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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.

Nasopharyngoscopy is a minimally invasive endoscopic procedure that allows visual observation and analysis of the velopharyngeal mechanism during speech. It can be used to assess both anatomic and physiologic abnormalities of the velopharyngeal valve. In cases of suspected velopharyngeal insufficiency (VPI), nasopharyngoscopy is particularly useful in determining the size, location, and cause of the velopharyngeal opening. This information is very important for surgical planning. Nasopharyngoscopy is also useful in the assessment of secondary surgery that was done for VPI. It can help determine the need for revision and the type of revision surgery that is most likely to be successful. The purpose of the chapter is to explain how nasopharyngoscopy is used in the evaluation of velopharyngeal function. This chapter includes specific tips for achieving a successful examination in children as young as age 3. Finally, important observations from nasopharyngoscopy are described. © 2025 The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG.

PURPOSE: Autistic adults consistently report difficulties understanding speech in adverse listening environments, which may be related to differences in social communication and participation. Research examining masked-speech recognition in autistic adults is limited, particularly in competing speech backgrounds with high degrees of informational masking. This work characterizes speech-in-speech and speech-in-noise recognition in young adults on the autism spectrum, as well as evaluates self-reported functional listening abilities and listening-related fatigue. METHOD: Masked-speech recognition was evaluated in both autistic (n = 20) and non-autistic (n = 20) young adults with normal hearing. Speech reception thresholds were adaptively measured in two-talker speech and speech-shaped noise using target sentences that were either semantically meaningful or anomalous. Functional listening abilities and listening-related fatigue were assessed using the Speech, Spatial, and Qualities of Hearing Scale and the Vanderbilt Fatigue Scale for Adults. Autism characteristics and social communication experiences were quantified using the Social Responsiveness Scale-Second Edition. RESULTS: Autistic adults displayed significantly poorer speech-in-speech recognition than their non-autistic peers, while speech-in-noise recognition did not differ between groups. Functional listening difficulties in daily life and listening-related fatigue were significantly higher for autistic participants. Autism characteristics strongly predicted functional listening abilities and listening-related fatigue in both groups. CONCLUSIONS: Autistic young adults experience objective speech-in-speech recognition difficulties that correspond with listening challenges in daily life. Autism characteristics and social communication experiences predict functional listening abilities reported by both autistic and non-autistic young adults with normal hearing. Speech-in-speech recognition difficulties observed here may amplify social communication challenges for adults on the autism spectrum. Future work must prioritize improved awareness of autistic listening differences.

In this article, the authors assist teachers who are working with young students at risk for reading disabilities by helping make sense of the large—but unwieldy—scientific knowledge base. They offer a conceptual framework for thinking about beginning reading instruction and intervention across three dimensions: the content of instruction (what to teach), the delivery of instruction (how to teach), and the timing of instruction (when to teach). The authors discuss each of these dimensions and describe how teachers can use them to help organize and make sense of what we know about beginning reading instruction for students experiencing reading difficulties.

Two approaches to systematic word review were integrated into an 18-week program of extended vocabulary instruction with kindergarten students from three high-need urban schools. Words in the embedded and semantically related review conditions received systematic and distributed review. In the embedded review condition, brief word definitions were integrated into the narratives of multiple storybooks. In the semantically related review condition, in-depth word review with explicit emphasis on semantic features and associations was provided during extension activities. Systematic review resulted in an almost twofold increase in target word learning. Embedded review was effective and time efficient, whereas semantically related review was time intensive but resulted in higher levels of word learning. There was a significant gain in Peabody Picture Vocabulary Test—III standard scores following the intervention.

The purpose of this study was to examine the effectiveness of a vocabulary intervention designed to supplement research–based classroom vocabulary instruction, implemented with students who may be at risk for language and learning difficulties. Participants included 43 kindergarten students who received research–based classroom vocabulary instruction. Students with the 20 lowest scores on the Peabody Picture Vocabulary Test–III administered at pretest received additional small–group supplemental vocabulary intervention. Results of within–subjects comparisons indicated that, overall, at–risk students made greater gains in word knowledge on target words that received the supplemental intervention as compared to words that received only classroom–based instruction. In addition, at–risk students who received the supplemental intervention demonstrated word–learning gains that approached those of their peers who received classroom instruction alone. Implications along with limitations of the current study and directions for future research are discussed.

The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swallowing (FEES) maintains high intra- and interrater reliability in detecting pharyngeal dysphagia and aspiration without the addition of FD&C Blue No. 1 to food. Twenty consecutive adults referred for a swallow evaluation participated. Nine subjects received blue-dyed food and 11 subjects received regular nondyed food, i.e., yellow pudding and white skim milk. Four variables were rated: (1) the stage transition characterized by depth of bolus flow to at least the vallecula prior to the pharyngeal swallow; (2) evidence of bolus retention in the vallecula or pyriform sinuses after the pharyngeal swallow; (3) laryngeal penetration defined as material in the laryngeal vestibule but not passing below the level of the true vocal folds either before or after the pharyngeal swallow; and (4) tracheal aspiration defined as material below the level of the true vocal folds either before or after the pharyngeal swallow. Three speech–language pathologists experienced in interpreting FEES results independently and blindly reviewed the digitized videotape three times. Intrarater agreements for the four variables with blue-dyed and non-blue-dyed food trials were 100% and monochrome trials ranged from 95% to 100%. Average kappa values for interrater reliability ranged from moderate to excellent agreement (0.61–1.00) for all viewing conditions. Kappa values for blue-dyed trials versus monochrome trials were 0.83 and for non-blue-dyed trials versus monochrome trials were 0.88, indicative of excellent reliability under both viewing conditions. FEES maintains both high intra- and interrater reliability in detecting the critical features of pharyngeal dysphagia and aspiration using either blue-dyed or non-blue-dyed foods. The endoscopist, therefore, can be assured of reliable FEES results using regular, non-dyed food trials.

In the acute-care setting patients with altered mental status as a result of such diverse etiologies as stroke, traumatic brain injury, degenerative neurologic impairments, dementia, or alcohol/drug abuse are routinely referred for dysphagia testing. A protocol for dysphagia testing was developed that began with verbal stimuli to determine patient orientation status and ability to follow single-step verbal commands. Although unknown, it would be beneficial to ascertain if this information on mental status was predictive of aspiration risk. The purpose of this investigation was to determine if there was a difference in odds for aspiration based upon correctly answering specific orientation questions, i.e., 1. What is your name? 2. Where are you right now? and 3. What year is it?, and following specific single-step verbal commands, i.e., 1. Open your mouth. 2. Stick out your tongue. and 3. Smile. In a consecutive retrospective manner data from 4070 referred patients accrued between 1 December 1999 and 1 January 2007 were analyzed. The odds of liquid aspiration were 31% greater for patients not oriented to person, place, and time (odds ratio [OR] = 1.305, 95% CI = 1.134–1.501). The odds of liquid aspiration (OR = 1.566, 95% CI = 1.307–1.876), puree aspiration (OR = 1.484, 95% CI = 1.202–1.831), and being deemed unsafe for any oral intake (OR = 1.688, 95% CI = 1.387–2.054) were, respectively, 57, 48, and 69% greater for patients unable to follow single-step verbal commands. Being able to answer orientation questions and follow single-step verbal commands provides information on odds of aspiration for liquid and puree food consistencies as well as overall eating status prior todysphagia testing. Knowledge of potential increased odds of aspiration allows for individualization of dysphagia testing thereby optimizing swallowing success.

Background:  Pulmonary aspiration is a leading cause of nosocomial infection in the intensive care unit (ICU) and step-down unit (SDU). A key goal is to identify patients who exhibit increased aspiration risk before beginning oral alimentation. This study investigated the success of recommending specific oral diets to ICU and SDU patients based on passing a 3-oz water swallow challenge. Methods:  A referral-based sample of 401 ICU and 92 SDU patients were prospectively analyzed. Amount of liquid and food ingested at the next day's meal 12 hours to 24 hours after passing a 3-oz challenge and specific diet recommendations were accessed electronically from oral intake information entered on each participant's daily care sheets. Drinking and eating success, clinically evident aspiration events, and accuracy of diet order recommendations were recorded. Care providers were blinded to the purpose of the study. Results:  All 401 ICU and 92 SDU patients were successfully drinking thin liquids and eating 12 hours to 24 hours after passing a 3-oz challenge. Mean volume of liquid ingested at the next day's meal was 360 mL ± 181.2 mL for ICU and 356.4 mL ± 173.5 mL for SDU patients. Percent of meal eaten ranged from 10% to 100%. Patient care sheets indicated specific diet recommendations were followed with 100% accuracy. Conclusions:  Successfully recommending specific oral diets for ICU and SDU patients based on passing a 3-oz water swallow challenge was supported. Importantly, when a simple bedside 3-oz challenge administered by a trained provider is passed, specific diet recommendations can be made safely and confidently without the need for further objective dysphagia testing.

Objective. To determine what effect, if any, the presence or absence of a nasogastric (NG) tube in the same person had on the incidence of anterograde aspiration. Design. Case series with planned data collection. Setting. Large, urban, tertiary care teaching hospital. Subjects and Methods. Referred sample of 62 consecutively enrolled adult inpatients for fiber-optic endoscopic evaluation of swallowing (FEES). Group 1 (n = 21) had either small-bore (n = 13) or large-bore (n = 8) NG tubes already in place and had a FEES first with the NG tube in place and a second FEES after NG tube removal. Group 2 (n = 41) did not have an NG tube and had a FEES first without an NG tube and a second FEES after placement of a small-bore NG tube. Time between FEES was approximately 5 minutes. Patients were tested with thin liquid and puree food consistencies. Occurrence of aspiration for each consistency dependent on the presence or absence of an NG tube was recorded. Results. There were no significant differences (P > .05) in aspiration status for both liquid and puree consistencies in the same person dependent on presence or absence of either a small-bore or large-bore NG tube. Conclusions. Since objective swallowing evaluation (eg, FEES) can be performed with an NG tube in place, it is not necessary to remove an NG tube to evaluate for aspiration. Similarly, there is no contraindication to leaving an NG tube in place to supplement oral alimentation until nutritional requirements are achieved.