Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Use of the Penetration-Aspiration Scale in Dysphagia Research: A Systematic Review

Abstract

The penetration-aspiration scale (PAS) is an 8-point scale used to characterize the depth and response to airway invasion during videofluoroscopy. Though widely used in the field of deglutition, there is a lack of consensus regarding the statistical properties of the scale. In order to better understand the state of the literature and the statistical use of the PAS, a systematic review was undertaken to descriptively examine trends in statistical and reporting practices of the PAS since its inception. Online databases were searched for studies citing the original PAS article, which yielded 754 unique articles. Of these, 183 studies were included in the review. Results showed inconsistencies in the statistical use of the scale; 79 studies treated the PAS as ordinal, 71 as categorical, and 49 as interval. Ten types of categorizations were identified. Reporting of power analyses (9%), as well as inter- (26%) and intra-rater (17%) reliability, was uncommon. Among studies that administered multiple bolus volumes or consistencies, 55% reported PAS analyses at the participant/group level only. This review confirms the existence of discrepancies in the statistical treatment of the PAS. A lack of consensus among researchers limits comparisons between studies. The approach to handling this scale dictates the statistical tests used, potentially affecting results and interpretations. Consistent application of statistically sound approaches to PAS analyses is vital for the future of deglutition research.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Data Availability

Data are available on the Open Science Framework at the following url: https://osf.io/5m2r7/

References

  1. 1.

    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8.

  2. 2.

    Steele CM, Grace-Martin K. Reflections on clinical and statistical use of the penetration-aspiration scale. Dysphagia. 2017;32(5):601–16.

  3. 3.

    Sullivan LM. Essentials of biostatistics in public health. 3rd ed. Massachusetts: Jones & Bartlett Learning; 2018.

  4. 4.

    McCullough G, Rosenbek J. Ordinality and intervality of a penetration-aspiration scale. J Med Speech Lang Pathol. 1998;6:65–72.

  5. 5.

    McCullough GH, Wertz RT, Rosenbek JC, Mills RH, Webb WG, Ross KB. Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures. Dysphagia. 2001;16(2):110–8.

  6. 6.

    Hind JA, Gensler G, Brandt DK, Gardner PJ, Blumenthal L, Gramigna GD, et al. Comparison of trained clinician ratings with expert ratings of aspiration on videofluoroscopic images from a randomized clinical trial. Dysphagia. 2009;24(2):211–7.

  7. 7.

    Stoeckli SJ, Huisman TA, Seifert B, Martin-Harris BJ. Interrater reliability of videofluoroscopic swallow evaluation. Dysphagia. 2003;18(1):53–7.

  8. 8.

    Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.

  9. 9.

    Allen J, Blair D, Miles A. Assessment of videofluoroscopic swallow study findings before and after cricopharyngeal myotomy. Head Neck. 2017;39(9):1869–75.

  10. 10.

    Arrese LC, Carrau R, Plowman EK. Relationship between the eating assessment tool-10 and objective clinical ratings of swallowing function in individuals with head and neck cancer. Dysphagia. 2017;32(1):83–9.

  11. 11.

    Serel Arslan S, Demir N, Karaduman AA. The anxiety level of caregivers of neurological patients with dysphagia. Dysphagia. 2017;32(4):570–4.

  12. 12.

    Bhattacharyya N, Kotz T, Shapiro J. Dysphagia and aspiration with unilateral vocal cord immobility: incidence, characterization, and response to surgical treatment. Ann Otol Rhinol Laryngol. 2002;111(8):672–9.

  13. 13.

    Bhattacharyya N, Kotz T, Shapiro J. The effect of bolus consistency on dysphagia in unilateral vocal cord paralysis. Otolaryngol Head Neck Surg. 2003;129(6):632–6.

  14. 14.

    Bonilha HS, Blair J, Carnes B, Huda W, Humphries K, McGrattan K, et al. Preliminary investigation of the effect of pulse rate on judgments of swallowing impairment and treatment recommendations. Dysphagia. 2013;28(4):528–38.

  15. 15.

    Borggreven PA, Verdonck-de Leeuw I, Rinkel RN, Langendijk JA, Roos JC, David EF, et al. Swallowing after major surgery of the oral cavity or oropharynx: a prospective and longitudinal assessment of patients treated by microvascular soft tissue reconstruction. Head Neck. 2007;29(7):638–47.

  16. 16.

    Cartmill B, Cornwell P, Ward E, Davidson W, Porceddu S. A prospective investigation of swallowing, nutrition, and patient-rated functional impact following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer. Dysphagia. 2012;27(1):32–45.

  17. 17.

    Cartmill B, Cornwell P, Ward E, Davidson W, Porceddu S. Swallowing, nutrition and patient-rated functional outcomes at 6 months following two non-surgical treatments for T1-T3 oropharyngeal cancer. Support Care Cancer. 2012;20(9):2073–81.

  18. 18.

    Cvejic L, Harding R, Churchward T, Turton A, Finlay P, Massey D, et al. Laryngeal penetration and aspiration in individuals with stable COPD. Respirology. 2011;16(2):269–75.

  19. 19.

    Daniels SK, Schroeder MF, DeGeorge PC, Corey DM, Rosenbek JC. Effects of verbal cue on bolus flow during swallowing. Am J Speech Lang Pathol. 2007;16(2):140–7.

  20. 20.

    Daniels SK, Corey DM, Hadskey LD, Legendre C, Priestly DH, Rosenbek JC, et al. Mechanism of sequential swallowing during straw drinking in healthy young and older adults. J Speech Lang Hear Res. 2004;47(1):33–45.

  21. 21.

    Drozdz DR, Costa CC, Jesus PR, Trindade MS, Weiss G, Neto AB, et al. Pharyngeal swallowing phase and chronic cough. Int Arch Otorhinolaryngol. 2012;16(4):502–8.

  22. 22.

    Eom MJ, Chang MY, Oh DH, Kim HD, Han NM, Park JS. Effects of resistance expiratory muscle strength training in elderly patients with dysphagic stroke. NeuroRehabilitation. 2017;41(4):747–52.

  23. 23.

    Falsetti P, Acciai C, Palilla R, Bosi M, Carpinteri F, Zingarelli A, et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis. 2009;18(5):329–35.

  24. 24.

    Gillespie MB, Brodsky MB, Day TA, Sharma AK, Lee FS, Martin-Harris B. Laryngeal penetration and aspiration during swallowing after the treatment of advanced oropharyngeal cancer. Arch Otolaryngol Head Neck Surg. 2005;131(7):615–9.

  25. 25.

    Gross RD, Gisser R, Cherpes G, Hartman K, Maheshwary R. Subclinical dysphagia in persons with Prader–Willi syndrome. Am J Med Genet A. 2017;173(2):384–94.

  26. 26.

    Hashizume A, Banno H, Katsuno M, Hijikata Y, Yamada S, Inagaki T, et al. Quantitative assessment of swallowing dysfunction in patients with spinal and bulbar muscular atrophy. Intern Med. 2017;56(23):3159–65.

  27. 27.

    Hedström J, Tuomi L, Andersson M, Dotevall H, Osbeck H, Finizia C. Within-bolus variability of the penetration-aspiration scale across two subsequent swallows in patients with head and neck cancer. Dysphagia. 2017;32(5):683–90.

  28. 28.

    Hind JA, Nicosia MA, Roecker EB, Carnes ML, Robbins J. Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. Arch Phys Med Rehabil. 2001;82(12):1661–5.

  29. 29.

    Huang KL, Liu TY, Huang YC, Leong CP, Lin WC, Pong YP. Functional outcome in acute stroke patients with oropharyngeal dysphagia after swallowing therapy. J Stroke Cerebrovasc Dis. 2014;23(10):2547–53.

  30. 30.

    Hutcheson KA, Barrow MP, Warneke CL, Wang Y, Eapen G, Lai SY, et al. Cough strength and expiratory force in aspirating and nonaspirating postradiation head and neck cancer survivors. Laryngoscope. 2018;128(7):1615–21.

  31. 31.

    Kang JY, Choi KH, Yun GJ, Kim MY, Ryu JS. Does removal of tracheostomy affect dysphagia?A kinematic analysis. Dysphagia. 2012;27(4):498–503.

  32. 32.

    Kim L, Chun MH, Kim BR, Lee SJ. Effect of repetitive transcranial magnetic stimulation on patients with brain injury and dysphagia. Ann Rehabil Med. 2011;35(6):765–71.

  33. 33.

    Kim SK, Mo SJ, Moon WS, Jun PS, Kim CR. Effects of cervical kyphosis on recovery from dysphagia after stroke. Ann Rehabil Med. 2016;40(5):816–25.

  34. 34.

    Kim SB, Lee SJ, Lee KW, Lee JH, Kim DW. Usefulness of early videofluoroscopic swallowing study in acute stroke patients with dysphagia. Ann Rehabil Med. 2018;42(1):42–51.

  35. 35.

    Lee HY, Hong JS, Lee KC, Shin YK, Cho SR. Changes in hyolaryngeal movement and swallowing function after neuromuscular electrical stimulation in patients with dysphagia. Ann Rehabil Med. 2015;39(2):199–209.

  36. 36.

    Lee KL, Kim WH, Kim EJ, Lee JK. Is swallowing of all mixed consistencies dangerous for penetration-aspiration? Am J Phys Med Rehabil. 2012;91(3):187–92.

  37. 37.

    Lee JH, Lee KW, Kim SB, Lee SJ, Chun SM, Jung SM. The functional dysphagia scale is a useful tool for predicting aspiration pneumonia in patients with Parkinson disease. Ann Rehabil Med. 2016;40(3):440–6.

  38. 38.

    Lee KL, Kim DY, Kim WH, Kim EJ, Lee WS, Hahn SJ, et al. The influence of sour taste on dysphagia in brain injury: blind study. Ann Rehabil Med. 2012;36(3):365–70.

  39. 39.

    Leonard RJ, White C, McKenzie S, Belafsky PC. Effects of bolus rheology on aspiration in patients with dysphagia. J Acad Nutr Diet. 2014;114(4):590–4.

  40. 40.

    Lim KB, Lee HJ, Yoo J, Kwon YG. Effect of low-frequency rTMS and NMES on subacute unilateral hemispheric stroke with dysphagia. Ann Rehabil Med. 2014;38(5):592–602.

  41. 41.

    Lim KB, Lee HJ, Lim SS, Choi YI. Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a randomized controlled trial. J Rehabil Med. 2009;41(3):174–8.

  42. 42.

    Lin WS, Chou CL, Chang MH, Chung YM, Lin FG, Tsai PY. Vagus nerve magnetic modulation facilitates dysphagia recovery in patients with stroke involving the brainstem—a proof of concept study. Brain Stimul. 2018;11(2):264–70.

  43. 43.

    Maruo T, Fujimoto Y, Ozawa K, Hiramatsu M, Suzuki A, Nishio N, et al. Laryngeal sensation and pharyngeal delay time after (chemo)radiotherapy. Eur Arch Otorhinolaryngol. 2014;271(8):2299–304.

  44. 44.

    Michou E, Mistry S, Jefferson S, Singh S, Rothwell J, Hamdy S. Targeting unlesioned pharyngeal motor cortex improves swallowing in healthy individuals and after dysphagic stroke. Gastroenterology. 2012;142(1):29–38.

  45. 45.

    Mituuti CT, Arone MMADS, Rosa RR, Berretin-Felix G. Effects of sensory neuromuscular electrical stimulation on swallowing in the elderly affected by stroke. Top Geriatr Rehabil. 2018;34(1):71–81.

  46. 46.

    Molfenter SM, Hsu CY, Lu Y, Lazarus CL. Alterations to swallowing physiology as the result of effortful swallowing in healthy seniors. Dysphagia. 2018;33(3):380–8.

  47. 47.

    Moon JH, Jung JH, Won YS, Cho HY, Cho K. Effects of expiratory muscle strength training on swallowing function in acute stroke patients with dysphagia. J Phys Ther Sci. 2017;29(4):609–12.

  48. 48.

    Murono S, Hamaguchi T, Yoshida H, Nakanishi Y, Tsuji A, Endo K, et al. Evaluation of dysphagia at the initial diagnosis of amyotrophic lateral sclerosis. Auris Nasus Larynx. 2015;42(3):213–7.

  49. 49.

    Muss L, Wilmskoetter J, Richter K, Fix C, Stanschus S, Pitzen T, et al. Changes in swallowing after anterior cervical discectomy and fusion with instrumentation: a presurgical versus postsurgical videofluoroscopic comparison. J Speech Lang Hear Res. 2017;60(4):785–93.

  50. 50.

    Nayak VK, Bhattacharyya N, Kotz T, Shapiro J. Patterns of swallowing failure following medialization in unilateral vocal fold immobility. Laryngoscope. 2002;112(10):1840–4.

  51. 51.

    O’Rourke A, Humphries K, Lazar A, Martin-Harris B. The pharyngeal contractile integral is a useful indicator of pharyngeal swallowing impairment. Neurogastroenterol Motil. 2017;29(12):e13144.

  52. 52.

    Omari TI, Dejaeger E, Tack J, Van Beckevoort D, Rommel N. Effect of bolus volume and viscosity on pharyngeal automated impedance manometry variables derived for broad dysphagia patients. Dysphagia. 2013;28(2):146–52.

  53. 53.

    Omari TI, Papathanasopoulos A, Dejaeger E, Wauters L, Scarpellini E, Vos R, et al. Reproducibility and agreement of pharyngeal automated impedance manometry with videofluoroscopy. Clin Gastroenterol Hepatol. 2011;9(10):862–7.

  54. 54.

    Park DH, Chun MH, Lee SJ, Song YB. Comparison of swallowing functions between brain tumor and stroke patients. Ann Rehabil Med. 2013;37(5):633–41.

  55. 55.

    Park JS, An DH, Oh DH, Chang MY. Effect of chin tuck against resistance exercise on patients with dysphagia following stroke: a randomized pilot study. NeuroRehabilitation. 2018;42(2):191–7.

  56. 56.

    Park GW, Kim SK, Lee CH, Kim CR, Jeong HJ, Kim DK. Effect of chronic obstructive pulmonary disease on swallowing function in stroke patients. Ann Rehabil Med. 2015;39(2):218–25.

  57. 57.

    Park JS, Hwang NK, Oh DH, Chang MY. Effect of head lift exercise on kinematic motion of the hyolaryngeal complex and aspiration in patients with dysphagic stroke. J Oral Rehabil. 2017;44(5):385–91.

  58. 58.

    Park JS, Oh DH, Chang MY, Kim KM. Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial. J Oral Rehabil. 2016;43(5):364–72.

  59. 59.

    Park JS, Oh DH, Hwang NK, Lee JH. Effects of neuromuscular electrical stimulation in patients with Parkinson’s disease and dysphagia: a randomized, single-blind, placebo-controlled trial. NeuroRehabilitation. 2018;42(4):457–63.

  60. 60.

    Park JW, Kim Y, Oh JC, Lee HJ. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study. Dysphagia. 2012;27(4):521–7.

  61. 61.

    Park JW, Sim GJ, Yang DC, Lee KH, Chang JH, Nam KY, et al. Increased bolus volume effect on delayed pharyngeal swallowing response in post-stroke oropharyngeal dysphagia: a pilot study. Ann Rehabil Med. 2016;40(6):1018–23.

  62. 62.

    Park D, Woo SB, Lee DH, Yu KJ, Cho JY, Kim JM, et al. The correlation between clinical characteristics and radionuclide salivagram findings in patients with brain lesions: a preliminary study. Ann Rehabil Med. 2017;41(6):915–23.

  63. 63.

    Park JW, Oh JC, Lee JW, Yeo JS, Ryu KH. The effect of 5Hz high-frequency rTMS over contralesional pharyngeal motor cortex in post-stroke oropharyngeal dysphagia: a randomized controlled study. Neurogastroenterol Motil. 2013;25(4):324.

  64. 64.

    Pearson WG, Davidoff AA, Smith ZM, Adams DE, Langmore SE. Impaired swallowing mechanics of post radiation therapy head and neck cancer patients: a retrospective videofluoroscopic study. World J Radiol. 2016;8(2):192–9.

  65. 65.

    Pitts T, Bolser D, Rosenbek J, Troche M, Okun MS, Sapienza C. Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Chest. 2009;135(5):1301–8.

  66. 66.

    Power ML, Hamdy S, Singh S, Tyrrell PJ, Turnbull I, Thompson DG. Deglutitive laryngeal closure in stroke patients. J Neurol Neurosurg Psychiatry. 2007;78(2):141–6.

  67. 67.

    Pryor LN, Ward EC, Cornwell PL, O’Connor SN, Finnis ME, Chapman MJ. Impact of nasogastric tubes on swallowing physiology in older, healthy subjects: a randomized controlled crossover trial. Clin Nutr. 2015;34(4):572–8.

  68. 68.

    Restivo DA, Casabona A, Nicotra A, Zappia M, Elia M, Romano MC, et al. ALS dysphagia pathophysiology: differential botulinum toxin response. Neurology. 2013;80(7):616–20.

  69. 69.

    Robbins J, Coyle J, Rosenbek J, Roecker E, Wood J. Differentiation of normal and abnormal airway protection during swallowing using the penetration-aspiration scale. Dysphagia. 1999;14(4):228–32.

  70. 70.

    Rofes L, Arreola V, Martin A, Clavé P. Effect of oral piperine on the swallow response of patients with oropharyngeal dysphagia. J Gastroenterol. 2014;49(12):1517–23.

  71. 71.

    Rofes L, Arreola V, López I, Martin A, Sebastián M, Ciurana A, et al. Effect of surface sensory and motor electrical stimulation on chronic poststroke oropharyngeal dysfunction. Neurogastroenterol Motil. 2013;25(11):888.

  72. 72.

    Rofes L, Arreola V, Mukherjee R, Swanson J, Clavé P. The effects of a xanthan gum-based thickener on the swallowing function of patients with dysphagia. Aliment Pharmacol Ther. 2014;39(10):1169–79.

  73. 73.

    Russo AD, Reckziegel ER, Krum-Santos AC, Augustin MC, Scheeren B, Freitas CD, et al. Clinical scales predict significant videofluoroscopic dysphagia in machado joseph disease patients. Mov Disord Clin Pract. 2015;2(3):260–6.

  74. 74.

    Sawan T, Harris ML, Kobylecki C, Baijens L, van Hooren M, Michou E. Lung function testing. Mov Disord Clin Pract. 2016;3(2):146–50.

  75. 75.

    Sdravou K, Walshe M, Dagdilelis L. Effects of carbonated liquids on oropharyngeal swallowing measures in people with neurogenic dysphagia. Dysphagia. 2012;27(2):240–50.

  76. 76.

    Serel S, Demir N, Karaduman A, Cengiz M, Yakut Y. Head and neck cancer: changes in artrokinematic parameters of neck and swallowing function after radiotherapy. Int J Hematol Oncol. 2013;23(2):97–103.

  77. 77.

    Starmer HM, Quon H, Kumar R, Alcorn S, Murano E, Jones B, et al. The effect of radiation dose on swallowing: evaluation of aspiration and kinematics. Dysphagia. 2015;30(4):430–7.

  78. 78.

    Steele CM, Bayley MT, Peladeau-Pigeon M, Nagy A, Namasivayam AM, Stokely SL, et al. A randomized trial comparing two tongue-pressure resistance training protocols for post-stroke dysphagia. Dysphagia. 2016;31(3):452–61.

  79. 79.

    Tabor L, Gaziano J, Watts S, Robison R, Plowman EK. Defining swallowing-related quality of life profiles in individuals with amyotrophic lateral sclerosis. Dysphagia. 2016;31(3):376–82.

  80. 80.

    Troche MS, Okun MS, Rosenbek JC, Altmann LJ, Sapienza CM. Attentional resource allocation and swallowing safety in Parkinson’s disease: a dual task study. Parkinsonism Relat Disord. 2014;20(4):439–43.

  81. 81.

    Troche MS, Brandimore AE, Okun MS, Davenport PW, Hegland KW. Decreased cough sensitivity and aspiration in Parkinson disease. Chest. 2014;146(5):1294–9.

  82. 82.

    Troche MS, Rosenbek JC, Okun MS, Sapienza CM. Detraining outcomes with expiratory muscle strength training in Parkinson disease. J Rehabil Res Dev. 2014;51(2):305–10.

  83. 83.

    Troche MS, Sapienza CM, Rosenbek JC. Effects of bolus consistency on timing and safety of swallow in patients with Parkinson’s disease. Dysphagia. 2008;23(1):26–32.

  84. 84.

    Vogel AP, Rommel N, Oettinger A, Horger M, Krumm P, Kraus EM, et al. Speech and swallowing abnormalities in adults with POLG associated ataxia (POLG-A). Mitochondrion. 2017;37:1–7.

  85. 85.

    Woisard-Bassols V, Alshehri S, Simonetta-Moreau M. The effects of botulinum toxin injections into the cricopharyngeus muscle of patients with cricopharyngeus dysfunction associated with pharyngo-laryngeal weakness. Eur Arch Otorhinolaryngol. 2013;270(3):805–15.

  86. 86.

    Yamada Y, Kawakami M, Wada A, Otsuka T, Muraoka K, Liu M. A comparison of swallowing dysfunction in Becker muscular dystrophy and Duchenne muscular dystrophy. Disabil Rehabil. 2018;40(12):1421–5.

  87. 87.

    Yang CJ, Roh JL, Choi KH, Kim MJ, Choi SH, Nam SY, et al. Pretreatment dysphagia inventory and videofluorographic swallowing study as prognostic indicators of early survival outcomes in head and neck cancer. Cancer. 2015;121(10):1588–98.

  88. 88.

    Agarwal J, Palwe V, Dutta D, Gupta T, Laskar SG, Budrukkar A, et al. Objective assessment of swallowing function after definitive concurrent (chemo)radiotherapy in patients with head and neck cancer. Dysphagia. 2011;26(4):399–406.

  89. 89.

    Argolo N, Sampaio M, Pinho P, Melo A, Nóbrega AC. Videofluoroscopic predictors of penetration-aspiration in Parkinson’s disease patients. Dysphagia. 2015;30(6):751–8.

  90. 90.

    Arslan SS, Demir N, Kılınç HE, Karaduman AA. The ability of the eating assessment tool-10 to detect aspiration in patients with neurological disorders. J Neurogastroenterol Motil. 2017;23(4):550–4.

  91. 91.

    Brodsky MB, McFarland DH, Dozier TS, Blair J, Ayers C, Michel Y, et al. Respiratory-swallow phase patterns and their relationship to swallowing impairment in patients treated for oropharyngeal cancer. Head Neck. 2010;32(4):481–9.

  92. 92.

    Caglar HB, Tishler RB, Othus M, Burke E, Li Y, Goguen L, et al. Dose to larynx predicts for swallowing complications after intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72(4):1110–8.

  93. 93.

    Daniels SK, Pathak S, Mukhi SV, Stach CB, Morgan RO, Anderson JA. The relationship between lesion localization and dysphagia in acute stroke. Dysphagia. 2017;32(6):777–84.

  94. 94.

    Dietsch AM, Rowley CB, Solomon NP, Pearson WG. Swallowing mechanics associated with artificial airways, bolus properties, and penetration-aspiration status in trauma patients. J Speech Lang Hear Res. 2017;60(9):2442–51.

  95. 95.

    Ellerston JK, Heller AC, Houtz DR, Kendall KA. Quantitative measures of swallowing deficits in patients with Parkinson’s disease. Ann Otol Rhinol Laryngol. 2016;125(5):385–92.

  96. 96.

    Guillén-Solà A, Chiarella SC, Martínez-Orfila J, Duarte E, Alvarado-Panesso M, Figueres-Cugat A, et al. Usefulness of citric cough test for screening of silent aspiration in subacute stroke patients: a prospective study. Arch Phys Med Rehabil. 2015;96(7):1277–83.

  97. 97.

    Guillén-Solà A, Messagi Sartor M, Bofill Soler N, Duarte E, Barrera MC, Marco E. Respiratory muscle strength training and neuromuscular electrical stimulation in subacute dysphagic stroke patients: a randomized controlled trial. Clin Rehabil. 2017;31(6):761–71.

  98. 98.

    Hegland KW, Okun MS, Troche MS. Sequential voluntary cough and aspiration or aspiration risk in Parkinson’s disease. Lung. 2014;192(4):601–8.

  99. 99.

    Hoffman MR, Mielens JD, Omari TI, Rommel N, Jiang JJ, McCulloch TM. Artificial neural network classification of pharyngeal high-resolution manometry with impedance data. Laryngoscope. 2013;123(3):713–20.

  100. 100.

    Hoffman MR, Jones CA, Geng Z, Abelhalim SM, Walczak CC, Mitchell AR, et al. Classification of high-resolution manometry data according to videofluoroscopic parameters using pattern recognition. Otolaryngol Head Neck Surg. 2013;149(1):126–33.

  101. 101.

    Huang ZS, Chen WL, Huang ZQ, Yang ZH. Dysphagia in tongue cancer patients before and after surgery. J Oral Maxillofac Surg. 2016;74(10):2067–72.

  102. 102.

    Ihalainen T, Rinta-Kiikka I, Luoto TM, Thesleff T, Helminen M, Korpijaakko-Huuhka AM, et al. Risk factors for laryngeal penetration-aspiration in patients with acute traumatic cervical spinal cord injury. Spine J. 2018;18(1):81–7.

  103. 103.

    Jang DH, Choi KH, Kim DH, Lim CM, Kim JS. Comparison between the radionuclide salivagram and videofluoroscopic swallowing study methods for evaluating patients with aspiration pneumonia. Ann Nucl Med. 2013;27(3):247–52.

  104. 104.

    Keage MJ, Delatycki MB, Gupta I, Corben LA, Vogel AP. Dysphagia in friedreich ataxia. Dysphagia. 2017;32(5):626–35.

  105. 105.

    Keeling WB, Hernandez JM, Lewis V, Czapla M, Zhu W, Garrett JR, et al. Increased age is an independent risk factor for radiographic aspiration and laryngeal penetration after thoracotomy for pulmonary resection. J Thorac Cardiovasc Surg. 2010;140(3):573–7.

  106. 106.

    Kim MJ, Park YH, Park YS, Song YH. Associations between prolonged intubation and developing post-extubation dysphagia and aspiration pneumonia in non-neurologic critically Ill patients. Ann Rehabil Med. 2015;39(5):763–71.

  107. 107.

    Kraaijenga SA, Oskam IM, van der Molen L, Hamming-Vrieze O, Hilgers FJ, van den Brekel MW. Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer. Oral Oncol. 2015;51(8):787–94.

  108. 108.

    Kraaijenga SA, van der Molen L, Jacobi I, Hamming-Vrieze O, Hilgers FJ, van den Brekel MW. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises. Eur Arch Otorhinolaryngol. 2015;272(11):3521–31.

  109. 109.

    Kritas S, Dejaeger E, Tack J, Omari T, Rommel N. Objective prediction of pharyngeal swallow dysfunction in dysphagia through artificial neural network modeling. Neurogastroenterol Motil. 2016;28(3):336–44.

  110. 110.

    Kumai Y, Samejima Y, Watanabe M, Yumoto E. Videofluoroscopic evaluation of pharyngeal swallowing dysfunction after esophagectomy with three-field lymph node dissection. Eur Arch Otorhinolaryngol. 2017;274(1):321–6.

  111. 111.

    Kwon M, Lee JH, Kim JS. Dysphagia in unilateral medullary infarction: lateral versus medial lesions. Neurology. 2005;65(5):714–8.

  112. 112.

    Lee SY, Kim BH, Park YH. Analysis of dysphagia patterns using a modified barium swallowing test following treatment of head and neck cancer. Yonsei Med J. 2015;56(5):1221–6.

  113. 113.

    Lee YS, Lee KE, Kang Y, Yi TI, Kim JS. Usefulness of submental ultrasonographic evaluation for dysphagia patients. Ann Rehabil Med. 2016;40(2):197–205.

  114. 114.

    Martin-Harris B, Brodsky MB, Michel Y, Ford CL, Walters B, Heffner J. Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Head Neck Surg. 2005;131(9):762–70.

  115. 115.

    Martin-Harris B, McFarland D, Hill EG, Strange CB, Focht KL, Wan Z, et al. Respiratory-swallow training in patients with head and neck cancer. Arch Phys Med Rehabil. 2015;96(5):885–93.

  116. 116.

    May NH, Pisegna JM, Marchina S, Langmore SE, Kumar S, Pearson WG. Pharyngeal swallowing mechanics secondary to hemispheric stroke. J Stroke Cerebrovasc Dis. 2017;26(5):952–61.

  117. 117.

    McHorney CA, Martin-Harris B, Robbins J, Rosenbek J. Clinical validity of the SWAL-QOL and SWAL-CARE outcome tools with respect to bolus flow measures. Dysphagia. 2006;21(3):141–8.

  118. 118.

    Molfenter SM, Steele CM. The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale. Dysphagia. 2013;28(4):494–500.

  119. 119.

    O’Neil-Pirozzi TM, Lisiecki DJ, Jack Momose K, Connors JJ, Milliner MP. Simultaneous modified barium swallow and blue dye tests: a determination of the accuracy of blue dye test aspiration findings. Dysphagia. 2003;18(1):32–8.

  120. 120.

    Omari TI, Dejaeger E, van Beckevoort D, Goeleven A, Davidson GP, Dent J, et al. A method to objectively assess swallow function in adults with suspected aspiration. Gastroenterology. 2011;140(5):1454–63.

  121. 121.

    Ortega O, Rofes L, Martin A, Arreola V, López I, Clavé P. A comparative study between two sensory stimulation strategies after 2 weeks treatment on older patients with oropharyngeal dysphagia. Dysphagia. 2016;31(5):706–16.

  122. 122.

    Pitts T, Troche M, Mann G, Rosenbek J, Okun MS, Sapienza C. Using voluntary cough to detect penetration and aspiration during oropharyngeal swallowing in patients with Parkinson disease. Chest. 2010;138(6):1426–31.

  123. 123.

    Plowman EK, Tabor LC, Robison R, Gaziano J, Dion C, Watts SA, et al. Discriminant ability of the eating assessment tool-10 to detect aspiration in individuals with amyotrophic lateral sclerosis. Neurogastroenterol Motil. 2016;28(1):85–90.

  124. 124.

    Plowman EK, Watts SA, Robison R, Tabor L, Dion C, Gaziano J, et al. Voluntary cough airflow differentiates safe versus unsafe swallowing in amyotrophic lateral sclerosis. Dysphagia. 2016;31(3):383–90.

  125. 125.

    Rajappa AT, Soriano KR, Ziemer C, Troche MS, Malandraki JB, Malandraki GA. Reduced maximum pitch elevation predicts silent aspiration of small liquid volumes in stroke patients. Front Neurol. 2017;8:436.

  126. 126.

    Randall DR, Strong EB, Belafsky PC. Altered pharyngeal structure and dynamics among patients with cervical kyphosis. Laryngoscope. 2017;127(8):1832–7.

  127. 127.

    Saito T, Hayashi K, Nakazawa H, Yagihashi F, Oikawa LO, Ota T. A significant association of malnutrition with dysphagia in acute patients. Dysphagia. 2018;33(2):258–65.

  128. 128.

    Samuels SE, Tao Y, Lyden T, Haxer M, Spector M, Malloy KM, et al. Comparisons of dysphagia and quality of life (QOL) in comparable patients with HPV-positive oropharyngeal cancer receiving chemo-irradiation or cetuximab-irradiation. Oral Oncol. 2016;54:68–74.

  129. 129.

    Sassi FC, Medeiros GC, Zilberstein B, Jayanthi SK, de Andrade CRF. Screening protocol for dysphagia in adults: comparison with videofluoroscopic findings. Clinics. 2017;72(12):718–22.

  130. 130.

    Schroeder MF, Daniels SK, McClain M, Corey DM, Foundas AL. Clinical and cognitive predictors of swallowing recovery in stroke. J Rehabil Res Dev. 2006;43(3):301–10.

  131. 131.

    Sejdić E, Steele CM, Chau T. Classification of penetration–aspiration versus healthy swallows using dual-axis swallowing accelerometry signals in dysphagic subjects. IEEE Trans Biomed Eng. 2013;60(7):1859–66.

  132. 132.

    Starmer HM, Tippett D, Webster K, Quon H, Jones B, Hardy S, et al. Swallowing outcomes in patients with oropharyngeal cancer undergoing organ-preservation treatment. Head Neck. 2014;36(10):1392–7.

  133. 133.

    Steele CM, Sejdić E, Chau T. Noninvasive detection of thin-liquid aspiration using dual-axis swallowing accelerometry. Dysphagia. 2013;28(1):105–12.

  134. 134.

    Steele CM, Bailey GL, Chau T, Molfenter SM, Oshalla M, Waito AA, et al. The relationship between hyoid and laryngeal displacement and swallowing impairment. Clin Otolaryngol. 2011;36(1):30–6.

  135. 135.

    Tabor LC, Plowman EK, Romero-Clark C, Youssof S. Oropharyngeal dysphagia profiles in individuals with oculopharyngeal muscular dystrophy. Neurogastroenterol Motil. 2018;30(4):e13251.

  136. 136.

    Terré R, Panadés A, Mearin F. Botulinum toxin treatment for oropharyngeal dysphagia in patients with stroke. Neurogastroenterol Motil. 2013;25(11):896.

  137. 137.

    Troche MS, Schumann B, Brandimore AE, Okun MS, Hegland KW. Reflex cough and disease duration as predictors of swallowing dysfunction in Parkinson’s disease. Dysphagia. 2016;31(6):757–64.

  138. 138.

    van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Rasch CR, Hilgers FJ. A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia. 2011;26(2):155–70.

  139. 139.

    van der Molen L, Heemsbergen WD, de Jong R, van Rossum MA, Smeele LE, Rasch CR, et al. Dysphagia and trismus after concomitant chemo-intensity-modulated radiation therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures. Radiother Oncol. 2013;106(3):364–9.

  140. 140.

    Vilardell N, Rofes L, Arreola V, Speyer R, Clavé P. A comparative study between modified starch and Xanthan Gum thickeners in post-stroke oropharyngeal dysphagia. Dysphagia. 2016;31(2):169–79.

  141. 141.

    Vilardell N, Rofes L, Arreola V, Martin A, Muriana D, Palomeras E, et al. Videofluoroscopic assessment of the pathophysiology of chronic poststroke oropharyngeal dysphagia. Neurogastroenterol Motil. 2017;29(10):1–8.

  142. 142.

    Waito A, Bailey GL, Molfenter SM, Zoratto DC, Steele CM. Voice-quality abnormalities as a sign of dysphagia: validation against acoustic and videofluoroscopic data. Dysphagia. 2011;26(2):125–34.

  143. 143.

    Yang S, Choi KH, Son YR. The effect of stroke on pharyngeal laterality during swallowing. Ann Rehabil Med. 2015;39(4):509–16.

  144. 144.

    Zhang J, Zhou Y, Wei N, Yang B, Wang A, Zhou H, et al. Laryngeal elevation velocity and aspiration in acute ischemic stroke patients. PLoS ONE. 2016;11(9):e0162257.

  145. 145.

    Lee KM, Joo MC, Yu YM, Kim MS. Mylohyoid motor evoked potentials can effectively predict persistent dysphagia 3 months poststroke. Neurogastroenterol Motil. 2018;30(7):e13323.

  146. 146.

    Silverman EP, Carnaby G, Singletary F, Hoffman-Ruddy B, Yeager J, Sapienza C. Measurement of voluntary cough production and airway protection in Parkinson disease. Arch Phys Med Rehabil. 2016;97(3):413–20.

  147. 147.

    Allen JE, White CJ, Leonard RJ, Belafsky PC. Prevalence of penetration and aspiration on videofluoroscopy in normal individuals without dysphagia. Otolaryngol Head Neck Surg. 2010;142(2):208–13.

  148. 148.

    Banno H, Katsuno M, Suzuki K, Tanaka S, Suga N, Hashizume A, et al. Swallowing markers in spinal and bulbar muscular atrophy. Ann Clin Transl Neurol. 2017;4(8):534–43.

  149. 149.

    Bath PM, Scutt P, Love J, Clavé P, Cohen D, Dziewas R, et al. Pharyngeal electrical stimulation for treatment of dysphagia in subacute stroke: a randomized controlled trial. Stroke. 2016;47(6):1562–70.

  150. 150.

    Cola MG, Daniels SK, Corey DM, Lemen LC, Romero M, Foundas AL. Relevance of subcortical stroke in dysphagia. Stroke. 2010;41(3):482–6.

  151. 151.

    de Bruijn MJ, Rinkel RN, Cnossen IC, Witte BI, Langendijk JA, Leemans CR, et al. Associations between voice quality and swallowing function in patients treated for oral or oropharyngeal cancer. Support Care Cancer. 2013;21(7):2025–32.

  152. 152.

    Frowen J, Cotton S, Corry J, Perry A. Impact of demographics, tumor characteristics, and treatment factors on swallowing after (chemo)radiotherapy for head and neck cancer. Head Neck. 2010;32(4):513–28.

  153. 153.

    Frowen J, Drosdowsky A, Perry A, Corry J. Long-term swallowing after chemoradiotherapy: prospective study of functional and patient-reported changes over time. Head Neck. 2016;38(Suppl 1):E307–15.

  154. 154.

    Gallas S, Marie JP, Leroi AM, Verin E. Sensory transcutaneous electrical stimulation improves post-stroke dysphagic patients. Dysphagia. 2010;25(4):291–7.

  155. 155.

    Hedström J, Tuomi L, Finizia C, Olsson C. Correlations between patient-reported dysphagia screening and penetration-aspiration scores in head and neck cancer patients post-oncological treatment. Dysphagia. 2018;33(2):206–15.

  156. 156.

    Hegland KW, Davenport PW, Brandimore AE, Singletary FF, Troche MS. Rehabilitation of swallowing and cough functions following stroke: an expiratory muscle strength training trial. Arch Phys Med Rehabil. 2016;97(8):1345–51.

  157. 157.

    Hind J, Divyak E, Zielinski J, Taylor A, Hartman M, Gangnon R, et al. Comparison of standardized bariums with varying rheological parameters on swallowing kinematics in males. J Rehabil Res Dev. 2012;49(9):1399–404.

  158. 158.

    Hind JA, Nicosia MA, Gangnon R, Robbins J. The effects of intraoral pressure sensors on normal young and old swallowing patterns. Dysphagia. 2005;20(4):249–53.

  159. 159.

    Hwang JM, Cheong YS, Kang MG, Chun SM, Min YS, Lee YS, et al. Recommendation of nasogastric tube removal in acute stroke patients based on videofluoroscopic swallow study. Ann Rehabil Med. 2017;41(1):9–15.

  160. 160.

    Kim MS, Lee SJ, Kim TU, Seo DH, Hyun JK, Kim JI. The influence of laterality of pharyngeal bolus passage on Dysphagia in hemiplegic stroke patients. Ann Rehabil Med. 2012;36(5):696–701.

  161. 161.

    Kim HD, Choi JB, Yoo SJ, Chang MY, Lee SW, Park JS. Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. J Oral Rehabil. 2017;44(1):59–64.

  162. 162.

    Ko KR, Park HJ, Hyun JK, Seo IH, Kim TU. Effect of laryngopharyngeal neuromuscular electrical stimulation on dysphonia accompanied by dysphagia in post-stroke and traumatic brain injury patients: a pilot study. Ann Rehabil Med. 2016;40(4):600–10.

  163. 163.

    Ko EJ, Chae M, Cho SR. Relationship between swallowing function and maximum phonation time in patients with Parkinsonism. Ann Rehabil Med. 2018;42(3):425–32.

  164. 164.

    Krisciunas GP, Castellano K, McCulloch TM, Lazarus CL, Pauloski BR, Meyer TK, et al. Impact of compliance on dysphagia rehabilitation in head and neck cancer patients: results from a multi-center clinical trial. Dysphagia. 2017;32(2):327–36.

  165. 165.

    Langmore SE, McCulloch TM, Krisciunas GP, Lazarus CL, Van Daele DJ, Pauloski BR, et al. Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: a randomized clinical trial. Head Neck. 2016;38(Suppl 1):E1221–31.

  166. 166.

    Lee JH, Kim SB, Lee KW, Lee SJ, Lee JU. Effect of repetitive transcranial magnetic stimulation according to the stimulation site in stroke patients with dysphagia. Ann Rehabil Med. 2015;39(3):432–9.

  167. 167.

    Lee SJ, Lee KW, Kim SB, Lee JH, Park MK. Voluntary cough and swallowing function characteristics of acute stroke patients based on lesion type. Arch Phys Med Rehabil. 2015;96(10):1866–72.

  168. 168.

    Lin PH, Hsiao TY, Chang YC, Ting LL, Chen WS, Chen SC, et al. Effects of functional electrical stimulation on dysphagia caused by radiation therapy in patients with nasopharyngeal carcinoma. Support Care Cancer. 2011;19(1):91–9.

  169. 169.

    Malandraki GA, Hind JA, Gangnon R, Logemann JA, Robbins J. The utility of pitch elevation in the evaluation of oropharyngeal Dysphagia: preliminary findings. Am J Speech Lang Pathol. 2011;20(4):262–8.

  170. 170.

    McCullough GH, Kim Y. Effects of the Mendelsohn maneuver on extent of hyoid movement and UES opening post-stroke. Dysphagia. 2013;28(4):511–9.

  171. 171.

    Meyer TK, Pisegna JM, Krisciunas GP, Pauloski BR, Langmore SE. Residue influences quality of life independently of penetration and aspiration in head and neck cancer survivors. Laryngoscope. 2017;127(7):1615–21.

  172. 172.

    Murguia M, Corey DM, Daniels SK. Comparison of sequential swallowing in patients with acute stroke and healthy adults. Arch Phys Med Rehabil. 2009;90(11):1860–5.

  173. 173.

    Park BH, Seo JH, Ko MH, Park SH. Effect of 45° reclining sitting posture on swallowing in patients with dysphagia. Yonsei Med J. 2013;54(5):1137–42.

  174. 174.

    Park JS, Oh DH, Hwang NK, Lee JH. Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial. J Oral Rehabil. 2016;43(6):426–34.

  175. 175.

    Plowman EK, Tabor-Gray L, Rosado KM, Vasilopoulos T, Robison R, Chapin JL, et al. Impact of expiratory strength training in amyotrophic lateral sclerosis: results of a randomized, sham-controlled trial. Muscle Nerve. 2019;59(1):40–6.

  176. 176.

    Ra JY, Hyun JK, Ko KR, Lee SJ. Chin tuck for prevention of aspiration: effectiveness and appropriate posture. Dysphagia. 2014;29(5):603–9.

  177. 177.

    Rajaei A, Ashtari F, Azargoon SA, Chitsaz A, Nilforoush MH, Taheri M, et al. The association between saliva control, silent saliva penetration, aspiration, and videofluoroscopic findings in Parkinson’s disease patients. Adv Biomed Res. 2015;4:108.

  178. 178.

    Restivo DA, Marchese-Ragona R, Patti F, Solaro C, Maimone D, Zappalá G, et al. Botulinum toxin improves dysphagia associated with multiple sclerosis. Eur J Neurol. 2011;18(3):486–90.

  179. 179.

    Restivo DA, Casabona A, Centonze D, Marchese-Ragona R, Maimone D, Pavone A. Pharyngeal electrical stimulation for dysphagia associated with multiple sclerosis: a pilot study. Brain Stimul. 2013;6(3):418–23.

  180. 180.

    Robbins J, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, et al. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007;88(2):150–8.

  181. 181.

    Robbins J, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;53(9):1483–9.

  182. 182.

    Rogus-Pulia N, Rusche N, Hind JA, Zielinski J, Gangnon R, Safdar N, et al. Effects of device-facilitated isometric progressive resistance oropharyngeal therapy on swallowing and health-related outcomes in older adults with dysphagia. J Am Geriatr Soc. 2016;64(2):417–24.

  183. 183.

    Rosenbek JC, Robbins J, Willford WO, Kirk G, Schiltz A, Sowell TW, et al. Comparing treatment intensities of tactile-thermal application. Dysphagia. 1998;13(1):1–9.

  184. 184.

    Starmer HM, Yang W, Raval R, Gourin CG, Richardson M, Kumar R, et al. Effect of gabapentin on swallowing during and after chemoradiation for oropharyngeal squamous cell cancer. Dysphagia. 2014;29(3):396–402.

  185. 185.

    Su HK, Khorsandi A, Silberzweig J, Kobren AJ, Urken ML, Amin MR, et al. Temporal and physiologic measurements of deglutition in the upright and supine position with videofluoroscopy (vfs) in healthy subjects. Dysphagia. 2015;30(4):438–44.

  186. 186.

    Suiter DM, McCullough GH, Powell PW. Effects of cuff deflation and one-way tracheostomy speaking valve placement on swallow physiology. Dysphagia. 2003;18(4):284–92.

  187. 187.

    Troche MS, Okun MS, Rosenbek JC, Musson N, Fernandez HH, Rodriguez R, et al. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology. 2010;75(21):1912–9.

  188. 188.

    Troche MS, Huebner I, Rosenbek JC, Okun MS, Sapienza CM. Respiratory-swallowing coordination and swallowing safety in patients with Parkinson’s disease. Dysphagia. 2011;26(3):218–24.

  189. 189.

    Troche MS, Brandimore AE, Foote KD, Morishita T, Chen D, Hegland KW, et al. Swallowing outcomes following unilateral STN vs GPi Surgery: a retrospective analysis. Dysphagia. 2014;29(4):425–31.

  190. 190.

    van der Molen L, van Rossum MA, Ackerstaff AH, Smeele LE, Rasch CR, Hilgers FJ. Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients’ views. BMC Ear Nose Throat Disord. 2009;9:10.

  191. 191.

    Verin E, Leroi AM. Poststroke dysphagia rehabilitation by repetitive transcranial magnetic stimulation: a noncontrolled pilot study. Dysphagia. 2009;24(2):204–10.

  192. 192.

    Leder SB, Suiter DM, Green BG. Silent aspiration risk is volume-dependent. Dysphagia. 2011;26(3):304–9.

  193. 193.

    Miles A, McFarlane M, Scott S, Hunting A. Cough response to aspiration in thin and thick fluids during FEES in hospitalized inpatients. Int J Lang Commun Disord. 2018;53(5):909–18.

  194. 194.

    Kuhlemeier KV, Palmer JB, Rosenberg D. Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia. 2001;16(2):119–22.

  195. 195.

    Michou E, Mistry S, Jefferson S, Tyrrell P, Hamdy S. Characterizing the mechanisms of central and peripheral forms of neurostimulation in chronic dysphagic stroke patients. Brain Stimul. 2014;7(1):66–73.

  196. 196.

    Power ML, Fraser CH, Hobson A, Singh S, Tyrrell P, Nicholson DA, et al. Evaluating oral stimulation as a treatment for dysphagia after stroke. Dysphagia. 2006;21(1):49–55.

  197. 197.

    Steele CM, Mukherjee R, Kortelainen JM, Pölönen H, Jedwab M, Brady SL, et al. Development of a non-invasive device for swallow screening in patients at risk of oropharyngeal dysphagia: results from a prospective exploratory study. Dysphagia. 2019;34(5):698–707.

  198. 198.

    Power ML, Hamdy S, Goulermas JY, Tyrrell PJ, Turnbull I, Thompson DG. Predicting aspiration after hemispheric stroke from timing measures of oropharyngeal bolus flow and laryngeal closure. Dysphagia. 2009;24(3):257–64.

  199. 199.

    Molfenter SM, Steele CM. Physiological variability in the deglutition literature: hyoid and laryngeal kinematics. Dysphagia. 2011;26(1):67–74.

  200. 200.

    Molfenter SM, Steele CM. Temporal variability in the deglutition literature. Dysphagia. 2012;27(2):162–77.

  201. 201.

    Molfenter SM, Steele CM. Variation in temporal measures of swallowing: sex and volume effects. Dysphagia. 2013;28(2):226–33.

  202. 202.

    Steele CM, Peladeau-Pigeon M, Barbon CAE, Guida BT, Namasivayam-MacDonald AM, Nascimento WV, et al. Reference values for healthy swallowing across the range from thin to extremely thick liquids. J Speech Lang Hear Res. 2019;62(5):1338–63.

  203. 203.

    Hutcheson KA, Barrow MP, Barringer DA, Knott JK, Lin HY, Weber RS, et al. dynamic imaging grade of swallowing toxicity (digest): scale development and validation. Cancer. 2017;123(1):62–70.

  204. 204.

    Hutcheson KA, Barrow MP, Plowman EK, Lai SY, Fuller CD, Barringer DA, et al. Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: a case series. Laryngoscope. 2018;128(5):1044–51.

  205. 205.

    Kamal M, Mohamed ASR, Volpe S, Zaveri J, Barrow MP, Gunn GB, et al. Radiotherapy dose-volume parameters predict videofluoroscopy-detected dysphagia per DIGEST after IMRT for oropharyngeal cancer: results of a prospective registry. Radiother Oncol. 2018;128(3):442–51.

  206. 206.

    Lazarus CL, Ganz C, Ru M, Miles BA, Kotz T, Chai RL. Prospective instrumental evaluation of swallowing, tongue function, and QOL measures following transoral robotic surgery alone without adjuvant therapy. Head Neck. 2019;41(2):322–8.

  207. 207.

    Kirsh E, Naunheim M, Holman A, Kammer R, Varvares M, Goldsmith T. Patient-reported versus physiologic swallowing outcomes in patients with head and neck cancer after chemoradiation. Laryngoscope. 2018;129(9):2059–64.

  208. 208.

    Colodny N. Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (fees) using the penetration-aspiration scale: a replication study. Dysphagia. 2002;17(4):308–15.

  209. 209.

    Butler SG, Markley L, Sanders B, Stuart A. Reliability of the penetration aspiration scale with flexible endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol. 2015;124(6):480–3.

Download references

Acknowledgements

The authors would like to acknowledge Dr. Sonja Molfenter’s guidance and assistance with manuscript preparation.

Funding

N/A

Author information

Correspondence to James C. Borders.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Borders, J.C., Brates, D. Use of the Penetration-Aspiration Scale in Dysphagia Research: A Systematic Review. Dysphagia (2019). https://doi.org/10.1007/s00455-019-10064-3

Download citation

Keywords

  • Penetration-Aspiration Scale
  • Statistical analysis
  • Research trends
  • Deglutition