Abstract
Background: Functional deterioration of the tongue and lips causes hypoplasia of the bolus, limits the diet that can be ingested, and leads to malnutrition, but there have been few reports on the relationship. In this study, we considered that the oral diadochokinesis of patients admitted to general hospitals could be used as an index to grasp nutritional status and diet modification, and investigated the relationship.
Aim: To verify the reliability of a four-parameter scoring system for videofluoroscopic (VF) examination of swallowing performed to determine whether patients with dysphagia should be given solid food.
Patients and Methods: The participants were 10 patients who underwent VF at our hospital between March and May 2022. VF examinations were performed using jelly as the solid food, and swallowing function was assessed based on four parameters: 1) oral food processing (processing movement) and tongue motion, 2) propulsion from the oral cavity to the pharynx, 3) timing of swallowing reflex initiation, and 4) pharyngeal clearance after swallowing. Each parameter was scored on a scale from 0 points (normal) to 3 points (severe). Five assessors were assigned to each participant’s examination: two speech-language therapists, one nurse, one registered dietitian, and one radiological technologist. A doctor was additionally assigned as a benchmark assessor. We verified the intraclass correlation of the five assessors and the benchmark and the correlation coefficient between the assessors and the benchmark.
Results: The intraclass correlations of the five assessors to the benchmark were 1) r＝0.54, 2) r＝0.35, 3) r＝0.50, and 4) r＝0.73. The correlation coefficients between the five assessors and the benchmark were 1) r＝0.6, 2) r＝0.43, 3) r＝0.62, and 4) r＝0.77.
Conclusions: In the four-parameter VF scoring system for swallowing function, reliability was highest for parameter 4), moderate for parameters 1) and 3), and weakest for parameter 2). We had to add some supplementary information to increase the reliability of the scoring system. We recognized once again that various events can occur in a series of swallowing movements such as in this study.
