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Objectives: To develop an expert consensus statement on the clinical use of swallowing fluoroscopy in adults that reduces practice variation and identifies opportunities for quality improvement in the care of patients suffering from swallowing impairment., Methodology: A search strategist reviewed data sources (PubMed, Embase, Cochrane, Web of Science, Scopus) to use as evidence for an expert development group to compose statements focusing on areas of controversy regarding swallowing fluoroscopy. Candidate statements underwent two iterations of a modified Delphi protocol to reach consensus., Results: A total of 2184 publications were identified for title and abstract review with 211 publications meeting the criteria for full text review. Of these, 148 articles were included for review. An additional 116 publications were also included after reviewing the references of the full text publications from the initial search. These 264 references guided the authors to develop 41 candidate statements in various categories. Forty statements encompassing patient selection, fluoroscopic study choice, radiation safety, clinical team dynamics, training requirements, videofluoroscopic swallow study and esophagram techniques, and interpretation of swallowing fluoroscopy met criteria for consensus. One statement on esophagram technique reached near-consensus., Conclusions: These 40 statements pertaining to the comprehensive use of swallowing fluoroscopy in adults can guide the development of best practices, improve quality and safety of care, and influence policy in both the outpatient and inpatient settings. The lack of consensus on some aspects of esophagram technique likely reflects gaps in knowledge and clinical practice variation and should be a target for future research. Laryngoscope, 133:255-268, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: The effectiveness of the use of carbonation in preventing penetration/aspiration or enhancing swallowing function in adults remains unclear. This systematic review aimed to evaluate the effectiveness of carbonation on improving swallowing function in adult subjects., Methods: Literature published before March 2021 was inspected using MEDLINE, CINAHL, Web of Science Core Collection, The Cochrane Library, Cochrane Central Register of Controlled Trials, and Ichushi-web databases. We searched for intervention studies or randomized control trials considering the effects of carbonated liquids on swallowing function. The risk of bias was assessed using the Cochrane tool for assessing the risk of bias for randomized controlled trials and the Risk of Bias Assessment Tool for Nonrandomized Studies., Results: The systematic review identified 19 studies with a total of 586 participants. The effects of carbonation on swallowing function are diverse. Overall, most studies showed that carbonation promotes swallowing function compared to other liquids. Five studies were included in the quantitative synthesis. Meta-analysis showed that carbonated liquids prevent aspiration (risk difference [RD] -0.27%, 95% confidence interval [CI] -0.44 to -0.10; I 2  = 0%; number needed to treat 3.8, 95% CI 2.2 to 15.0; moderate quality of evidence) when compared to noncarbonated thin liquids. Carbonated liquids also increased the duration of swallowing apnea than did noncarbonated liquids (standardized mean difference 0.25 (mean difference 0.36 seconds), 95% CI 0.03 to 0.47; I 2  = 0%; low quality of evidence)., Conclusions: Carbonation had favorable effects on swallowing function. Further in-depth studies are needed to clarify the benefits of carbonation., Level of Evidence: NA Laryngoscope, 132:1924-1933, 2022., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Co-ordination of breathing and swallowing is essential for normal pharyngeal function and to protect the airway. To allow for safe passage of a bolus through the pharynx, respiration is interrupted (swallowing apnoea); however, the control of airflow and diaphragmatic activity during swallowing and swallowing apnoea are not fully understood. Here, we validated a new airflow discriminator for detection of respiratory airflow and used it together with diaphragmatic and abdominal electromyography (EMG), spirometry and pharyngeal and oesophageal manometry. Co-ordination of breathing and spontaneous swallowing was examined in six healthy volunteers at rest, during hypercapnia and when breathing at 30 breaths min–1. The airflow discriminator proved highly reliable and enabled us to determine timing of respiratory airflow unambiguously in relation to pharyngeal and diaphragmatic activity. During swallowing apnoea, the passive expiration of the diaphragm was interrupted by static activity, i.e. an ‘active breath holding’, which preserved respiratory volume for expiration after swallowing. Abdominal EMG increased throughout pre- and post-swallowing expiration, more so during hyper- than normocapnia, possibly to assist expiratory airflow. In these six volunteers, swallowing was always preceded by expiration, and 93 and 85% of swallows were also followed by expiration in normo- and hypercapnia, respectively, indicating that, in man, swallowing during the expiratory phase of breathing may be even more predominant than previously believed. This co-ordinated pattern of breathing and swallowing potentially reduces the risk for aspiration. Insights from these measurements in healthy volunteers and the airflow discriminator will be used for future studies on airway protection and effects of disease, drugs and ageing. [ABSTRACT FROM AUTHOR]

Background: Swallowing function can become impaired due to primary medical conditions or age‐related presbyphagia, resulting in swallowing disorders, known as dysphagia. Specific manoeuvres that target different musculature have been innovated and researched, but whole‐body exercises (WBE) that target multiple large groups of body systems and muscles have been rarely considered in dysphagia management, despite the causes of dysphagia being often systemic. Aims: To identify intervention studies that have used or incorporated WBE to target swallowing function in humans, and report on their findings. Methods & Procedures: A scoping review was conducted given the paucity and novelty of this topic in research and practice. Key search terms were used to search five major databases on for all human studies published before 28 November 2022. Studies that were not interventional or used animal models were excluded. All swallowing and oromotor‐related outcomes were extracted from the studies. Two researchers independently reviewed all search results following the PRISMA‐ScR guideline before meeting to resolve any disagreements. Main Contribution: Final analysis was conducted on 11 papers that described 10 studies, with 10 papers (9 studies) reporting positive findings for swallowing or oromotor function‐related outcomes. Studies ranged from randomised controlled trials to case studies in design. The study design and populations were heterogeneous, with outcome measures for swallowing and oromotor function ranging from subjective questionnaires to instrumental assessments. Conclusions & Implications: Dysphagia rehabilitation that incorporates WBE as part of a comprehensive programme appears to be more beneficial than either WBE or swallowing‐related interventions alone. This review is an initial attempt to systematically examine the evidence on this topic. There is a need for future research to study how WBE can be used, either alone or combined with traditional swallowing exercises, to influence swallowing function in different healthy and clinical populations. WHAT THIS PAPER ADDS: What is already known on this subject: Dysphagia rehabilitation usually focuses only on the swallowing muscles and structures of the head, neck, and respiratory system. Whole‐body exercise (WBE) and fitness are associated with stronger performance of the tongue muscles, there may be transference potential of WBE to swallowing function. What this paper adds to existing knowledge: This review found 10 studies conducted in the last decade that investigated the inclusion of WBE in programmes intended to improve swallowing and/or oromotor‐related outcomes. The studies varied widely in design and methodology, but most reported evidence in support of the inclusion of WBE to improve or maintain swallowing and/or oromotor‐related functions. What are the potential or actual clinical implications of this work?: There is potential for WBE to have a synergistic effect on swallowing function when combined with traditional swallowing exercises. Future clinical research should compare different rehabilitation approaches with controls. Clinicians should enlist allied health professionals who can provide whole‐body rehabilitation when managing dysphagia. [ABSTRACT FROM AUTHOR]

Background: Endovascular clot retrieval (ECR) is known to reduce global disability at 3 months post stroke however limited research exists regarding the trajectory of specific clinical impairments including language, swallowing and cognitive deficits between onset and 3 months. Aims: To assess language, swallowing, and cognitive performance following ECR and explore whether impairment severity is correlated with modified Thrombolysis in Cerebral Infarction score (mTICI), stroke severity or quality of life (QoL). Methods: Assessment was completed within 7 days (T1), 1 month (T2) and 3 months (T3) post‐stroke. Performance was measured with the Functional Oral Intake Scale (FOIS), Repeatable Battery for Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT A and B) and Brixton Spatial Awareness Test. The Western Aphasia Battery (WAB) was used for left hemisphere stroke. QoL was measured with the Stroke and Aphasia Quality of Life Scale. Results: Twenty‐five participants (median 72 years; 64% male) were prospectively recruited following ECR. High reperfusion success (68% mTICI 3) and low stroke severity post ECR (median 24 h NIHSS = 3, IQR 7–18) were noted. At T1, 10 participants presented with aphasia, eight required a modified diet and 20 had impaired cognition. At T3 all had recovered to a normal oral diet, 39% had persistent cognitive impairment and 45% of patients with left hemisphere stroke remained aphasic. Performance on the WAB, FOIS, RBANS and TMT changed significantly over time (all p < 0.05). The severity score at T1 for all measures, excluding TMT B and Brixton, was significantly correlated with 24 h NIHSS. WAB scores at T3 were correlated with QoL (r = 0.618; p = 0.043). Conclusion: This exploratory study found the longitudinal performance of language, swallowing and cognition significantly improved over time and severity in the first‐week post‐ECR was correlated with 24 h NIHSS rather than the degree of reperfusion. WHAT THIS PAPER ADDS: What is already known on the subject: Randomised control trials have demonstrated the benefit of ECR in patients with ischemic stroke using global measures of disability and function. Limited research exists regarding the trajectory of specific clinical impairments including language, swallowing and cognitive deficits. There is also a reliance on screening assessments and a lack of consideration of the influence of co‐occurring impairments. What this paper adds to existing knowledge: This prospective study is amongst the first to explore the longitudinal trajectory of language, swallowing and cognitive impairment using a standardised assessment battery. Twenty‐four‐hour NIHSS was significantly correlated with language, swallowing, global cognition and some measures of executive function. Language performance post ECR was correlated with domain‐specific cognitive assessment of attention, immediate memory and delayed memory, which differed from swallowing performance post ECR that correlated with measures of executive function. What are the potential or actual clinical implications of this work?: It is important for speech‐language pathologists and the wider medical team to monitor language, swallowing and cognitive performance post ECR regardless of treatment success. Stroke severity at 24 h post‐ECR influences the severity of language, swallowing and cognitive impairments. [ABSTRACT FROM AUTHOR]

Background: Competent clinical reasoning forms the foundation for effective and efficient clinical swallowing examination (CSE) and consequent dysphagia management decisions. While the nature of initial CSEs has been evaluated, it remains unclear how new information gathered by speech–language therapists (SLTs) throughout a patient's acute‐care journey is integrated into their initial clinical reasoning and management processes and used to review and revise initial management recommendations. Aims: To understand how SLTs' clinical reasoning and decision‐making regarding dysphagia assessment and management evolve as patients transition through acute hospital care from referral to discharge. Methods & Procedures: A longitudinal, qualitative approach was employed to gather information from two SLTs who managed six patients at a metropolitan acute‐care hospital. A retrospective 'think‐aloud' protocol was utilized to prompt SLTs regarding their clinical reasoning and decision‐making processes during initial and subsequent CSEs and patient interactions. Three types of concept maps were created based on these interviews: a descriptive concept map, a reasoning map and a hypothesis map. All concept maps were evaluated regarding their overall structure, facts gathered, types of reasoning engaged in (inductive versus deductive), types of hypotheses generated, and the diagnosis and management recommendations made following initial CSE and during subsequent dysphagia management. Outcomes & Results: Initial CSEs involved a rich process of fact‐gathering, that was predominantly led by inductive reasoning (hypothesis generation) and some application of deductive reasoning (hypothesis testing), with the primary aims of determining the presence of dysphagia and identifying the safest diet and fluid recommendations. During follow‐up assessments, SLTs engaged in increasingly more deductive testing of initial hypotheses, including fact‐gathering aimed at determining the tolerance of current diet and fluid recommendations or the suitability for diet and/or fluid upgrade and less inductive reasoning. Consistent with this aim, SLTs' hypotheses were focused primarily on airway protection and medical status during the follow‐up phase. Overall, both initial and follow‐up swallowing assessments were targeted primarily at identifying suitable management recommendations, and less so on identifying and formulating diagnoses. None of the patients presented with adverse respiratory and/or swallowing outcomes during admission and following discharge from speech pathology. Conclusions & Implications: Swallowing assessment and management across the acute‐care journey was observed as a high‐quality, patient‐centred process characterized by iterative cycles of inductive and deductive reasoning. This approach appears to maximize efficiency without compromising the quality of care. The outcomes of this research encourage further investigation and translation to tertiary and post‐professional education contexts as a clear understanding of the processes involved in reaching diagnoses and management recommendations can inform career‐long refinement of clinical skills. WHAT THIS PAPER ADDS: What is already known on the subject: SLTs' clinical reasoning processes during initial CSE employ iterative cycles of inductive and deductive reasoning, reflecting a patient‐centred assessment process. To date it is unknown how SLTs engage in clinical reasoning during follow‐up assessments of swallowing function, how they assess the appropriateness of initial management recommendations and how this relates to patient outcomes. What this paper adds to the existing knowledge: Our longitudinal evaluation of clinical reasoning and decision‐making patterns related to swallowing management in acute care demonstrated that SLTs tailored their processes to each patient's presentation. There was an emphasis on monitoring the suitability of the initial management recommendations and the potential for upgrade of diet or compensatory swallowing strategies. The iterative cycles of inductive and deductive reasoning reflect efficient decision‐making processes that maintain high‐quality clinical care within the acute environment. What are the potential or actual clinical implications of this work?: Employing efficient and high‐quality clinical reasoning is a hallmark of good dysphagia practice in maximizing positive patient outcomes. Developing approaches to understanding and making explicit clinical reasoning processes of experienced clinicians may assist SLTs of all developmental stages to provide high standards of care. [ABSTRACT FROM AUTHOR]

Background: : Dysphagia is prevalent in subjects with Parkinson's disease (PD). Swallowing intervention to improve or maintain swallowing function is of major importance as dysphagia may considerably impact physical and psycho‐social health. Aims: : A mixed methods systematic review was conducted to summarize and appraise literature reporting (1) effects of behavioural interventions for swallowing in individuals with PD; and (2) participants' perspectives of swallowing interventions. Methods & Procedures: : Electronic databases were searched systematically in July 2020 for articles published between 2014 and 2020. In addition, studies published between 2000 and 2014 were identified non‐systematically through previous reviews. Peer‐reviewed quantitative and qualitative research in English or German documenting behavioural interventions for swallowing in individuals with a diagnosis of PD was eligible for inclusion. Participants at all disease stages were included. Behavioural interventions included rehabilitative and compensatory strategies. Studies reporting swallowing outcomes with and without a comparative group were included. For each study, the National Health and Medical Research Council level of evidence was defined. Included studies were critically appraised using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. An integrated synthesis was performed after separate analysis of effect data and data reflecting participants' experiences. This review was conducted based on published JBI methodology and the guideline from the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis system was followed. Main Contribution: : A total of 33 studies published in English met the inclusion criteria. Thirty‐one studies reported quantitative data, one was qualitative and one was mixed methods. Intervention effects on swallowing function, swallowing safety and swallowing‐related quality of life were reported for various treatment approaches. Three studies explored how participants perceived the intervention. Overriding themes including subjects' views regarding treatment schedules and levels of effort or comfort associated with the intervention were identified across these studies. Combining evidence of intervention effects and subjects' experiences was possible for one rehabilitative and one compensatory intervention. Conclusions & Implications: : Beneficial effects of swallowing interventions have been reported; however, most experiments were case studies of variable methodological quality. Randomized‐controlled trials with robust methodology to explore treatment effects in larger samples is needed to guide clinical practice. Research reporting subjects' views is scarce. More studies exploring how individuals perceive behavioural interventions for swallowing are necessary to inform clinical decision‐making. WHAT THIS PAPER ADDS: What is already known on the subject: Dysphagia is common in individuals with PD. Swallowing intervention is of major importance as dysphagia may negatively affect physical and psycho‐social health of subjects with PD. What this study adds: Beneficial effects of behavioural interventions for swallowing, including rehabilitative and compensatory strategies, have been reported; however, available data are mostly based on case studies of variable quality. Data on how participants perceive specific behavioural interventions are lacking. Based on the available data, integration of efficacy data and individuals' experiences is limited. What are the clinical implications of this work?: Given the current evidence of intervention effects and individuals' views on behavioural treatment strategies, interventions implemented into clinical practice require careful evaluation on a case‐by‐case basis. More high‐quality research is needed to examine interventions' short‐ and long‐term effects in larger samples to guide clinical practice. In addition to studies evaluating intervention effects, research exploring participants' experiences with interventions is required as a foundation for clinical decision‐making. [ABSTRACT FROM AUTHOR]

Background: Ultrasound (US) is not widely used as part of the speech and language therapy (SLT) clinical toolkit. The COVID‐19 pandemic has intensified interest in US as an alternative to SLT instrumental tools such as the videofluoroscopic swallowing study (VFSS), fibreoptic endoscopic evaluation of swallowing (FEES) and endoscopic evaluation of the larynx (EEL) as a non‐invasive, non‐aerosol‐generating procedure that can be delivered at the bedside to assess swallowing and/or laryngeal function. To establish the appropriacy of routine US use, and in response to a national professional body request for a position statement, a group of expert SLTs conducted a rapid review of the literature. Aim: To explore critically the clinical utility of US as an assessment tool for swallowing and laryngeal function in adults. Methods & Procedures: A rapid review of four databases was completed to identify articles using US to assess swallowing and/or laryngeal function in adults compared with reference tests (VFSS/FEES/EEL/validated outcome measure). Screening was completed according to predefined inclusion/exclusion criteria and 10% of abstracts were rescreened to assess reliability. Data were extracted from full texts using a predeveloped form. The QUADAS‐2 tool was used for quality ratings. Information from included studies was summarized using narrative synthesis and visual illustration. Outcomes & Results: Ten papers used US to assess swallowing, and 13 to assess laryngeal function. All were peer‐reviewed primary studies across a range of clinical populations and with a wide geographical spread. Four papers had an overall low risk of bias, but the remaining 19 had at least one domain where risk of bias was judged as high or unclear. Applicability concerns were identified in all papers. The papers that used US to assess swallowing varied widely in terms of the anatomical structures assessed and methodology employed. The papers assessing laryngeal function were more homogenous in their methodology. Sensitivity and specificity data were provided for 12 of the laryngeal function papers with ranges of 64.3–100% and 48.5–100%, respectively. Conclusions & Implications: There is burgeoning evidence to support the use of US as an adjunct to SLT clinical assessment of swallowing and laryngeal function. However, the current literature does not support its use as a tool in isolation. Further research is required to establish reliability in US assessment as well as clear SLT‐driven protocols and training. What this paper addsWhat is already known on the subjectUS has demonstrated potential as an assessment tool for objective parameters of swallowing. Its use for laryngeal assessment (gross vocal fold movement) is also widely recognized within the literature. This review appraised the literature related to US as an alternative or adjunctive tool for the assessment of swallowing and laryngeal function.What this paper adds to existing knowledgeThis paper identifies that the current evidence base for US as a swallowing or laryngeal assessment tool is heterogenous and of variable quality. No study combined the assessment of swallowing and laryngeal function, and only two studies assessed more than one parameter of swallowing, limiting the clinical application of the results.What are the potential or actual clinical implications of this work?This review shows that US is a non‐invasive accessible tool that can offer a detailed focal assessment of swallowing and laryngeal function, such as hyoid displacement and vocal fold mobility. With the development of protocols, training packages and competency standards, US has the potential to be used as an adjunct to SLT assessment of swallowing and laryngeal function. There is not currently enough evidence to support the use of US as a stand‐alone tool for SLT assessment of swallowing or laryngeal function. [ABSTRACT FROM AUTHOR]

Background: While the relationship between speech, language and communication needs (SLCN) and mental health difficulties has been recognized, speech and language therapists (SLTs), and mental health professionals face challenges in assessing and treating children with these co‐occurring needs. There exists a gap in the evidence base for best practice for professionals working with children and young people (CYP) who experience difficulties in both areas. Aims: To explore the views of SLTs and mental health clinicians about their experiences of working with CYP exhibiting co‐occurring SLCN and mental health difficulties. Methods & Procedures: Semi‐structured interviews were conducted with eight SLTs and six mental health professionals, including psychotherapists, clinical psychologists, play therapists and counsellors, with experience working with CYP with SLCN. Interviews were analysed using reflexive thematic analysis and themes were identified from the data. Outcomes & Results: Participants felt that SLCN and mental health difficulties frequently co‐occur. Participants described how CYP with SLCN and mental health issues commonly experience difficulties across and between the domains of language and cognition, emotional well‐being and challenging behaviour. Findings suggest that there are organizational limitations in the fields of SLT and mental health that have implications for the efficacy of assessment and treatment of CYP with SLCN and mental health difficulties. Traditional talking therapies were perceived to be inaccessible and ineffective for CYP with SLCN and mental health difficulties. Interventions blending behaviour and emotion programmes with language and communication interventions were considered potentially beneficial. Conclusions & Implications: Future research should explore and evaluate current services and service set‐up in SLT and mental health. The findings from this study have important implications for the efficacy of treatments provided to this population suggesting that more research needs to be done into effective diagnosis and interventions for this population. WHAT THIS PAPER ADDS: What is already known on the subject: Research suggests that CYP with SLCN, such as developmental language disorder (DLD), are likely to experience mental health difficulties including depression, anxiety and poor emotional well‐being. CYP who experience difficulties with SLCN and poor mental health are not well understood and this area remains under‐researched. This has implications for clinician knowledge and therefore the effective diagnosis and treatment of children and adolescents experiencing SLCN and mental health difficulties. In addition, little is known about the accessibility of talking therapies to CYP presenting with SLCN and mental health difficulties. What this paper adds to existing knowledge: SLCN issues are understood by SLTs and mental health issues are understood by mental health professionals, but where these co‐occur difficulties exist for the diagnostic process, with professionals perceiving that CYP in this category are often undiagnosed or misdiagnosed. Organizational boundaries between SLT and mental health were perceived to contribute to a lack of understanding of SLCN and mental health needs, which has implications for effective diagnosis and treatment. Traditional talking therapies were thought to be inaccessible for CYP with SLCN and mental health difficulties. Interventions used in both SLT and psychotherapy were perceived as clinically useful if combined. What are the potential or actual clinical implications of this work?: This paper highlights implications for the accessibility and efficacy of the assessment and treatment provided to this population and to the organization of services currently treating this group of CYP. A direction for future research would be to undertake service evaluations and intervention‐based studies. [ABSTRACT FROM AUTHOR]

Introduction: Dysphagia affects up to 70% of care home residents, increasing morbidity and hospital admissions. Speech and language therapists make recommendations to support safe nutrition but have limited capacity to offer ongoing guidance. This study aimed to understand if recommendations made to support safe and effective care are implemented and how these relate to the actual care delivered. Methods: Eleven mealtimes with residents with dysphagia were observed during 2020 using a tool capturing 12 elements of expected practice. Staff actions during mealtimes were compared with adherence to residents' care plans and speech and language therapist recommendations. Results: Written recommendations predominantly focused on food and fluid modification. Observations (n = 66) revealed food texture, posture, and alertness were adhered to on 90% of occasions, but alternating food and drink, prompting and ensuring swallow completed adherence was less than 60%. Thickened fluids frequently did not align with required International Dysphagia Diet Standardisation Initiative levels. Nutrition care provided in the dining room was less safe due to a lack of designated supervision. Conclusion: Care homes need to be supported to establish a safe swallowing culture to improve residents' safety and care experience. WHAT THIS PAPER ADDS: What is already known on this subject?: Dysphagia is associated with considerable morbidity and mortality and has been identified as an independent risk factor for mortality in nursing home residents.There is evidence that compensatory swallowing strategies, safe feeding advice and dietary modifications can reduce the risk of aspiration pneumonia.Care for nursing home residents at mealtimes is often task‐centred and delegated to those with limited training and who lack knowledge of useful strategies to support the nutrition and hydration needs of residents with dysphagia. What this study adds?: Written advice from speech and language therapists on safe nutrition and hydration for residents with dysphagia is focused mainly on food and fluid modification.Nurses and healthcare assistants have limited understanding of International Dysphagia Diet Standardisation Initiative levels or safe swallowing strategies and recommended practices to support safe nutrition care for residents with dysphagia are inconsistently applied especially when residents are eating in dining areas.Care homes are not aware of Royal College of Speech and Language Therapists guidance on how safe nutrition care of residents with dysphagia should be supported. What are the clinical implications of this work?: Care homes need to prioritise a safe swallowing culture that ensures that residents with swallowing difficulties are assisted to eat and drink in a way that enhances their mealtime experience and minimises adverse events that may result in hospital admission.Speech and language therapists could play an important role in training and supporting care home staff to understand and use safe swallowing strategies with residents with dysphagia.The Royal College of Speech and Language Therapists could provide more assistance to care homes to support and guide them in how to implement safe feeding routines.Care home staff have limited knowledge about how to implement safe feeding routines and need more guidance from speech and language specialists on how they can support residents with dysphagia to eat safely.Creating a safe swallowing culture within care homes could help to improve nutrition care and enhance patient safety. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists and nurses need to work together to keep patients with swallowing difficulties safe throughout their acute stroke admission. Speech and language therapists make recommendations for safe swallowing following assessment and nurses put recommendations into practice and monitor how patients cope. There has been little research into the everyday realities of ongoing swallow safety management by these two disciplines. Patient safety research in other fields of healthcare indicates that safety can be enhanced through understanding the cultural context in which risk decisions are made. Aims: To generate new understanding for how speech and language therapists (SLTs) and nurses share information for ongoing management of swallows safety on stroke units. Methods & Procedures: An ethnographic methodology involving 40 weeks of fieldwork on three stroke wards in England between 2015 and 2017. Fieldwork observation (357 h) and interviews with 43 members of SLT and nursing staff. Observational and interview data were analysed iteratively using techniques from the constant comparative method to create a thematically organized explanation. Outcomes & Results: An explanation for how disciplinary differences in time and space influenced how SLT and nursing staff shared information for ongoing management of swallow safety, based around three themes: (1) SLTs and nurses were aligned in concern for swallow safety across all information‐sharing routes; however, (2) ambiguity was introduced by the need for the information contained in swallowing recommendations to travel across time, creating dilemmas for nurses. Patients could improve or deteriorate after recommendations were made and nurses had competing demands on their time. Ambiguity had consequences for (3) critical incident reporting and relationships. SLTs experienced dilemmas over how to act when recommendations were not followed. Conclusions & Implications: This study provides new understanding for patient safety dilemmas associated with the enactment and oversight of swallowing recommendations in context, on stroke wards. Findings can support SLTs and nurses to explore together how information for ongoing dysphagia management can be safely implemented within ward realities and kept up to date. This could include considering nursing capacity to act when SLTs are not there, mealtime staffing and SLT 7‐day working. Together they can review their understanding of risk and preferred local and formal routes for learning from it. What this paper adds: What is already known on the subject: It is known that information to keep swallowing safe is shared through swallowing recommendations, which are understood to involve a balance of risks between optimizing the safety of the swallow mechanism and maintaining physiological and emotional health. There is increasing appreciation from patient safety research, of the importance of understanding the context in which hospital staff make decisions about risk and patient safety. What this paper adds to existing knowledge: The paper provides new empirical understanding for the complexities of risk management associated with SLT and nursing interactions and roles with respect to ongoing swallow safety. What are the potential or actual clinical implications of this work?: Findings can underpin SLT and nurse discussion about how swallow safety could be improved in their own settings. [ABSTRACT FROM AUTHOR]

Background: Silent aspiration (SA) is common post‐stroke and associated with increased risk of pneumonia, length of stay and healthcare costs. Clinical swallow examinations (CSEs) are unreliable measures of SA. There is no consensus on the clinical components that best detect SA. Cough reflex testing (CRT) is an alternative/adjunct whose SA detection accuracy also lacks consensus. Aims: To investigate the feasibility of CSE versus CRT against gold standard flexible endoscopic evaluation of swallowing (FEES) for SA identification and to estimate its prevalence in a hyperacute stroke setting. Methods & Procedures: A single‐arm preliminary, prospective, feasibility study of patients less than 72 h post‐stroke, over a 31‐day period on a hyperacute stroke unit: the Royal Victoria Infirmary, Newcastle‐upon‐Tyne, UK. Ethical approval for the study was obtained. The study tested the feasibility and acceptability of introducing CRT and developing a standardized CSE. Consent/assent was obtained for all participants. Patients unfit for study were excluded. Outcomes & Results: A total of 62% of patients less than 72 h post‐stroke (n = 61) were eligible. A total of 75% of those approached (n = 30) consented. A total of 23 patients completed all tests. The principal barrier was anxiety regarding FEES. Mean test time for CRT = 6 min; CSE = 8 min; FEES = 17 min. Patients rated CRT and FEES on average as moderately uncomfortable. A total of 30% (n = 7) of participants who received FEES presented with SA. Conclusions & Implications: CRT, CSE and FEES are feasible in 58% of hyperacute stroke patients in this setting. FEES anxiety is the main recruitment barrier and is not always well tolerated. Results support further work to establish optimum methods and differential sensitivity/specificity of CRT and CSE in hyperacute stroke for SA identification. WHAT THIS PAPER ADDS: What is already known on this subject: SA significantly increases the risk of pneumonia in the early days post‐stroke. CSEs are unreliable for identification of SA risk in this population. CRT is gaining popularity as a potential tool to identify stroke patients at risk of SA, though there are questions regarding the efficacy of the clinical protocol currently being used in the UK. What this study adds to existing knowledge: This study demonstrates that it is practical and feasible to carry out a larger scale study in this setting to compare CSE and CRT including a consideration of an approach combining both methods for clinical identification of SA versus FEES. Preliminary findings suggest that CSE may have higher levels of sensitivity than CRT for SA identification. What are the potential or actual clinical implications of this work?: The results of this study suggest that further work is needed to establish the optimum methods and differential sensitivity/specificity of clinical tools for SA detection in hyperacute stroke. [ABSTRACT FROM AUTHOR]

Background: Perceptual, cognitive and previous clinical experience may influence a novice Videofluoroscopic Swallowing Study (VFSS) analyst's trajectory towards competency. Understanding these factors may allow trainees to be better prepared for VFSS training and may allow training to be developed to accommodate differences between trainees. Aims: This study explored a range of factors previously suggested in the literature as influencing the development of novice analysts' VFSS skills. We hypothesised that knowledge of swallow anatomy and physiology, visual perceptual skills, self‐efficacy and interest, and prior clinical exposure would all influence VFSS novice analysts' skill development. Methods & Procedures: Participants were undergraduate speech pathology students recruited from an Australian university, who had completed the required theoretical units in dysphagia. Data assessing the factors of interest were collected—the participants identified anatomical structures on a still radiographic image, completed a physiology questionnaire, completed subsections of the Developmental Test of Visual Processing—Adults, self‐reported the number of dysphagia cases they managed on placement, and self‐rated their confidence and interest. Data for 64 participants relating to the factors of interest were compared with their ability to accurately identify swallowing impairments following 15 h of VFSS analytical training, using correlation and regression analysis. Outcomes & Results: Success in VFSS analytical training was best predicted by clinical exposure to dysphagia cases and the ability to identify anatomical landmarks on still radiographic images. Conclusions & Implications: Novice analysts vary in the acquisition of beginner‐level VFSS analytical skill. Our findings suggest that speech pathologists who are new to VFSS may benefit from clinical exposure to dysphagia cases, sound foundational knowledge of anatomy relevant to swallowing and the ability to see the anatomical landmarks on still radiographic images. Further research is required to equip VFSS trainers and trainees for training, to understand differences between learners during skill development. WHAT THIS PAPER ADDS: What is already known on the subject: The existing literature suggests that no vice Video fluoroscopic Swallowing Study (VFSS) analysts training may be influenced by their personal characteristics and experience. What this study adds: This study found that student clinicians, clinical exposure to dysphagia cases and their ability to identify anatomical landmarks relevant to swallowing on still radiographic images prior to training best predicted their ability to identify swallowing impairments after training. What are the clinical implications of this work?: Given the expense of training health professionals, further research is required into the factors that successfully prepare clinicians for VFSS training, including clinical exposure, foundational knowledge of anatomy relevant to swallowing and the ability to identify the anatomical landmarks on still radiographic images. [ABSTRACT FROM AUTHOR]

Background: Post‐COVID Syndrome (also known as Long COVID) refers to the multi‐system condition affecting individuals following COVID‐19 infection. This can include speech and language therapy (SLT) needs, including voice, swallowing, communication and upper airway difficulties. There is limited published literature in this clinical area of practice, particularly for those receiving input from community SLT services. Aims: To describe and compare demand, typical SLT presentation and service delivery across two National Health Service (NHS) Long COVID multidisciplinary services. Independent retrospective service evaluation was completed for each service. Descriptive statistics were produced and compared across services. This service evaluation followed The Strengthening the Reporting of Observation Studies in Epidemiology guidelines for cohort studies. Outcomes & Results: The findings indicated similarities across the two services in SLT service need and demand, clinical presentations and intervention approaches provided within Long COVID services. There were specific differences in the service provision and delivery of intervention in cognitive communication and upper airways subspecialities. Conclusions & Implications: This study highlights the clinical complexities of SLT needs in individuals with Long COVID and the importance for an appropriately skilled and supported workforce within effective multidisciplinary teams. We call for consensus on SLT practices and a consistent and standardized approach to evaluation for SLT needs in Long COVID. WHAT THIS PAPER ADDS: What is already known on this subject: SLT needs, including voice, swallowing, communication and upper airway difficulties, are present in individuals presenting with Long COVID, both in those who were or were not hospitalized. SLTs are seeing such individuals in a variety of settings, including community services and Long COVID multidisciplinary teams. There is minimal evidence of the clinical presentations and interventions provided to individuals with SLT needs compared across Long COVID services. What this study adds to existing knowledge: This study compares two NHS Long COVID services providing a SLT service pathway. It highlights the similarities and differences in service demand and capacity, patient presentation, and SLT intervention to make suggestions for future practice consideration and priority evaluation. Expert consensus among SLT clinicians is a priority to ensure clinicians are delivering consistent and equitable care for patients, while new evidence and data emerge. A consistent and standardized approach to data collection and outcome measures is essential to ensure future research captures the impact and value of SLT input with individuals with Long COVID. What are the clinical implications of this work?: The complexities and multifactorial SLT needs of individual with Long COVID call for appropriate SLT staffing provision, skill and training to fulfil the needs of this population. Speech and language therapists should be integrated with multidisciplinary Long COVID services to provide holistic care for patients and to support the professionals working with individuals with post‐COVID voice, swallowing, communication and upper airway symptoms. [ABSTRACT FROM AUTHOR]

Background: Cervical auscultation has been used clinically as an augmentative procedure for swallow examination. Despite its frequent use for screening and preliminary assessment of swallowing, the usefulness of cervical auscultation is controversial due to a lack of sufficient research, particularly in quantifying swallowing sounds. Aims: To document the acoustic characteristics of normal swallowing sound associated with swallowing bolus of different consistencies among younger healthy adults. Methods & Procedures: A total of 30 healthy young adult participants swallowed 5 ml thickened liquids of four different consistencies (slightly thick, mildly thick, moderately thick and extremely thick) prepared using a starch‐based commercial thickener, and the corresponding swallowing sounds were recorded using a wireless accelerometric stethoscope. An array of acoustic measures including duration of swallowing sound (DSS), duration to peak intensity (DPI), frequency at peak intensity (FPI), peak intensity (PI), average intensity (AI), and difference between peak and average intensity (DPAI) values associated with the swallowing signals were obtained. Outcomes & Results: In general, increased durational measures of the swallowing sounds were associated with an increase in bolus consistency. Intensity measures including PI, AI and DPAI were found to be stable across different consistencies. The change in FPI did not appear to be particularly meaningful due to its high variability. In addition, no significant differences were observed between men and women. Conclusions & Implications: Swallow sounds associated with different bolus consistencies could be quantified and used to differentiate consistencies. The present findings could serve as a reference for future swallowing research of normal and dysphagic population. WHAT THIS PAPER ADDS: What is already known on the subject: Cervical auscultation using traditional stethoscope has been used as part of an informal clinical swallow examination by practitioners. Validity of cervical auscultation is controversial, possibly due to the lack of normative data on swallow sounds. What this paper adds to existing knowledge: The present study explored the possibility of using wireless accelerometric stethoscopy for cervical auscultation for dysphagia screening. Acoustic profiles of swallow sounds associated with boluses of different consistencies in healthy individuals were examined. What are the potential or actual clinical implications of this work?: Findings contribute to our knowledge about the acoustic characteristics of swallow sounds of boluses of different consistencies in healthy young individuals. The study provides normative clinical data on cervical auscultation using wireless accelerometric stethoscope for normal swallow. [ABSTRACT FROM AUTHOR]

Background: The use of ultrasound as an adjunct to clinical swallowing evaluation provides quantitative physiological and morphological data. As a low‐risk procedure, ultrasound imaging can be performed outside of a medical setting. This is particularly important for patients living in rural areas with restricted access to a hospital. Technical advances have produced pocket‐sized ultrasound technology that is more affordable, and therefore within the fiscal reach of most allied health services. Aims: To explore the validity and reliability of pocket‐sized ultrasound technology in dysphagia assessment. Methods & Procedures: Data were acquired from 43 patients with dysphagia using the Clarius ultrasound device. Ultrasound and videofluoroscopic measures of hyoid and laryngeal displacement during liquid and puree swallowing were collected concurrently to quantify correlation and agreement between identical measures derived from the two instruments. Reliability of ultrasound was assessed for measures of hyoid and laryngeal displacement, tongue thickness, and size of the submental muscles in eight patients. Reliability was evaluated for the entire process of data acquisition including scanning and online measurement using an iPad in a clinical setting and for offline measurement on a computer screen to explore environmental influences on reliability. Outcomes & Results: Results revealed poor correlation between the measures of interest across instruments. Reliability of the entire process of data acquisition in a clinical setting was insufficient while reliability was more promising for offline measurements. Conclusions & Implications: The clinical use of pocket‐sized ultrasound devices, such as the Clarius system, for swallowing evaluation is not indicated at this time. Enhanced validity and reliability of the entire process of data acquisition are needed prior to clinical translation of such technology. WHAT THIS PAPER ADDS: What is already known on the subject: The use of ultrasound allows for radiation‐free, non‐invasive swallowing assessment. Some data suggest that ultrasound is valid and reliable in the evaluation of swallowing using standard‐sized equipment. Insufficient validity and reliability have been reported for pocket‐sized ultrasound technology in the assessment of healthy swallowing. What this paper adds to existing knowledge: This research is the first to provide validity and reliability data of the pocket‐sized Clarius technology in the evaluation of swallowing in patients with dysphagia. Insufficient validity and reliability of online data acquisition in a clinical environment were found. Reliability for offline measurement was more promising. What are the potential or actual clinical implications of this work?: The clinical use of pocket‐sized ultrasound devices, such as the Clarius system, for swallowing assessment is not indicated at this time. [ABSTRACT FROM AUTHOR]

Background: Digital cervical auscultation (CA) has been proposed since the 1950s for screening aspiration among patients with dysphagia. Researchers have investigated the 'external' effects such as bolus viscosity, volume, and head and neck positions. However, the influences of standardized liquid viscosity and food texture on swallowing sounds have not been fully understood due to lacking uniform standardization of bolus preparation. Furthermore, a paucity of the literature recommends proper viscous liquids and foods to start swallowing training or monitor the swallowing progress during the continuum of disease based on acoustic signals. Aims: To investigate the effects of eight‐level liquids and foods on swallowing sound features based on the International Dysphagia Diet Standardisation Initiative (IDDSI). Methods & Procedures: We collected swallowing sounds from 30 healthy participants ranging in age from 19 to 60 years and who were self‐reporting no history of swallowing disorders. Each participant swallowed liquids and foods regarding different consistency or texture with their head–trunk in a neutral position. Outcomes & Results: Features of swallowing acoustic signals and the IDDSI flow test as well as food test confirmed the level 3 moderately thick (MO3) was more suitable to categorize into liquids and the level 4 extremely thick (EX4) was more corresponded to the properties of food bolus. We found significant differences in duration of acoustic signals across different liquids and foods except between swallowing level 0 thin liquid and level 1 slightly thick liquid, as well as EX4 and level 5 minced and moist. Our results also demonstrated liquid viscosity significantly impacted the peak intensity of swallowing sounds. Conclusions & Implications: As an initial exploration of digital CA across eight levels of different liquids and foods according to the IDDSI, we established the baseline findings for future comparisons with other study populations or other various consistent liquids/foods. Although both MO3 and EX4 can be considered as liquid or food boluses with high thickness, MO3 might be suitable as the 'start liquid' for patients with dysphagia; however, the decision still needs to be confirmed by the healthcare provider based on patients' safety and the area of deficit. We also concluded there are influences of varied fluid consistency and food texture on swallowing sounds. Furthermore, future investigations should explore whether changing viscosity levels could either continuously or discretely disturb the swallowing acoustic signals. What this paper adds: What is already known on the subject: Previous studies have found that the 'external' effects such as bolus viscosity, volume, and head and neck positions. Due to lacking uniform standardization of bolus preparation, there is limited information about the influences of standardized liquid viscosity and food texture on swallowing sounds. What this paper adds to the existing knowledge: As an initial exploration, we utilized digital CA with a large sample of viscous liquids and different textures of foods based on the IDDSI to investigate the swallowing sounds. What are the potential or actual clinical implications of this work?: This study confirms that the effects of various fluid consistency and food texture on swallowing acoustic signals. However, the findings of this study support the need for further research relating to changing viscosity could either continuously or discretely disturb the swallowing acoustic signals. [ABSTRACT FROM AUTHOR]

Background: Person‐centred services are inherently related to patients/caregivers' needs. However, the extent to which dysphagia services within Singapore meet consumer needs is largely unknown. Involving patients/caregivers in service evaluation/redesign deepens the understanding of consumer needs. This process also increases the success of implementing service enhancements through relevant and meaningful change. Aim: This study aimed to identify aspects of dysphagia services, within acute and subacute settings in Singapore, perceived as highly important and easy to change by patients/caregivers. Methods & Procedures: Using concept mapping methodology, 5 patients and 11 caregivers reflected on their experiences of receiving dysphagia care and proposed 59 unique suggestions to improve dysphagia services within Singapore. Then, each individual sorted the suggestions into groups based on similarity and rated each statement for its perceived importance and changeability for service enhancement. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and bivariate analysis to generate clusters of conceptually similar suggestions and a prioritised list of suggestions for service enhancement. Results: Twelve clusters were identified, with most rated as more important than changeable for service improvement. Participants prioritised 23 (39%) of the suggestions as highly important and easy to change, and these focused on ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. Conclusion: These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients/caregivers. WHAT THIS PAPER ADDS: What is already known on this subject: Little is known about patients and caregivers' experiences and expectations of receiving dysphagia services in Singapore. Consulting them in service review and improvement deepens understanding of their needs and increases the success of implementing meaningful service enhancements. What this study adds to existing knowledge: This study shows that patients and caregivers in Singapore identified a wide range of dysphagia service issues and prioritised a list of suggestions for service improvement. They prioritised four key areas for service optimisation: ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. What are the clinical implications of this work?: This research highlights the importance of considering the consumers' perspectives in service review and redesign. Patients and caregivers in Singapore identified four prioritised areas for service enhancements. These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients and caregivers. [ABSTRACT FROM AUTHOR]

Background: Above cuff vocalisation (ACV) involves the application of an external flow of air via the subglottic port of a tracheostomy. ACV can facilitate vocalisation and may improve swallowing and quality of life for patients with a tracheostomy. A recent systematic review highlighted the limited evidence available for the acceptability, effectiveness, safety or optimal implementation of ACV. Aims: To explore the experience of healthcare professionals (HCPs) using ACV and their perceptions of best practice. Methods and Procedures: Semi‐structured interviews were conducted with a range of HCPs with experience using ACV. Topics included: experiences with ACV, management of ACV, opinions about ACV, impact of COVID‐19, future directions for ACV and impact on length of stay. Interviews were conducted online from December 2020 to March 2022. Data were analysed using reflexive thematic analysis. Outcomes and Results: Twenty‐four HCPs were interviewed from seven countries and five professional groups. Four interconnected themes were developed: (1) moral distress amplifying the need to fix patients; (2) subjectivity and uncertainty leading to variations in practice and purpose; (3) knowledge and experience leading to control and caution; and (4) worth a try or a last resort. Theme four contained three sub‐themes: (a) part of the toolbox; (b) useful but limited tool; and (c) following the patient's lead. The moral distress experienced by HCPs and their essential 'need to fix' patients seems to underpin the varied opinions of ACV. These opinions appear to be formed primarily on the basis of experience, because of the underlying subjectivities and uncertainties. As knowledge and experience with ACV increased, and adverse events were experienced, most HCPs became more cautious in their approach to ACV. Conclusions and Implications: More research is needed to reduce the subjectivities and uncertainties surrounding ACV. The implementation of standardised procedures, processes, and competencies may help to reduce the frequency of adverse events and support a more controlled approach. Widening the focus of the purpose of ACV to include swallowing may help to maximise the potential benefits. WHAT THIS PAPER ADDS: What is already known on the subject: There is limited and low‐quality evidence for above cuff vocalisation (ACV) and clinical application and practice varies substantially. However, the reasons for this variation in practice and healthcare professionals' (HCPs') opinions of ACV were unclear. What this study adds: HCPs' experiences and opinions of ACV vary as a result of the uncertainty and subjectivity surrounding ACV compounded by their personal experiences with it. A need for caution also appears to emerge as HCPs become more familiar and experienced with using ACV. What are the clinical implications of this work?: Implementing standardised procedures, safety processes and competencies may help to compensate for the uncertainty and subjectivity surrounding ACV and may reduce the frequency of adverse events. Widening the focus of purpose of ACV, including swallowing in addition to communication, may increase the number of potential candidates and increase the potential benefits of ACV. Using multidisciplinary team (MDT) simulation training for ACV competency development might help to improve MDT working and ACV implementation. [ABSTRACT FROM AUTHOR]

Background: Studies suggest swallow intervention programmes that incorporate visual biofeedback and motor programming principles can improve swallowing and quality of life for people with idiopathic Parkinson's disease (IPD) and dysphagia. Few studies have examined outcomes using instrumentation. Aims: Using fibreoptic endoscopic examination of swallowing (FEES), this study examines the effectiveness of a neurorehabilitation intervention involving biofeedback via surface electromyography (sEMG) to improve swallowing in people with IPD, and to explore the feasibility of the intervention approach. Methods & Procedures: We recruited 12 participants with IPD and dysphagia. A total of 10 completed the study. Intervention was delivered for 1 h per day, 5 days per week, for 4 weeks (20 h). Swallowing tasks using sEMG biofeedback incorporated principles of motor learning and neuroplasticity. Instrumental and non‐instrumental assessment, including quality‐of‐life measures carried out at four different time points (two pre‐treatment and two post‐treatment). The final assessment was at 3 months post‐intervention. Outcome & Results: Statistically significant improvement (p < 0.05) in oral intake methods (95% confidence interval (CI) = 4.70–5.50) and in pharyngeal residue from saliva (95% CI = 2.14–3.15) and solids (95% CI = 2.4–3.5) post‐intervention were confirmed using FEES with improvements at 3 months. The intervention protocol was well tolerated. Participants reported positive change in saliva control and duration of mealtimes as well as unanticipated improvements in voice and cognitive attention. Conclusions & Implications: An intensive neurorehabilitation with biofeedback shows positive effects in improving swallow function in IPD. This protocol is feasible with amendments to inform a larger clinical trial. What this paper adds: What is already known on the subject: Biofeedback has positive effects on increasing swallowing function and quality of life in people with IPD and dysphagia. sEMG is the most common method used to deliver swallowing biofeedback in this population. The quality of the evidence on the intervention, based on findings from a recent systematic review, is low. Included studies in this review were heterogeneous in terms of type and frequency of biofeedback, study design and outcome measures. The majority of outcome measures were subjective and higher quality studies to examine the efficacy of biofeedback using sEMG are needed. What this study adds: Recognizing the limitations of earlier studies, this within‐subject feasibility study examined the efficacy and effectiveness of an intensive biofeedback intervention using sEMG in a sample of people with dysphagia and IPD. Valid and reliable outcome measures were used and repeated after a 3‐month period. The feasibility of the methodological approach was also tested and a qualitative component was included in the study. Positive findings were evident. Qualitative information added new perspectives and provided direction for new outcomes to be included in future studies. This study helps to inform further research trials as well as clinical practice. Clinical implications of this study: This intensive intervention using principles of neuroplasticity and motor programming with sEMG biofeedback led not only to positive swallowing outcomes but also to unexpected benefits such as improved voice production and general attention skills. No adverse events were reported. Improvement in function was retained at 3 months post‐intervention. Despite the small sample size, participants described the benefits of the treatment, and enjoyed sEMG biofeedback tasks, especially using an sEMG game mode. This suggests that intensive biofeedback not only improved swallowing but also was acceptable to these participants. This intensive protocol has merit and is worth considering further in clinical practice. [ABSTRACT FROM AUTHOR]

Summary: The brain tumor classification is implemented through biopsy, which is not normally executed before classic mind surgery. Machine learning (ML) algorithms assist radiologists in tumor analysis, not including obtrusive evaluations. The conventional ML strategies need separate feature extraction to tumor detect thus it needs more computation time to perform classification. Deep learning (DL) based convolution neural networks (CNNs) have been focused on brain tumor detection. In this paper, the CNN algorithm is improved based on meta‐heuristics, which are used for pre‐trained systems for databases to categorize MRI brain tumor images. Pre‐trained DL, binary swallow swarm optimization (BSSO) is used for improving the weight and predispositions of the CNN algorithm. It is a block‐wise calibrating system which is dependent on transfer learning. The current technique is assessed over a publically accessible magnetic resonance imaging (MRI) brain tumor database containing three categories as glioma, meningioma, and pituitary by the most noteworthy rate among everyone brain tumor in medical training. The proposed strategy is assessed over T1‐weighted contrast‐enhanced MRI (CE‐MRI) benchmark data. To assess the execution, utilize the proposed strategies to the CE‐MRI dataset for tumor detection and in the general execution of the BSSO‐CNN model is estimated using the execution assessment measurements such as precision, sensitivity (recall), specificity, F1‐score, and accuracy. Exploratory outcomes demonstrated with the purpose of the proposed strategy higher when compared to other methods to all metrics. [ABSTRACT FROM AUTHOR]

Background: Dysphagia is a highly prevalent condition and affects a wide range of cohorts. A common compensatory strategy to manage dysphagia is diet modification. However, this technique is often associated with poor patient quality of life and adverse long‐term effects. Carbonated liquids have shown promise as an alternative compensatory strategy for the management of dysphagia. Aims: To examine the effect of genetic taste status and intensity of carbonation on swallowing and palatability in a healthy young adult population. To examine the palatability of carbonated liquids over time. Methods & Procedures: A total of 35 healthy young adults were recruited for this prospective, quantitative cohort study. They each drank 150 ml of still water (SW), lightly carbonated water (LCW) and highly carbonated water (HCW). Swallow function, palatability and genetic taste status were assessed using the timed water swallow test, the hedonic general labelled magnitude scale and participant ratings of the bitterness of propylthiouracil strips, respectively. Participants were divided into groups of supertasters, moderate tasters and non‐tasters. Outcomes & Results: A significant difference was found between SW and HCW on three tests of swallow function. Average time per swallow increased (p = 0.03), average swallow velocity decreased (p = 0.001) and average volume per swallow decreased (p = 0.017) on HCW compared with SW. HCW had a greater impact on swallow function than LCW. A significant mean difference in palatability ratings was found across intensity levels of carbonated fluids (p = 0.002), specifically between SW and HCW (p = 0.001). HCW was less palatable than SW. The palatability of carbonated liquids, investigated within a subgroup of five participants, did not decrease after a 24‐h period during which participants only drank carbonated liquids (p = 0.102). A significant difference was found between supertasters' (n = 9) (mean = 13.33) and non‐tasters' (n = 20) (mean = –24.5) palatability ratings of HCW (p = 0.03). Despite differences in swallow function between SW and HCW, no differences were detected between supertasters' and non‐tasters' swallow function on SW, LCW or HCW. Conclusions & Implications: Carbonated liquids have the ability to alter swallow function in a healthy young adult population; however, liquids must be highly carbonated in order to have an effect. Additionally, highly carbonated liquids are less palatable than SW, but the palatability of carbonated liquids does not decrease over time. Furthermore, supertasters find HCW more palatable than non‐tasters. These findings suggest that carbonated liquids alter swallowing in a healthy population. Further research in a clinical population is needed to better understand the potential role of sensory stimulation as a dysphagia intervention. What this paper adds: What is already known on the subject: Several studies have found that carbonated liquids have the ability to alter swallow function in both healthy and clinical populations. However, there is a lack of evidence around the optimum intensity of CO2 in carbonated liquids and the palatability of carbonated liquids as well as the palatability of carbonated fluids over time. What this paper adds to existing knowledge: The findings from this study suggest that carbonated liquids can alter swallow function in a healthy young adult population, but liquids must be highly carbonated in order to have an effect. HCW is less palatable than SW, but the palatability of carbonated liquids does not decrease over time. Additionally, supertasters find HCW more palatable than non‐supertasters (non‐tasters). What are the potential or actual clinical implications of this work?: The findings from this study suggest that carbonated liquids may be suitable for use as a sensory stimulation technique for people with dysphagia, as their palatability does not decrease over time; however, further research in a clinical population is needed in order to determine this. Additionally, intensity of stimulus is an important factor to consider during dysphagia evaluation to identify what intensity is required to optimize swallowing. [ABSTRACT FROM AUTHOR]

Background: Quantitative measures can increase precision in describing swallowing function, improve interrater and test–retest reliability, and advance clinical decision‐making. The Test of Mastication and Swallowing Solids (TOMASS) and the Timed Water Swallow Test (TWST) are functional tests for swallowing that provide quantitative results. Aims: To explore the relationship between TOMASS and TWST; evaluate test–retest and interrater reliability; explore age and gender effects; and gather normative data. Methods & Procedures: Healthy community dwelling participants (n = 298, ≥ 20 years old) were recruited. Of those, 126 were included in the reliability study. Participants completed the TWST and TOMASS. Outcomes & Results: Associations between TWST and TOMASS measures were found using Pearson's correlation coefficient. Age was positively associated with an increase in the number of bites (n = 292, r = 0.15, p = 0.009), masticatory cycles (n = 291, r = 0.33, p < 0.0001) and duration (n = 292, r = 0.32, p < 0.0001) for the TOMASS. For the TWST, age was positively associated with an increase in duration (n = 296, r = 0.23, p < 0.0001), and negatively associated with volume (n = 296, r = −0.205, p < 0.0001), and swallowing capacity (n = 296, r = −0.24, p < 0.0001). Females required more bites, masticatory cycles, swallows and longer time than males in TOMASS. In TWST, females required more swallows, longer time, and had lower volume per swallow and reduced swallowing capacity than males. Intraclass correlation coefficient (ICC) revealed good test–retest reliability and moderate to excellent interrater reliability. Conclusions & Implications: This study provides support for the validity of the TOMASS and TWST. Reduced efficiency in one of the tests might indicate a need to evaluate performance in the other. Extended chewing time and increased number of masticatory cycles might be compensatory behaviours for reduced oral processing abilities that are motor, sensory and/or mechanical. WHAT THIS PAPER ADDS: The TOMASS and TWST are functional tests of swallowing that provide quantitative results. They are easy to incorporate as part of the clinical evaluation of swallowing due to low cost and quick administration. Age and gender effects were found for the TWST and TOMASS, but they were only tested on relative measures rather than absolute measures. Different types of crackers used for TOMASS led to differences in performance and in normative values. What is already known on the subject: Associations between performance during TWST and TOMASS were found: time, number of swallows and time per swallow were correlated, meaning that need for more time and more swallows is reflected in both drinking and chewing. The study provides further support for age and gender effects in TWST and TOMASS, on both relative and also on absolute measures, which were not investigated previously. Longer durations in TOMASS and TWST with an increase in age, are likely to be the result of compensatory behaviours to allow safe swallowing. Normative data for a country‐specific cracker are presented (Israel). What are the potential or actual clinical implications of this work?: Reduced efficiency in one of the tests might indicate a need to evaluate performance in the other. Establishing country specific norms for commonly available crackers is necessary, since crackers size and ingredients, such as fat content and moisture, influence chewing and swallowing. There is a balancing act between safety and efficiency in older adults' swallowing behaviour. Reducing pace in eating and drinking probably supports safer swallowing. [ABSTRACT FROM AUTHOR]

Background: The Test of Masticating and Swallowing Solids (TOMASS) is an international standardized swallowing assessment tool. However, its psychometric characteristics have not been analysed in patients with dysphagia. Aims: To analyse TOMASS's (1) inter‐ and intra‐rater reliability in a clinical population of patients with dysphagia, (2) known‐group validity, (3) concurrent validity and (4) correlation with meal duration. Methods & Procedures: Two age‐ and gender‐matched groups of 39 participants each were recruited: A group of patients with dysphagia and a control group with no history of dysphagia. The TOMASS was carried out in both populations, video‐recorded and scored offline by two speech and language therapists (SLT 1 and SLT 2) (inter‐rater reliability) and twice by the same SLT (intra‐rater reliability). In the clinical group, the TOMASS was carried out three times: (1) to verify understanding of the required tasks, (2) performed concurrently during fibreoptic endoscopic evaluation of swallowing (FEES) to assess validity and (3) during clinical assessment to assess reliability. TOMASS under endoscopic control was recorded and the number of white‐out events was counted to compare with the number of observed swallows per cracker during standard TOMASS as a measure of concurrent validity. As additional measures of TOMASS validity, oral dental status, classified as 'functional' or 'partially functional', and duration of a standard meal were assessed by an SLT (SLT 1 or SLT 2), and then correlated with TOMASS. Outcome & Results: TOMASS's inter‐ and intra‐rater reliability were high (intraclass correlation coefficient (ICC) > 0.95) in both the clinical and the control groups. The number of masticatory cycles (p = 0.020), swallows (p = 0.013) and total time (p = 0.003) of TOMASS were significantly lower in the control group than in the clinical group. Patients with 'partially functional' oral dental status showed a significantly higher number of masticatory cycles per cracker and a longer duration of ingestion than patients with a 'functional' one. Concurrent validity suggested a substantial agreement between TOMASS and FEES in defining the number of swallows per cracker. The mean difference of the two measures was –0.02 (95% confidence interval (CI) = –1.7 to 1.2). Meal duration significantly correlated with the 'number of swallows per cracker' (r = 0.49; p = 0.002) and 'total time' (r = 0.41; p = 0.011). Conclusions & Implications: Preliminary psychometric analysis of TOMASS in a clinical sample of outpatients with dysphagia suggests that it is a reliable and valid (specifically related to the number of swallows per cracker) tool. TOMASS's application in clinical practice to quantitatively measure solid bolus ingestion is recommended. What this paper addsWhat is already known on the subjectThe Test of Masticating and Swallowing Solids (TOMASS) is an international standardized swallowing assessment tool to evaluate oral preparation and oral phase of solids. The TOMASS' reliability and validity were tested on healthy subjects and normative data were gained.What this paper adds to existing knowledgeThe study provides the first data on the validity and reliability of the TOMASS in a clinical population. The TOMASS was proved to be a reliable and valid tool also in patients with dysphagia and to distinguish between patients with dysphagia and healthy subjects.What are the potential or actual clinical implications of this work?The use of the TOMASS in clinical practice is recommended as a valid and reliable tool to quantitatively measure the ingestion of solid in patients with dysphagia. [ABSTRACT FROM AUTHOR]

Background: Most people with stroke exhibit a variety of impairments that need to be addressed by a multidisciplinary team. Communication and swallowing disorders are common and should be screened very early. To guarantee a patient‐centred approach, all patients, even those with speech and language disorders, must be actively engaged in the healthcare process. Effective communication is essential to success in many of the needed interventions. However, healthcare professionals often do not receive formal training in communicating with these patients, thus increasing the risk of preventable adverse events. Aims: To describe the design, implementation and evaluation of a post‐acute stroke multidisciplinary team training using patient actors in a simulation approach. Methods & Procedures: A 2‐day course focused on the transdisciplinary knowledge related to communication and swallowing that all members of the multidisciplinary stroke team should acquire was implemented. A case‐based learning methodology used simulation and resorting to patients' actors. Learning outcomes were evaluated by comparing the results obtained in two knowledge tests, one for each topic, which participants performed before and after each day course. Reaction to the training was gathered concerning the content, teacher quality and course organization. The follow‐up was performed 6 months later to assess training skills transfer to the workplace environment. Outcomes & Results: All the participants considered that the programme objectives were relevant or truly relevant and revealed that the programme's dynamic, rhythm and scenarios set were excellent. After the end of the programme, both communication and swallowing knowledge increased. Most participants had the opportunity to employ the acquired training skills in their work environment. The main barriers identified to implementing these skills were the 'need for additional training', the 'lack of time' or 'the lack of opportunities'. Conclusions & Implications: Simulation is a central method to increase and improve health professionals' skills when intervening with stroke patients. Using simulation with patient actors allows flexibility and diversification of clinical situations under analysis, which can provide a multiplier effect of reflection and learning. The implemented training achieved its objectives. WHAT THIS PAPER ADDS: What is already known on this subject: Simulation in the training of health professionals is increasingly used as a good practice, allowing the recreation of scenarios identical to those in the context of professional practice. This strategy is used not only in initial training but also for the development of advanced skills. What this study adds to the existing knowledge: This study reports the use of simulation using actor patients for the development of transdisciplinary skills in the topics of communication and swallowing in people with stroke What are the clinical and practical implications of this work?: The study demonstrates that in a short period of training, the use of simulation with actor patients favours the development of transdisciplinary skills in the topics of communication and swallowing in people with stroke. At the same time, the skills developed are transferable to professional practice. [ABSTRACT FROM AUTHOR]

In contrast to taste sensitivity, the assessment of texture or tactile sensitivity has received relatively little attention in the food context. Texture plays an important role in food preferences and food intake, and individual differences make it important to understand physiological drivers of perception as tactile sensitivity. The multi‐dimensional and dynamic aspects of texture perception suggest there is not one single method that can explain individual differences. This scoping review aims to systematically map methods assessing tactile sensitivity, in the context of food, highlighting differences in approach and implementation. Eligibility criteria included papers describing methods to assess individual differences in tactile sensitivity, that involved human participants and the context was relevant to food behavior. Sources are peer‐reviewed publications of original research in English. In mapping the methods, we assessed how they relate to food texture parameters (mechanical, geometrical, and surface) and the dynamics of breaking down (touch with hand, first bite/sip, oral processing, residual or after‐swallowing sensations). We also review other parameters associated (oral processing, preference, diet and food intake behavior). The literature in this relatively young area is still very fragmented and it is difficult to have a clear picture regarding best practices or recommendations for the measurement of tactile sensitivity in the food context. Future studies should aim to methodological harmonization for application in the food behavior area, with a design of experiment combining different aspects of tactile sensitivity to food, focusing on the thresholds and perceived intensity of textural parameters as well as affective and behavioral responses, and covering the whole spectrum of tactile texture perception (mechanical, geometrics, and surface), including the dynamics of perception. [ABSTRACT FROM AUTHOR]

Introduction: It is important for the endoscopic thyroid surgeon to understand the pros and cons of trans‐oral endoscopic thyroidectomy‐vestibular approach (TOETVA) vis‐à‐vis, open conventional thyroidectomy (OTx) so he/she can help patients in making informed choices regarding the type of procedure to opt for. Swallowing related quality of life (SWAL‐QoL) has not been compared between the two approaches. Using a rigorous qualitative methodology and validated reliable tool, this study set out to compare the swallowing related quality of life in patients undergoing TOETVA versus OTx. Methods: Prospective study at 3 time points in patients planned for hemithyroidectomy (Preoperative, 1 week and 12 weeks). Data were collected on patients at a tertiary teaching institute in India. Participants ranged from age 18–60 years with a diagnosis of benign euthyroid nodule undergoing hemithyroidectomy. Exclusion criteria were—(1) pre‐existing vocal cord abnormalities, (2) undergoing surgery for recurrent nodules, and (3) any neuro‐muscular disease affecting swallowing ability. Main outcome measure was comparison of swallowing related quality of life domain scores between patients undergoing hemithyroidectomy via either endoscopic trans‐oral or open approach. Results: Of the 82 included patients, 40 underwent TOETVA and 42 OTx. Both the groups were comparable in terms of demographic and clinicopathological profile. The mean preoperative SWAL‐QOL scores were comparable in all domains. Mean SWAL‐QoL scores for all domains on postoperative day 7 were significantly better in TOETVA group with domains burden, eating desire, mental health and communication having medium effect sizes. Physical symptom domain was better in the OTx group but had a small effect size. The difference in SWAL‐QoL domains between the two groups persisted for 3 months also. Conclusion: Swallowing related quality of life after trans‐oral endoscopic thyroidectomy compared to conventional open surgery has not been reported in the literature. Our findings suggest that trans‐oral endoscopic thyroidectomy results in significant superior swallowing related quality of life in the majority of domains. Presentations: Part of this study was presented as oral presentation during World Congress of Endoscopic Surgery, September 2022, Busan, KoreaPart of this study was presented as oral presentation and was awarded Dr C Palanivelu Best Paper Award during annual meeting of the Association of Surgeons of India (ASICON), December 2022, Mumbai, IndiaPart of this study was presented as travel award presentation during annual meeting of the Korean Society of Endoscopic and Robotic Surgery, April 2023, Seoul, Korea [ABSTRACT FROM AUTHOR]

Background: The emerging global issue of climate change has large‐scale effects on health and well‐being, including communication disorders. The broad range of the speech and language therapy profession's scope of practice incorporates prevention, advocacy and equality in service delivery. These act as a springboard for involvement in climate change and health. Aims: This is an appeal to speech and language therapists (SLTs) to focus and take action on this issue and its considerable effects on communication and swallowing disorders. Methods & Procedures: This article discusses the importance of taking a public health position on prevention and equality of services to manage environmental determinants of communication and swallowing disorders. It also describes the extent to which climate change affects these disorders and exacerbates the inequality of healthcare services in low‐ and middle‐income countries. Main Contribution: Five strategies are provided for action on fulfilling therapists' roles in reducing the incidence, development and exacerbation of climate‐related communication and swallowing disorders, as well as the role of SLTs in acting as advocates. The case is made for expanding the scope of services to focus on prevention and service equality so as to best meet the needs of the wider community. Conclusions & Implications: Despite other challenges currently facing SLTs, climate change and its increasing effects on communication disorders and dysphagia is difficult to ignore. SLTs owe it to their clients, the wider community, low‐ and middle‐income countries, the economy, and the future to take action. What this paper addsWhat is already known on the subjectMultiple studies published in peer‐reviewed scientific journals show that climate change is extremely likely to be due to human activities. The global effects will be higher temperatures, changes in precipitation, more droughts and heatwaves, stronger and more intense hurricanes, and a rising sea level which directly threaten the health of entire populations. Other health professions are beginning to take climate change into account in training and practice.What this paper adds to existing knowledgeMany disorders of communication and swallowing are caused or exacerbated by the effects of climate change. Increasing temperatures, extremes of precipitation, population displacement and air pollution contribute to cardiovascular and cerebrovascular events, respiratory disease, malnutrition, premature birth, air‐ and water‐borne diseases, and mental illness. These may affect the communication and swallowing abilities across the lifespan, but particularly those of children and older adults.What are the potential or actual clinical implications of this work?SLTs' roles in prevention, advocacy and education act as a starting point for involvement in climate change and health. Three practical strategies for action include educating SLTs and other health professionals on climate change and its effects on communication and swallowing, promoting awareness with clients and their families, and gathering and disseminating reliable data. [ABSTRACT FROM AUTHOR]

More and more studies have being done on the deformation process of food and the formation of food bolus during chewing. However, it is hard to observe the food oral processing (FOP) of subjects and obtain related data directly. A bionic chewing robot based on a six‐axis parallel mechanism was proposed in this paper. The robot can not only simulate the movement of the lower jaw but also set a variety of oral processing parameters, such as the number and shape of teeth, oral temperature, saliva volume, chewing cycles, speed and force. Meanwhile, dental wax and peanuts were taken as food samples, and the chewing experiments were carried out by the bionic chewing robot and subjects, respectively. The results showed that the bionic chewing robot could be used to mimic human FOP and produce food bolus. Especially when the chewing cycles met the requirement of swallowing, the median particle size of the peanut bolus and the mixing effect index of the dental wax bolus in the two different experiments were highly consistent. In addition, the robot was proved to have the same food texture detection function as the texture analyzer. [ABSTRACT FROM AUTHOR]

Background: A clinical swallow examination (CSE) provides integral information that informs the diagnostic decision‐making process within dysphagia management. However, multiple studies have highlighted a high degree of reported variability within the CSE process. It has been hypothesized that such variability may be the result of the clinical reasoning process rather than poor practices. Aims: To elucidate the nature of expert, speech–language therapists' (SLTs) clinical reasoning during an initial bedside assessment of patients referred for suspected dysphagia in the acute care environment. Methods & Procedures: An exploratory 'observation of practice' qualitative methodology was used to achieve the aim. Four expert SLTs, from two clinical services, completed CSEs with 10 new referrals for suspected dysphagia. All assessments were video‐recorded, and within 30 min of completing the CSE, a video‐stimulated 'think aloud' semi‐structured interview was conducted in which the SLT was prompted to articulate their clinical reasoning at each stage of the CSE. Three types of concept maps were generated based on this video and interview content: a descriptive concept map, a reasoning map and a hypothesis map. Patterns that consistently characterized the assessment process were identified, including the overall structure; types of reasoning (inductive versus deductive), facts (i.e., clinical information) drawn upon; and outcomes of the process (diagnosis and recommendations). Interview content was examined to identify types of expert reasoning strategies using during the CSE. Outcomes & Results: SLTs' approach to clinical assessment followed a consistent structure, with data gathered pre‐bedside, during the patient interview and direct assessment before a management recommendation was made. Within this structure, SLTs engaged in an iterative approach with inductive hypothesis‐generating and deductive hypothesis‐testing, with each decision‐making pathway individually tailored and informed by patient‐specific facts collected during the assessment. Clinical assessment was primarily geared towards management of an initial acute presentation with less focus on formulating a diagnostic statement. Conclusions & Implications: Variability in reported dysphagia practice is likely the result of a patient‐centred assessment process characterized by iterative cycles of fact‐gathering in order to generate and test clinical hypotheses. This has implications for the development of novel assessment tools, as well as professional development and education of novice SLTs. What this paper addsWhat is already known on the subjectCSE practices are reportedly variable, which has led to calls for more stringent, standardized assessment tools. Emerging evidence suggests that this variation is non‐random, but may arise from clinical reasoning processes.What this paper adds to existing knowledgeWe directly observed expert SLTs conducting CSEs and identified patterns in practice that were consistent across all CSEs evaluated. These patterns were consistent in structure, whereas the content of the assessment items varied and was tailored to individual patient presentation. Overall, expert SLTs engaged in balanced cycles of inductive hypothesis generation and deductive hypothesis‐testing, a hallmark of good clinical assessment and practice.What are the potential or actual clinical implications of this work?Ensuring quality CSE requires a more nuanced approach that considers the role of clinical reasoning in SLTs' decision‐making and the potential unintended negative consequences of standardized assessment tools. [ABSTRACT FROM AUTHOR]

Stroke clinical guidelines recommend care processes that optimize patient outcomes and minimize hospital‐acquired complications. However, audits and surveys illustrate that recommended care is not always consistently or thoroughly implemented. This paper outlines the methods for implementing and evaluating a new bundle of care. Screen‐Clean‐Hydrate bundles together recommendations from the Australian Clinical Guidelines for Stroke Management and supplements these with evidence‐informed best practice from the literature for: swallow screening within 4 h of presentation to hospital (Screen); oral health assessment and delivery of oral care (Clean); and hydration assessment and management (Hydrate). The study is a pre−post Type 2 hybrid effectiveness/implementation design with an embedded process evaluation, which will be conducted in two acute stroke units in a capital city of Australia. The integrated‐Promoting Action on Research Implementation in Health Services (iPARIHS) framework will be used to guide study design, conduct, and evaluation. Clinical effectiveness will be measured by rates of hospital‐acquired complications and proxy measures of cost (length of stay, procedure costs) for 60 patient participants pre‐ and postimplementation. Implementation outcomes will focus on acceptability, feasibility, uptake and fidelity, and identification of barriers and enablers to implementation through staff interviews, medical record audits, and researcher field notes. Due to its design as a hybrid effectiveness/implementation study, once completed, the study will provide information on both intervention and implementation effectiveness, including details of successful and unsuccessful multidisciplinary implementation strategies. This will inform a larger multisite effectiveness/implementation trial for future upscale, leading to improved compliance with stroke guidelines and therefore stroke outcomes. [ABSTRACT FROM AUTHOR]

Background: The potential for using ultrasound by speech and language therapists (SLTs) as an adjunct clinical tool to assess swallowing function has received increased attention during the COVID‐19 pandemic, with a recent review highlighting the need for further research on normative data, objective measurement, elicitation protocol and training. The dynamic movement of the hyoid, visible in ultrasound, is crucial in facilitating bolus transition and protection of the airway during a swallow and has shown promise as a biomarker of swallowing function. Aims: To examine the kinematics of the hyoid during a swallow using ultrasound imaging and to relate the patterns to the different stages of a normal swallow. To evaluate the accuracy and robustness of two different automatic hyoid tracking methods relative to manual hyoid position estimation. Methods & Procedures: Ultrasound data recorded from 15 healthy participants swallowing a 10 ml water bolus delivered by cup or spoon were analysed. The movement of the hyoid was tracked using manually marked frame‐to‐frame positions, automated hyoid shadow tracking and deep neural net (DNN) tracking. Hyoid displacement along the horizontal image axis (HxD) was charted throughout a swallow, and the maximum horizontal displacement (HxD max) and maximum hyoid velocity (HxV max) along the same axis were automatically calculated. Outcomes & Results: The HxD and HxV of 10 ml swallows are similar to values reported in the literature. The trajectory of the hyoid movement and its location at significant swallow event time points showed increased hyoid displacement towards the peak of the swallow. Using an interclass correlation coefficient, HxD max and HxV max values derived from the DNN tracker and shadow tracker are shown to be in high agreement and moderate agreement, respectively, when compared with values derived from manual tracking. Conclusions & Implications: The similarity of the hyoid tracking results using ultrasound to previous reports based on different instrumental tools supports the possibility of using hyoid movement as a measure of swallowing function in ultrasound. The use of machine learning to automatically track the hyoid movement potentially provides a reliable and efficient way to quantify swallowing function. These findings contribute towards improving the clinical utility of ultrasound as a swallowing assessment tool. Further research on both normative and clinical populations is needed to validate hyoid movement metrics as a means of differentiating normal and abnormal swallows and to verify the reliability of automatic tracking. WHAT THIS PAPER ADDS: What is already known on this subject: There is growing interest in the use of ultrasound as an adjunct tool for assessing swallowing function. However, there is currently insufficient knowledge about the patterning and timing of lingual and hyoid movement in a typical swallow. We know that movement of the hyoid plays an essential role in bolus transition and airway protection. However, manual tracking of hyoid movement is time‐consuming and restricts the extent of large‐scale normative studies. What this study adds: We show that hyoid movement can be tracked automatically, providing measurable continuous positional data. Measurements derived from this objective data are comparable with similar measures previously reported using videofluoroscopy and of the two automatic trackers assessed, the DNN approach demonstrates better robustness and higher agreement with manually derived measures. Using this kinematic data, hyoid movement can be related to different stages of swallowing. Clinical implications of this study: This study contributes towards our understanding of the kinematics of a typical swallow by evaluating an automated hyoid tracking method, paving the way for future studies of typical and disordered swallow. The challenges of image acquisition highlight issues to be considered when establishing clinical protocols. The application of machine learning enhances the utility of ultrasound swallowing assessment by reducing the labour required and permitting a wider range of hyoid measurements. Further research in normative and clinical populations is facilitated by automatic data extraction allowing the validity of prospective hyoid measures in differentiating different types of swallows to be rigorously assessed. [ABSTRACT FROM AUTHOR]

Background: National UK guidance makes recommendations for speech and language therapy staffing levels in critical care and rehabilitation settings. Traumatic spinal cord injury patients often require admission primarily to critical care services within a major trauma centre prior to transfer to a specialist spinal injury unit but may not receive similar levels of care. Dysphagia and communication difficulties are recognised features of cervical spinal cord injury; however, little is known about access to speech and language therapy services to provide rehabilitation and improve outcomes. Aims: The aim of this study was to compare the workforce and clinical practices of speech and language therapy services in eight spinal injury units and four major trauma centres in England through an online survey. Methods & Procedures: An online survey was created with 26 multiple‐choice questions across seven sub‐sections, with options for free‐text comments. These were sent to a named speech and language therapy contact at each of the specified units. Responses were uploaded into Excel for analyses, which included descriptive statistics and analysis of themes. Outcomes & Results: Responses were received from 92% (11/12) speech and language therapy services invited, which included seven out of eight spinal injury units and all four major trauma centres. No units met national staffing recommendations. Staff in spinal injury units provided an average of 27 h per week input to the unit compared to 80 h in a major trauma centre. Despite caseload variations, speech and language range of therapy involvement and prioritisation process were equivalent. Access to instrumental assessment varied, with less use of Fibreoptic Endoscopic Evaluation of Swallowing in spinal injury units despite its clinical value to the spinal cord injury caseload. Conclusions & Implications: Speech and language therapy services delivering post‐acute and long‐term rehabilitation to spinal cord injury patients are limited by their resources and capacity, which restricts the level of therapy delivered to patients. This may have an impact on clinical outcomes for communication and swallowing impairments. Further evidence is needed of the interventions delivered by speech and language therapists and outcomes will be beneficial alongside benchmarking similar services. What this paper adds: What is already known on this subject: In England, people who sustain a spinal cord injury are admitted to a major trauma centre prior to transfer to a specialist spinal injury unit. Dysphagia and communication impairments are recognised as a complication of cervical spinal cord injury and benefit from speech and language therapy intervention. National recommendations exist for staffing levels, expertise and competencies for speech and language therapists working in critical care and rehabilitation units. What this study adds: This study identified variations in the levels of speech and language therapy staffing, seniority, service delivery and access to instrumental assessments for dysphagia between major trauma centres and spinal injury units. None of the services complied with national staffing recommendations. Clinical implications of this study: Speech and language therapy services in spinal injury units are often available part‐time or have limited access to diagnostic tools which limits the range and intensity of rehabilitation input available. This has clinical implications for outcomes for swallowing and communication as well as long‐term consequences for integrating back into community. [ABSTRACT FROM AUTHOR]

The inherent mechanical properties of soft structures allow fragile objects to be safely manipulated without the need for precise force control. Soft structures and driving mechanisms are employed in applications ranging from gripping and locomotion to biomedical devices. Such soft structures can be especially beneficial for manipulating excessively relaxed live soft human tissue, to relieve discomfort or medical conditions. An example is obstructive sleep apnea (OSA), where soft tissue narrows or blocks the upper airway while sleeping, causing difficulty breathing. In this paper, an approach to relieve OSA using injectable soft magnetic pillars paired with a removable magnet holder that can be worn while sleeping to secure the upper airway is reported. The approach provides an alternative to currently available treatments that may cause inconveniences such as difficulty swallowing, protrusion through soft tissue, repetitive surgeries, or sleep disruption. Experimental results and computational studies are used to determine the necessary degree of pulling force and distance, which can be adjusted by controlling the number of implanted soft magnetic pillars and external magnetic field strength. Further experiments using cadavers demonstrate the opening of the upper airway confirming the feasibility of the approach. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Wong et al papers. To view these articles, visit https://doi.org/10.1111/apt.16561 and https://doi.org/10.1111/apt.16783 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Wong et al papers. To view these articles, visit https://doi.org/10.1111/apt.16561 and https://doi.org/10.1111/apt.16801 [ABSTRACT FROM AUTHOR]

Aim: To explore the correlations between examination tolerance and anxiety, knowledge needs and examination cooperation in sedation‐free gastroscopy examinees. Design: Cross‐sectional survey using convenience sampling. Methods: A total of 170 healthy adults who underwent sedation‐free gastroenteroscopy were asked to complete a visual analogue scale (VAS) to rate their examination tolerance, the state anxiety questionnaire (S‐AI), a newly designed knowledge needs questionnaire and a cooperation questionnaire. Results: The VAS score was 4.47 ± 1.96, the state anxiety score was 39.46 ± 9.81, the total score for knowledge needs was 44.89 ± 11.02, and the average cooperation score was 2.47 ± 0.38. The VAS score during the examination positively correlated with the pretest state anxiety score and pretest knowledge needs score and negatively correlated with the examination cooperation score. The results of multiple linear regression analysis showed that after undergoing the examination for the first time, anxiety, body position and swallowing control were the main factors influencing the examination tolerance of sedation‐free gastroscopy examinees. Patient or Public Contribution: We would like to thank the staff and patients of the participating hospital for their assistance and cooperation in performing the current study. [ABSTRACT FROM AUTHOR]

Second, I believe that the linkages between my empirical findings and theoretical conclusions can be rendered clearer if we start to consider abortion I as a migration issue i - something for which I have argued in other contexts.[46] While "abortion" and "migration" are often theorized separately from one another, recently high-profile abortion bans (such as Texas the 2021 Texas Senate Bill 8) have served to inspire widespread media coverage and public discussion about how abortion restrictions compel internal and external migration. According to the Guttmacher Institute, there were an estimated 56 million induced abortions worldwide during 2010-2014, of which approximately 25 million (or 45%), were deemed "unsafe".[12] Due to the high rate of unsafe abortions worldwide, which almost always occur when abortion is legally restricted, approximately $232 million USD were spent on post-abortion medical care in 2014 alone.[13] In the United States, where one can, under many circumstances, receive a third trimester abortion in places like Albuquerque, anti-choice legislation has made it increasingly difficult for many pregnant people - and particularly those who are poor and live in rural areas - to access abortion care. I Roe v. Wade i , which, in 1973, granted limited abortion rights to women on the grounds that banning many abortions violated a woman's constitutionally protected right to privacy, nevertheless allows significant state discretion in terms of offering abortion care in the second and third trimesters of pregnancy. "Esmeralda" had never intended to have a second trimester abortion.[1] After taking a pregnancy test at home an El Paso, Texas - about a 4.5-h drive from the Albuquerque, New Mexico abortion clinic at which I interviewed her - she discovered that she was 11 weeks pregnant. [Extracted from the article]

The 'hard-to-swallow' phenomenon previously reported for peanut paste has been investigated for other oil seed butters. The temporal dominance of sensation ( TDS) technique showed similar findings, adding to the list of materials that do not follow Hutchings and Lillford's breakdown path ( J ournal of T exture S tudies 19: 103-115). From our data, we propose a modification to the Hutchings and Lillford model that allows for initial hydration of dry foods. The model holds well for oil seed pastes and may also help to explain the behavior of some dry, carbohydrate-rich foods previously constrained to fit extant models. Because TDS does not measure the magnitude of an attribute, we undertook time intensity studies to assess stickiness of peanut pastes during oral processing. In the absence of another attribute becoming dominant, the intensity of sticky/cohesive sensations may remain paramount but diminish in intensity, prior to swallowing. Practical Applications Modeling oral processing may help us to understand the triggers for swallowing and thus assist people with swallowing difficulties (dysphagia). The much cited model developed by Hutchings and Lillford appears not to hold for all foods and exceptions necessarily require further investigation. This paper considers other published studies on oral processing of low water foods, offering an alternative interpretation to those previously given. [ABSTRACT FROM AUTHOR]

Saliva exerts multiple functions in relation to the initial digestive processes taking place in the upper parts of the gastrointestinal tract. Ingestion of food and beverages, in turn, is a strong stimulus for secretion of saliva with a differential composition depending on the neuronal stimulation pattern. This review paper provides insight into the mechanisms by which saliva acts in relation to taste, mastication, bolus formation, enzymatic digestion and swallowing. Also, the protective functions of saliva including maintenance of dental and mucosal integrity will be discussed as they indirectly influence the digestive process. The final part of this study focuses on the implications of xerostomia and salivary gland dysfunction on gastrointestinal functions. [ABSTRACT FROM AUTHOR]

Abstract: Oral habits are tongue protrusion in malocclusions, causing deterioration of oral functions necessary for feeding, chewing, swallowing, and vocalization. In order to realize a noninvasive measurement of the habits, we propose and experiment acoustic feature analysis to discriminate tongue habits. Compared to normal speech, tongue‐protruded speech is pronounced between the frontal teeth. The speech is emphasized at a wide‐range band of frequency components due to turbulence, as can be heard in the pronunciation of consonants. In this paper, we confirm these differences in acoustic features, such as zero‐crossing that can capture the characteristics of voiced and unvoiced sounds and Mel Frequency Cepstrum Coefficient (MFCC) that is a filter bank analysis for front‐end processing at speech recognition. We collect samples for that focus on the differences in oral habits of subjects, and significant of acoustic features that measured from the samples are confirmed. Finally, tongue habit discrimination using k‐nearest neighbor algorithm achieved discrimination rate of about 85% to 98% on the databases. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) pandemic has renewed interest in the use of ultrasound (US) amongst dysphagia‐trained clinicians working with infants and children. US is a portable, minimally intrusive tool which carries reduced risk of aerosol‐generation provoked by other instrumental swallowing assessment tools such as fibreoptic endoscopic evaluation of swallowing (FEES). For this reason, US could be a valuable addition to the dysphagia assessment toolkit. A recently published rapid review of US evidence for the assessment of swallowing and laryngeal function in the adult population provided a framework for this neonatal and paediatric review. Aims: This enhanced rapid review aimed to establish the applicability of US as an instrumental assessment tool for sucking, swallowing and laryngeal function in the neonatal and paediatric populations. Methods & Procedures: A rapid review of six electronic databases was conducted to identify articles using US to assess sucking, swallowing or laryngeal function in the selected populations, compared with varied reference tests. Abstract screening was completed according to pre‐defined inclusion/exclusion criteria with 10% of articles assessed by a second screener. Data was extracted from the included studies using a pre‐developed form. A modified QUADAS‐2 tool was used to assess study quality. Results from the included studies were summarised and grouped into sucking, swallowing and laryngeal function data. Outcomes & Results: Twelve studies using US in the assessment of swallowing and/or laryngeal function met inclusion criteria. No studies using US for assessment of sucking met the inclusion criteria. All were peer‐reviewed, primary studies across a range of clinical populations and with a wide geographical spread. Five studies had an overall low risk of bias. Seven studies had at least one domain where risk of bias was judged as high. All studies had high applicability. The two studies assessing swallowing differed in terms of aims and use of US. The studies assessing laryngeal function predominately investigated vocal fold movement and laryngeal pathology. Sensitivity and specificity data were provided or calculated from raw data for nine of the laryngeal function studies (respective ranges of 75%–100% and 80%–100%). Conclusions & Implications: Emerging evidence exists to support the use of US as adjunct to clinical assessment of swallowing and laryngeal function in the neonatal and paediatric population. A paucity of evidence to support use of US in the assessment of sucking exists. Further research is needed to establish evidence‐based assessment and analysis protocols as well as development of paediatric data. [ABSTRACT FROM AUTHOR]

The paper reviews human mastication, focusing on its age-related changes. The first part describes mastication adaptation in young healthy individuals. Adaptation to obtain a food bolus ready to be swallowed relies on variations in number of cycles, muscle strength and volume of emitted saliva. As a result, the food bolus displays granulometric and rheological properties, the values of which are maintained within the adaptive range of deglutition. The second part concerns healthy ageing. Some mastication parameters are slightly modified by age, but ageing itself does not impair mastication, as the adaptation possibilities remain operant. The third part reports on very aged subjects, who display frequent systemic or local diseases. Local and/or general diseases such as tooth loss, salivary defect, or motor impairment are then indistinguishably superimposed on the effects of very old age. The resulting impaired function increases the risk of aspiration and choking. Lastly, the consequences for eating behaviour and nutrition are evoked. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Dysphagia resulting from bulbous pemphigoid is a rare but significant manifestation. A 77‐year‐old with bullous pemphigoid with no neurological history presented with severe oropharyngeal dysphagia, attributable to underlying blistering and edema, as documented on a fiberoptic endoscopic swallow examination. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Frazzoni et al and Rogers & Gyawali papers. To view these articles, visit https://doi.org/10.1111/apt.16371 and https://doi.org/10.1111/apt.16393 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Frazzoni et al papers. To view these articles, visit https://doi.org/10.1111/apt.16371 and https://doi.org/10.1111/apt.16400 [ABSTRACT FROM AUTHOR]

Background: Exercise‐based swallowing training (EBST) and transcutaneous neuromuscular electrical stimulation (TNMES) are common modalities used to treat late dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC). We aimed to investigate and compare the efficacies of EBST and TNMES as proactive treatments administered early after radiotherapy. Methods: Patients with early post‐radiotherapy NPC (n = 120) underwent either TNMES or EBST. Flexible endoscopic evaluation of swallowing (FEES), quality of life (QOL), and swallowing function questionnaires were completed before the intervention as well as immediately, 6, and 12 months after the intervention. Outcome measures included the scores for the swallowing function score (SFS), penetration and aspiration scale (PAS), dynamic imaging grade of swallowing toxicity (DIGEST), functional oral intake scale (FOIS), swallowing performance status scale (SPSS), pharyngeal motor impairment (PMI), pharyngeal function impairment (PFI), and functional assessment after cancer therapy–nasopharyngeal (FACT‐NP) questionnaire. Results: Three months after radiotherapy, 31 and 34 patients underwent TNMES and EBST, respectively, and completed swallowing assessments at all four assessment timepoints. All patients showed post‐radiotherapy impairments in the SFS, PAS, DIGEST, PMI, and PFI. Compared with the EBST group, the TNMES group showed significant improvements in the PFI and PMI scores, with small‐to‐medium effect sizes. Additionally, compared with the EBST group, the TNMES group demonstrated a trend toward slightly better improvements in the PAS, DIGEST, FOIS, and SPSS scores immediately and 6 months after the intervention. The SFS scores improved from baseline in both groups; however, the TNMES group showed an earlier improvement. Finally, the TNMES group showed better QOL according to the FACT‐NP than the EBST group. Conclusion: Proactive TMNES and EBST are safe and feasible modalities for improving swallowing in patients with NPC when administered early after radiotherapy. Although TNMES showed better results than EBST, these results should be interpreted with caution given the study limitations. Level of evidence: 1B. [ABSTRACT FROM AUTHOR]

Objectives: This study identified the frequency and severity of dysphagia, dysphonia, and laryngopharyngeal reflux symptoms in people with Ehlers–Danlos syndromes (EDS) or hypermobility spectrum disorders (HSD) and explored differences between diagnostic groups. Methods: Participants were recruited via non‐probability convenience sampling. Information was gathered via online survey, including the Reflux Symptom Index (RSI; Belafsky et al., J Voice. 2002;16:274–277), the Eating and Drinking Assessment Tool (EAT‐10; Belafsky et al., Ann Otol Rhinol Laryngol. 2008;117:919–924), and the Voice Handicap Index (VHI; Jacobson et al., Am J Speech Lang Pathol. 1997;6(3):66–70). These were analyzed using ANOVAs. Results: There were 1620 participants (96.6% female, 2.8% male) that met the inclusion criteria. The mean age was 38.09 (SD 12.22). 75.51% had hypermobile EDS (hEDS), 17.83% had HSD and 3.33% had classic EDS (cED). The cohort's mean scores were RSI = 22.95 (SD 9.01), EAT‐10 = 11.91 (SD 9.66), and VHI score = 31.99 (SD 24.36). The hEDS group had significantly higher mean scores than the HSD group on RSI score and on some RSI items, on EAT‐10 score and on all EAT‐10 items, and on one VHI item. Conclusion: People with EDS/HSD experience symptoms of acid reflux, dysphagia, and dysphonia to varying degrees with significant differences between hEDS than HSD. Awareness of the impact of EDS/HSD on throat symptoms will enable health care professionals to anticipate throat symptoms more readily in this population, providing individualized and effective management plans. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Sensory function during the oral processing of liquids is thought to play a key role in informing the tailoring of swallowing motor behaviors to the flow characteristics of the bolus. In addition to taste receptors, the mouth and tongue house trigeminal nerve receptors that support the sensory detection of bolus size, shape (stereognosis), mass, temperature and movement. Recent studies suggest that healthy adults lose tongue strength with advancing age. However, little is known about changes in the sensory function of the tongue attributable to age, or associated with reductions in strength. In this study, we explored lingual tactile acuity in healthy young and older adults, and measured the relationship between tactile acuity and measures of tongue strength. The results showed an age-related reduction in lingual tactile acuity that was not explained by variations in tongue strength. Practical Applications Sensory motor interactions are a topic of interest in understanding the processing activities that take place in the mouth during eating and swallowing. In this paper, we explore a test of sensory acuity in the mouth, in which the tongue is used to 'read' embossed letters on Teflon strips. Our questions were to determine whether sensory acuity for this task declines with age, or with age-related reductions in tongue strength. We determined that older people perform this task with less accuracy, suggesting some changes in oral sensory function with age. However, these changes were not related to tongue strength. The findings suggest that strength does not play a major role in the kind of sensory discrimination task tested in this study. [ABSTRACT FROM AUTHOR]

Objective This paper reviews potential age-associated risk factors for satisfactory oral function and oral disease to inform the development of care pathways for the older person. Background Alterations in dental status or both physical and biological change associated with age can impact on oral disease and oral function. Materials and Methods Older people tend to have fewer teeth and some are edentulous. Physical and biological changes in bodily function with age can also affect oral health care either directly or indirectly. Results Reductions in chewing ability impact on the foods people choose to eat because of perceived difficulty with chewing, with a potentially deleterious affect on dietary quality. This is worse in people with xerostomia where chewing and swallowing are impaired anyway. Change in the cell-mediated inflammatory response impacts on gingival and periodontal disease manifestation and progression. Sarcopenia makes the physical act of toothbrushing more challenging. Caries remains a clinical problem that affects both the crowns and the roots of teeth. Coronal lesions tend to be around existing restorations where there is no evidence base about care/prevention. Conclusion The physical and clinical changes that occur with ageing require an altered pattern of care for older people which is adjusted to their disease risk and encourage diversity of foods consumption. [ABSTRACT FROM AUTHOR]