吞咽造影量化分析的信度研究

目的采用自主开发的吞咽造影数字化采集与分析系统进行吞咽造影时间学参数和运动学参数的量化分析，确定该分析方法的信度。 方法选取吞咽功能障碍患者18例，接受标准吞咽造影检查，分别选择质地为3ml、5ml由600kg/m3硫酸钡混悬液调制的稀流质、浓流质、糊状食团，每位受试者共进行6次吞咽。由两名分析者分别对所采集的吞咽造影视频进行间隔时间为4周的2次分析，分析参数包括口腔运送时间、软腭上抬时间、舌骨位移时间、喉关闭时间、环咽肌开放时间、舌骨向前位移、舌骨向上位移、环咽肌开放幅度及咽腔收缩率。 结果不同参数之间信度存在差异，除两名分析者测得的舌骨向前位移（HAM）及向上位移（HSM）的内测信度为0.41～0.60，信度欠佳，以及间测信度为0.61～0.80，信度中等外，其余参数信度均较好。 结论自主开发的吞咽造影数字化采集与分析系统信度比较理想，该软件可用于临床吞咽造影量化分析。     

针刺结合神经肌肉电刺激对脑卒中后咽期吞咽障碍的影响

目的:观察针刺结合神经肌肉电刺激对脑卒中后咽期吞咽障碍患者康复的影响。方法:按随机数字表法将40例脑卒中患者分为2组各20例,对照组给予常规药物治疗、吞咽功能训练和神经肌肉电刺激,观察组在对照组的基础上给予针刺治疗。治疗前后采用表面肌电分析(记录sEMG最大波幅)、透视吞咽功能检查(VFSS)对患者吞咽功能进行评价。结果:治疗20d后,2组患者的sEMG最大波幅、VFSS总评分及咽期VFSS评分明显高于治疗前(P0.05),且观察组更高于对照组(P0.05)。结论:针刺结合神经肌肉电刺激能明显提高脑卒中后咽期吞咽障碍患者的康复效果。     

Research note: Synchronization of timed videofluoroscopic tapes of swallowing with other data channels

A method is described for achieving precise time registration of videotaped images and other simultaneously recorded data channels. A tone burst is superimposed on nonvideo channels as the video timer is stopped for a few frame counts.     

Bolus propulsive activity of the tongue in dysphagic cancer patients

Videofluoroscopic recordings were analyzed for liquid swallows in dysphagic patients with cancer involving the pharynx. Temporal measurements were made for the tongue stripping action in relation to velar and hyoid function. Dysphagic subjects as a group displayed an altered sequence of activity compared to normal controls, with the onset of stripping occurring after velar closure. Tongue stripping action and hyoid movement appeared to be time-locked to a greater extent than tongue stripping and velar closure. Duration of the stripping gesture was longer in dysphagic patients than in normal controls.     

电视透视吞咽检查定量评价脑干梗死患者吞咽障碍特点的临床研究

目的 采用电视透视吞咽检查（VFSS）数字化分析方法,定量分析脑干梗死后吞咽障碍患者吞咽障碍的特点,并分析各项参数与误吸严重程度的相关性。 方法 采用吞咽造影数字化分析方法采集脑干梗死后吞咽障碍患者12例（患者组）和健康受试者10例（健康组）的VFSS影像资料,每例受检者按要求1次性吞咽浓流质5ml,每例完成2次吞咽。分析的参数包括口腔运送时间（OTT）,吞咽反应时间（SRT）,舌骨运动时间（HMT）,食道上括约肌开放时间（UOT）,喉关闭时间（LCT）;同时采用8分制渗漏误吸量表（PAS）评估患者误吸严重程度,并分析各项参数与误吸严重程度的相关性。 结果 患者组的OTT［（3.091±1.803）s］、HMT［（1.498±0.550）s］、LCT［（0.651±0.186）s］与健康组比较,均显著延长,差异均有统计学意义（P<0.05）,且SRT与误吸严重程度呈正相关（r=0.440,P=0.032）。 结论 脑干梗死患者的吞咽障碍表现涉及口腔期及咽期。OTT、HMT、LCT等参数可用于脑干梗死后吞咽障碍的评估,SRT可用于预测误吸的发生。     

The Dysphagia Outcome and Severity Scale

The Dysphagia Outcome and Severity Scale (DOSS) is a simple, easy-to-use, 7-point scale developed to systematically rate the functional severity of dysphagia based on objective assessment and make recommendations for diet level, independence level, and type of nutrition. Intra- and interjudge reliabilities of the DOSS was established by four clinicians on 135 consecutive patients who underwent a modified barium swallow procedure at a large teaching hospital. Patients were assigned a severity level, independence level, and nutritional level based on three areas most associated with final recommendations: oral stage bolus transfer, pharyngeal stage retention, and airway protection. Results indicate high interrater (90%) and intrarater (93%) agreement with this scale. Implications are suggested for use of the DOSS in documenting functional outcomes of swallowing and diet status based on objective assessment.     

How Thick Is Thick? Multicenter Study of the Rheological and Material Property Characteristics of Mealtime Fluids and Videofluoroscopy Fluids

Objective rheological assessment of fluids given to dysphagic patients at mealtime and during videofluoroscopy was carried out using a multicenter format. Thin, quarter-thick, half-thick and full-thick fluids were examined for the degree of correlation between mealtime fluids and their allegedly matched videofluoroscopy counterparts. The study was carried out to determine whether perceived subjective differences between mealtime fluids and videofluoroscopy fluids could be quantified using the rheological parameters of viscosity, density, and yield stress. The results showed poor correlation between mealtime fluids and videofluoroscopy fluids over all parameters. In general, the videofluoroscopy fluids were more viscous, more dense, and showed higher yield stress values than their mealtime counterparts. Given these results, it is reasonable to assume that the fluids used during videofluoroscopy do not provide an accurate indication of swallowing ability at mealtime. Therefore, it is suggested that clinicians use objective methods to rheologically match videofluoroscopy fluids to mealtime fluids.     

Evaluating Swallowing Dysfunction Using a 100-ml Water Swallowing Test

This study used comparison with videofluoroscopic examination of swallowing (VFES) to examine the validity of a 100-ml water swallowing test (WST) in assessing swallowing dysfunction. Fifty-nine consecutive outpatients (15 females, 44 males) with clinically suspected dysphagia were enrolled in this study. Each subject underwent a 100-ml WST followed by VFES. Data was obtained on swallowing speed and signs of choking (coughing and a wet-hoarse voice). The analytical results revealed that 49 subjects had abnormal swallowing speeds (< 10 ml/s) in the 100-ml WST, and 47 of them were identified as having dysphagia by VFES. Among the ten participants with normal swallowing speed (> 10 ml/s), eight were diagnosed with dysphagia by VFES. Notably, 14 participants choked in the 100-ml WST, 11 of whom exhibited aspiration or penetration in VFES. Among the 45 participants without choking in WST, 12 displayed aspiration or penetration in VFES. The sensitivity of swallowing speed in detecting the swallowing dysfunction was 85.5%, and the specificity was 50%. Moreover, the sensitivity of using choking or wet-horse voice in the 100-ml WST as the sole factor for predicting the presence of aspiration was 47.8%, while the specificity was 91.7%. Therefore, this study concluded that swallowing speed is a sensitive indicator for identifying patients at risk for swallowing dysfunction. Moreover, choking in the 100-ml WST may be a potential specific indicator for followup aspiration.     

Impact of the diagnostic procedure on outcome measures of swallowing rehabilitation in head and neck cancer patients

This study was designed to determine whether swallow rehabilitation outcomes were affected by the type of evaluation procedure utilized by the clinician. The two evaluation techniques compared were the bedside examination and videofluoroscopy (the modified barium swallow). Ten institutions participated in this study, enrolling a total of 103 partial laryngectomized patients, 21 in the bedside arm and 82 in the videofluoroscopy arm. Data on recovery of oral intake were collected weekly. All patients received an X-ray study of swallow at 3 months after the operation. Mean time to oral intake of food was significantly lower in patients assessed with bedside examination. Overall swallow measures of transit times and swallow efficiencies after 3 months revealed significantly better function in the videofluoroscopy group. Results are discussed in terms of the visibility of swallow physiology with the two assessment techniques, the accuracy of therapy planning with the bedside examination versus videofluoroscopy and the ability of head and neck cancer patients to tolerate some aspiration without developing aspiration pneumonia. This research was funded by NIH grant PO1 CA40007     

Radiation Dose in Videofluoroscopic Swallow Studies

Videofluoroscopy has become an increasingly important armament in the investigation and assessment of swallowing disorders. However, very little work has been published on the radiation dose used in such examinations and currently there is no national diagnostic reference level in the United Kingdom. Videofluoroscopy in our hospital is performed predominantly by one radiologist (IZM) in a single fluoroscopy room. We recorded the screening times of 230 patients over a 45-month period. Screening time ranged from 18 to 564 s (median = 171 s) associated with a median dose-area product of 1.4 Gy cm². This is below the third quartile level of 2.7 Gy cm² for all such examinations performed across the northern England. The effective dose associated with a typical videofluoroscopy dose-area product is 0.2 mSv. Videofluoroscopy is the most appropriate instrumental examination for assessing oropharyngeal swallow biomechanics and intervention strategies. This data set is based on the largest number of videofluoroscopy swallow studies published to date. Our results show that videofluoroscopy can be performed using minimal radiation doses. This study was performed at Freeman Hospital, Newcastle upon Tyne, UK.