Establishing Reference Values and Clinical Decision Points for Quantitative Videofluoroscopic Measures of Swallowing

University Health Network, Toronto ON

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Abstract

Project Summary/Abstract Dysphagia (swallowing impairment) is a serious health condition seen in many age-related disease and injury processes. Although videofluoroscopy (VF) is an international “gold standard” dysphagia diagnostic exam, there is a paucity of available normative physiologic VF reference values in healthy adults across the age span to guide interpretation of this examination. This fundamental gap in knowledge contributes to poor agreement in the identification of swallowing impairment and its underlying mechanisms. To enable better dysphagia diagnostics, there is a critical need to establish reference values for VF swallowing measures across the healthy age span. In our previous R01 (DC011020), we developed a rigorous method for measuring swallowing physiology from VF: the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT Method). We published initial ASPEKT reference values from 40 young healthy adults (<60 years) and performed preliminary analyses to compare data from healthy older adults and small cohorts of adults with dysphagia to these reference data. Through this renewal application, we will validate the ASPEKT Method healthy reference values for swallowing across the adult life span, demonstrate scalability of the ASPEKT Method across commonly used variations in clinical VF testing protocols, and profile swallowing pathophysiology in clinical groups where dysphagia is a cause of morbidity to identify clinical decision points that can be used for diagnosis and outcome measurement. Our vision is that the ASPEKT Method will enable clinicians to compare patient measures to healthy reference values, facilitating quantification and evidence- based interpretation of the presence, nature and severity of swallowing impairment. Ultimately, we seek to generate data that will shift subjective dysphagia diagnostic practices toward a quantitative, evidence-based diagnostic framework that will improve resource utilization, treatment planning and patient outcomes.