-parameter Evaluation Model for Risk of Aspiration in Dysphagia: A Pilot Study. Dysphagia 38, 406–414 (2023). https://doi.org/10.1007/s00455-022-10479-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-022-10479-5

Keywords

Search

Navigation