[Dysphagia] How to identify silent aspiration clinically

[Heidi.Bassani at amedd.army.mil (Bassani, Heidi D Ms WRAMC-Wash DC)]

I am not currently conducting research, although there are many people
who are.  Anyone with accesss to a library can peruse the many articles
that examine a plethora of research recently done in the field of
dysphagia.  I will not take the time to list articles here, since as
clinicians, we should all be able to choose, read and examine literature
to determine if the study is well designed and if the stated hypothesis
is what is truly being tested, etc, etc.  However, you are correct in
that clinical efficacy is lacking at the moment, but we are moving in
the right direction.  Without dwelling on this matter any further, my
question to all of you is this?
 
If you were a doctor, and a pt came to you with a broken leg, would you
palpitate to feel for the fracture and cast it based on your clinical
exam or would you order an x-ray?  Then why should we be making
decisions on silent aspiration (and many will say on dysphagia in
general) clinically, when there are diagnostic examinations that provide
more information than clinical assessment.  Yes, there is a lot to be
learned from clinical assessment and you cannot complete an VFSS without
also seeing the pt clinically.  But you have said yourself, that SLP's
are so variable in that assessment (as they are in interpretation of
VFSS).  So shouldn't our goal be to standardized what works the best and
make that our Gold Standard, as VFSS is often called?  As such, there is
quite a bit of research out there being done and more to come.  It's
only a matter of time.  In the meantime some of you asking may want to
browse the ASHA archives for a number of papers including Clinical
Indicators for Instrumental Assessment of Dysphagia (2000)
<http://www.asha.org/NR/rdonlyres/00D749C6-84BF-4ECC-8855-AF42C8FBB360/0
/22856_3.pdf>  Clinical Indicators of Improvement: Measuring the Effects
of Swallowing Treatment
<http://search.asha.org/cs.html?url=http%3A//convention.asha.org/2005/ha
ndouts/293_McCullough_Gary_071648_100305102817.doc&qt=clinical+indicator
s&col=asha+ashfoun+nsslha&n=1> , Dysphagia: ASHA Policy Documents
<http://search.asha.org/cs.html?url=http%3A//www.asha.org/members/slp/cl
inical/dysphagia/dysphagia_docs.htm&qt=clinical+indicators&col=asha+ashf
oun+nsslha&n=6> , etc.  and some may enjoy the article (which I cannot
critique because I have not read it thoroughly yet) "Dysphagia
Evaluation Practices: Inconsistencies in Clinical Assessment and
Instrumental Examination Decision-Making" by Barbara A. Mathers-Schmidt,
Mary Kurlinski In Dysphagia, 18( 2) pp. 114-125.
 
 I don't general reply to this list-serve and I won't belabor this point
anymore, but I just wanted to say that we can't be calling for
evidence-based practice on one hand and then be making certainty
judgements about assessment practices on the other without the evidence
to back it up. Thanks for listening. 
________________________________

From: Drirenect@aol.com [mailto:Drirenect@aol.com] 
Sent: Thursday, January 12, 2006 1:41 PM
To: Bassani, Heidi D Ms WRAMC-Wash DC; dysphagia@b9.com
Subject: Re: [Dysphagia] How to identify silent aspiration clinically


Since there is no evidence based research in dysphagia, I would wonder
on what you are basing your research. See 

http://www.ahrq.gov/clinic/epcsums/dysphsum.htm

Evidence Report/Technology Assessment: Number 8

Diagnosis and Treatment of Swallowing Disorders (Dysphagia) in
Acute-Care Stroke 

________________________________

Under its Evidence-based Practice Program
<http://www.ahcpr.gov/clinic/epc> , the Agency for Health Care Policy
and Research (AHCPR) is developing scientific information for other
agencies and organizations on which to base clinical guidelines,
performance measures, and other quality improvement tools. Contractor
institutions review all relevant scientific literature on assigned
clinical care topics and produce evidence reports and technology
assessments, conduct research on methodologies and the effectiveness of
their implementation, and participate in technical assistance
activities.