Maureen Lefton-Greif, a Johns Hopkins speech-language pathologist, discusses her latest research on dysphagia and the video fluoroscopic swallow study (VFSS). The findings on this X-ray focus on the swallowing mechanism function that is not visible during clinical exams. They are also good for discovering if swallowing is sufficient to meet the nutritional goal. However, due to variables in the results, a new tool — the BaByVFSSImP — was created. The development of this novel tool may lead to improved clinical practice, future research and better the outcomes for bottle-fed infants with dysphagia.
Hello, my name is Maureen Lifting and I'm a professor in the Department of pediatrics and oology head neck surgery at the Johns Hopkins University School of Medicine. By training, I'm a certified speech language pathologist. And my clinical work and research have focused on swallowing disorders that develop early in life. Dysphagia is the term used to refer to swallowing disorders. It is well recognized that the incidence of dysphagia has been increasing in the pediatric population. It is also well recognized that the early detection of these problems and the prompt initiation of treatments can decrease the downstream consequences of dysphagia which are not trivial. Dysphagia can contribute to lung disease when foods or liquids are aspirated or go down the wrong way. Another consequence can occur when dysphagia interferes with infants and Children getting the nutrition they need for growth, brain development and their overall well-being. In addition, dysphagia can cause stressful interactions between Children and their caregivers and it can cause social and economic burdens for the entire family. Currently, the primary test used to evaluate for the presence and extensive swallowing dysfunction is an x-ray swallow study called the video fluoroscopic swallow study or V F S S. The V F S S is an x-ray exam that allows us to see the parts of the swallowing mechanism function during swallowing, which are not visible on clinical exams. It shows how these structures direct liquids and foods from the mouth into the stomach. While infants and Children are swallowing, we can see whether foods or liquids are directed the right way or if they're aspirated into the airways and we can determine whether swallowing function is efficient for Children to meet their nutritional goals. We've come a long way with our understanding of pediatric dysphagia and its consequences. However, despite this progress and despite the V F S S exam being considered the gold standard for the evaluation of swallowing dysfunction, we have been without a standardized and validated approach for reading, interpreting and reporting the findings from the V F S S exams performed in some of our most vulnerable Children. This lack of standardization has caused unnecessary or excessive variability which in turn appears to have increased the number of exams that Children receive more exams mean more exposure to x-rays and potentially this variability has led to a decrease in the accuracy of findings reported from these exams. So to increase the clinical and research utility of V F S S exams and decrease the consequences related to unnecessary or excessive variability. My colleague, Doctor Martin Harris at Northwestern and I conducted research that supported the development and validation of a new tool called the baby V F S. SI MP. The baby V F S SI MP supports the detection of essential components of swallowing which are critical for air weight protection and bolus clearance through the pharynx. And it enables quantification of physiologic impairments in these components during swallowing as to its clinical utility. The baby V F S S is a novel and validated tool that can elevate the care we provide to bottle fed Children with dysphagia and optimize their outcomes. In addition, in the future, it can be used to identify phenotypes of swallowing impairments in specific patient populations. It can help direct interventions to these physiologic impairments. It can provide objective measures for dysphagic interventions and it can also provide objective measures for a functional outcomes and metrics for future research. Again, early identification of swallowing dysfunction and the prompt initiation of event interventions that are directed towards specific swallowing impairments are critical. The baby V F S S is a novel tool that can inform clinical practice future research and most importantly, improve the outcomes for bottle fed Children with dysphagia.
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