Academic literature on the topic 'Volume-viscosity swallow test (V-VST)'

(1) Background: The volume-viscosity swallow test (V-VST) is a clinical tool for screening and diagnosis of oropharyngeal dysphagia (OD). Our aims were to examine the clinical utility of the V-VST against videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallow (FEES) and to map the V-VST usage with patients at risk of OD across the years since it was described for the first time, carrying a systematic and a scoping review. (2) Methods: We performed both a systematic review (SR) including studies that look at the diagnostic test accuracy, and a scoping review (ScR) with articles published from September 2008 to May 2020. Searches were done in different databases, including PubMed and EMBASE from September 2008 until May 2020, and no language restrictions were applied. A meta-analysis was done in the SR to assess the psychometric properties of the V-VST. Quality of studies was assessed by Dutch Cochrane, QUADAS, GRADE (SR), and STROBE (ScR) criteria. The SR protocol was registered on PROSPERO (registration: CRD42020136252). (3) Results: For the diagnostic accuracy SR: four studies were included. V-VST had a diagnostic sensitivity for OD of 93.17%, 81.39% specificity, and an inter-rater reliability Kappa = 0.77. Likelihood ratios (LHR) for OD were 0.08 (LHR–) and 5.01 (LHR+), and the diagnostic odds ratio for OD was 51.18. Quality of studies in SR was graded as high with low risk of bias. In the ScR: 34 studies were retrieved. They indicated that V-VST has been used internationally to assess OD’s prevalence and complications. (4) Conclusions: The V-VST has strong psychometric properties and valid endpoints for OD in different phenotypes of patients. Our results support its utility in the screening and clinical diagnosis and management of OD.

BackgroundDysphagia is a common complication after stroke. Water swallowing test (WST) is a recognised but limited tool in providing details about dysphagia, including severity and how to adjust the diet based on the test results.MethodsWe performed a prospective observational study of comparing WST and volume–viscosity swallow test (V-VST) in patients with acute stroke within 14 days. All patients had WST and if failed would have a V-VST. The primary outcome was to compare the dysphagia levels assessed by these two test tools. The secondary outcome was to explore the predictive capability in patients who were at high risk of pneumonia by these two swallowing tests.ResultsConsecutively 276 patients with stroke were enrolled in our study, and 197 had normal WST. Among 79 patients who had both WST and V-VST, 20 showed swallowing safety and effectiveness by V-VST. The chance of being on tube feeding was strongly related to the positive results of failed WST (p<0.001). Both tests showed good predictive ability in patients with stroke for pneumonia even some of them were placed on tube feeding (p=0.001 in WST and p<0.001 in V-VST).ConclusionsV-VST performed better as a clinical screening test for dysphagia in patients with acute stroke at the bedside.Trial registration numberChiCTR1800016442.

Objetivo: avaliar a sensibilidade e a especificidade do protocolo Volume-Viscosity Swallow Test (V-VST) para detectar a presença de disfagia em pacientes com doença pulmonar obstrutiva crônica (DPOC) em relação à videofluoroscopia. Método: estudo transversal, descritivo, analítico, com amostra de conveniência de indivíduos de ambos os sexos, ingressantes no Programa Multiprofissional de Reabilitação Pulmonar. Os participantes realizaram avaliação fonoaudiológica clínica da deglutição através do protocolo V-VST e avaliação instrumental pela videofluoroscopia da deglutição, sendo através dos resultados dessas calculado o valor de sensibilidade e especificidade do V-VST. Resultados: foram avaliados 29 sujeitos com média de idade de 63,9±8,6 anos (intervalo de 40 a 78 anos), a maioria do gênero masculino (51,7%). A avaliação segundo o protocolo V-VST demonstrou que a maioria dos participantes tinha deglutição sem alterações (55,2%). A análise do V-VST apresentou baixa sensibilidade (39,10%) e baixa especificidade (33,30%) em relação à videofluoroscopia com valor preditivo positivo de 69,20%. Conclusão: A aplicação do protocolo V-VST para avaliação clínica da deglutição apresentou baixa sensibilidade e especificidade em relação à videofluoroscopia para identificar a presença de disfagia em sujeitos com DPOC.

Oropharyngeal dysphagia is a prevalent complication following stroke (PS-OD), and one that is sometimes spontaneously recovered. This study describes the natural history of PS-OD between admission and three months post-stroke, and the factors associated with its prevalence and development. PS-OD was assessed with the volume-viscosity swallow test (V-VST) in all stroke patients on admission and at the three-month follow-up. We analyzed clinical, demographic, and neuroanatomical factors of 247 older post-stroke patients (National Institute of Health Stroke Scale (NIHSS) = 3.5 ± 3.8), comparing among those with PS-OD the ones with and without spontaneous recovery. PS-OD prevalence on admission was 39.7% (34.0% impaired safety; 30.8%, efficacy) and 41.7% (19.4% impaired safety; 39.3%, efficacy) at three months. Spontaneous swallow recovery occurred in 42.4% of patients with unsafe and in 29.9% with ineffective swallow, associated with younger age and optimal functional status. However, 26% of post-stroke patients developed new signs/symptoms of ineffective swallow related to poor functional, nutritional and health status, and institutionalization. PS-OD prevalence on admission and at the three-month follow-up was very high in the study population. PS-OD is a dynamic condition with some spontaneous recovery in patients with optimal functional status, but also new signs/symptoms can appear due to poor functionality. Regular PS-OD monitoring is needed to identify patients at risk of nutritional and respiratory complications.

Introduction: Neurogenic dysphagia is a frequent disorder affecting people with neurological diseases. Many experts work together to diagnose and treat dysphagia. The aim: The article focuses on the specificity of neurogenic dysphagia, its symptoms and treatment possibilities. The speech pathologist can be included in the diagnostic process and can evaluate the intake of liquids and foods based on a variety of consistency tests. In clinical conditions, screening tests such as water swallowing test, multiple consistency tests: GUSS (Gugging Swallowing Screen), V-VST (Volume-Viscosity Swallow Test) and EAT-10 questionnaire can be used successfully. If you have limited ability to perform instrumental tests, they can help you to expand your diagnosis. Review and Discussion:Treatment of swallowing disorders is based on a daily modification of the patient’s posture and consistency of the eaten meals. Nursing staff are involved in this adaptation activity, which plays an invaluable role in the diagnosis and treatment of patients in neurological and rehabilitation departments. Conclusions: Despite the knowledge of the problem, difficulty swallowing is still unnoticed. The effects of this neglect are felt both for patients and from the perspective of management within treatment units For people suffering from neurological diseases, swallowing disorders should be diagnosed on a compulsory basis and their assessment should be a permanent part of the standard procedures for assessing patients with neurological deficits.

One of the more important and critical referrals that otolaryngologists can receive from colleagues in internal medicine, family medicine and geriatrics is the assessment of swallowing problems or dysphagia of their patients. The term “dysphagia” is derived from two Greek words which literally mean difficulty in swallowing. Swallowing is a complex series of precisely coordinated voluntary and involuntary muscular movements in the mouth, pharynx and esophagus that serves to deliver food from the oral cavity into the stomach. Normal swallowing consists of three phases: oral preparatory, pharyngeal and esophageal. One normal swallow of a bolus of food should only take less than one second to reach the esophagus. Dysphagia may manifest as difficulty managing secretions, drooling, delayed swallowing, coughing or choking with the swallow, a wet gurgly voice, and multiple swallow attempts. The complaint of dysphagia in an elderly patient should not be attributed to normal aging alone, but should be considered an alarm symptom that requires immediate definition of the exact cause and initiation of appropriate therapy.1 Dysphagia and Aspiration Pneumonia2,3 Dysphagic patients who aspirate have a seven-fold risk for acquiring pneumonia. In patients with an acute stroke, 40-70% have dysphagia. Of these, aspiration occurs in 40-50%. 50-75% of patients with degenerative diseases of the central nervous system (e.g. Alzheimer’s disease) also have dysphagia. Thus, people older than 75 years old have a six time higher risk of contracting aspiration pneumonia than younger individuals. Factors that increase the risk of aspiration pneumonia in dysphagia patients include volume of aspirate, oropharyngeal colonization with pathogens such as Staphylococcus aureus, Klebsiella sp. or E. coli (due to decreased salivary clearance and poor oral hygiene) and poor nutritional status (that leads to decreased immunity). Oropharyngeal Dysphagia Dysphagia is typically distinguished into two types based on the phase of swallowing affected. Dysphagia secondary to a lesion above the esophagus is called orophayrngeal dysphagia. Dysphagia involving the upper esophageal sphincter to the stomach is considered esophageal dysphagia. This discussion will concentrate on oropharyngeal dysphagia. Oral dysfunction causes drooling, food spillage, difficulty initiating a swallow, piecemeal swallows, and articulation problems. Pharyngeal dysfunction gives a sensation of food “getting stuck” immediately upon swallowing, regurgitation into the nose, coughing or choking while eating, and vocal problems. Difficulty is localized to the cervical region, usually involving liquids. In contrast, patients with esophageal dysphagia usually describe the onset of symptoms several seconds after initiating swallow. Difficulty is localized to the suprasternal notch or behind the sternum, usually involving solids.1 Oropharyngeal dysphagia is of unique clinical significance. Affected patients often have impaired ability to verbalize their discomfort or to cooperate with evaluation and therapy because of their neurological conditions. This dysphagia is usually not only a local problem, but just one aspect of a systemic disease syndrome. Diagnosis is a challenge because the problem is usually not obviously visible. Management therefore requires a coordinated team approach involving several medical and allied medical professionals. Aside from otolaryngologists, neurologists, radiologists, gastroenterologists, oncologists, rehabilitation medicine specialists and speech-language pathologists will have their specific roles.4 Oropharyngeal dysphagia can be locally caused by poor dentition, mucosal lesions, problems in salivary production, or by a number of neuromuscular disease syndromes. The central nervous system is commonly involved, as with cerebro-vascular accidents (usually in the brainstem), Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis, and brainstem tumors. The peripheral nervous system can also be involved, as with poliomyelitis or myasthenia gravis.. Local structural lesions may be inflammatory, neoplastic, compressive or post-surgical in nature. There can also be hypertensive or hypotensive motility disorders of the upper esophageal sphincter. 5,6 Physical Examination A comprehensive physical examination should be part of the initial evaluation of all patients with oropharyngeal dysphagia. Examination of the oral cavity, head and neck, and supraclavicular region may reveal apparent problems that cause the dysphagia. Neurological examination, which includes testing of all cranial nerves, especially those involved in swallowing (sensory components of CS V, IX, X and motor components of CN V, VII, X, XI and XII), may also detect disorders with more subtle physical findings of the various neuromuscular syndromes that could cause dysphagia. 7 Diagnostic Testing Classic barium-swallow radiography is the most basic diagnostic test for dysphagia, though more useful for esophageal problems. While esophageal manometry is more useful for esophageal dysphagia, it may also be helpful for patients who have oropharyngeal dysphagia with inconclusive results from other examinations. It is especially useful in cases in which surgical myotomy is being considered. 7 Videofluoroscopic evaluation of swallowing (VFES) gives a real-time and detailed analysis of swallowing mechanics from the oral to the esophageal stages, making this the gold standard of swallowing examinations. However, its prohibitive cost and the non-portability make it impractical for several patient settings, most particularly critical patients in Intensive Care Units. Fiberoptic endoscopic evaluation of swallowing (FEES) is the diagnostic procedure performed mainly by otolaryngologists, and will be the discussed in some detail here. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) Flexible Rhinopharyngoscopy is the preferred technique for examining the pharynx because anatomic structures are visualized without interfering with normal physiology of respiration and phonation.8 FEES is an extension technique done to examine swallowing events for both diagnostic and rehabilitative purposes 9 and was first described by Susan Langmore in 1988.10 FEES involves assessment of swallowing function for food and liquid, as well as the response to therapeutic interventions. Before any food testing, velopharyngeal closure, anatomy of the tongue base and hypopharynx, vocal fold movement, status of pharyngeal musculature and patients’ ability to swallow saliva and secretions are first noted. If the equipment is available, sensory testing by eliciting the laryngeal adductor reflex (LAR), using calibrated air pulses delivered to the epithelium innervated by the internal branch of the superior laryngeal nerve, should also be performed.11 Being an involuntary reflex, this information is important when dealing with patients with impaired cognition.8,11 Food samples colored with green food dye (for better visibility) are typically presented in sequence: pureed food, honey thick liquid, nectar thick liquid, thin liquid, mechanical soft food, and regular food. The examiner may also include items from the patient’s current diet. 11 The patient may only swallow when asked to do so. Any premature spillage into the hypopharynx should be noted as this is frequently associated with laryngeal penetration. The oropharyngeal stage is not endoscopically visible because the tip of the endoscope will contact the base of the tongue, the epiglottis and the bolus itself when the swallowing reflex starts (swallowing white-out). During this stage, laryngeal penetration of food may be suspected if there are indirect signs like coughing or food in the laryngeal vestibule. After each swallow, it is likewise important to note the amount and location of residual food in the hypopharynx. When the patient talks or moves his head, these may also penetrate the larynx. 8,12,13 The most frequent adverse effect reported for FEES is discomfort. Topical anesthesia in the nose is not usually employed as it may affect the swallowing mechanism. Other adverse reactions such as changes in heart rate, epistaxis, laryngospasm and vasovagal response may be risky to the patient, but these events are not common. 7,10 Because of its ease of use, portability and lower cost, FEES is now the first choice method of swallowing investigation in Europe. The detection of aspiration of the bolus into the airways (even silent aspiration13) and the presence of bolus residue in the pharynx in FEES correlates very well with VFES, the gold standard. 8 Based on FEES results, the clinician can recommend resumption of oral feeding (with specified food consistencies) or shifting to non-oral options such as the nasogastric tube or percutaneous endoscopic gastrostomy. In either case, he can also recommend the initiation of swallowing rehabilitation therapy if deemed necessary. A Medical Position Statement of the American Gastroenterological Association enumerates the following steps in the Management of Oropharyngeal Dysphagia, all of which are within the scope of Otolaryngologists:4 Ascertain whether oropharyngeal dysphagia is likely Identify structural etiologies of oropharyrngeal dysfunction Ascertain the functional integrity of the oropharyrngeal swallow Evaluate the risk of aspiration pneumonia Determine if the pattern of dysphagia is amenable to therapy Otolaryngologists should be actively involved in the management of critically ill patients via a standardized endoscopy protocol,12 making it routine to perform FEES procedures on these patients, in order to make the best diagnostic decisions about their dysphagia, preventing aspiration pneumonia and its potentially fatal consequences.

Background: The dysphagia screening in acute ischemic stroke plays an important role in patients with risk of dysphagia. The aim of this hospital-based case-control study is to explore if V-VST, as a new nurse-driven dysphagia screening tool for AIS patients, might help to reduce the rate of post-stroke pneumonia and early withdraw of feeding tube. Methods: 1598 acute ischemic stroke patients were enrolled in this study. The standard protocol in AIS patients were assessed by WST (before intervention and plus with V-VST after intervention). The V-VST assessment were be trained in two senior nurses and all AIS patients were assessed by V-VST during July 1and Dec 30 th , 2017. Among 299 AIS patients with suspected, all clinical data were analyzed. The comparison of their rate of pneumonia in hospital and withdraw rate of tubefeeding before discharge were performed between patients post-intervention (January 1, 2018-June 30, 2019)and those admitted before the intervention (January 1, 2016-June 30, 2017). Results: The baseline characteristics of the pre- and post- intervention AIS groups were similar in age, gender, NIHSS. The implementation of V-VST have a statistically significant reducing the risk of pneumonia with an adjusted HR (0.60, 95% CI 0.43-0.84, P=0.003). Additionally, follow-up V-VST were likely to be associated the withdraw rate of tube-feeding at discharge (29/168 vs 38/131 P=0.016).There is also a trend of length of tube-feeding decreasing (8.32±12.27 vs 6.84±8.61 P=0.241). Conclusion: In our study, the V-VST is a feasible bedside tool. The implemental might be associated with the reduction of post-stroke pneumonia. Therefore, it meets the requirements of a clinical screening test for dysphagia in acute stroke patients at bedside. Large prospective interventional study is needed to confirm our findings. V-VST: Volume-viscosity Swallow Test WST: Water Swallow Test AIS: Acute Ischemic Stroke HR: hazard ratio

Objective: The purpose of this study was to compare the clinical signs in patients with acute ischemic stroke(AIS) and identify which of them was associated with the severity of dysphagia. Methods: This was a prospective observational study enrolled AIS within 14 onset days. All patients had swallowing evaluations by the modified Volume Viscosity Swallowing Test (the modified V-VST). Five clinical signs suggestive of swallow function impaired were directly observed in the patients who failed the test. We compared the performance of clinical signs between different completing volumes at three viscosity series. The area under curves (AUCs) were made to show the ability of specific clinical signs in predicting the dysphagia severity in patients with AIS. Results: 184 hospital-based AIS patients who failed the modified V-VST were enrolled from June 2017 to December 2019. 123 patients were identified as moderate swallow function impaired and 61 patients were identified as serious. Larynx movement and tongue movement were significant different clinical signs at all of three viscosities (p≤0.001). The AUC of larynx movement in predicting severity of dysphagia was 0.733( 95% CI 0.658-0.808,P<0.001). Conclusions: Larynx movement and tongue movement were easy clinical signs for medical staffs to assess the dysphagia severity quickly. Additionally, larynx movement showed stronger ability to predict the severity of dysphagia in AIS patients.

RESUMO Objetivo descrever a eficácia e segurança da deglutição, o risco nutricional e a qualidade de vida em deglutição e relacionar o risco nutricional com a qualidade de vida dos indivíduos com doença pulmonar crônica. Método 17 indivíduos com diagnóstico de doença pulmonar crônica foram avaliados por meio do Volume-Viscosity Swallow Test (V-VST), Quality of Life in Swallowing Disorders (SWAL-QOL), Mini Nutritional Assessment (MNA) e índice de massa corpórea. Resultados foi encontrada alteração de eficácia da deglutição em nove (52,94%) dos indivíduos e eficácia+segurança em dois (11,77%). Todos os indivíduos estavam eutróficos na avaliação nutricional. Houve relação entre o risco nutricional com os domínios 3 (r=-0,803; p=0,05) e 5 (r=0,636; p=0,026) do SWAL-QOL. Conclusão houve alteração de eficácia e segurança da deglutição, no entanto não foi encontrado risco nutricional evidente na amostra avaliada. Ainda, houve relação entre o risco nutricional com a qualidade de vida em deglutição.

Apraxia occurs frequently in patients with dementia. Buccofacial apraxia (BFA) characteristics have been less investigated than limb or speech apraxia. An association between BFA and oropharyngeal dysphagia (OD) in old patients with dementia has not yet been explored. We aimed to assess the prevalence of BFA in patients with dementia and evaluate the relationship between BFA, OD, and dementia. We have prospectively included 117 outpatients with dementia referred to a geriatric consultation. Oropharyngeal dysphagia was diagnosed using the volume viscosity swallowing test (V-VST). Buccofacial apraxia was evaluated by miming 7 meaningless gestures. A complementary geriatric assessment of 6-domains completed the evaluation. Buccofacial apraxia was present in 54 (48.6%) patients. Proxies reported OD more frequently in the group of patients with BFA compared to the group without ( P = .04). Prevalence of OD assessed with the V-VST was similar between patients with and without apraxia ( P = .9). Patients with BFA had a significant lower Mini-Mental State Examination suggesting a more severe cognitive decline (18.1 ± 4.5 vs 15.8 ± 5, P = .01), a lower activities of daily living relative to disabilities (5 ± 0.8 vs 4.3 ± 1.3, P = .001), and had a lower gait speed that indicated frailty ( P = .03).In conclusion, our results indicate a relationship between BFA and severity of dementia, disability, and frailty with no significant association between BFA and OD.

Dissertação de Mestrado em Cuidados Continuados e Paliativos apresentada à Faculdade de Medicina
Introdução: A identificação precoce das perturbações da deglutição em doentes com AVC com recurso a instrumentos não invasivos e de fácil administração pode minimizar as suas consequências e reduzir a comorbidade e a mortalidade. A prevalência de disfagia orofaríngea é superior a 30%. O V-VST apresenta boas propriedades psicométricas, permitindo a identificação precoce de doentes em risco de desenvolver complicações respiratórias e nutricionais. Para além de que é possível obter-se recomendações preventivas quanto ao tipo de dieta até à confirmação do diagnóstico por meio de exames instrumentais. Embora o V-VST esteja traduzido para o português europeu, não está validado.Objetivo: O objetivo deste estudo é contribuir para a validação do V-VST – versão portuguesa, em doentes com AVC em fase subagudo, bem como validar suas instruções de aplicação.Material e Método: A versão portuguesa do V-VST, assim como, suas instruções, foram apresentadas a um painel de peritos constituído por seis terapeutas da fala, a fim de aferir a validade de conteúdo. Após aprovação ética, o V-VST foi aplicado a 33 doentes com AVC em fase subaguda, a fim de se analisar as suas propriedades psicométricas, ou seja, a consistência interna e a fiabilidade (inter e intra observador). A validade do critério foi avaliada através da aplicação simultânea do 3Oz wst. Os dados recolhidos foram analisados com o IBM SPSS versão 24.0.Resultados: A validade de conteúdo demonstra uma concordância muito boa entre os elementos do painel de peritos para todos os itens do V-VST (IVC = 0,95), bem como suas instruções (IVC = 0,83). Resultados de consistência interna e fiabilidade evidenciaram que a V-VST apresenta fiabilidade inter- observador boa (néctar-Kendall Tau = 0,722; Apha de Cronbach = 0,816; líquido-Kendall Tau = 0,700; Apha de Cronbach = 0,830; pudim-Kendall Tau = 0,777; Apha de Cronbach = 0,866) e correlações intraclasse (néctar-Kendall Tau = 0,788; Apha de Cronbach = 0,876; líquido-Kendall Tau = 0,700; Apha de Cronbach = 0,830; pudim-Kendall Tau = 0,617; Apha de Cronbach = 0,744). Valores obtidos da comparação entre o teste V-VST e o 3Oz wst apresentaram resultados semelhantes entre si (IVC = 0,83).Conclusão: O V-VST - versão parece evidência ser uma ferramenta válida, fiável para o rastreio da disfagia em doentes com AVC subagudo. No entanto, são necessários mais estudos nesta área em desenvolvimento científico e académico.
Background: The early identification of swallowing disorders in patients with stroke resorting to non invasive and easily administered instruments can minimize its consequences and reduce comorbidity and mortality among these patients. The prevalence of functional oropharyngeal dysphagia in these patients is superior than 30%. The V-VST exhibit good psychometric properties, allowing the early identification of patients at risk of developing respiratory and nutritional complications. Its use also allows dietary preventive recommendations to patients until diagnosis confirmation by instrumental examinations. Although the V-VST is translated into Portuguese European, it is not validated.Objectives: The goal of this study is to contribute to the validation of the V-VST – Portuguese version, in patients with subacute stroke as well as to validate its instructions.Material and Methods: Once a different thickener was being used during this study and in order to obtain the same viscosity values of the original study, the thickener dosage was reformulated. The V-VST- Portuguese version, as well as its instructions, was presented to a panel of experts constituted by six speech and language therapists, in order to assess its content validity. After an ethical approval, it was applied to thirty-three patients with subacute stroke, to analyze its psychometric properties, namely its internal consistency and reliability (inter and intra raters). Criterion validity was assessed through the simultaneous application of the 3Oz wst test. Collected data were analyzed with IBM SPSS version 24.0. Results: The Content validity demonstrate a very good agreement between all members of the panel of experts for all the items of the V-VST (I-CVI/Ave=0.95) as well as to its instructions (I-CVI=0.83). Results of internal consistency and reliability showed that the V-VST presents good interclass (nectar-Kendall Tau=0.722; Apha de Cronbach=0.816; liquid-Kendall Tau=0.700; Apha de Cronbach=0.830; pudding-Kendall Tau=0.777; Apha de Cronbach=0.866) and intraclass correlations (nectar-Kendall Tau=0.788; Apha de Cronbach=0.876; liquid-Kendall Tau=0.700; Apha de Cronbach=0.830; pudding-Kendall Tau=0.617; Apha de Cronbach=0.744). Values obtained from the comparison between the V-VST and 3Oz wst test have given similar results (I-CVI=0.83).Conclusion: The V-VST - Portuguese version seems to be a valid, reliable and practical tool for assessing dysphagia in patients with subacute stroke. Further studies need to be done in the future.