Many patients with dysphagia following neurological events can and do experience a resolution of their swallowing difficulties, sometimes without any intervention. However, it is challenging for clinicians to distinguish mild dysphagia from no dysphagia. The question of where to draw the line between normal and pathological swallowing is the subject of this small-scale pilot study. The authors investigated the diagnostic accuracy of a swallowing battery (SwaB) which consists of three validated tests:
- The repetitive saliva swallowing test (RSST) with a cut-off of more than three swallows in 30 seconds;
- Timed water swallow test (TWST) with cut-off >10mL of water/ second swallowed with no coughing/throat clearing;
- Test of masticating and swallowing solids (ToMaSS) – total duration and swallows within 95% CI for age/sex.
They compared the findings of the SwaB on 19 patients with mild dysphagia (Functional Oral Intake score of 5-7) or no known dysphagia who were two weeks to 14 weeks post stroke or traumatic brain injury with the patients’ instrumental swallowing assessment (FEES). A binary classification was used and a ‘pass’ on all three tests was required for an overall pass. Using the original cut-off values for the RSST and the TWST, and a slightly adjusted cut-off for the ToMaSS, they found that the SwaB correctly predicted 77% of failed FEES and 83% of those that passed FEES assessment. The authors conclude that the SwaB has good promise as a clinical tool for monitoring mild dysphagia. Further research with larger patient numbers will help validate cut-off norms and more clearly establish mild dysphagia from no dysphagia.