Dysphagia assessment and RehaIngest
RehaIngest could offer a more reliable approach to dysphagia measurement and act as a great complement to screening via a Clinical Bedside Assessment (CBA)
Following a stroke, reliable assessment of dysphagia is necessary and trained personnel typically use a range of liquid and solid textures to map out the physiological dysfunction, identify the need for further investigation, test the effectiveness of any selected treatments and enable the development of a management plan.
In general, a CBA is used by a Speech and Language Therapist (SLT) but there are challenges in inter and intra-rater reliability. There isn’t a standardised approach to this and studies on reliability suffer from difficulties due to this as data can’t be aggregated to produce consistent findings.
Typically the CBA is used to determine the need for, and appropriateness of, additional instrumental assessment via videofluoroscopy or fibre optic endoscopic evaluation.
The limitations of clinical testing, eg poor detection of silent aspiration and poor information on the efficacy of an intervention, mean that a reliable, timely and cost effective instrumental swallow evaluation is really needed for all patients.
The modified barium swallow (MBS) is a dynamic assessment of the oral, pharyngeal and upper oesophageal phases of swallowing using videofluoroscopy. It provides a comprehensive instrumental assessment of swallowing, determining not only whether the patient is aspirating but also why. MBS allows for experimentation with dietary textures, postures and manoeuvres hypothesised to improve the safety and efficiency of the swallow.Fibre optic endoscopic evaluation.
MBS is not without it’s limitations including potential difficulty in transporting stroke patients to a radiology department, exposure to radiation and the limitations of basing management recommendations on a single “snapshot” view of swallowing function.
Fibre optic endoscopic evaluation of swallowing (FEES) is an assessment of swallowing using a flexible nasendoscope, which is passed into the nares, over the velum and into the pharynx. FEES has been shown to be as effective as MBS in detecting laryngeal penetration, aspiration and residue.
It’s not intended that RehaIngest act as a replacement to MBS or FEES. However, it might help to clarify the need for these instrumental assessments and certainly has shown itself to offer a number of benefits for the SLT.
RehaIngest is easy to use, safe and quick to setup - and supports measurement whilst using a range of liquids and solids. RehaIngest can monitor the pharyngeal phase of swallowing in real-time or be setup to monitor over a period of hours; this way it gets around the limitation of a single snapshot measurement that may not be representative of the true clinical picture.
Whilst some attempts have been made to produce measurement methods based on EMG of the muscles these are too prone to error to be relied up. RehaIngest combines EMG with Bioimpedance and the software rapidly scores the quality of the swallowing process.