SUCCESSFUL DYSPHAGIA MANAGEMENT REQUIRES ACCURATE, SUCCINCT DIAGNOSIS AND CHARACTERIZATION OF SWALLOWING SAFETY IMPAIRMENTS. HOWEVER, THE PENETRATION-ASPIRATION SCALE (PAS) REMAINS THE ONLY AVAILABLE TOOL DEVELOPED EXCLUSIVELY FOR ASSESSMENT OF AIRWAY PROTECTION. TO BEST SUPPORT EFFORTS TO ADVANCE THE FIELD?S UNDERSTANDING OF SWALLOWING SAFETY, IT IS CRUCIAL TO UNDERSTAND CURRENT CLINICIAN PRACTICE PATTERNS, PERCEPTIONS, AND ACCURACY REGARDING THE PAS. A 46-ITEM SURVEY WAS DEVELOPED AND DISTRIBUTED TO DEGLUTOLOGISTS INTERNATIONALLY EXAMINING: (1) DEMOGRAPHICS; (2) SCALE PRACTICES; (3) SWALLOWING SAFETY PRIORITIES; (4) SCALE PERCEPTIONS; AND (5) ACCURACY. THE FIRST FOUR SECTIONS CONSISTED OF QUESTIONNAIRES. IN THE OPTIONAL FIFTH SECTION, RESPONDENTS WERE ASKED TO SCORE FIVE VIDEOS OF SWALLOWS COLLECTED VIA VIDEOFLUOROSCOPY AND PREVIOUSLY PAS-SCORED BY TWO TRAINED RATERS. IN TOTAL, 335 RESPONSES WERE ANALYZED. THE MAJORITY OF RESPONDENTS SELF-REPORTED PAS TRAINING (84%); 90% OF UNTRAINED RESPONDENTS WERE RECEPTIVE TO TRAINING. RESPONDENTS REPORTED USING THE PAS ?ALWAYS? (40%) OR ?FREQUENTLY? (29%), AND THAT THE PAS CARRIES ?A GREAT DEAL OF? WEIGHT IN ASSESSMENT (40%). REPORTED APPLICATION OF THE PAS WAS HETEROGENEOUS, WITH THE MOST COMMON APPROACH BEING ?SINGLE WORST SCORE PER UNIQUE PRESENTATION? (45%). MOST RESPONDENTS (64%) PRIORITIZED A PARAMETER NOT CAPTURED BY THE PAS. UNTRAINED RESPONDENTS WERE SIGNIFICANTLY MORE CONFIDENT WITH PAS RATINGS THAN TRAINED RESPONDENTS (X2?=?7.47; P?=?0.006). OF 1460 PAS RATINGS PROVIDED, 364 OF THEM WERE ACCURATE (25%) WHEN COMPARED TO RATINGS BY TRAINED LAB MEMBERS. RESULTS OF THIS SURVEY REFLECT UBIQUITOUS USE OF THE PAS, UNMET NEEDS FOR ASSESSMENT OF SWALLOWING SAFETY, LOW ACCURACY DESPITE GENERALLY HIGH CONFIDENCE, AND HETEROGENOUS TRAINING THAT DOES NOT CORRESPOND TO CONFIDENCE. THIS EMPHASIZES THE NEED FOR ADDITIONAL TRAINING IN CLINICAL APPLICATION OF THE PAS AS WELL AS DEVELOPMENT OF NOVEL METRICS TO OPTIMIZE ASSESSMENTS OF

BACKGROUND: SWALLOWING IMPAIRMENTS RESULTING FROM STROKE HAVE FEW REHABILITATIVE OPTIONS. PRIOR EVIDENCE SUGGESTS LINGUAL STRENGTHENING EXERCISE MAY PROVIDE SOME BENEFIT, BUT MORE RANDOMIZED CONTROLLED TRIALS ARE REQUIRED. THE PURPOSE OF THIS STUDY WAS TO EXAMINE EFFICACY OF PROGRESSIVE LINGUAL RESISTANCE TRAINING ON LINGUAL PRESSURE GENERATIVE CAPACITY AND SWALLOWING OUTCOMES FOR INDIVIDUALS WITH DYSPHAGIA AFTER STROKE. METHODS: PARTICIPANTS WITH DYSPHAGIA WITHIN 6 MONTHS OF ACUTE STROKE WERE RANDOMLY ASSIGNED TO: (1) TREATMENT: PROGRESSIVE RESISTANCE TONGUE EXERCISE USING PRESSURE SENSORS FOR 12 WEEKS WITH USUAL CARE; OR (2) CONTROL: USUAL CARE ONLY. OUTCOMES WERE MEASURED AT BASELINE, 8 AND 12 WEEKS TO ASSESS GROUP DIFFERENCES IN LINGUAL PRESSURE GENERATION, SWALLOW SAFETY, EFFICIENCY, ORAL INTAKE, AND SWALLOWING QUALITY OF LIFE.

FOODS AND LIQUIDS HAVE PROPERTIES THAT ARE OFTEN MODIFED AS PART OF CLINICAL DYSPHAGIA MANAGEMENT TO PROMOTE SAFE AND EFCIENT SWALLOWING. HOWEVER, RECENT STUDIES HAVE QUESTIONED WHETHER THIS PRACTICE IS SUPPORTED BY THE EVIDENCE. TO ADDRESS THIS, A SCOPING REVIEW WAS CONDUCTED TO ANSWER THE QUESTION: CAN PROPERTIES OF FOOD AND LIQUIDS MODIFY SWALLOWING PHYSIOLOGY AND FUNCTION IN ADULTS? ONLINE SEARCH IN SIX DATABASES YIELDED A SET OF 4235 NON-DUPLICATE ARTICLES. USING COVIDENCE SOFTWARE, TWO INDEPENDENT REVIEWERS SCREENED THE ARTICLES BY TITLE AND ABSTRACT, AND 229 FULL-TEXT ARTICLES WERE SELECTED FOR FULL-TEXT REVIEW. ONE-HUNDRED ELEVEN STUDIES MET THE INCLUSION CRITERIA FOR QUALITATIVE SYNTHESIS AND ASSESSMENT OF RISK OF BIAS. THREE RANDOMIZED CONTROLLED TRIALS AND 108 NON-RANDOMIZED STUDIES WERE ANALYZED. LARGE AMOUNTS OF VARIABILITY IN INSTRUMENTAL ASSESSMENT, PROPERTIES OF FOOD AND LIQUIDS, AND SWALLOWING MEASURES WERE FOUND ACROSS STUDIES. SOUR, SWEET, AND SALTY TASTE, ODOR, CARBONATION, CAPSAICIN, VISCOSITY, HARDNESS, ADHESIVENESS, AND COHESIVENESS WERE REPORTED TO MODIFY THE ORAL AND PHARYNGEAL PHASE OF SWALLOWING IN BOTH HEALTHY PARTICIPANTS AND PATIENTS WITH DYSPHAGIA. MAIN SWALLOW MEASURES MODIFED BY PROPERTIES OF FOOD AND LIQUIDS WERE ENETRATION/ASPIRATION, ORAL TRANSIT TIME, LINGUAL PRESSURES, SUBMENTAL MUSCLE CONTRACTION, ORAL AND PHARYNGEAL RESIDUE, HYOID AND LARYNGEAL MOVEMENT, PHARYNGEAL AND UPPER ESOPHAGEAL SPHINCTER PRESSURES, AND TOTAL SWALLOW DURATION. THE EVIDENCE POOLED IN THIS REVIEW SUPPORTS THE CLINICAL PRACTICE OF FOOD TEXTURE AND LIQUID CONSISTENCY MODIFCATION IN THE MANAGEMENT OF DYSPHAGIA WITH THE CAVEAT THAT ALL CLINICAL ENDEAVORS MUST BE UNDERTAKEN WITH A CLEAR RATIONALE AND PATIENT-SPECIFC EVIDENCE THAT MODIFYING FOOD OR LIQUID BENEFTS SWALLOW SAFETY AND EFCIENCY WHILE MAINTAINING QUALITY OF LIFE.

OBJECTIVES: DYSPHAGIA IS COMMON IN OLDER ADULTS. HOWEVER, THERE ARE NO CURRENT ESTIMATES OF DYSPHAGIA IN COMMUNITY-DWELLING OLDER ADULTS THOSE RECEIVING MEAL SUPPORT. IT IS UNKNOWN WHETHER DYSPHAGIA IS ASSOCIATED WITH OTHER MEASURES OF PHYSICAL FUNCTION (ACTIVITIES OF DAILY LIVING [ADL] ABILITY OR NUTRITION STATUS). THE STUDY PURPOSES WERE TO DETERMINE THE PREVALENCE OF SELF-REPORTED DYSPHAGIA AND TO IDENTIFY FACTORS ASSOCIATED WITH SELF-REPORTED DYSPHAGIA IN COMMUNITY-DWELLING OLDER ADULTS RECEIVING MEAL SUPPORT. DESIGN: A CROSS-SECTIONAL STUDY. SETTING AND PARTICIPANTS: 476 COMMUNITY-DWELLING OLDER ADULTS (78.5±0.51 YEARS) ACROSS FIVE ELDER NUTRITION PROGRAM MEAL SERVICES IN WISCONSIN PARTICIPATED IN THE STUDY. MEASUREMENTS: DATA WERE COLLECTED THROUGH ADMINISTRATION OF VALIDATED ADL AND NUTRITION QUESTIONNAIRES (NUTRITIONAL STATUS, FUNCTIONAL STATUS WITH ADLS, CHEWING ABILITY, DENTAL CONDITIONS, AND PRIOR DIAGNOSES OF DYSPHAGIA, PNEUMONIA, AND DEMENTIA). FOR SELF-REPORTED DYSPHAGIA, THE VALIDATED 10-ITEM EATING ASSESSMENT TOOL (EAT-10) WAS USED. RESULTS: THE PREVALENCE OF SELF-REPORTED DYSPHAGIA (EAT-10 SCORE OF 3) WAS 20.4%. MULTIVARIATE LOGISTIC REGRESSION RESULTS INDICATED THAT POOR NUTRITIONAL STATUS (OR=3.1, P=0.04), DIFFICULTY CHEWING (OR=2.2, P=0.03), PRIOR DYSPHAGIA DIAGNOSIS (OR=34.8, P

AGING INVOLVES PHYSIOLOGICAL AND NON-PHYSIOLOGICAL CHANGES THAT AFFECT THE PERCEPTION OF THE ELDERLY ON THE PHENOMENON OF FOOD, HOWEVER, INTERNATIONAL INVESTIGATIONS COULD NOT REPRESENT THE CHILEAN POPULATION, BECAUSE OF THE LITTLE INFORMATION ABOUT THE PERCEPTION OF THE ELDERLY WITH PRESBYPHAGIA AND THE FACTORS THAT INFLUENCE THEIR DIET. THE PURPOSE OF THIS QUALITATIVE STUDY WITH PHENOMENOLOGICAL DESIGN IS TO KNOW THE PERCEPTION OF OLDER ADULTS WITH PRESBYPHAGIA ABOUT FOOD PHENOMENON, CONSIDERING PHYSIOLOGICAL AND NON-PHYSIOLOGICAL FACTORS ALONG WITH THE ORGANOLEPTIC PROPERTIES OF FOODS THAT THEY PREFER. FOR THIS, A SEMISTRUCTURED INTERVIEW WAS APPLIED TO EIGHT OLDER ADULTS WITH PRESBYPHAGIA ATTENDING AT THE PRACTICAL ACTIVITIES CENTER (SAMPLING BY SATURATION). THE SPEECH WAS PROCESSED THROUGH AXIAL CODING IN TWO LEVELS: FORMATION OF CODES (THROUGH APPOINTMENTS OF THE INTERVIEWEE), MEMOS (CONCEPTS OF RESEARCHERS) AND SELECTIVE CODING, THROUGH THE INTEGRATION OF FAMILY CODES, APPLYING THE METHOD OF CONSTANT COMPARISONS, USING ATLAS.TI 6. THE RESULTS INDICATE THAT SOCIAL AND PSYCHOLOGICAL FACTORS ARE INVOLVED IN FEEDING. ORGANOLEPTIC PROPERTIES THAT INFLUENCE THE PERCEPTION OF THE ELDERLY ARE: SIZE, CONSISTENCY, TASTE, TEMPERATURE AND INTENSITY OF THE COLOR, WHICH AFFECT THE CHOICE OF FOOD. IN CONCLUSION THE PERCEPTION OF THE ELDERLY WITH PRESBYPHAGIA FOOD, IS INFLUENCED BY PHYSIOLOGICAL AND NON-PHYSIOLOGICAL FACTORS WHICH DETERMINE THE PREFERENCE OF ORGANOLEPTIC PROPERTIES AND FOOD CHOICES. IN ADDITION TO BEING INFLUENCED BY ACQUIRED HABITS AND GEOGRAPHIC LOCATION.

LANGUAGE ASSESSMENT IN PERSONS WITH BRAIN INJURY MAKES IT POSSIBLE TO KNOW WHETHER THEY REQUIRE LANGUAGE REHABILITATION OR NOT. GIVEN THE IMPORTANCE OF A PRECISE EVALUATION, ASSESSMENT INSTRUMENTS MUST BE VALID AND RELIABLE, SO AS TO AVOID MISTAKEN AND SUBJECTIVE DIAGNOSES. AIM. TO VALIDATE 'LEXICAL SCREENING FOR APHASIAS' IN A SAMPLE OF 58 CHILEAN INDIVIDUALS. SUBJECTS AND METHODS. A SCREENING-TYPE LANGUAGE TEST, LASTING 20 MINUTES AND BASED ON THE LEXICAL PROCESSING MODEL DEVISED BY PATTERSON AND SHEWELL (1987), WAS CONSTRUCTED. THE SAMPLE WAS MADE UP OF TWO GROUPS CONTAINING 29 APHASIC SUBJECTS AND 29 CONTROL SUBJECTS FROM DIFFERENT HEALTH CENTRES IN THE REGIONS OF BIOBIO AND MAULE, CHILE. THEIR AGES RANGED BETWEEN 24 AND 79 YEARS AND HAD BETWEEN 0 AND 17 YEARS' SCHOOLING. TESTS WERE CARRIED OUT TO DETERMINE DISCRIMINATING VALIDITY, CONCURRENT VALIDITY WITH THE APHASIA DISORDER ASSESSMENT BATTERY, RELIABILITY, SENSITIVITY AND SPECIFICITY. RESULTS. THE STATISTICAL ANALYSIS SHOWED A HIGH DISCRIMINATING VALIDITY (P < 0.001), AN ACCEPTABLE MEAN CONCURRENT VALIDITY WITH APHASIA DISORDER ASSESSMENT BATTERY (RS = 0.65), HIGH MEAN RELIABILITY (ALPHA = 0.87), MODERATE MEAN SENSITIVITY (69%) AND HIGH MEAN SPECIFICITY (86%). CONCLUSION. 'LEXICAL SCREENING FOR APHASIAS' IS VALID AND RELIABLE FOR ASSESSING LANGUAGE IN PERSONS WITH APHASIAS; IT IS SENSITIVE FOR DETECTING APHASIC SUBJECTS AND IS SPECIFIC FOR PRECLUDING LANGUAGE DISORDERS IN PERSONS WITH NORMAL LANGUAGE ABILITIES.

PURPOSE: MENOPAUSE MARKS THE END OF FERTILITY AND RAPID DECLINE OF OVARIAN HORMONES IN THE FEMALE BODY, WHICH CORRESPONDS TO A MYRIAD OF CHANGES TO BODILY SYSTEMS, INCLUDING THE UPPER AERODIGESTIVE TRACT. DESPITE SUBSTANTIAL EVIDENCE THAT MENOPAUSE NEGATIVELY IMPACTS ORAL HEALTH, BONES, AND SKELETAL MUSCLES, LITTLE RESEARCH HAS EXAMINED THESE EFFECTS AS THEY RELATE TO SWALLOWING. THE PURPOSE OF THIS SCOPING REVIEW WAS TO COMPILE AND SUMMARIZE THE EXISTING LITERATURE INVESTIGATING THE RELATIONSHIP BETWEEN MENOPAUSE AND SWALLOWING-RELATED STRUCTURES AND PHYSIOLOGY. METHODS: SEARCH TERMS WERE SELECTED FOR THREE DATABASES (PUBMED, SCOPUS, AND CINAHL) TO GATHER RELEVANT LITERATURE EVALUATING THE RELATIONSHIP BETWEEN MENOPAUSE AND SWALLOWING-RELATED ANATOMY AS WELL AS SWALLOWING FUNCTIONS IN BOTH HUMAN AND ANIMAL MODELS. RELEVANT ARTICLES WERE REVIEWED, COLLATED, AND SUMMARIZED TO SYNTHESIZE FINDINGS, IDENTIFY GAPS IN THE LITERATURE, AND PROVIDE SUGGESTIONS FOR FUTURE DIRECTIONS. RESULTS: THIS SCOPING REVIEW YIELDED 204 STUDIES WITH THE MAJORITY OF THESE STUDIES RELATING TO ONE OR MORE OF THE FOLLOWING CATEGORIES: ORAL HEALTH, SALIVA, MANDIBULAR STRUCTURES, AND TASTE. COMMON ORAL SYMPTOMS REPORTED IN THE LITERATURE INCLUDED XEROSTOMIA, HYPOSALIVATION, TOOTH DECAY, INFLAMMATION OF ORAL MUCOSA, AND ORAL PAIN. ALTHOUGH LITERATURE SUPPORTS THAT MENOPAUSE ADVERSELY AFFECTS ORAL HEALTH, SALIVA, MANDIBULAR STRUCTURES, AND ALTERS TASTE, A DEARTH OF INFORMATION WAS EVIDENT REGARDING HOW THESE HORMONE-DEPENDENT CHANGES CAN ADVERSELY AFFECT SWALLOWING. CONCLUSIONS: THE RELATIONSHIP BETWEEN MENOPAUSE AND SWALLOWING HAS BEEN OVERLOOKED BY FIELD OF SPEECH LANGUAGE PATHOLOGY. BY IDENTIFYING THE MAJOR GAPS IN THE LITERATURE, THESE RESULTS WILL INFORM FUTURE INVESTIGATIONS EVALUATING RELATIONSHIPS AMONG OVARIAN HORMONES AND SWALLOWING.

DETERMINAR EL UMBRAL DE VISCOSIDAD QUE POSIBILITE UNA DEGLUCIÓN SEGURA EN ADULTOS MAYORES CON DISFAGIA SECUNDARIA A UN ICTUS. MÉTODO: ESTUDIO ANALÍTICO DE CORTE TRANSVERSAL. PARTICIPARON 6 ADULTOS MAYORES DE 60 AÑOS CON DISFAGIA POST-ICTUS. SE LES ADMINISTRÓ SEIS VISCOSIDADES (50MPA S, 110MPA S, 170MPA S, 230MPA S, 290MPA S Y 350MPA S) CREADAS CON AGUA SIN GAS Y ESPESANTE BASADO EN ALMIDÓN DE MAÍZ. SE EVALUARON LOS SIGNOS DE SEGURIDAD DE LA DEGLUCIÓN (VOZ HÚMEDA, TOS Y SATURACIÓN DE OXÍGENO) EN CADA VISCOSIDAD, MEDIANTE NASOFIBROSCOPÍA. SE COMPARÓ EL RENDIMIENTO DE CADA VISCOSIDAD EN LOS SIGNOS DE SEGURIDAD DE LA DEGLUCIÓN CON EL OBJETIVO DE CONOCER QUÉ VISCOSIDAD SERÍA EL UMBRAL DE SEGURIDAD DEGLUTORIA. RESULTADOS: EL 100% DE LOS SIGNOS DE ALTERACIÓN DE LA SEGURIDAD NO SE PRESENTÓ EN NINGUNA VISCOSIDAD EVALUADA. CONCLUSIONES: NO ES POSIBLE DETERMINAR EL UMBRAL DE VISCOSIDAD QUE POSIBILITA UNA DEGLUCIÓN SEGURA EN PACIENTES CON DISFAGIA SECUNDARIA A UN ICTUS EN LAS VISCOSIDADES EVALUADAS. SE DISCUTEN DIVERSOS FACTORES QUE PUEDEN HABER INFLUIDO EN LOS RESULTADOS, TALES COMO: EL TAMAÑO MUESTRAL, UTILIZACIÓN DE NASOFIBROSCOPÍA PARA EVALUAR VISCOSIDADES BAJAS, E, INTERVALOS DE LAS VISCOSIDADES EVALUADAS.

ANATOMICAL SEGMENTATIONS GENERATED USING ARTIFICIAL INTELLIGENCE (AI) HAVE THE POTENTIAL TO SIGNIFICANTLY IMPROVE VIDEO FLUOROSCOPIC SWALLOW STUDY (VFS) ANALYSIS. AI SEGMENTS ALLOW FOR VARIOUS METRICS TO BE DETERMINED WITHOUT ADDITIONAL TIME CONSTRAINTS STREAMLINING AND CREATING NEW OPPORTUNITIES FOR ANALYSIS. WHILE THE OPPORTUNITY IS VAST, IT IS IMPORTANT TO UNDERSTAND THE CHALLENGES AND LIMITATIONS OF THE UNDERLYING AI TASK. THIS WORK EVALUATES A BOLUS SEGMENTATION NETWORK. THE FIRST SWALLOW OF THIN OR LIQUID BOLUS FROM 80 UNIQUE PATIENTS WERE MANUALLY CONTOURED FROM BOLUS FIRST SEEN IN THE ORAL CAVITY TO END OF SWALLOW MOTION. THE DATA WAS SPLIT INTO A 75/25 TRAINING AND VALIDATION SET AND A 4-FOLD CROSS VALIDATION WAS DONE. A U?NET ARCHITECTURE ALONG WITH VARIATIONS WERE TESTED WITH THE DICE COEFFICIENT AS THE LOSS FUNCTION AND OVERALL PERFORMANCE METRIC. THE AVERAGE VALIDATION SET RESULTED IN A DICE COEFFICIENT OF 0.67. ADDITIONAL ANALYSIS TO CHARACTERIZE THE VARIABILITY OF IMAGES AND PERFORMANCE ON SUB INTERVALS WAS CONDUCTED INDICATING HIGH VARIABILITY AMONG THE PROCESSES REQUIRED FOR TRAINING THE NETWORK. IT WAS FOUND THAT BOLUS IN THE ORAL CAVITY CONSISTENTLY DEGRADES PERFORMANCE DUE TO MISCLASSIFICATION OF TEETH AND UNIMPORTANT RESIDUE. THE DICE COEFFICIENTS DEPENDENCE ON STRUCTURE SIZE CAN HAVE SUBSTANTIAL EFFECTS ON THE REPORTED VALUE. THIS WORK SHOWS THE EFFICACY OF BOLUS SEGMENTATION AND IDENTIFIES KEY AREAS THAT ARE DETRIMENTS TO THE PERFORMANCE OF THE NETWORK.