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有所增加。视频透视吞咽研究(VFSS)是评估吞咽困难的主要方法，越来越多地在奶瓶喂养的儿童中进行。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。本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地点训练有素的语音语言病理学家(SLP)对300次VFSS检查的评分，基于评分员可靠性的测量和因素分析，从经验上将该工具的组件减少到可靠、简约和临床相关的集合。我们假设SLP内和SLP之间至少80%的可靠性，最终的组件集将分布在五个功能域中。在目标2中，我们将通过表征工具各组成部分得分与健康、发展和幸福感的外部指标之间的关系，来确定每个领域内各组成部分的结构效度。我们假设，在该工具上得分较高(吞咽功能较差)，将与较差的健康、发育和幸福指标相关。在目标3中，我们将测量在VFSS过程中引入不同液体浓度时生理性吞咽损伤分数的变化。我们假设不同一致性的损伤分数会有所不同。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，最终改善对患有这种疾病的儿童的诊断和治疗。公共卫生和安全相关性：吞咽功能障碍在幼儿中越来越常见，并与严重后果相关。这项研究将通过以下方式帮助改善受影响儿童的诊断、护理和预后：(1)为描述和跟踪吞咽障碍的自然历史提供基础；(2)为吞咽困难的干预提供结果测量；(3)作为临床试验的生物标记物，对被诊断为吞咽困难相关特定诊断条件的儿童进行试验。标准化、可靠和经过验证的工具将可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.