Standardization of Videofluoroscopic Swallow Studies for Bottle-Fed Children

描述（由申请人提供）：吞咽障碍（吞咽困难）和相关风险在幼儿中增加。影像透视吞咽研究（VFSS）是评估吞咽困难的主要方法，越来越多地应用于奶瓶喂养的儿童。然而，没有标准化的方法来描述吞咽障碍的类型和严重程度。该项目的目标是开发和测试一种标准化的测量工具和评分方案，用于量化奶瓶喂养儿童的吞咽障碍。在目标1中，我们将根据两个临床站点训练有素的语言病理学家（slp）对300个VFSS考试的评分进行可靠性和因子分析，经验地将该工具的组成部分减少为可靠、简洁和临床相关的一组。我们假设slp内部和slp之间至少有80%的可靠性，并且最终的组件集将分布在五个功能域中。在目标2中，我们将通过描述工具上的组件得分与健康、发展和福祉的外部指标之间的关系，在每个领域内建立组件的结构效度。我们假设，该工具的得分越高（吞咽功能越差），与健康、发展和幸福的指标越差有关。在目标3中，我们将测量在VFSS期间引入不同液体浓度时生理性吞咽损伤评分的变化。我们假设损伤分数在一致性之间会有所不同。这些研究将有助于开发一种临床实用、可靠和有效的标准化工具，用于评估、测量和报告奶瓶喂养儿童的生理性吞咽障碍，最终改善患有这种疾病的儿童的诊断和管理。公共健康和安全相关性：吞咽功能障碍在幼儿中越来越常见，并与严重后果相关。本研究将有助于改善患儿的诊断、护理和结局：(1)为描述和追踪吞咽障碍的自然病史提供依据；(2)为吞咽困难的干预措施提供结果指标；(3)为诊断出与吞咽困难相关的特定诊断条件的儿童进行临床试验提供生物标志物。标准化、可靠和有效的工具将通过基于网络的培训模块立即传播。

DESCRIPTION (provided by applicant): Swallowing disorders (dysphagia) and associated risks have increased in young children. Videofluoroscopic swallowing studies (VFSS), the primary method used to evaluate dysphagia, are increasingly performed in bottle-fed children. However, there are no standardized approaches to characterize the type and severity of the swallowing impairment. The goal of this project is to develop and test a standardized measurement tool and scoring schema for the quantification of swallowing impairment in bottle-fed children. In Aim 1, we will empirically reduce components for the tool into a reliable, parsimonious, and clinically relevant set based on measures of rater reliability and factor analysis from the scoring of 300 VFSS exams by trained speech-language pathologists (SLPs) at two clinical sites. We hypothesize at least 80% reliability within and between SLPs and the final set of components will be distributed into five functional domains. In Aim 2, we will establish the construct validity of the components within each domain by characterizing the relationship between component scores on the tool and external indicators of health, development, and well-being. We hypothesize that higher scores on the tool (poorer swallowing function), will be associated with poorer indicators of health, development, and well-being. In Aim 3, we will measure changes in physiologic swallowing impairment scores when different liquid consistencies are introduced during the VFSS. We hypothesize impairment scores will differ between consistencies. These studies will help develop a clinically practical, reliable, and valid standardized tool for assessing, measuring, and reporting physiologic swallowing impairment in bottle-fed children, ultimately resulting in improved diagnosis and management of children with this condition. PUBLIC HEALTH AND SAFETY RELEVANCE: Swallowing dysfunction is increasingly common in young children and associated with significant consequences. This study will help to improve the diagnosis, care, and outcomes of affected children by: (1) providing a basis for characterizing and tracking the natural history of swallowing impairments, (2) providing outcome measures for interventions for dysphagia, and (3) serving as biomarkers for clinical trials with children diagnosed with specific diagnostic conditions associated with dysphagia. The standardized, reliable, and validated tool will be available for immediate dissemination through web-based training modules.