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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: Safe and timely oral alimentation is crucial for optimum patient care.Objective: To determine the short-term success of recommending specific oral diets, including drinking thin liquids, to acute care hospitalized patients at risk for dysphagia based on passing a 3-ounce water swallow challenge protocol.Design: Prospective single group consecutively referred case series.Setting: Large, urban, tertiary care, teaching hospital.Participants: 1000 hospitalized patients.Intervention: 3-ounce (90 cc) water swallow challenge protocol.Measurements: Specific diet recommendations and volume (in cc) of liquid ingested at the next day's meal 12–24 h after passing a 3-ounce challenge protocol were accessed electronically from oral intake information entered on each participant's daily care logs. Eating and drinking success, clinically evident aspiration events and compliance with ordering the recommended diet were recorded. Care providers were blinded to the study's purpose.Results: Of 1000 patients, 907 met the inclusion criteria of stable medical, surgical or neurological conditions 12–24 h after passing a 3-ounce water swallow challenge protocol. All 907 were both eating and drinking thin liquids successfully and without overt signs of dysphagia. Median volume of liquid ingested was 340 cc [interquartile range (IQR), 240–460]. Specific diet recommendations were followed with 100% accuracy.Conclusions: A 3-ounce water swallow challenge protocol successfully identified patients who can be safely advanced to an oral diet without subsequent identification of overt signs of aspiration within 12–24 h of testing. Importantly, when a clinical 3-ounce challenge protocol administered by a trained provider is passed, specific diet recommendations, including drinking thin liquids, can be made safely and without the need for additional instrumental dysphagia testing.

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.

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.

Purpose: To compare the amplitude, latency, morphology, and threshold of the auditory P300 using standard oddball and omitted paradigms. Research Design: P300 waveforms were measured from the Cz electrode site. Frequent stimuli for both paradigms were 1000 Hz tone bursts. Target stimuli for the standard oddball paradigm were 2000 Hz tone bursts and an omitted stimulus, or silent gap, for the omitted paradigm. Study Sample: Fifteen bilaterally normal-hearing young adults. Results: There were significantly lower amplitudes, poorer morphology, and higher thresholds for the P300 using an omitted paradigm compared to the standard oddball paradigm. Conclusion: These results suggest that the auditory P300 could have a larger exogenous component than traditionally thought.

Purpose This longitudinal study investigated the emergence of English tense marking in young (Spanish–English) dual language learners (DLLs) over 4 consecutive academic semesters, addressing the need for longitudinal data on typical acquisition trajectories of English in DLL preschoolers. Method Language sample analysis was conducted on 139 English narrative retells elicited from 39 preschool-age (Spanish–English) DLLs (range = 39–65 months). Growth curve models captured within- and between-individual change in tense-marking accuracy over time. Tense-marking accuracy was indexed by the finite verb morphology composite and by 2 specifically developed adaptations. Individual tense markers were systematically described in terms of overall accuracy and specific error patterns. Results Tense-marking accuracy exhibited significant growth over time for each composite. Initially, irregular past-tense accuracy was higher than regular past-tense accuracy; over time, however, regular past-tense marking outpaced accuracy on irregular verbs. Conclusions These findings suggest that young DLLs can achieve high tense-marking accuracy assuming 2 years of immersive exposure to English. Monitoring the growth in tense-marking accuracy over time and considering productive tense-marking errors as partially correct more precisely captured the emergence of English tense marking in this population with highly variable expressive language skills. Supplemental Materials https://doi.org/10.23641/asha.5176942