Assessing the Physiology of Swallowing Impairment: Measuring the Measurement Method and Characterizing Diagnostic Impairment ProfilesPublic
Swallowing impairment or dysphagia has many possible causes with severe sequelae. One major mediator of the relationship between causes and sequelae is the physiologic impairment of the swallowing mechanism. Assessing the physiology of swallowing impairment is of great importance so that treatment can target physiology to mitigate sequelae. The assessment of swallowing physiology is primarily conducted through Modified Barium Swallow Studies (MBSS), where Videofluoroscopy (VFS) of a patient swallowing an x-ray opaque bolus is recorded and interpreted by a Speech Language Pathologist (SLP). On the one hand, the goals of this assessment are objective as they are aimed at understanding physiologic biomechanics of impairments. On the other hand, the methods of this assessment are subjective in that clinicians must choose what boluses to give, what physiologic aspects of the swallow to assess, and how to score impairment for those physiologic aspects. The Modified Barium Swallow Impairment Profile (MBSImP™©) is a measurement method that standardized the subjective elements of the assessment, and subsequently enjoyed widespread clinical uptake. This widespread uptake of MBSImP resulted in the accumulation of over 50,000 patient records in a Swallowing Data Registry (SDR), a dataset that forms the basis for the analyses of this dissertation. This SDR is used in Chapter 1 to test the degree to which MBSImP’s standardization of the subjective side of MBSS has resulted in a valid and reliable measurement tool. Chapter 2 leverages MBSImP and the SDR to conduct a high-level comparison of the physiologic impairment profiles of five diagnoses commonly associated with dysphagia.
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