Page 71 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

VFSs were performed only in the patient group as part of usual care either because of symptomatic dysphagia or according to clinical protocols. VFS was recorded in an upright position in lateral view with 25 frames per second. The subjects swallowed 3 and 10 cc thin liquid (IDDSI level 0), 5 cc thick liquid (level 3), and a piece of gingerbread (level 7) coated in Omnipaque consecutively from a spoon (Omnipaque contrast agent, GE Healthcare, Chicago, Illinois, United States). Pharyngeal swallowing safety (penetration/aspiration) and efficiency (residue) was graded by means of the validated Dynamic Imaging Grade for Swallowing Toxicity (DIGEST) (14, 26, 27). A higher score indicates more severe pharyngeal dysphagia. In case one of the consistencies was not tested, the DIGEST score was assessed based on the assessed consistencies. Also, aspiration on VFS (yes/no) was assessed.
The Functional Oral Intake Scale (FOIS) was assessed reflecting functional oral intake of food and liquid. It was filled in by the clinician by asking the participant about his/her diet. The FOIS ranges from 1 to 7 with 1 meaning nothing by mouth to 7 meaning no oral restrictions (28, 29).
Maximal inter-incisor (mouth) opening (MIO) was measured between the central incisors, using a disposable TheraBite range of motion scale (Atos Medical, Sweden) (30). Two measurements were performed, with the highest value recorded as the maximum mouth opening.
Also, a study-specific questionnaire was used with questions based on earlier published study specific questionnaires (27, 30). First, participants were asked to rate their swallowing function as a percentage, with 100% representing the swallowing function they had before cancer treatment (self-rated percentage swallowing function). The same question was asked regarding the speed of eating and drinking (self-rated percentage eating and drinking speed). Experienced maximal mouth opening (good, fair, moderate, or bad), taste and olfaction (normal, limited or absent), xerostomia (none, moderate, or bad) and dental prosthesis use (none, partial, or complete) were also included in the questionnaire as well as patient-reported degree of dyspnea, pain, and fatigue (not at all, a little, quite a bit and very much) were assessed.
The Swallowing Quality of Life Questionnaire (SWAL-QOL), a validated 44-item questionnaire, was used to assess swallowing function and its influence on daily life (15, 31). It includes ten domains: burden*, food selection*, eating duration*, eating desire*, fear*, sleep, fatigue, communication, mental health*, social functioning*, and symptom frequency of which subscores can be calculated. The total SWAL-QOL score is calculated from the subscales marked with an asterisk. All scores range from 0 to 100 with higher scores indicating more dysphagia- related problems.
The two speech language pathologists (SLPs) who performed the VFS of patient, were asked to independently rate the degree of dysphagia (no, mild, moderate or severe). This rating was therefore based on patients’ performance on VFS as well as the swallowing related complaints discussed prior to the VFS. The highest degree of the two ratings was used.
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The SPEAD-test to objectify swallowing capacity
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