In order to ensure appropriateness and feasibility of examination items for remote evaluation for deglutition disorders, a questionnaire based on the Delphi method was administered to 122 speech–language–hearing therapists (STs), and a set of examination items was selected. The participants were instructed to view a video recording of a remote assessment situation and answer a 30-item questionnaire. Of 19 items ensuring the appropriateness for deglutition disorders detection, 13 items ultimately met the consensus criteria for remote feasibility. Factor analysis extracted three factors: ‘oral observation,’ ‘overall evaluation,’ and ‘perceptual voice judgment.’ In free-text responses, “quality and stability of the voice that may be heard through the device” were the most common concerns, followed by “the need to correct of the camera angle, magnification, and targets that should be projected,” “concerns about the technical aspects of the assistants and their role in relation with the examiner/ST,” and “the need for palpation as well as visual confirmation.” The proposed 13-item examination is considered to capture the characteristics of deglutition disorders, while items that appeared difficult to implement remotely were excluded. The fact that some items could be influenced by the video calling experience when judging the feasibility of remote implementation, the acceptability of such items, is likely to increase in the future.

Objective: Oral care is effective for preventing pneumonia, but objective evaluation of its effect on swallowing is lacking. Oral assessment scores, such as the Oral Health Assessment Tool (OHAT), are used to evaluate the oral environment to monitor oral care.  Methods: We investigated the relationship between OHAT score and swallowing function in 24 patients aged 64–97 years. Results: The OHAT score did not correlate with the video endoscopy (VE) or video fluorography (VF) scores. Furthermore, the OHAT score was not significantly different between the multiple and no or single pneumonia episode groups. The group with multiple episodes of pneumonia had lower VE and VF scores than that with no or a single episode of pneumonia (p < 0.01). Conclusions: Oral assessment, VE, and VF scores are necessary to evaluate swallowing in patients with suspected dysphagia. In addition, recurrent pneumonia among patients with a good oral environment has multiple contributing factors, including subclinical aspiration, pharyngeal clearance, and delayed activation of the gag reflex.

In our prior published study, we extracted evaluation items suitable for remote administration, and made a relatively simple Remote Examination of Deglutition (RED). This study aimed at verifying the reliability and validity of RED. The participants were 21 healthy elderly individuals and 72 postoperative oral cancer (OC) patients. OC patients underwent videofluoroscopic dysphagia examination, and severity was judged on the dysphagia severity scale (DSS). Reliability and validity of RED were examined in all participants under face-to-face conditions, in comparison with the Mann Assessment of Swallowing Ability (MASA). Reliability and validity of remote administration of RED were examined in 40 participants. ROC curves were used to find cut-off RED scores to predict aspiration and deglutition disorders. The Cronbach's alpha coefficient for the items was 0.882. There was a high correlation between the total score of RED and MASA in the face-to-face condition. When RED score was compared among different severity groups (DSS1–4, DSS5–6, and DSS7), the total and oral preparatory stage scores revealed significant group differences. The area under the curve (AUC) for aspiration based on the ROC curve was 0.913, with a sensitivity/specificity of 0.80/0.98. The AUC for deglutition disorders was 0.819, with a sensitivity/specificity of 0.74/0.67. In both face-to-face and remote conditions, the reliability of RED was good.The reliability and validity of RED were confirmed. RED has shown the potential to assess the likelihood of aspiration and deglutition disorders in OC patients remotely as an initial assessment tool.

Objective Oral care is effective for preventing pneumonia, but objective evaluation of its effect on swallowing is lacking. Oral assessment scores, such as the Oral Health Assessment Tool (OHAT), are used to evaluate the oral environment to monitor oral care. Methods We investigated the relationship between OHAT score and swallowing function in 24 patients aged 64–97 years. Results The OHAT score did not correlate with the video endoscopy (VE) or video fluorography (VF) scores. Furthermore, the OHAT score was not significantly different between the multiple- and no- or single-pneumonia episode groups. The group with multiple episodes of pneumonia had lower VE and VF scores than those with no or a single episode of pneumonia (p < 0.01). Conclusions Oral assessment, VE, and VF scores are necessary to evaluate swallowing in patients with suspected dysphagia. In addition, recurrent pneumonia among patients with a good oral environment has multiple contributing factors, including subclinical aspiration, pharyngeal clearance, and delayed activation of the gag reflex.