Dysphagia Research Bites

Is it a case of trouble with swallowing or trouble with eating? In this episode, Dr Megan Parsons, medical speech-language pathologist, unpacks a framework that changed how she thinks about swallowing problems. Chantelle and Megan explore why “dysphagia” isn’t always a problem of the swallow itself, and why working out what is driving the difficulty might be the most important clinical question we ask.
If you’ve ever documented “dysphagia” without being sure what was driving it, this episode is for you.
 
In this episode we cover:
What cognitive dysphagia is, and what it looks like at mealtimes
Why a patient can have intact swallowing anatomy and physiology and still not eat
Whether “cognitive dysphagia” belongs across populations, including adults with developmental and intellectual disability
A systems-based framework for dysphagia and how it shifts assessment, chart review and documentation
When the swallow isn’t the problem, and how to flag concerns outside our scope without handballing the patient
How to look for respiratory contributors to dysphagia during a clinical swallow evaluation
How to see natural eating behaviour in a hospital setting, and why involving family matters
The role of clinical reasoning in what makes us pathologists, not just therapists
 
The publication this episode is based on:
Winchester, J & Winchester, C (2015). Cognitive dysphagia and effectively managing the five systems. Perspectives on Gerontology, 20(3), 116–132.
You can access the article here: http://dysphagiamanagement.com/wp-content/uploads/2015/03/CognitiveDysphagia_Winchester_2015.pdf
 
For more clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

Safety, nutrition, enjoyment and the dining experience all need to be part of the conversation when we are talking about texture modified meals in aged care. In this episode of Dysphagia Research Bites, Chantelle sits down with Vanessa Chan to unpack a mixed methods study looking into these very things. They explore the whole journey of a meal, from the kitchen to the dining room, and what speech pathologists can do to influence it.
 
In this episode we cover:
Why the whole mealtime workflow matters, from preparation and labelling through to serving and feeding assistance
Whether texture modified diets are being over-prescribed, and what happens when recommendations are changed without an SLP review
Why an instrumental assessment isn't always feasible in the community and aged care, and what that means for practice
The problem with texture modified menus: limited variety, inconsistent quality and nutritional gaps
How access to drinks, thickening practices and staff training can affect residents' hydration and safety
Why some residents choose to avoid the dining room, and how our own assumptions as clinicians can get in the way
How well IDDSI has been implemented in practice, and what needs to improve
Why choking risk deserves more attention in our profession
 
The publication this episode is based on:
Wu, X., Yousif, L., Miles, A., & Braakhuis, A. (2022). Exploring meal provision and mealtime challenges for aged care residents consuming texture-modified diets: A mixed methods study. Geriatrics, 7(3), 67. https://doi.org/10.3390/geriatrics7030067. PMID: 35735772.
 
Additional resources for aged care providers can be found at Swallowing and Dysphagia Support: https://www.swallowinganddysphagiasupport.com.au
 
For more community-based clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com

How many times does your patient swallow in a minute? It sounds like a simple question but the answer might tell you more than you'd expect. In this episode of Dysphagia Research Bites, Chantelle sits down with Dr Sonal Pathak to explore spontaneous swallowing frequency: what it is, how it's measured, and why it could become one of the most practical objective tools in your clinical toolkit, both at the bedside in hospital and out in the community.
 
In this episode we cover:
 
The difference between spontaneous and volitional swallows, and why this distinction matters for how you measure them
Why the measurement environment needs to be carefully controlled — and what can accidentally inflate your data
How long you actually need to record (the answer may surprise you)
The role of spontaneous swallowing frequency as a screening tool in acute care, and what makes it accessible to non-SLP staff
Why Sonal's doctoral research focused on this measure as an outcome measure in a post-acute setting and what that means for how we evaluate treatment effectiveness
Why this measure may be particularly useful for clients with mild or subclinical dysphagia where other clinical signs are absent
 
 
One of the publications this episode is based on:
Crary, Carnaby & Sia (2013): https://pubmed.ncbi.nlm.nih.gov/25088166/
 
For comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course

What if you could interpret a video fluoroscopy report the way a doctor reads a blood test, with clear reference ranges, and the ability to say with confidence whether a value is within or outside what's expected for a healthy adult? That's exactly what Dr Catriona Steele and her team at the University of Toronto have been working on, and in this episode she walks us through what they've found.
 
In this episode we cover:
What prompted the development of VFSS reference values.
How the ASPEKT method differs from ordinal rating tools like MBSImP and what it means to measure swallowing rather than describe it
What the reference data tells us about residue, and why ASPEKT's approach to measuring residue is conceptually different from the Bolus Clearance Ratio and DIGEST
The 2D vs 3D measurement problem: the validity challenges of pixel-based area measures and what Catriona's team is doing about it
How many thin fluid swallows you actually need before you can confidently rule out aspiration and whether consecutive sips count
Why bolus position at swallow onset was dropped from the reference value framework  and what replaced it
What emerging ASPEKT data is showing across clinical populations including Parkinson's disease and COPD
ASPEKT Academy and the clinical workshop coming to Australia
 
The publications this episode is based on:
Steele, C. M., Peladeau-Pigeon, M., Barbon, C. A. E., Guida, B. T., Tapson, M. S., Valenzano, T. J., & Waito, A. A. (2023). Reference values for videofluoroscopic measures of swallowing: An update. Journal of Speech, Language, and Hearing Research, 66(8), 2758–2773. https://doi.org/10.1044/2023_JSLHR-22-00608

Updated 2026 Reference Values available here: https://figshare.com/s/428ddbd2d1d009abcd01

Register for upcoming ASPEKT VFSS Workshops Here:
https://steeleswallowinglab.ca/srrl/education/aspekt-academy/#:~:text=ASPEKT%20Academy%20is%20a%202%2Dday,be%20offered%204%20times.%20The
 
For comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course

Aspiration and aspiration pneumonia are not the same thing. We know this theoretically. In this episode of Dysphagia Research Bites, Chantelle sits down with Melissa Kane to unpack a 2022 tutorial paper that illustrates the case for looking beyond aspiration itself and toward the individual: their host defences, their medical complexity, their oral health, their lifestyle, when determining the real risk of an adverse event.

This episode covers:
Why the presence of aspiration does not have a linear relationship with adverse outcomes
The BOLUS Framework: a clinical tool that consolidates existing evidence into a practical set of risk-assessment questions spanning Bolus variables, Oral care, Lifestyle and ADLs, Unintended (Iatrogenic) risks, and System Health
How oral health, feeding dependence, mobility, tube presence, and medical co-morbidities each factor into aspiration risk
The importance of person-centred language when discussing risk with clients and families
How using this framework in a real-world case enabled a client who was nil by mouth to significantly increase their oral intake and improve quality of life

The publication this episode is based on:

Palmer, P. M., & Padilla, A. H. (2022). Risk of an adverse event in individuals who aspirate: A review of current literature on host defenses and individual differences. American Journal of Speech-Language Pathology, 31(1), 148–162. https://doi.org/10.1044/2021_AJSLP-20-00375

Some of the tools & articles mentioned in this episode:
EAT-10 (Eating Assessment Tool-10):https://www.nhsexpertcorner.com/sites/default/files/2021-04/eat10toolenglish_form.pdf
Drooling Frequency and Severity Scale (DFSS): https://www.movementdisorders.org/MDS-Files1/PDFs/Task-Force-Papers/sm004.doc
Functional Oral Intake Scale (FOIS): https://www.archives-pmr.org/article/S0003-9993(05)00196-6/abstract
Oral Health Assessment Tool (OHAT):https://www.dental.sa.gov.au/assets/downloads/Care-for-older-people-toolkit/Residential-care/3.-Oral_Health_Assessment_Tool-OHAT.PDF
Langmore, S. E., Terpenning, M. S., Schork, A., Chen, Y., Murray, J. T., Lopatin, D., & Loesche, W. J. (1998). Predictors of aspiration pneumonia: How important is dysphagia? Dysphagia, 13(2), 69–81. https://doi.org/10.1007/PL00009559 — available via: https://pubmed.ncbi.nlm.nih.gov/9513300/
Ashford, J. R. (2005). Pneumonia: Factors beyond aspiration. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 14(1), 10–16. https://doi.org/10.1044/sasd14.1.10 — the Three Pillars framework is also summarised at: https://www.sasspllc.com/three-pillars-of-pneumonia
O'Keeffe, S., Murray, A., Leslie, P., Collins, L., Lazenby-Paterson, T., McCurtin, A., Mulkerrin, S., & Smith, A. (2021). Aspiration, risk and risk feeding: A critique of the Royal College of Physicians guidance on care of people with eating and drinking difficulties. Advances in Communication and Swallowing, 24(1), 1–10. https://doi.org/10.3233/ACS-210031

For comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course