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Purpose: This qualitative study explored the practices of hospital-based speech-language pathologists (SLPs) conducting modified barium swallow studies (MBS) for infants at risk for dysphagia. Specifically, this research aimed to determine whether or not SLPs use side-lying position during MBS, to examine possible differences in the use of positioning, and to better understand SLPs' perceptions and experiences in this practice. Using a constructivist view, research questions guiding this inquiry were as follows: What is the current practice of hospital-based pediatric SLPs in regard to the use of side-lying position during infant MBS? What is the experience of the hospital-based SLP in their use of side-lying position during MBS? How do SLPs report perceived barriers or benefits to using side-lying position during MBS? Method: Employing a purposive-convenience sampling technique, data were collected using semistructured interviews of SLPs serving at-risk infants with dysphagia. All participants were practicing in Level-III or -IV neonatal intensive care units. Interviews were recorded, transcribed, loaded into NVivo, and coded using initial and consensus coding. Themes achieved saturation following six interviews. Results: Three themes emerged from the analysis: (a) variations in practice patterns, (b) factors influencing clinical practice, and (c) items that SLPs identified as needs to facilitate change in their clinical practice. Conclusions: Although SLPs acknowledged the importance of MBS replicating an infant's typical feeding, some SLPs who consistently use side-lying position during feeding do not assess feeding in side-lying position during MBS. This inconsistency in practice results from SLPs' perceived barriers, including lack of experience, concern over interdisciplinary conflict, need for MBS protocols, and lack of research on the potential impacts of side-lying positioning on swallowing. Participants reported the need for research to determine whether side-lying position alters, possibly improves, swallow functions and safety (e.g., airway protection) for at-risk infants.
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Purpose: Changes in voice quality after consuming food or drink have been used as a clinical indicator of dysphagia during the clinical swallowing evaluation (CSE); however, there is conflicting evidence of its efficacy. This study investigated if dysphonia and/or voice change after swallowing are valid predictors of penetration, aspiration, or pharyngeal residue. Our approach aimed to improve current methodologies by collecting voice samples in the fluoroscopy suite, implementing rater training to improve interrater reliability and utilizing continuous measurement scales, allowing for regression analyses. Method: In this prospective study, 30 adults (aged 49–97 years) referred for a videofluoroscopic swallowing study (VFSS) were audio-recorded completing a sustained /i/ prior to VFSS and again after swallowing each bolus during the VFSS. Swallowing function was measured using the reorganized Penetration–Aspiration Scale and the Normalized Residue Ratio Scale. Following listener training, 84 voice samples were perceptually rated using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Ordinal and logistic regression were used to determine whether voice quality and voice quality change after swallowing were predictors of airway invasion and pharyngeal clearance. Results: Results indicated that the presence of dysphonia at baseline during a sustained /i/ task as measured by the CAPE-V predicted airway invasion but not pharyngeal residue. Voice change after swallowing associated with vowel /i/ production as measured by the CAPE-V did not predict either dysphagia measure. Conclusion: These results indicate that voice change during a sustained /i/ after swallowing appears unrelated to airway invasion or pharyngeal residue; however, in the absence of known laryngeal pathology, dysphonia prior to a CSE should alert speech-language pathologists of a possible comorbid dysphagia.
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Background: While maximum isometric pressure (MIP) is widely used in clinical and research settings, reduced lingual swallow pressure (LSP) has been observed in patients with dysphagia and in older healthy adults. However, limited evidence exists on the test–retest reliability of LSP across different bolus consistencies. Objective: This study assessed the test–retest reliability of LSP measurements in both younger and older adults with healthy swallowing function to identify factors influencing oral swallowing pressure. Methods: Participants 18–40 years (younger) and 60+ years (older) were assessed across four separate sessions. Bolus types included trials of saliva, thin, mildly thick and extremely thick water, randomised across study visits. Two-way mixed effects models with absolute agreement were used to calculate intraclass correlation coefficients (ICCs) and evaluate test–retest reliability of LSP for each swallow type (regular or effortful) and bolus type. Linear mixed effects regression modelling was used to examine the factors influencing LSP. Results: A total of 51 participants were included. Test–retest reliability for LSP ranged from good to excellent across both groups (ICC = 0.79–0.98). Reliability was non-significantly higher in the older group (ICC = 0.96) and during effortful swallows (ICC = 0.94). Effort level significantly influenced LSP estimates, with effortful swallows producing about 1.83 times more lingual pressure than regular swallows. There were no significant effects of age, sex, or bolus type on LSP. Conclusion: These findings suggest that LSP measurements are reliable across measurement time points in nondysphagic participants, regardless of age, effort level, or bolus type. Only swallow effort level significantly influenced LSP estimates. © 2025 John Wiley & Sons Ltd.
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- Journal Article (3)
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- English (1)