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First Steps Towards Development of an Instrument for the Reproducible Quantification of Oropharyngeal Swallow Physiology in Bottle-Fed Children

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Abstract

The incidence of feeding/swallowing impairments (deglutition disorders) in young children is rising and poses serious acute and long-term health consequences. Accurate detection and prompt intervention can lessen the impact of dysphagia-induced sequelae. Videofluoroscopic Swallow Studies (VFSSs) are used to make critical decisions for medically fragile children despite procedural variability and the lack of agreed upon measures for interpreting and reporting results. This investigation represents the first steps in the development of a novel tool for the quantification of oropharyngeal swallow physiology from full-length VFSS examinations in bottle-fed children. The Modified Barium Swallow Impairment Profile MBSImP™© served as the conceptual assessment model for development of components and operational score variants to characterize distinguishable VFSS observations. Twenty-four components of swallowing physiology were validated via expert consensus. Training materials included a library of 94 digitized video images comprised of distinct score variants for each component. Materials were disseminated to seven speech-language pathologists (SLPs) who participated in didactic and self-training sessions, and rated components. All SLPs achieved ≥80% reliability criterion after completing two or three training sessions. Agreement for 17 (71%) components was achieved after two sessions. Nutritive sucking/oral and airway-related components were most difficult to distinguish. Three sessions were required for 2 (33%) of the sucking/oral components and 4 (57%) of the airway-related components. These findings support the feasibility to standardize training and reliably score swallowing physiology using precise definitions and unambiguous visual images, and represent preliminary steps towards content validity and reliability of a standardized VFSS tool for bottle-fed children.

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Acknowledgements

The authors wish to thank the families for partaking in this project. Our gratitude is expressed for the contributions of the Speech Language Pathologists that were involved in this work including Jeannine Hoch, M.A., M. Cara Erskine, M. Ed., Sandra B. Martin, M.S. Keeley McKelvey, M.S., Heather Mcghee, M.S., and Melissa Montiel, M.S. Portions of the preliminary data were presented at the Dysphagia Research Society 2016 Annual Meeting, 25–27 February 16, Tucson, Arizona. This work was partially supported by the National Institutes of Health Grants NIDCD 5R01DC011290-05 (ML-G and BM-H). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding

This study was funded by NIH/NIDCD (1R01DC011290).

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Authors and Affiliations

  1. Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, The Johns Hopkins University School of Medicine, David M. Rubenstein Building, 200 North Wolfe Street, Baltimore, MD, 21287, USA

    Maureen A. Lefton-Greif & Jeanne M. Pinto

  2. Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA

    Maureen A. Lefton-Greif

  3. Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA

    Maureen A. Lefton-Greif

  4. Department of Otolaryngology Head and Neck Surgery, College of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA

    Katlyn Elizabeth McGrattan & Bonnie Martin-Harris

  5. Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC, 29425, USA

    Katlyn Elizabeth McGrattan & Bonnie Martin-Harris

  6. Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA

    Katlyn Elizabeth McGrattan & Bonnie Martin-Harris

  7. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 East Monument Street, Suite 2-500, Baltimore, MD, 21287, USA

    Kathryn A. Carson

  8. Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA

    Kathryn A. Carson

  9. Department of Pediatrics, The Johns Hopkins University School of Medicine, 600 North Wolfe Street CMSC 1102, Baltimore, MD, 21287, USA

    Jennifer M. Wright

  10. Ralph H, Johnson Veterans Affairs Medical Center, Charleston, SC, 29425, USA

    Bonnie Martin-Harris

Authors
  1. Maureen A. Lefton-Greif
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  2. Katlyn Elizabeth McGrattan
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  3. Kathryn A. Carson
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  4. Jeanne M. Pinto
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  5. Jennifer M. Wright
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  6. Bonnie Martin-Harris
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Corresponding author

Correspondence to Maureen A. Lefton-Greif.

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Conflict of interest

Maureen A. Lefton-Greif, Kathryn A. Carson, Katlyn Elizabeth McGrattan, Jeanne M. Pinto, Jennifer M. Wright, and Bonnie Martin-Harris have received research grant funding from NIH/NIDCD.

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Lefton-Greif, M.A., McGrattan, K.E., Carson, K.A. et al. First Steps Towards Development of an Instrument for the Reproducible Quantification of Oropharyngeal Swallow Physiology in Bottle-Fed Children. Dysphagia 33, 76–82 (2018). https://doi.org/10.1007/s00455-017-9834-y

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  • DOI: https://doi.org/10.1007/s00455-017-9834-y

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