Amy is from Lake Panasoffkee, Fl and is a graduating with a bachelor’s degree in Communications Sciences and Disorders from the University of Florida. Amy works as an undergraduate research assistant under Dr.Plowman at Aerodigestive Research Core. She is also completing a senior honors thesis under Dr.Plowman’s mentorship, as well as Dr. Plowman’s PhD student Raele Robison. After Amy graduates, she plans to obtain a Master’s degree in Speech-Language Pathology at the University of Florida. Amy is excited to explore all the different areas that Speech Pathologists work in while deciding which avenue is the right one for her. In Amy’s spare time she likes to paddleboard and play soccer.
Delineating Swallowing Safety and Efficiency Impairment Profiles in Amyotrophic Lateral Sclerosis
Amy M. Ashley, BHS-CSD
Raele D. Robison, MS, CCC-SLP
Emily K. Plowman, PhD., CCC-SLP
University of Florida
Abstract
Swallowing impairment (dysphagia) affects approximately 85% of individuals with amyotrophic lateral sclerosis (ALS) and is characterized by impairments in safety (aspiration) and efficiency (residue) (Chen and Garrett, 2005). Despite its high prevalence, the relative evolution of impairments is unknown. We therefore aimed to determine swallowing safety and efficiency profiles in individuals with ALS. We hypothesized that swallowing safety would be preserved longer into the ALS disease progression and that efficiency impairments would be relatively more prevalent given the noted early degeneration of the tongue in in ALS (DePaul and Brooks 1993).
Eighty ALS individuals completed one standardized videofluoroscopic swallowing examination. Two independent and blinded raters performed validated ratings of the Penetration Aspiration Scale (PAS, Rosenbek, 1996) and Analysis of Swallowing Physiology: Kinematics and Timing method (Steele, 2020). Binary groups of safety (safe: PAS: <2; unsafe:PAS: >3) and efficiency (efficient= <3% total residue; inefficient: ≥3%) were derived for impairment profile comparisons. Descriptives and a 2×2 contingency table with Chi Squared was performed using SPSS and alpha set at 0.05.
Swallowing Safety: 60% (n=48) of ALS patients were safe and 40% (n=32) unsafe. Within the unsafe group, 17.5% (n=14) were penetrators and 22.5% (n=18) were aspirators.
Swallowing Efficiency: Swallowing efficiency could not be determined for 19 individuals. Of the remaining participants (n=61), 39% (n=24) were efficient and 61% (n=37) were inefficient.
Global Swallowing Profiles: Although the occurrence of inefficiency and unsafe swallowing were relatively the same; the presentation of global swallowing impairment profiles differed X2(1)=8.5, p=0.003. A relatively even distribution was noted for safe/efficient, unsafe/inefficiency and for safe/inefficient (28-33%), however less than 7% of patients demonstrated unsafe and efficient swallowing.
The current cross-sectional study suggests that swallowing efficiency impairments are four times more likely to develop before swallow safety impairments. Further work utilizing a longitudinal study design is warranted to further explore this observation in a valid manner.
