Page 69 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

The SPEAD-test
The SPEAD-test contains three subtasks covering the full range of food consistencies including texture levels 0, 3 and 7, respectively, according to the International Dysphagia Diet Standardization Initiative (IDDSI) framework, all at room temperature (Figure 1) (25). These three textures were selected given the frequent use of these in daily life. The level 0 texture consists of 100 g of water. The level 3 texture consists of 100 g of lemonade (15 g of strawberry flavored syrup added to 85 mL of water), thickened with two 4 g spoons of the thickening agent Nestlé ThickenUp© Clear (Nestlé Health Science, Oosterhout, The Netherlands). The level 7 texture consists of a cream cracker (3.125 grams).
The participant is comfortably seated upright in a chair at a table. The observer is seated opposite to the subject. The subject is instructed to ingest the three substances in order of increasing consistency, as quick as comfortably possible, with at least a one-minute break in between consistencies, as timed by the observer. The subject is asked to cough or stop whenever necessary and eat or drink like he or she is used to (e.g., with or without prosthesis, with or without spoon). All consistencies that the participant ingested in daily life at the time of the test were offered. Naturally, the patient was informed about the outcome of the VFS and was advised to skip a consistency in case of (silent) aspiration (penetration-aspiration score (PAS) of 7 or 8) on VFS for safety. The use of water during the ingestion of the solid is only allowed in case the person tested is completely unable to ingest the solid without it. For the purposes of the current study, we used a camera to videotape the subject from the viewpoint of the observer during the test.
Figure 1 Consistencies of the SPEAD-test. Left: 100 g water (International Dysphagia Diet Standardization Initiative (IDDSI) level 0). Middle: 100 g thickened lemonade (IDDSI level 3). Right: 3.125 g cream cracker (IDDSI level 7).
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The SPEAD-test to objectify swallowing capacity
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