Katlyn Elizabeth McGrattan1,2, Heather C McGhee3,4, Keeley L McKelvey3,4, Clarice S Clemmens5, Elizabeth G Hill6, Allan DeToma6, Jeanne G Hill7, Cephus E Simmons7, Bonnie Martin-Harris3,5,8. 1. Department of Speech-Language and Hearing Sciences, University of Minnesota, 164 Pillsbury Drive SE, Minneapolis, MN, 55455, USA. kmcgratt@umn.edu. 2. Department of Otolaryngology, Boston Children's Hospital, Boston, MA, USA. kmcgratt@umn.edu. 3. Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC, USA. 4. Department of Speech Language Pathology, Medical University of South Carolina, Charleston, SC, USA. 5. Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA. 6. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA. 7. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. 8. Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA.
Abstract
BACKGROUND: Infant videofluoroscopic swallow studies (VFSSs) require clinicians to make determinations about swallowing deficits based on a limited number of fluoroscopically observed swallows. Although airway protection is known to decline throughout a bottle-feed, the paucity of data regarding the timing of this degradation has limited the development of procedural protocols that maximize diagnostic validity. OBJECTIVE: We tested the stability of key components of swallow physiology and airway protection at four standardized timepoints throughout the VFSS. MATERIALS AND METHODS: Thirty bottle-fed infants with clinical signs of swallow dysfunction underwent VFSS. Fluoroscopy was turned on to allow visualization of five swallows at 0:00, 0:30, 1:30 and 2:30 (minutes:seconds [min:s]). We evaluated swallows for components of swallow physiology (oral bolus hold, initiation of pharyngeal swallow, timing of swallow initiation) and airway protection (penetration, aspiration). We used model-based linear contrasts to test differences in the percentage of swallows with low function component attributes. RESULTS: All components of swallow physiology exhibited a change throughout the VFSS (P≤0.0005). Changes were characterized by an increase in the number of sucks per swallow (P<0.0001), percentage of swallows with incomplete bolus hold (P=0.0005), delayed initiation of pharyngeal swallow (P<0.0001), delayed timing of swallow initiation (P=0.0004) and bolus airway entry (P<0.0001). These findings demonstrate that infants with dysphagia exhibit a change in swallow physiology throughout the videofluoroscopic swallow exam. CONCLUSION: Fluoroscopic visualization that is confined to the initial swallows of the bottle feed limit the exam's diagnostic validity. Developing evidence-based procedural guidelines for infant VFSS execution is crucial for maximizing the exam's diagnostic and treatment yield.
BACKGROUND:Infant videofluoroscopic swallow studies (VFSSs) require clinicians to make determinations about swallowing deficits based on a limited number of fluoroscopically observed swallows. Although airway protection is known to decline throughout a bottle-feed, the paucity of data regarding the timing of this degradation has limited the development of procedural protocols that maximize diagnostic validity. OBJECTIVE: We tested the stability of key components of swallow physiology and airway protection at four standardized timepoints throughout the VFSS. MATERIALS AND METHODS: Thirty bottle-fed infants with clinical signs of swallow dysfunction underwent VFSS. Fluoroscopy was turned on to allow visualization of five swallows at 0:00, 0:30, 1:30 and 2:30 (minutes:seconds [min:s]). We evaluated swallows for components of swallow physiology (oral bolus hold, initiation of pharyngeal swallow, timing of swallow initiation) and airway protection (penetration, aspiration). We used model-based linear contrasts to test differences in the percentage of swallows with low function component attributes. RESULTS: All components of swallow physiology exhibited a change throughout the VFSS (P≤0.0005). Changes were characterized by an increase in the number of sucks per swallow (P<0.0001), percentage of swallows with incomplete bolus hold (P=0.0005), delayed initiation of pharyngeal swallow (P<0.0001), delayed timing of swallow initiation (P=0.0004) and bolus airway entry (P<0.0001). These findings demonstrate that infants with dysphagia exhibit a change in swallow physiology throughout the videofluoroscopic swallow exam. CONCLUSION: Fluoroscopic visualization that is confined to the initial swallows of the bottle feed limit the exam's diagnostic validity. Developing evidence-based procedural guidelines for infant VFSS execution is crucial for maximizing the exam's diagnostic and treatment yield.
Authors: William Christopher Lang; Neil R M Buist; Annmarie Geary; Scott Buckley; Elizabeth Adams; Albyn C Jones; Stephen Gorsek; Susan C Winter; Hanh Tran; Brian R Rogers Journal: Dysphagia Date: 2010-09-19 Impact factor: 3.438
Authors: Maureen A Lefton-Greif; Katlyn Elizabeth McGrattan; Kathryn A Carson; Jeanne M Pinto; Jennifer M Wright; Bonnie Martin-Harris Journal: Dysphagia Date: 2017-09-11 Impact factor: 3.438
Authors: Katlyn Elizabeth McGrattan; Robert J Graham; Christine J DiDonato; Basil T Darras Journal: Am J Speech Lang Pathol Date: 2021-04-06 Impact factor: 2.408