John C. Rosenbek

A penetration-aspiration scale.

The development and use of an 8-point, equalappearing interval scale to describe, penetration and aspiration events are described. Scores are determined primarily by the depth to which material passes in the airway and by whether or not material entering the airway is expelled. Intra-and interjudge reliability have been established. Clinical and scientific uses of the scale are discussed.

Prosodic disturbance and neurologic lesion

Abstract Although associations between prosodic disturbances and neurologic lesion have been mentioned in the clinical literature, little progress has been made in the acoustic description of the abnormal prosodic patterns that typify neurologic dysfunctions. This report is a preliminary acoustic description of the prosodic disturbances associated with ataxic dysarthria, apraxia of speech, parkinsonian dysarthria, and right-hemisphere dysarthria. Several types of prosodic disturbance are identified and speculations are offered concerning their relation to site of lesion. In general, the patterns of prosodic disturbance described acoustically in this report confirm and elaborate G. H. Monrad-Krohns ( Problems of dynamic neurology . Jerusalem: Hebrew Univ. Press, 1963) observations.

Swallowing after unilateral stroke of the cerebral cortex

We report differential patterns of swallowing in 40 patients with their first ischemic middle cerebral artery (MCA) stroke and compare these to 20 nonstroke controls. Stroke patients were divided a priori, into groups by right or left and, post hoc, primarily anterior or posterior MCA territory lesions. The left hemisphere subgroup was differentiated from controls by longer pharyngeal transit durations and from the right hemisphere group by shorter pharyngeal response durations. The right hemisphere subgroup was characterized by longer pharyngeal stage durations and higher incidences of laryngeal penetration and aspiration of liquid. Anterior lesion subjects demonstrated significantly longer swallowing durations on most variables compared to both normal and posterior lesion subjects. Changes in the consistency of foods and other modifications for safe nutrition should be considered during the first month of recovery for unilateral stroke patients with swallowing difficulty.

Sensitivity and specificity of clinical/bedside examination signs for detecting aspiration in adults subsequent to stroke

UNLABELLEDnWhile detecting the presence of aspiration is only one aspect of a noninstrumented examination of swallowing function, it is an important component due to its potential health status consequences. The purpose of this investigation was to investigate the sensitivity and specificity of clinical/bedside examination signs for predicting aspiration on videofluoroscopic examination of swallowing. Sixty consecutive, acute stroke patients were investigated with clinical/bedside and videofluoroscopic exams. Clinical signs consisted of history, oral motor/speech praxis, voice, and trial swallow ratings. Results confirm that more work needs to be done if data collected from noninstrumented examinations are to be strongly predictive of aspiration on VFSE. However, comparisons of the current results with previous investigations provides a promising framework for future research.nnnEDUCATIONAL OBJECTIVESn(1) To understand the use of sensitivity and specificity in detecting disease; (2) To understand the current evidence regarding clinical signs of aspiration.

Thermal application reduces the duration of stage transition in dysphagia after stroke.

The present study had two purposes. The first was to provide variability data on objectively measured durational parameters of swallowing as accomplished by dysphagic patients secondary to stroke. The second was to examine the short-term effects of thermal application on these same durational measures. The study employed a cross-over design with each dysphagic stroke subject swallowing 10 times in both untreated and treated conditions. Two findings emerged: (1) swallowing durations in the 22 dysphagic stroke subjects were highly variable within and across subjects and have distributions that were nonnormal with nonhomogeneous variances; (2) thermal application reduced duration of stage transition (DST) and total swallow duration (TSD). Implications of these findings are discussed.

Inter- and Intrajudge Reliability for Videofluoroscopic Swallowing Evaluation Measures

Abstract Interjudge reliability for videofluoroscopic (VFS) swallowing evaluations has been investigated, and results have, for the most part, indicated that reliability is poor. While previous studies are well-designed investigations of interjudge reliability, few reports of intrajudge reliability are available for VFS measures derived from frame-by-frame analysis that clinicians typically employ. The purpose of this study was to examine the inter- and intrajudge reliability of VFS examination measures commonly used to assess swallowing functions. No training to criteria occurred. VFS examinations were conducted on 20 patients who had suffered a stroke within six weeks and had no structural abnormalities or tracheostomies. Three clinical judges served as subjects and rated the VFS examinations from videotape using frame-by-frame analysis. A clinicians repeated review of measures employed in the 20 examinations indicated high intrajudge reliability for a number of measures, suggesting that an experienced clinician may employ consistent standards for rating certain VFS measures across patients and time. These standards appear to vary among clinicians and yield unacceptable interjudge reliability. The need to train clinicians to criteria to improve interjudge reliability is discussed.

Inter-And Intrajudge Reliability Of A Clinical Examination Of Swallowing In Adults

This study investigates inter- and intrajudge reliability of a clinical examination of swallowing in adults. Several investigations have sought correlations between clinical indicators of dysphagia and the actual presence of dysphagia as determined by videofluoroscopy. Whereas some investigations have reported interjudge reliability for the videofluoroscopic measures employed, none have reported reliability for clinical measures. Without established reliability for rating clinical measures, conclusions drawn regarding the utility of a measure for detecting aspiration can be called into question. Results of the present study indicate that fewer than 50% of the measures clinicians typically employ are rated with sufficient inter- and intrajudge reliability. Measures of vocal quality and oral motor function were rated more reliably than were history measures or measures taken during trial swallows. There is a need to define more clearly the measures employed in clinical examinations and to be consistent in reporting reliability for clinical measures of swallowing function in future research.

Relationships between speech intelligibility and the slope of second-formant transitions in dysarthric subjects

The relationship between speech intelligibility on a single-word identification test and the average second-formant (F2) slope of selected test words was examined for a group of 25 men and ten women with amyotrophic lateral sclerosis (ALS). A Spearman rank-order correlation coefficient greater than 0.80 was obtained for both the male and female subjects. This moderately high correlation indicates that the F2 slope index is a useful acoustic measure of speech proficiency in ALS. F2 slope indices are reported for normal control populations of geriatric men and women. In addition, progressive deterioration of the F2 slope index is illustrated in a case study of one woman with ALS.

Comparing Treatment Intensities of Tactile-Thermal Application*

Abstract. The purpose of this study was to investigate the relationships of four intensities of tactile-thermal application (TTA) to changes in duration of stage transition (DST) and performance on a newly designed scale of penetration and aspiration by groups of patients made dysphagic by stroke. Patients were randomly assigned to receive 150, 300, 450, or 600 trials of TTA during each of 2 weeks. Data on the time required to provide such treatment, the actual number of trials clinicians were able to provide, and on the influence of the four intensities are provided. No single intensity emerged as the most therapeutic. It is suggested that subsequent studies with larger groups include intensities between 300 and 550.

A speaking task analysis of the dysarthria in cerebellar disease.

Cerebellar disease affects a number of skilled movements, including those in speech. Ataxic dysarthria, the speech disorder that typically accompanies cerebellar disease, was studied by acoustic methods. Control subjects and subjects with ataxic dysarthria were recorded while performing a number of speaking tasks, including sustained vowel phonation, syllable repetition, monosyllabic word production (intelligibility test), sentence recitation, and conversation. Acoustic data derived from the speech samples confirmed the hypothesis that temporal dysregulation is a primary component of the speech disorder. The data also show that the nature of the disorder varies with the speaking task. This result agrees with observations on other motor systems in subjects with cerebellar disease and may be evidence of a dissociation of impairments. Suggestions are offered on the selection of measures for a given task and on the role of the cerebellum in the regulation of speaking.