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The Impact of Rheologically Controlled Materials on the Identification of Airway Compromise on the Clinical and Videofluoroscopic Swallowing Examinations


Numerous studies have suggested that the clinical evaluation of swallowing fails to adequately identify those patients who aspirate or do not aspirate on a videofluoroscopic swallowing examination. These conclusions, however, are based on comparisons between swallowed materials that were not rheologically matched. The present study used a battery of rheologically matched test materials, involving thin and thick liquids and cohesive and adhesive semisolids. Using these test items, results from a clinical swallow evaluation were compared to the results of a videofluorographic evaluation using identical test materials. Results suggest that the use of three test materials, including thin and thick liquids given in volumes of 5 and 10 ml, demonstrated the strongest associations between cough on the clinical examination and aspiration on the videofluoroscopic examination.

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  1. 1.

    Linden P, Siebens AA: Dysphagia: predicting laryngeal penetration. Arch Phys Med Rehabil 64:281–284, 1983

  2. 2.

    Splaingard ML, Hutchins B, Sulton LD, Chanduri G: Aspiration in rehabilitation patients: videofluoroscopy versus bedside clinical assessment. Arch Phys Med Rehabil 69:637–640, 1988

  3. 3.

    Linden P, Kuhlemeier KV, Patterson C: The probability of correctly predicting subglottic penetration from clinical observations. Dysphagia 8:170–179, 1993

  4. 4.

    Horner J, Massey W, Riski J, Lathrop D, Chase K: Aspiration following stroke: clinical correlates and outcome. Neurology 38:1359–1362, 1988

  5. 5.

    Mann G, Hankey GGJ, Cameron D: Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cardiovasc Dis 10:380–386, 2000

  6. 6.

    Mari F, Matei M, Ceravolo MG, Pisani A, Montesi A, Provinciali L: Predictive value of clinical indices in detecting aspiration in patients with neurological disorders. J Neurol Neurosurg Psychiatry 63:456–460, 1997

  7. 7.

    Daniels SK, McAdam CP, Brailey K, Foundas AL: Clinical assessment of swallowing and prediction of dysphagia severity. Am J Speech Lang Pathol 6:17–23, 1997

  8. 8.

    McCulloch GH, Wertz RT, Rosenbek JC, Dineen C: Clinicians’ preferences and practices in conducting clinical/bedside and videofluoroscopic swallowing examinations in an adult neurogenic population. Am J Speech Lang Pathol 8:149–163, 1999

  9. 9.

    Mills RH: Increasing the precision of the videofluoroscopic swallowing examination. In: RH Mills (ed.): Evaluation of Dysphagia in Adults. Austin, TX: Pro-Ed, pp 103–144, 2000

  10. 10.

    Cichero JAY, Hay G, Murdoch BE, Halley PJ: Videofluoroscopic fluids versus mealtime fluids: differences in viscosity and density made clear. J Med Speech Lang Pathol 5:203–215, 1997

  11. 11.

    Zenner PM, Losinski DS, Mills RH: Using cervical auscultation in the clinical dysphagia examination in long-term care. Dysphagia 10:27–31, 1995

  12. 12.

    Harju A: Development of a diagnostic and nourishment system for people with swallowing disorders. Master’s Thesis, University of Minnesota, 1995

  13. 13.

    Christensen C, Casper LM: Oral and nonoral perception of solution viscosity. J Food Sci 52:445–447, 1987

  14. 14.

    Wood FY: Psychophysical studies on the consistency of liquid foods. In: Rheology and Texture of Foodstuffs. SCI Monogr No. 27:40, 1968

  15. 15.

    Osorio FA, Steffe JF: Back extrusion of power law fluids. J Texture Stud 18:43–63, 1988

  16. 16.

    Bourne MC: Food Texture and Viscosity: Concept and Measurement, 2nd ed. San Diego, CA: Academic Press, 2002

  17. 17.

    Crary MC, Gorham M, Baldwin BO: Relationships between a clinical examination and fluorographic feeding recommendations. Dysphagia 13:124, 1998 (abstract)

  18. 18.

    Sackett DL, Haynes RB, Tugwell P, Guyatt GH: Clinical Epidemiology: A Basic Science for Clinical Medicine. Boston: Little, Brown, 1991

  19. 19.

    Warms T, Richards J: “Wet voice” as a predictor of penetration and aspiration in oropharyngeal dysphagia. Dysphagia 15:84–88, 2000

  20. 20.

    Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL: Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Hear Res 37:1041–1049, 1994

  21. 21.

    Pelletier CA, Lawless HT: Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Dysphagia 18:231–241, 2003

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The authors thank Amy Harju, M.A., R.D., for her help in providing test stimuli from the sensory panels and dietitians in the greater Minneapolis area; Don Tymchuck of Med-Diet Laboratories, Inc., for his inspiration and guidance to begin this work; and Cynthia DuBose, M.A., for her assistance in data collection. This study was supported by a grant from the Sota-Tec Foundation.

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Correspondence to Michael E. Groher PhD.



Table 3 Appendix 1. Formulae for the preparation of liquid viscosities
Table 4 Appendix 2. Formulae for the cohesive and adhesive test samples

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Groher, M.E., Crary, M.A., Carnaby (Mann), G. et al. The Impact of Rheologically Controlled Materials on the Identification of Airway Compromise on the Clinical and Videofluoroscopic Swallowing Examinations. Dysphagia 21, 218–225 (2006).

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  • Dysphagia
  • Aspiration
  • Clinical swallowing examination
  • Videofluoroscopic examination
  • Rheology
  • Deglutition
  • Deglutition disorders