Quantifying swallowing function after stroke: A functional dysphagia scale based on videofluoroscopic studies


      Han TR, Paik N-J, Park JW. Quantifying swallowing function after stroke: a functional dysphagia scale based on videofluoroscopic studies. Arch Phys Med Rehabil 2001;82:677-82. Objective: To develop a sensitive, specific scale for quantifying functional dysphagia in stroke patients, using results obtained from videofluoroscopic swallowing studies. Design: Data collected from a serial oral and pharyngeal videofluoroscopic swallowing study. Setting: A dysphagia clinic in a department of rehabilitation medicine at a tertiary care university hospital. Participants: One hundred three consecutively admitted stroke patients. Interventions: Videoflurorscopy to measure a scale of 11 variables: lip closure score, bolus formation, residue in oral cavity, oral transit time, triggering of pharyngeal swallow, laryngeal elevation and epiglottic closure, nasal penetration, residue in valleculae, coating of pharyngeal wall after swallow, and pharyngeal transit time. Main Outcome Measures: Polychotomous linear logistic regression analysis of videofluoroscopic and aspiration results. Scale sensitivity and specificity, and the correlation between the total score of the scale and aspiration grade were analyzed. Results: The scale's sensitivity and specificity for detecting supraglottic penetration and subglottic aspiration were 81%, 70.7%, and 78.1%, 77.9%, respectively. A significant positive correlation was found between the scale's total score and the severity of aspiration (Spearman's r =.58943, p =.00001). Conclusion: This functional dysphagia scale, which was based on a videofluoroscopic swallowing study in stroke patients, is a sensitive and specific method for quantifying the severity of dysphagia. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation


      To read this article in full you will need to make a payment


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Holas MA
        • DePippo KL
        • Reding MJ.
        Aspiration and relative risk of medical complications following stroke.
        Arch Neurol. 1994; 51: 1051-1053
        • Horner J
        • Buoyer FG
        • Alberts MJ
        • Helms MJ.
        Dysphagia following brain-stem stroke: clinical correlates and outcome.
        Arch Neurol. 1991; 48: 1170-1173
        • Horner J
        • Massey EW.
        Silent aspiration following stroke.
        Neurology. 1988; 38: 317-319
        • Roth EJ.
        Medical complications encountered in stroke rehabilitation.
        Phys Med Rehabil Clin North Am. 1991; 2: 563-578
        • Logemann JA.
        Manual for the videofluorographic study of swallowing.
        2nd ed. : PRO-ED, Austin (TX)1993
        • Mann LL
        • Wong K.
        Development of an objective method for assessing viscosity of formulated foods and beverages for the dysphagic diet.
        J Am Diet Assoc. 1996; 96: 585-588
        • Hosmer DW
        • Lemeshow S.
        Applied logistic regressions.
        : John Wiley, New York1989
        • Schulzer M.
        Diagnostic tests: a statistical review.
        Muscle Nerve. 1994; 17: 815-819
        • Shrout PE
        • Fleiss JL.
        Intraclass correlations: uses in assessing rater reliability.
        Psychol Bull. 1979; 86: 420-428
        • Gorden C
        • Hewer RL
        • Wade DT.
        Papers and short reports: dysphagia in acute stroke.
        Br Med J. 1987; 295: 411-414
        • Kidd D
        • Lawson J
        • Nesbitt R
        • MacMahon J.
        Aspiration in acute stroke: a clinical study with videofluoroscopy.
        Q J Med. 1993; 86: 825-829
        • Linden P
        • Siebens AA.
        Dysphagia: predicting laryngeal penetration.
        Arch Phys Med Rehabil. 1983; 64: 281-284
        • Nakagawa T
        • Sekizawa K
        • Arai H.
        High incidence of pneumonia in elderly patients with basal ganglia infarction.
        Arch Intern Med. 1997; 157: 321-324
        • Robbins J
        • Levine RL
        • Maser A
        • Rosenbek JC
        • Kempster GB.
        Swallowing after unilateral stroke of the cerebral cortex.
        Arch Phys Med Rehabil. 1993; 74: 1295-1300
        • Teasell RW
        • Bach D
        • McRae M.
        Prevalence and recovery of aspiration poststroke: a retrospective analysis.
        Dysphagia. 1994; 9: 35-39
        • Teasell RW
        • McRae M
        • Marchuk Y
        • Finestone H.
        Pneumonia associated with aspiration following stroke.
        Arch Phys Med Rehabil. 1996; 77: 707-709
        • Barer DH.
        The natural history and functional consequences of dysphagia after hemispheric stroke.
        J Neurol Neurosurg Psychiatry. 1989; 52: 236-241
        • Odderson IR
        • Keaton JC
        • McKenna BS.
        Swallow management in patients on an acute stroke pathway: quality is cost effective.
        Arch Phys Med Rehabil. 1995; 76: 1130-1133
        • Smithard DG
        • O'Neill PA
        • Park C
        • Morris J
        • Wyatt R
        • England R
        • et al.
        Complications and outcome after acute stroke. Does dysphagia matter?.
        Stroke. 1996; 27: 1200-1204
        • Daniels SK
        • Brailey K
        • Priestly DH
        • Herrington LR
        • Weisberg LA
        • Foundas AL.
        Aspiration in patients with acute stroke.
        Arch Phys Med Rehabil. 1998; 79: 14-19
        • DePippo KL
        • Holas MA
        • Reding MJ.
        The Burke dysphagia screening test: validation of its use in patients with stroke.
        Arch Phys Med Rehabil. 1994; 75: 1284-1286
        • DePippo KL
        • Holas MA
        • Reding MJ.
        Validation of the 3-oz water swallow test for aspiration following stroke.
        Arch Neurol. 1992; 49: 1259-1261
        • Addington WR
        • Stephens RE
        • Gilliland K
        • Rodriquez M.
        Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke.
        Arch Phys Med Rehabil. 1999; 80: 150-154
        • Logemann JA
        • Shanahan T
        • Rademaker AW
        • Kahrilas PJ
        • Lazar R
        • Halper A.
        Oropharyngeal swallowing after stroke in the left basal ganglion/internal capsule.
        Dysphagia. 1993; 8: 230-234
        • Holt S
        • Colliver J
        • Guram M
        • Neal C
        • Verhulst SJ
        • Taylor TV.
        Measurement of gastric emptying rate in humans. Simplified scanning method.
        Dig Dis Sci. 1990; 35: 1345-1351
        • Splaingard MI
        • Hutchins B
        • Sulton LD
        • Chaudhuri G.
        Aspiration in rehabilitation patients: videofluoroscopy vs bedside clinical assessment.
        Arch Phys Med Rehabil. 1988; 69: 637-640
        • Leder SB.
        Serial fiberoptic endoscopic swallowing evaluations in the management of patients with dysphagia.
        Arch Phys Med Rehabil. 1998; 79: 1264-1269
        • Johnson ER
        • McKenzie SW
        • Rosenquist CJ
        • Lieberman JS
        • Sievers AE.
        Dysphagia following stroke: quantitative evaluation of pharyngeal transit times.
        Arch Phys Med Rehabil. 1992; 73: 419-423
        • Veis SL
        • Logemann JA.
        Swallowing disorders in persons with cerebrovascular accident.
        Arch Phys Med Rehabil. 1985; 66: 372-375
        • Mann G
        • Hankey GJ
        • Cameron D.
        Swallowing function after stroke: prognosis and prognostic factors at 6 months.
        Stroke. 1999; 30: 744-748
        • Schmidt J
        • Holas M
        • Halvorson K
        • Reding M.
        Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke.
        Dysphagia. 1994; 9: 7-11
        • Teasell RW
        • McRae M
        • Heitzner J
        • Bhardwaj A
        • Finestone H.
        Frequency of videofluroscopic modified barium swallow studies and pneumonia in stroke rehabilitation patients: a comparative study.
        Arch Phys Med Rehabil. 1999; 80: 294-298
        • Bisch EM
        • Logemann JA.
        Pharyngeal effects of bolus volume, viscosity and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects.
        J Speech Hear Res. 1994; 37: 1041-1049
        • Lazarus CL
        • Logemann JA
        • Rademaker AW
        • Kahrilas PJ.
        Effects of bolus volume, viscosity and repeated swallows in nonstroke subjects and stroke patients.
        Arch Phys Med Rehabil. 1993; 74: 1066-1070
        • Logemann JA
        • Pauloski BR
        • Colangelo L
        • Lazarus C
        • Fujiu M.
        Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia.
        J Speech Hear Res. 1995; 38: 556-563