Adaptation and Validation of the Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing: DIGEST-FEES

2021 ◽  
pp. 1-9
Author(s):  
Heather M. Starmer ◽  
Loni Arrese ◽  
Susan Langmore ◽  
Yifei Ma ◽  
Joseph Murray ◽  
...  
Keyword(s):  
Interrater Reliability ◽  
Rating Scale ◽  
Oral Intake ◽  
Weighted Kappa ◽  
Dynamic Imaging ◽  
Severity Scale ◽  
Endoscopic Evaluation ◽  
Md Anderson ◽  
Functional Oral Intake Scale ◽  
Anderson Dysphagia Inventory

Purpose While flexible endoscopic evaluation of swallowing (FEES) is a common clinical procedure used in the head and neck cancer (HNC) population, extant outcome measures for FEES such as bolus-level penetration–aspiration and residue scores are not well suited as global patient-level endpoint measures of dysphagia severity in cooperative group trials or clinical outcomes research. The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) was initially developed and validated for use during videofluoroscopic evaluations as a way to grade safety, efficiency, and overall pharyngeal swallowing impairment. The purpose of this study was to adapt and validate DIGEST for use with FEES. Method A modified Delphi exercise was conducted for content validation, expert consensus, adaptation, and operationalization of DIGEST-FEES. Three blinded, expert raters then evaluated 100 de-identified post-HNC treatment FEES examinations. Intra- and interrater reliability were tested with quadratic weighted kappa. Criterion validity against the MD Anderson Dysphagia Inventory, Functional Oral Intake Scale, Secretion Severity Scale, and Yale Residue Rating Scale was assessed with Spearman correlation coefficients. Results Interrater reliability was almost perfect for overall DIGEST-FEES grade (κ w = 0.83) and safety grade (κ w = 0.86) and substantial for efficiency grade (κ w = 0.74). Intrarater reliability was excellent for all raters (0.9–0.91). Overall DIGEST-FEES grade correlated with MD Anderson Dysphagia Inventory ( r = −.43, p < .0001), Functional Oral Intake Scale ( r = −.43, p < .0001), Secretion Severity Scale ( r = .47, p < .0001), Yale Vallecular Residue ( r = .73, p < .0001), and Yale Pyriform Sinus Residue ( r = .65, p < .0001). Conclusion DIGEST-FEES is a valid and reliable scale to describe the severity of pharyngeal dysphagia in patients with HNC. Supplemental Material https://doi.org/10.23641/asha.14642787

scholarly journals Clinical effectiveness of the sequential 4-channel NMES compared with that of the conventional 2-channel NMES for the treatment of dysphagia in a prospective double-blind randomized controlled study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Kyoung-Ho Seo ◽  
Joonyoung Jang ◽  
Eun Gyeong Jang ◽  
Yulhyun Park ◽  
So Young Lee ◽  
...  
Keyword(s):  
Neuromuscular Electrical Stimulation ◽  
Oral Intake ◽  
Clinical Effectiveness ◽  
Controlled Study ◽  
Double Blind ◽  
Registration Number ◽  
Md Anderson ◽  
Functional Oral Intake Scale ◽  
Anderson Dysphagia Inventory

Abstract Background To date, conventional swallowing therapies and 2-channel neuromuscular electrical stimulation (NMES) are standard treatments for dysphagia. The precise mechanism of 2-channel NMES treatment has not been determined, and there are controversies regarding the efficacy of this therapy. The sequential 4-channel NMES was recently developed and its action is based on the normal contractile sequence of swallowing-related muscles. Objective To evaluate and compare the rehabilitative effectiveness of the sequential 4-channel NMES with that of conventional 2-channel NMES. Methods In this prospective randomized case–control study, 26 subjects with dysphagia were enrolled. All participants received 2- or 4-channel NMES for 2–3 weeks (minimal session: 7 times, treatment duration: 300–800 min). Twelve subjects in the 4-channel NMES group and eleven subjects in the 2-channel NMES group completed the intervention. Initial and follow-up evaluations were performed using the videofluoroscopic dysphagia scale (VDS), the penetration-aspiration scale (PAS), the MD Anderson dysphagia inventory (MDADI), the functional oral intake scale (FOIS), and the Likert scale. Results The sequential 4-channel NMES group experienced significant improvement in their VDS (oral, pharyngeal, and total), PAS, FOIS, and MDADI (emotional, functional, and physical subsets) scores, based on their pretreatment data. VDS (oral, pharyngeal, and total) and MDADI (emotional and physical subsets) scores, but not PAS and FOIS scores, significantly improved in the 2-channel NMES group posttreatment. When the two groups were directly compared, the 4-channel NMES group showed significant improvement in oral and total VDS scores. Conclusions The sequential 4-channel NMES, through its activation of the suprahyoid and thyrohyoid muscles, and other infrahyoid muscles mimicking physiological activation, may be a new effective treatment for dysphagia. Trial registration: clinicaltrial.gov, registration number: NCT03670498, registered 13 September 2018, https://clinicaltrials.gov/ct2/show/NCT03670498?term=NCT03670498&draw=2&rank=1.

scholarly journals Validation of the Italian Version of the Functional Oral Intake Scale (FOIS-It) Against Fiberoptic Endoscopic Evaluation of Swallowing and Nutritional Status

Dysphagia ◽  
2021 ◽  
Author(s):  
Aurora Ninfa ◽  
Nicole Pizzorni ◽  
Angelo Eplite ◽  
Claudia Moltisanti ◽  
Antonio Schindler
Keyword(s):  
Nutritional Status ◽  
Rating Scale ◽  
Oropharyngeal Dysphagia ◽  
Oral Intake ◽  
Endoscopic Evaluation ◽  
Severity Rating ◽  
Group Validity ◽  
Functional Oral Intake Scale ◽  
Spearman’S Correlation ◽  
Etiological Heterogeneity

AbstractThe Functional Oral Intake Scale (FOIS) is a reliable and valid tool to assess functional oral intake of food and liquids in patients with oropharyngeal dysphagia (OD). Its validity was established for stroke patients against Videofluoroscopic Swallowing Study in English and Chinese and against Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in German. FOIS was cross-culturally validated into Italian (FOIS-It), but construct validity against instrumental assessment and nutritional status was not investigated. The study aims at contributing to the validation of the FOIS-It, by performing convergent and known-group validity against FEES and nutritional status in patients with OD of different etiologies. Overall, 220 adult patients with OD of etiological heterogeneity were recruited. FOIS-It score and Body Mass Index (BMI) were collected. FEES was performed to assess swallowing safety and efficiency based on the Penetration-Aspiration Scale (PAS) and the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Moderate to weak associations with PAS (ρ = − .37, p < .01), YPRSRS in the pyriform sinuses (ρ = − .20, p < .01), and BMI (ρ = .24, p < .01) were detected with Spearman’s correlation. FOIS-It distribution was compared with the Mann–Whitney U and Kruskal–Wallis tests. Significantly lower FOIS-It scores were detected among patients with penetration/aspiration (PAS > 2) and penetration (PAS > 2 ≤ 5) for all consistencies (p < .01), aspiration (PAS > 5) of liquids and semisolids (p < .001), residue in the pyriform sinuses (YPRSRS > 3) with semisolids (p < .001) and solids (p = .02), and malnutrition (BMI ≤ 18.5; p = .019). FOIS-It appears as a valid tool to assess functional oral intake against FEES’ measures of swallowing safety and efficiency and nutritional status in patients with OD of etiological heterogeneity.

scholarly journals Effectiveness of the sequential 4-channel NMES compared with conventional 2-channel NMES for the treatment of dysphagia in a prospective double-blind randomized controlled study

2020 ◽  
Author(s):  
Kyoung-Ho Seo ◽  
Joonyoung Jang ◽  
Eun Gyeong Jang ◽  
Yulhyun Park ◽  
So Young Lee ◽  
...  
Keyword(s):  
Neuromuscular Electrical Stimulation ◽  
Oral Intake ◽  
Controlled Study ◽  
Double Blind ◽  
Physical Scale ◽  
Registration Number ◽  
Md Anderson ◽  
Functional Oral Intake Scale ◽  
Anderson Dysphagia Inventory ◽  
Control Study

Abstract Background: To date, conventional swallowing therapies and 2-channel NMES are standard treatments for dysphagia. The precise mechanism of 2-channel neuromuscular electrical stimulation (NMES) treatment has yet to be determined, and controversy remains over the efficacy. The sequential 4-channel NMES was newly developed based on the normal contractile sequence of swallowing-related muscles. Objective: To evaluate and compare the rehabilitative effectiveness of sequential 4-channel NMES with that of conventional 2-channel NMES.Methods: In this prospective randomized case-control study, 23 subjects with dysphagia were enrolled. Twelve subjects with 4-channel NMES group and eleven subjects with 2-channel NMES group completed the intervention. Pretreatment and posttreatment evaluations were performed with the videofluoroscopic dysphagia scale (VDS), penetration-aspiration scale (PAS), MD Anderson dysphagia inventory (MDADI), functional oral intake scale (FOIS), and Likert scale.Results: The sequential 4-channel NMES group significantly improved the VDS (oral, pharyngeal, and total), PAS, FOIS, and MDADI (emotional, functional, and physical scale) compared with pretreatment data. The 2-channel NMES group significantly improved the VDS (oral, pharyngeal, and total) and MDADI (emotional, physical scale), but not the PAS and FOIS compared with pretreatment data. When the two groups were directly compared, the 4-channel NMES group showed significant improvement in oral and total VDS.Conclusions: Sequential 4-channel NMES activating the suprahyoid, thyrohyoid, and other infrahyoid muscles with proper interval time can be a new effective treatment for dysphagia.Trial registration : clinicaltrial.gov, registration number: NCT03670498, registered 13 September 2018, https://clinicaltrials.gov/ct2/show/NCT03670498?term=NCT03670498&draw=2&rank=1

Measuring Edema in Irradiated Head and Neck Cancer Patients

2007 ◽  
Vol 116 (8) ◽  
pp. 559-564 ◽  
Author(s):  
Joanne M. Patterson ◽  
Anthony Hildreth ◽  
Janet A. Wilson
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Interrater Reliability ◽  
Rating Scale ◽  
Anterior Commissure ◽  
Weighted Kappa ◽  
Common Side Effect ◽  
Intrarater Reliability ◽  
Good Test

Objectives: Edema is a common side effect of radiotherapy for head and neck cancer. Systems have been developed to record and monitor changes that occur after radiotherapy. These lack the sensitivity to record edema in specific laryngopharyngeal structures. The aim of this study was to develop a rating scale to measure edema in the larynx and pharynx. Methods: This was an exploratory study to develop a new measure, with the help of an expert panel, assessing interrater and intrarater reliability. A consensus group developed the rating scale. Eleven structures and 2 spaces were identified as areas sensitive to the development of edema. The terms no, mild, moderate, and severe were used to describe the degrees of edema. The scale was piloted and then tested for interrater and intrarater reliability on 5 speech and language therapists. They viewed 25 nasendolaryngoscopic images (23 patients who had had radiotherapy and 2 healthy volunteers). The images were rated with the scale. This process was repeated 1 week later. Results: Images were taken from patients with oral, oropharyngeal, nasopharyngeal, or laryngeal cancer. All had had radiotherapy or chemoradiotherapy. All raters were experienced in viewing larynges via nasendolaryngoscopy. The interrater reliability for scoring the edema rating scale was moderate (weighted kappa, 0.54). Lower levels of agreement were found for the tongue base, valleculae, pharyngeal walls, and anterior commissure. The intrarater reliability was very good (weighted kappa, 0.84). Conclusions: The edema rating scale can be scored with very good test-retest reproducibility and moderate levels of agreement between clinicians. Modifications to the method are suggested to increase interrater reliability.

scholarly journals Biofeedback eletromiográfico como coadjuvante pode ajudar a manter os resultados da terapia profilática de deglutição em longo prazo na doença de Parkinson? Um estudo piloto

2021 ◽  
Vol 26 ◽  
Author(s):  
Marcela Maria Alves da Silva Arone ◽  
Alcione Ghedini Brasolotto ◽  
Gabriele Ramos de Luccas ◽  
Marina Gatti ◽  
Claudia Tiemi Mituuti ◽  
...  
Keyword(s):  
Oral Intake ◽  
Severity Scale ◽  
Functional Oral Intake Scale

RESUMO Objetivo Este estudo piloto teve como objetivo verificar a influência do uso do biofeedback EMG como método coadjuvante para auxiliar na manutenção dos resultados a longo prazo da terapia da deglutição em idosos com doença de Parkinson em uma abordagem profilática. Métodos Os sujeitos foram avaliados quanto ao nível de ingestão oral (Functional Oral Intake Scale - FOIS), qualidade de vida (questionário SWAL-QOL) e videofluoroscopia da deglutição das consistências sólida, pudim e líquida. A gravidade da disfagia foi avaliada por meio do Dysphagia Outcome and Severity Scale (DOSS). Todos os procedimentos foram realizados antes, após três meses e após seis meses do tratamento fonoaudiológico para disfagia orofaríngea. Resultados Três sujeitos foram tratados com terapia fonoaudiológica profilática e três com terapia convencional fonoaudiológica profilática utilizando biofeedback EMG coadjuvante em um total de 18 sessões. Seis pacientes apresentaram melhora nos níveis de ingestão oral, gravidade da disfagia e qualidade de vida após o programa de reabilitação. O nível de ingestão oral foi mantido seis meses após a terapia convencional para dois pacientes e todos os participantes tratados com biofeedback EMG. Conclusão Ambas as modalidades de terapia profilática mostraram melhora na qualidade de vida, nível de ingestão oral e gravidade da disfagia, mas os benefícios foram mantidos ao longo do tempo apenas para os participantes do grupo experimental.

scholarly journals Associação entre escalas de avaliação de funcionalidade e severidade da disfagia pós-acidente vascular cerebral

CoDAS ◽  
2017 ◽  
Vol 29 (1) ◽  
Author(s):  
Karen de Oliveira dos Passos ◽  
Maria Cristina de Almeida Freitas Cardoso ◽  
Betina Scheeren
Keyword(s):  
Oral Intake ◽  
Severity Scale ◽  
Functional Oral Intake Scale

RESUMO Objetivo O objetivo deste estudo foi verificar a associação entre os resultados das escalas de funcionalidade e severidade da disfagia determinadas a partir de exames de videofluoroscopia em pacientes pós-AVC. Método Estudo observacional, retrospectivo e descritivo, com análise de 109 exames de Videofluoroscopia da Deglutição de pacientes pós-AVC. Dos exames da amostra foram coletadas informações quanto ao diagnóstico da severidade da disfagia e avaliados quanto à funcionalidade da deglutição de maneira independente por dois avaliadores. Resultados Foi constatada uma alta prevalência de disfagia classificada como discreta. Nos pacientes com disfagia foi observada a presença de aspiração laringotraqueal em um terço da amostra. Verificou-se associação significativa entre os escores das escalas Functional Oral Intake Scale e Dysphagia Outcome and Severity Scale em pacientes pós-AVC, ou seja, quanto maior o comprometimento da deglutição, menor o nível de ingestão por via oral na análise dos avaliadores (p < 0,001). Conclusão Há associação entre as escalas, podendo elas serem utilizadas como balizadores avaliativos e no gerenciamento da intervenção clínica fonoaudiológica.

scholarly journals Mixed Consistencies in Dysphagic Patients: A Myth to Dispel

Dysphagia ◽  
2021 ◽  
Author(s):  
Mozzanica Francesco ◽  
Pizzorni Nicole ◽  
Scarponi Letizia ◽  
Bazzotti Claudia ◽  
Ginocchio Daniela ◽  
...  
Keyword(s):  
Rating Scale ◽  
Pyriform Sinus ◽  
Endoscopic Evaluation ◽  
Pharyngeal Residue ◽  
Food Residue ◽  
Severity Rating ◽  
Vegetable Soup ◽  
Laryngeal Vestibule ◽  
Dysphagic Patients ◽  
Penetration Aspiration Scale

AbstractOnly limited and inconsistent information about the effect of mixed consistencies on swallowing are available. The aim of this study was to evaluate the location of the head of the bolus at the swallow onset, the risk of penetration/aspiration, and the severity of post-swallow pharyngeal residue in patients with dysphagia when consuming mixed consistencies. 20 dysphagic patients underwent a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) testing five different textures: liquid, semisolid, solid, biscuits-with-milk and vegetable-soup. The location of the head of the bolus at the onset of swallowing was rated using a five-points scale ranging from zero (the bolus is behind the tongue) to four (the bolus falls into the laryngeal vestibule), the severity of penetration/aspiration was rated using the Penetration Aspiration Scale (PAS), the amount of pharyngeal residue after the swallow was rated using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) in the vallecula and pyriform sinus. When consuming biscuits-with-milk and liquid the swallow onset occurred more often when the boluses were located in the laryngeal vestibule. Penetration was more frequent with biscuits-with-milk, while aspiration was more frequent with Liquid, followed by biscuits-with-milk and vegetable-soup, Semisolid and Solid. In particular, no differences in penetration and aspiration between liquids and biscuits-with-milk were found as well as among vegetable-soup, semisolid and solid. No significant differences in the amount of food residue after swallowing were demonstrated. The risk of penetration-aspiration for biscuits-with-milk and liquid is similar, while the risk of penetration-aspiration is lower for vegetable-soup than for liquid.

Change in Spontaneous Swallowing Frequency in HNC Patients Undergoing C/RT

2021 ◽  
pp. 019459982110207
Author(s):  
Giselle D. Carnaby ◽  
Aarthi Madhavan ◽  
Ali Barikroo ◽  
Michael Crary
Keyword(s):  
Repeated Measures ◽  
Prospective Cohort ◽  
Area Under The Curve ◽  
Objective Measure ◽  
Oral Intake ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Swallowing Function ◽  
Function Change ◽  
Functional Oral Intake Scale

Objective This study sought to evaluate the role and trajectory of spontaneous swallowing frequency (SFA) in patients with head and neck cancer (HNC) undergoing chemoradiotherapy (C/RT). Study Design. Prospective cohort. Setting University comprehensive cancer center. Methods A prospective cohort of 80 patients with HNC was followed from baseline to 3 months post-C/RT. Subjects were evaluated for performance on swallowing function, functional diet consumed, weight, swallowing frequency rate, perceived xerostomia, perceived pain, and mucositis. Relationships were evaluated using univariate correlations, t tests, and repeated-measures analysis of variance. The diagnostic accuracy of SFA to express dysphagia was calculated by area under the curve (AUROC) and displayed using receiver operator characteristic curves. Results In general, patients with HNC demonstrated a parabolic decline in most measures over the C/RT trajectory. SFA and perceived xerostomia did not show improved recovery by 3 months. SFA was related to swallow function, xerostomia, and functional diet consumed posttreatment and pain at 3 months. The ability of SFA to correctly identify clinical dysphagia (Mann Assessment of Swallowing–Cancer version [MASA-C]) and reduced oral intake (Functional Oral Intake Scale [FOIS]) at posttreatment was strong (AUROC MASA-C: 0.824 [95% CI, 0.63-1.00], P < .0018; AUROC FOIS: 0.96 [95% CI, 0.87-0.96], P < .0001). Conclusion This exploratory study suggests SFA may provide a useful method to identify dysphagia after HNC treatment. Furthermore, SFA may offer a simple, objective measure of swallowing function change in HNC over the C/RT trajectory.

scholarly journals Salivary caffeine in Parkinson’s disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Giorgio Leodori ◽  
Maria Ilenia De Bartolo ◽  
Daniele Belvisi ◽  
Alessia Ciogli ◽  
Andrea Fabbrini ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
De Novo ◽  
Oral Intake ◽  
Caffeine Intake ◽  
Motor Complications ◽  
Disease Rating ◽  
Caffeine Metabolism ◽  
Movement Disorder Society

AbstractWe aimed to investigate salivary caffeine content, caffeine absorption and metabolism in Parkinson’s disease (PD) and verify whether salivary caffeine can be used as a biomarker of PD. We enrolled 98 PD patients and 92 healthy subjects. Caffeine and its major metabolite, paraxanthine, were measured in saliva samples collected before and 4 h after the oral intake of caffeine (100 mg). We measured caffeine absorption as the normalized increase in caffeine levels, and caffeine metabolism as the paraxanthine/caffeine ratio. The Movement Disorder Society Unified Parkinson's Disease Rating Scale part III, the Hoehn & Yahr, the presence of motor complications, and levodopa equivalent dose (LED) were assessed and correlated with caffeine levels, absorption, and metabolism. The effects of demographic and environmental features possibly influencing caffeine levels were also investigated. Caffeine levels were decreased in patients with moderate/advanced PD, while caffeine levels were normal in patients with early and de-novo PD, unrelated to caffeine intake. Caffeine absorption and metabolism were normal in PD. Decreased salivary caffeine levels in PD were associated with higher disease severity, longer duration, and the presence of motor complications, no significant association was found with LED. Salivary caffeine decrease correlates with PD progression.

Sign in / Sign up

Export Citation Format

Share Document