Knowledge about swallowing physiology has greatly increased with the use of instrumental assessments such as videofluoroscopy (VFS). The authors of this paper performed an analysis of data obtained from 60 stroke patients who were assessed via a clinical swallow examination (CSE), followed by a videofluoroscopy within 24 hours. The CSE was based on two swallow trials each of thin and thick fluids, purée, and solid textures. The four-finger digit assessment of swallowing was used to assess laryngeal elevation, number of swallows per bolus and delay in initiating the swallow. Wet voice post-swallow and an estimation of oral stasis was also made. Each parameter was rated on a four-point scale from no abnormality/dysphagia (scored zero) to severe abnormality/dysphagia (score of three). These measures were correlated with VFS measures of comparable features, using the same rating scale.

Evidence for a strong positive correlation between CSE and VFS was only observed on one feature: digit assessment of larynx elevation combined with observation of post-swallow voice quality was positively associated with hyo-laryngeal elevation rated on VFS.

The authors suggest that the CSE serves an important function as part of a first consultation as it allows the clinician to take a good history and obtain preliminary information from swallow trials. More research is necessary to establish how we can reliably obtain better information about swallow physiology from the CSE, given that VFS is not always available. The study is useful in highlighting that the assessment of swallowing includes many more physiological observations aside from the presence / absence of aspiration. 

Utility of a clinical swallowing exam for understanding swallowing physiology.
Rangarathnam B, McCullough GH.
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Roganie Govender

University College London, Head & Neck Academic Centre, UK.

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