17. A Scientific Comparison of Three Tests for Swallowing Dysfunction That Are Not Reliant on Access to VF or FEES Facilities

Introduction Oral Pharyngeal Dysphagia (OPD) is a debilitating swallowing dysfunction that can lead to mortality through pneumonia, and severely impacts quality of life. Identifying the disease and tracking its rehabilitation is difficult when only expensive and scarce diagnostic tools are available. This study investigates three simple tests for OPD and employs sophisticated statistical tools to prove their degree of correlation. Objectives To compare the Timed Water Swallow Test (TWST) with a Meal Observation Test (MOT) and Visual Analogue Scale (VAS) as tools for detecting OPD and its treatment. Methods Non-hospitalized stroke patients (n = 22) with OPD (median 15.5 months after stroke) were assessed using TWST (ml/s), a 5-item MOT (score 0-4), and a VAS (0- 100 mm) for swallowing difficulties: at baseline, at 3 month end-of treatment and at long term follow-up -averagely 14 months post treatment. Results All tests correctly identified almost all patients as having pathological levels for OPD at baseline. There was very good correlation of the three tests’ results at baseline, end-of-treatment and at long term follow-up. Conclusions It seems that TWST has the widest degree of scientific evidence, and that both MOT and VAS give similar levels of certainty in diagnosing OPD. The lack of correlation of VAS with the other test methodologies suggests that caution is needed when deploying this method alone in patient evaluation; this may because of the hypothesised phenomenon of the patient’s observation baseline changing over time. This study demonstrates powerful alternatives to the clinician when preferred, or when more specialist VF or FEES resources are not readily available.

Dysphagia: A study to show the validity of three simple tests for swallowing difficulties, and the effectiveness of IQoro in treating this condition.

Peer reviewed, Prospective, Cohort pre- and post- study.

Oral Pharyngeal Dysphagia (OPD) is a debilitating swallowing dysfunction that can lead to mortality through pneumonia, and severely impacts quality of life. Identifying the disease and tracking its rehabilitation is difficult when only expensive and scarce diagnostic tools are available.

To compare the Timed Water Swallow Test (TWST) with a Meal Observation Test (MOT) and Visual Analogue Scale (VAS) as tools for detecting Oral Pharyngeal Dysphagia (OPD) and its treatment.

22 patients, F = 7, M = 15, median age 69 years (range 47 – 82) with OPD (median 15.5 months after stroke)

Inclusion criteria:

• long-standing OPD as assessed by the referring physicians
• first-ever stroke
• no other central neurological diseases
• the ability to cooperate

Initially a total of 48 patients had been referred, 26 of whom could not complete the study: 18 mortalities, 5 new stroke, and 3 unable to cooperate or tube-fed, leaving 22.

Patients were assessed using three different outcome measures for swallowing difficulties at three time points: before treatment, at end of treatment and at late follow up (averagely 14 months post-treatment). Treatment consisted of one of two alternative methods:

• IQoro neuromuscular training 30 seconds, three times per day for 3 months, or
• palatal plate therapy 30 minutes, three times per day for 3 months