2002 Volume 6 Issue 2 Pages 196-206
Videofluorography (VF) is considered to be the gold standard for evaluating dysphagia because of its usefulness in clarifying both morphological and functional swallowing problems．Although dysphagic persons are evaluated routinely with VF in well-equipped hospitals，in poorly-equipped institutes many patients are subjected to tube feeding without adequate evaluation and treatment of swallowing disorders．The development of clinical systems for assessing dysphagia without using VF has therefore been desired．
Three clinical tests (Modified Water Swallowing Test，Food Test，and Pre- and Post-Swallowing X-P)，a non-VF assessment flowchart that is composed of these three clinical tests，and a dysphagia severity scale were developed in Integrated Research on the Treatment of Dysphagia project，funded by the Comprehensive Research on Aging and Health program in 1999．We used the flowchart system for 63 dysphagic patients，and examined whether it could accurately identify those patients who have sufficient ability to swallow some foods with training．The results suggested that the cu-off line of the three clinical tests was appropriate．The sensitivity，the specificity，the predictive negative value test，and the concordance of the flowchart for distinguishing patients who can start direct therapy with food were sufficiently high．It was therefore concluded that the non-VF assessment flowchart is useful and safe for clinical use，especially in poorly-equipped institutions．
