| 제목 |
Analysis of videofluoroscopic swallow study according to fluid volume and multiple swallow method |
| 소속 |
Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, 54907, Republic of Korea1, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, 54907, Republic of Korea2 |
| 저자 |
Young-In Go1,2*, Da-Sol Kim1,2, Yu-Hui Won1,2, Sung-Hee Park1,2, Myoung-Hwan Ko1,2, Jeong-Hwan Seo1,2, Gi-Wook Kim1,2† |
| 사사 |
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Objectives
The videofluoroscopic swallow study is a gold standard test for the evaluation of swallowing disorders. The pathophysiology that induces aspiration varies greatly depending on a disease or patient’s swallowing patterns. Previous method of the VFSS is focused on aspiration according to small diet material (pudding, soft blended diet, Yoplait, rice, 2cc, 5cc water), so there was a limit to confirming whether aspiration was occurred during various swallowing patterns. The aim of this study was to investigate the outcome of VFSS when the different volume of the fluid and multiple swallow method were applied.
Methods
Data were collected from patients who underwent VFSS from March 2020 to June 2021. All the patients were tested with pudding, SBD, Yoplait, rice, 2cc, 5 cc and cupful amount of fluid which was mixed with barium contrast medium. During fluid test with cup, two methods were added: large volume swallow and multiple swallow. In large volume swallow test, patients were given an amount of fluid that was enough to open the upper and lower teeth with an instruction to swallow at one time. In multiple swallow test, the fluid was given and the patients were instructed to drink the cup of water 3 to 4 times or more continuously without a break. The distribution of PAS according to the 5cc, large volume and multiple swallow test was analyzed, and vertical distance, average velocity for laryngeal elevation, and pharyngeal transit time were analyzed and compared foreach test.
Result
Results of a total of 53 patients with various central nervous system or neuromuscular diseases were analyzed. In the 5cc swallow test, aspiration (PAS 5-8) occurred in 11 patients, whereas in both large volume and multiple swallow tests, aspiration occurred in 16 patients, suggesting that latter two groups had relatively more aspiration (Fig 1). There was no significant difference in all measured parameters between the aspiration and non-aspiration (PAS 1-4) group within each test, only except for the velocity at 5cc swallow test (Table 1). Although not statistically significant, in the 5cc and large volume tests, the aspiration group showed shorter laryngeal distance and range of elevation, slower velocity, longer PTT than the non-aspiration group. In the multiple swallowing test, the laryngeal distance, range of elevation and PTT were longer and the velocity was slower in the aspiration group than in the non-aspiration group (Table 1). In comparison between the three tests, there was a significant difference between 5cc and multiple swallow test and between large volume and multiple swallow test, respectively (Table 2), and it showed the longest in distance, range of larynx elevation, and time in the large volume test and the shortest in multiple swallow test (Table 3).
Conclusion
The large volume and multiple swallow test reflect various swallowing patterns, and may be used as a test method to further increase the sensitivity and specificity of aspiration |
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Density Plots according to Penetration-Aspiration Scale (PAS) of the three testing methods.
Differences between aspiration/non-aspiration groups in 5cc, large volume, and multiple swallowing tests.
Differences in parameters between 5cc, large volume, and multiple swallowing tests.
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