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Introduction: Previous studies estimating the reliability of the Penetration-Aspiration Scale (PAS) for scoring flexible endoscopic evaluation of swallowing (FEES®) have not considered prior experience in the procedure as an influencing factor. The current study aimed to compare the PAS scores assigned to a set of random, blinded endoscopic swallow studies across entirely novel and experienced FEES® clinicians. Methods: Expert clinicians independently rated a set of FEES® swallows, and novel clinicians did the same after a quick orientation and demonstration on components of PAS. The scores agreed upon by the expert clinicians were considered as a target score for each swallow against which the scores assigned by novel clinicians were compared. Results: Results revealed a significant difference in PAS scores across the two groups for all swallows except the first, postorientation (P < 0.05) probably indicating an immediate training effect that was not maintained. Analysis on learning pattern among the novel clinicians revealed no specific trend but suggested that the clinicians could identify normal and abnormal airway protection in majority of the trials, but had difficulty assigning the correct PAS scores. The penetration to the level of the glottis was most often incorrectly scored. Conclusion: The current study warns the clinicians about reliability of PAS scores communicated as a factor of clinical experience of the examiner who conducted the study. These results imply the need for task-specific training when it comes to implementation of tools in clinical science. Such training may help improve uniform practice and professional communication of patient-related data more reliable. [ABSTRACT FROM AUTHOR]

Introduction: Effortful swallow with progressive resistance has a potential clinical implication in improving the oro-muscular strength, swallow safety, and efficiency in elderly individuals. But to date, no studies have explored its benefits in training individuals with post-stroke dysphagia. Aim: The present study investigated the long- term effect of effortful swallow with progressive resistance on swallow safety, efficiency and quality of life in persons with dysphagia following stroke. Method: The study consisted of 5 males (mean age: 41.80yrs ± 9.6yrs) diagnosed with dysphagia post-stroke. The participants underwent 20 sessions (5 days/week) of intensive effortful swallow with progressive training spread across four weeks. In the first two weeks, the participants performed 10 × 3 sets of effortful swallows with a 50% of resistance load, which was further increased to 15 × 3 sets with a 70% resistance load. Results: DIGEST-FEES safety and overall swallow quality of life significantly improved post-therapy, whereas DIGEST-FEES efficiency and overall swallow grades showed no significant changes. Inter-rater reliability of DIGEST-FEES revealed substantial agreement between judges. Conclusion: The results are promising as the technique improved swallow safety, and swallow quality of life in persons with dysphagia following stroke. [ABSTRACT FROM AUTHOR]