Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Evaluating Swallowing Function among Patients with Amyotrophic Lateral Sclerosis and Dysphagia

Abstract

Introduction: The videofluoroscopic dysphagia scale (VDS) is used to predict the long-term prognosis of dysphagia among patients with the condition. Previously, a modified version of the VDS (mVDS) was established to overcome the relatively low inter-rater reliability of VDS, and was verified in patients with dysphagia, such as stroke patients. However, the validity of mVDS in patients with amyotrophic lateral sclerosis (ALS) has never been proved. Therefore, in this study, we attempted to seek the validity of the mVDS score in patients with ALS suffering from dysphagia. Method: Data from the videofluoroscopic swallowing study (VFSS) of 34 patients with ALS and dysphagia were retrospectively collected. We investigated the presence of aspiration pneumonia and the selected feeding method based on the VFSS. We also evaluated the correlations between the mVDS and the selected feeding method, and between the mVDS and the presence of aspiration pneumonia. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed during the data analysis. Results: In patients with ALS and dysphagia, the mVDS scores were statistically correlated with the selected feeding method (p < 0.05) and the presence of aspiration pneumonia (p < 0.05). In the ROC curve analysis, the area under the ROC curve values for the selected feeding method and the presence of aspiration pneumonia were 0.886 (95% confidence interval (CI), 0.730–0.969; p < 0.0001) and 0.886 (95% CI, 0.730–0.969; p < 0.0001), respectively. Conclusion: The mVDS can be a useful tool for quantifying the severity of dysphagia and interpreting the VFSS findings in patients with ALS and dysphagia. However, further studies involving a more general population of patients with ALS are needed to elucidate a more accurate cut-off value for the allowance of oral feeding and the presence of aspiration pneumonia.

Association between Anterior Surgical Approach and Dysphagia Severity in Patients with Cervical Spinal Cord Injury

“…The higher the modified VDS score, the more severe the dysphagia. Modified VDS has demonstrated its good inter-rater reliability (Cronbach α value, 0.886) in previous studies [19][20][21][22]. The PAS is a scale of 8 points (minimum-maximum, 1-8), scored by a physiatrist based on the degree of aspiration in the VFSS video.…”

Correlation between Forced Vital Capacity and the Severity of Frailty-Induced Dysphagia

“…VFSS was performed using a fluoroscopy device and recorded in a video file. During the VFSS, the patient swallowed the following substances in order: water, nectar (51–350 cP), rice porridge (351–1750 cP), and boiled rice (>1750 cP) [ 14 , 15 , 16 ]. The patient swallowed the substances in a sitting position, and all substances were mixed with barium.…”

“…The results were analyzed in terms of PAS and mVDS scores; aspiration was considered present when the PAS score was >5. The mVDS is a scale of 100 points, which is scored by a physiatrist based on several parameters in the VFSS video [ 14 , 15 , 16 ]. The parameters of the mVDS are listed in Table 1 .…”

“…The parameters of the mVDS are listed in Table 1 . Previous studies have demonstrated the inter-and intra-reliability of the Mvds [ 14 , 15 , 16 ].…”

Dysphagia of Neurological Origin – Amyotrophic Lateral Sclerosis

“…The interpretation of VFSS results can be done with the videofluoroscopic dysphagia scale (VDS), which contains 14 categories that represent oral functions (lip closure, mastication, bolus formation, premature bolus loss, apraxia, and oral transit time) and pharyngeal functions (pharyngeal triggering, laryngeal elevation, epiglottic closure, pharyngeal transit time, pharyngeal coating, vallecular and pyriform sinus residues, and tracheal aspiration) [32]. A modified version of VSD (mVSD) has been developed to overcome low inter-rater reliability of some categories in the VDS [33]. FEES is a valid, repeatable, and low-cost alternative, used to directly visualize the swallowing process and the saliva movement, and it is able to evaluate pharyngo-laryngeal sensitivity in addition to motility [34].…”