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Chapter 3
and perception, can help to evaluate the effectiveness of swallowing rehabilitation. However, few tests are available for this purpose.
One currently available test is the timed 100- or 150-mL water swallow test (WST), developed to identify the patients at risk for dysphagia associated aspiration and also was evaluated in HNC patients (19, 20, 21). Another test that measures the capacity of eating is the recently developed Test Of Masticating And Swallowing Solids (TOMASS), which measures the eating function by evaluating the number of bites, chews, and swallows and amount of time a patient needs to eat a cracker (22, 23). This test has not yet been validated in a HNC population. By focusing on a single substance, both (bedside) tests have limited bandwidth to assess a patient’s swallowing capacity along the continuum of swallowing ability. Because poor swallowing capacity in one texture might not mean that swallowing capacity for other textures is also poor, testing one texture might limit the clinical usefulness, prohibit full insight in the swallowing function, and possibly restrict the reliability and validity for assessing swallowing problems. A test that comprises all elements of the eating process is hypothesized more likely to be a good representation of patients’ capacity of eating and drinking in daily life.
Therefore, we developed a test which evaluates an individual’s (safe) swallowing capacity for eating as well as drinking; the Swallowing Proficiency for Eating And Drinking (SPEAD)-test. The SPEAD-test was based on WST and TOMASS, completing the spectrum of consistencies with tick liquid. The test entails the measurement of time needed to ingest three boluses of different consistencies (i.e., thin liquid, thick liquid and solid) and therefore measures the transport capacity of the upper digestive tract (in grams per second), a construct comparable to other physiological measures, e.g., to the forced vital lung capacity (in liters). The objective of this study was to evaluate the test’s feasibility, reliability and validity in patients treated for HNC and in healthy participants.