The validity of a three-part criteria for differentiating between delayed pharyngeal swallow and premature spillage secondary to poor oro-lingual control on videofluoroscopy

Abstract

Background and Aims The accurate differentiation between a delayed pharyngeal swallow (sensory impairment) and premature spillage secondary to poor oro-lingual control (motor impairment) is essential to effective dysphagia management. However both physiologic abnormalities result in an identical radiographic sign, that of pre-swallow pooling of the bolus in the pharynx. The dysphagia literature does not provide satisfactory guidelines for making this distinction on videofluoroscopy. The purpose of this study was to assess the validity of a three-part rating scale for differentiating between these two impairments. Methods Videofluoroscopy was used to evaluate the swallowing of 29 participants presenting with dysphagia following stroke. Sensory thresholds for these participants were established by electrical stimulation of the anterior faucial pillars. The videofluoroscopic swallowing studies were analysed using the three-part rating scale and results from this were compared to sensory thresholds using Pearson's product moment correlation. Results There was no significant correlation between the three-part criteria and sensory thresholds. Inter-rater reliability for some measures was poor. Conclusions The three-part criteria was not shown to be a valid measure for differentiating between delayed pharyngeal swallow and premature spillage secondary to poor oro-lingual control. Possible explanations for these findings are discussed, including the relevance of faucial pillar sensation to swallowing.