What: Dysphagia Research Society Annual Meeting
When: March 15–17, 2018 
Where: The Renaissance Baltimore Harborplace Hotel (202 E. Pratt St., Baltimore, MD 21202)

SIMPLER, QUICKER WAY TO HELP IDENTIFY STROKE PATIENTS AT RISK FOR SWALLOWING DISORDERS

Poster Presentation Session

Poster #9, Group 1

Baltimore Ballroom/Maryland Foyer

A standard swallow screening administered by a trained nurse may in some cases help clinicians more simply and quickly identify stroke patients at risk for dysphagia, a swallowing disorder that can lead to aspiration pneumonia. That’s according to findings from a small study in which researchers compared this so-called swallowing screen to a more in-depth, time intensive swallowing test known as the videofluoroscopic swallowing study—or VFSS. VFSS is done by a radiologist and can be more difficult to perform on some stroke patients. VFSS uses X-ray video to see how well a person swallows food or water, and patients have to be transported to radiology for the test.

The study results will be presented during a poster session at the Dysphagia Research Society’s annual meeting by Rachel Mulheren, Ph.D., postdoctoral fellow in the Solomon H. Snyder Department of Neuroscience and speech-language pathologist in the Department of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine.

For the study, the researchers looked at the results after a nurse-administered swallow screen for 48 stroke patients and again after VFSS. The outcomes were compared. Thirteen participants failed the swallow screen (meaning they had signs of having a swallowing problem), while 28 participants presented with a swallowing problem on VFSS. Of the 35 who passed the swallow screen (meaning they were not found to have a swallowing disorder according to the screen), 15 ended up being diagnosed with a swallowing problem after undergoing the VFSS test and were recommended for dysphagia therapy, and only two were recommended for diet modification.

Mulheren cautions that while the simple nurse-administered swallowing test can rule out dysphagia in stroke patients, clinicians must be careful in interpreting results for some patients who do not have overt signs or symptoms despite having dysphagia.

Mulheren is available for interview about the findings of this research upon request.

HOW AGE IMPACTS OUR ABILITY TO SWALLOW

Session 8: Advances in the Aging Swallow

Researcher Alba Azola, M.D., resident in the Department of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine, will present findings from a small study looking at the changes in the process of swallowing as a person ages. This research may one day assist clinicians in developing rehabilitation strategies that could prevent swallowing disorders in at-risk older adults.

For the study, 31 community-dwelling adults age 62-91 and without a history of swallowing disorders underwent a so-called videofluoroscopic swallowing study (VFSS), a test using X-ray video that looks at how well a person swallows food and liquid. Those results were compared to a retrospective analysis of 33 healthy younger adults 18-28 years of age who underwent the same test. For this, experts took the X-ray footage, slowed it down, analyzed the movement of the anatomic structures involved in swallowing and measured the duration of key events in swallowing. For example, they looked at how long the windpipe was closed off during the swallow, how long it took to close the airway and which swallowing activities were used to prevent food from getting into the lungs.

The researchers found that in older adults, the swallow started later, so the food was getting to the throat later than in younger adults, and the events that lead to the protection of the airway took longer to initiate. This means that older adults are at higher risk of having food going into their lungs, which increases the risk of aspiration pneumonia, a debilitating illness that can lead to death. Knowing this could help rehabilitation experts design exercises that address the specific deficiencies to which older adults are prone.  

In the U.S. alone, one in 25 adults will experience a swallowing problem. Swallowing disorders are more common in older adults, but they can impact younger adults as well. Of patients diagnosed with dysphagia (trouble swallowing), 2 to 27 percent die within 30 days of diagnosis, and approximately 50 percent die within one year of the diagnosis. The disorder can be treated by rehabilitative therapy such as swallowing exercises that include strength training.  

The researchers hope the findings of their study will aid clinicians in the development of interventions that slow the progress of swallowing issues as people age.

Azola is available to discuss the findings upon request.