Swallowing difficulties are life threatening and are the most common referral reason to speech and language therapists working with the adult population. Video fluoroscopic examination is a common instrumental tool used to assist in the assessment of the risk of aspiration and asphyxiation in swallowing difficulties. Rating scales have been the standard method of analysing the video fluoroscopy results but there has been some concern about the subjective nature of this approach. This study describes training of 40 SLT students at Hong Kong University; 20 were randomly assigned to use a subjective rating tool whilst the other 20 were randomly assigned to use an objective measurement tool (coordinate mapping protocol, Thompson et al., 2014) using computer imaging software. The students were all trained in using the method over a half day training session. Before attending the training and afterwards students rated 10 swallow samples from individuals with post stroke dysphagia. Intra and inter-rater reliability improved significantly following training in both conditions. However contrary to the initial hypothesis those students trained to use the subjective rating scales demonstrated better reliability than those trained on the objective rating method. The researchers hypothesise that this may be due to the increased technical demands, and the limited training opportunities. This study demonstrates the value of thorough training in the analysis of video-fluoroscopic swallowing studies, be this in the use of subjective or more technical objective tools.
Swallow assessment: is clinical judgement or objective measurement more reliable?
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