The following excerpt has been taken from our courses on Dysphagia management and therapy titled ‘Latest Trends in Dysphagia Management for Diagnosis and Therapy’.
Diagnostic techniques have expanded considerably and therapy techniques have also expanded far beyondthe realm of using compensatory strategies alone to treat swallowing dysfunction.
Below is a list of some of the newest methodologies of dysphagia management
1 – Three Ounce Water Test: First described in 1992 by DePippo et al. (1992). In this test the patient is asked to continuously drink three ounces of water without interruption. If the patient can do this without any difficulty, s/he passes the test, and does not require any further testing. Patient may be placed on an oral diet with thin liquids without aspiration risk. Suiter and Leder followed up these findings with further research and their findings support this. If, however, the patient fails the three ounce water test, via stopping, coughing, wet gurgly vocal quality, or choking, one can say that the patient failed the test, with further testing warranted. Noteworthy, is that patients who fail this test, via further testing, may be appropriately placed on an oral diet.
2 – Repetitive saliva swallowing test (RSST): The patient’s ability to swallow voluntarily is highly correlated with aspiration. To assess, ask patient to sit in comfortable resting position and wet the mouth with cold water, via tooth ettes. Ask patient to repeat swallows, as many as possible within thirty (30) seconds. Swallows are counted by direct palpation or visualization of laryngeal elevation. Three or more dry swallows is considered normal.
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The 8-Point Penetration-Aspiration Scale
- Material does not enter airway.
- Material enters the airway, remains above the vocal folds, and is ejected from the airway.
- Material enters the airway, remains above the vocal folds, and is not ejected from the airway.
- Material enters the airway, contracts the vocal folds, and is ejected from the airway.
- Material enters the airway, contracts the vocal folds, and is not ejected from the airway.
- Material enters the airway, passses below the vocal folds, and is ejected into the larynx or out of the airway.
- Material enters the airway, passes below the vocal folds, and is not ejected from the trachea despite effort.
- Material enters the airway, passes below the vocal folds, and no effort is made to eject.
Source: Rosenbek, JC, Robbins, J, Roecker EV, Coyle, JL, & Woods, JL. A Penetration-Aspiration Scale. Dysphagia 11:93-98, 1996.
Challenges with the PAS
- Inter rater agreement presents a problem with reliability.
- Aspiration patterning is unpredictable.
- The scoring is vague, for example, when a patient engages in a double swallow, which is scored?
- After the first swallow, judgments become more difficult.
- If gives a limited view of swallow deficit itself, result oriented.
- Results of aspiration vary from person to person.
- Signs of dysphagia vary over time in the same person.
- Signs of dysphagia vary from person to person.
- Results were found to be modestly negatively skewed on follow up studies.
- The scale is multidimensional, since more than one type of behavior is being judged.
- The scale measures the depth of bolus invasion into the airway.
- The scale measures the patient’s response to the bolus.
- Amount of penetration/aspiration is measured in a hierarchical fashion.
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