Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study

Abstract

Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1–13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.

An initial framework for use of ultrasound by speech and language therapists in the UK: Scope of practice, education and governance

“…This includes consideration of optimal education and service delivery models as well as whether the use of imaging may have a negative impact on clinical outcomes or efficiency of resource use. The research priorities in this area are described in a recentlypublished consensus paper 5 .…”

Medidas cinemáticas da deglutição obtidas por ultrassonografia: um protocolo de revisão de escopo

“…Além disso, a USG pode mensurar propriedades da motilidade de língua durante a deglutição 1,12,18,19 , como a observação do padrão de movimento e duração da atividade de propulsão da língua ao deglutir 14,20 .…”

“…Em contrapartida, a USG trata-se de um recurso instrumental em que as imagens estáticas e dinâmicas das estruturas do corpo humano são captadas em tempo real através da reflexão de ecos acústicos de alta frequência, os quais são enviados de um transdutor móvel para serem decodificados eletronicamente para análises imediatas ou tardias 10,11 . Desse modo, é considerado um método não invasivo, que não utiliza contraste ou radiação, realizado por meio de equipamentos portáteis e disponível nos serviços de saúde 7,12 .…”

“…Na investigação da deglutição em região orofaríngea, a USG tem sido realizada em indivíduos com ou sem distúrbios para avaliar a morfometria muscular e cinemática da função, observar medidas qualitativas e quantitativas, bem como para complementar o diagnóstico da disfagia 1,7,8,[11][12][13][14] . Apesar dos benefícios apresentados, a ultrassonografia ainda é um recurso pouco explorado na prática clínica devido à falta de confiabilidade no que se refere à aquisição de dados e seleção de imagens para interpretação, além da ausência de consenso sobre os parâmetros avaliados.…”

Kinematic measures of swallowing obtained with ultrasound: a scoping review protocol

“…On the other hand, US is an instrumental resource that makes static and dynamic images of human body structures in real-time through high-frequency acoustic echoes, which are sent from a movable transducer to be electronically decoded for immediate or later analyses 10,11 . This noninvasive method does not use either contrast agents or radiation and is performed with portable equipment available in health services 7,12 .…”