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Öğe Comparative analysis of videofluoroscopy and pulse oximetry for aspiration identification in patients with dysphagia after stroke and non-dysphagics(Springer, 2024) Bengisu, Serkan; Oge-Dasdogen, Oezlem; Yildiz, Hatice YeldaPurpose Dysphagia is a prevalent symptom observed in acute stroke. Several bedside screening tests are employed for the early detection of dysphagia. Pulse oximetry emerges as a practical and supportive method to augment the existing techniques utilized during bedside swallowing assessments. Desaturation levels, as measured by pulse oximetry, are acknowledged as indicative of aspiration by certain screening tests. However, the predictive capability of pulse oximetry in determining aspiration remains a subject of controversy. The objective of this study was to compare aspiration and oxygen desaturation levels by time and aspiration severity in dysphagic patients compared to healthy controls. It also aimed to evaluate the accuracy of pulse oximetry by comparing it with VFSS findings in detecting aspiration in both liquid (IDDSI-0) and semi-solid (IDDSI-4) consistencies.Materials and methods Eighty subjects (40 healthy and 40 acute stroke patients) participated. Patients suspected of dysphagia underwent videofluoroscopy as part of the stroke unit's routine procedure. Baseline SpO2 was measured before VFSS, and stabilized values were recorded. Sequential IDDSI-0 and IDDSI-4 barium tests were conducted with 5 ml boluses. Stabilized SPO2 values were recorded during swallowing and 3-min post-feeding. Patients with non-dysphagia received equal bolus monitoring. Changes in SPO2 during, before, and after swallowing were analyzed for each consistency in both groups.Results The study revealed a statistically significant difference in SPO2 between patients with dysphagia and controls for IDDSI-4 and IDSSI-0. In IDDSI-4, 20% of patients experienced SpO2 decrease compared to 2.5% in control group (p = 0.013). For IDDSI-0, 35% of patients showed SpO2 decrease, while none in the control group did (p = 0.0001). Aspiration rates were 2.5% in IDDSI-4 and 57.5% in IDDSI-0. In IDDSI-0, SpO2 decrease significantly correlated with aspiration (p = 0.0001). In IDDSI-4, 20.5% had SpO2 decrease without aspiration, and showing no significant difference (p = 0.613). Penetration-Aspiration Scale scores had no significant association with SpO2 decrease (p = 0.602). Pulse oximetry in IDDSI-4 had limited sensitivity (0%) and positive predictive value, (0%) while in IDDSI-0, it demonstrated acceptable sensitivity (60.9%) and specificity (100%) with good discrimination capability (AUC = 0.83).Conclusions A decrease in SPO2 may indicate potential aspiration but is insufficient alone for detection. This study proposes pulse oximetry as a valuable complementary tool in assessing dysphagia but emphasizes that aspiration cannot be reliably predicted based solely on SpO2 decrease.Öğe Dil ve konuşma terapistlerinin yatak başı yutma değerlendirmesine yönelik bilgilerinin incelenmesi(Ankara Üniversitesi, 31 Aralık 2022) Altun, Melis Buse; Bengisu, Serkan; Koçak, Ayşe NurAmaç: Yatak başı yutma değerlendirmesi (YBYD) yutma terapisinin doğru gerçekleştirilebilmesi için önem taşımaktadır. Bu çalışmada dil ve konuşma terapistlerinin (DKT) YBYD’ne yönelik uygulamaları ve bilgilerinin incelenmesi amaçlanmaktadır. Örneklem ve Yöntem: Genel tarama modeli ile yürütülen bu çalışmada, araştırmacılar tarafından geliştirilen “Dil ve Konuşma Terapistlerinin Yatak Başı Yutma Değerlendirilmesine Yönelik Bilgi Düzeyini Belirleme Anketi” kullanılmıştır. Araştırmaya 86 DKT katılmıştır. Anket üç bölümden oluşmaktadır. İlk bölüm DKT’lerin demografik bilgilerini, ikinci bölüm aktif olarak yutma terapisi gerçekleştiren terapistlerin YBYD uygulamalarını ve son bölümde ise 10 soruluk bilgi anketi içermektedir. Bulgular: Çalışmaya katılan DKT’lerin %90.7’si (n=78) eğitim süreçlerinde YBYD’ye yönelik eğitim aldığı belirtmekte ancak %61.6’sı (n=53) bu eğitimin yetersiz olduğunu düşünmektedirler. Katılımcıların sadece %12.8’nin (n=11) yutma terapisi yaptığı görülmüştür. Yutma terapisi yapan terapistlerin YBYD uygulamalarında farklılıklar olduğu kadar benzerlikler olduğu da görülmüştür. Genel gözlem, oral-motor muayene ve bilişsel farkındalık değerlendirmesi tüm terapistler tarafından YBYD sırasında uygulanmaktadır. Bilgi anketini içeren bölümde, besin alımı kararı bilgisini içeren 5. soruya (%16.3 n=14) ve YBYD’ni uygulayan meslek grubu bilgisini içeren 8.soruya (%48.8 n=42) doğru yanıtların az olduğu görülmüştür. Sonuç: Ülkemizde yutma terapisi ile ilgilenen DKT sayısının az olması bu araştırmanın bulgularını etkilediği düşünülmektedir. İkinci bölümü dolduran terapistlerin YBYD uygulamalarının, alanyazın ile uyumluluk gösterdiği ve gelen hastaya göre uygulamalarını modifiye edebildikleri görülmüştür. Yutma terapisi gerçekleştiren DKT sayısının az olmasına karşın katılımcıların üçüncü bölüme verdikleri yanıtların çoğunlukla doğru olduğu görülmüştür. Terapistlerin yetersiz hissetmelerindeki sebebin aktif uygulama yapmamaktan kaynaklanabileceği düşünülmektedir. Araştırma kapsamında elde edilen tüm bulgular alanyazın ile tartışılmış olup lisans, yüksek lisans ve doktora eğitim süreçlerinde YBYD ile ilgilenen uzmanlara yol göstereceği düşünülmektedir.Öğe Effectiveness of Conventional Dysphagia Therapy (CDT), Neuromuscular Electrical Stimulation (NMES), and Transcranial Direct Current Stimulation (tDCS) in Acute Post-Stroke Dysphagia: A Comparative Evaluation(Springer, 2024) Bengisu, Serkan; Demir, Numan; Krespi, YakupThis study aims to compare the effectiveness of conventional dysphagia therapy (CDT), neuromuscular electrical stimulation (NMES), and transcranial direct current stimulation (tDCS) in the treatment of post-stroke dysphagia. A single-blind randomized controlled trial was conducted with 40 acute stroke patients - 18 females and 22 males with a mean age of 65.8 +/- 11.9. The subjects were grouped into 4, with 10 individuals in each. The procedures administered to groups were as follows: the first group, sham tDCS and sham NMES; the second group, tDCS and sham NMES; the third group, NMES and sham tDCS; and the fourth group, all therapy procedures. CDT was applied to all groups either as a standalone procedure or combined with one or two of the instrumental techniques. Gugging Swallowing Screen (GUSS) and Videofluoroscopic Swallowing Study (VFSS) were employed to determine the severity of dysphagia and the effectiveness of treatment modalities. Additionally, the Penetration Aspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Dysphagia Severity Rating Scale (DSRS) were administered to interpret VFSS data. Pre- and post-treatment comparisons of all groups have revealed a statistically significant difference for all parameters except for the PAS scores at International Dysphagia Diet Standardization Initiative (IDDSI)-Level 4 consistencies. However, the differences between pre- and post-treatment scores of the fourth group across all parameters were significant - GUSS (p = 0.005), FOIS (p = 0.004), DSRS (p = 0.005), PAS IDDSI-4 (p = 0.027), PAS IDDSI-0 (p = 0.004). Inter-group comparisons, on the other hand, pointed out that the difference between pre- and post-treatment GUSS, FOIS, DSRS, and PAS scores at IDDSI Level-0 consistencies was statistically significant for all groups - GUSS (p = 0,009), FOIS (p = 0,004), DSRS (p = 0,002), PAS IDDSI-0 (p = 0,049). Closer examination of treatment groups indicated that the tDCS + CDT group, the NMES + CDT group, and the group that underwent the combination of three modalities made better progress than the one that was treated with only CDT. Though not statistically significant, the NMES + CDT group achieved better improvement than the tDCS + CDT group. This study has yielded that the group in which NMES, tDCS, and CDT were applied in combination has achieved better results than all the other groups. All treatment modalities applied to accelerate the general recovery process in acute stroke patients with dysphagia were found to be effective for the treatment of post-stroke swallowing disorders. The use of instrumental treatments such as NMES and tDCS enhanced the effectiveness of the treatment and provided more significant progress. Furthermore, combining treatment modalities such as NMES and tDCS was more effective when compared to using only conventional therapy. As a result, the most effective treatment outcomes were obtained by the group receiving CDT, NMES, and tDCS in combination. Therefore, the use of combined approaches has been recommended in appropriate patients; yet the provisional results should be tested in randomized trials with more participants.Öğe Reliability, validity and normative data of the timed water swallow test accompanied by sEMG(Springer, 2024) Selen Akil, Dilan; Bengisu, Serkan; Sezer, Eyüp; Krespi, Yakup; Topbaş, Saime SeyhunPurpose Swallowing disorders are highly interrelated with increased morbidity and mortality rates; therefore, early detection is crucial. Most screening tools rely on subjective observation, thus making objective assessment tools more vital. Timed Water Swallowing Test (TWST) is a screening tool used in the field providing quantitative data. This study aimed to investigate the swallowing parameters in a wide age range by using TWST and to expand the already existing normative data pool accordingly. It is also aimed to examine the reliability of the TWST and assess its validity in stroke survivors. Materials and methods This study had a cross-sectional design. TWST carried out simultaneously along with surface EMG and laryngeal sensor on 196 healthy subjects aged 10 to 80 for normative data. Also, TWST carried out 30 patients having a history of recent stroke. Test-retest and inter-rater scoring analysis were used for reliability purposes, while Gugging Swallowing Screen (GUSS) test was used for validity purposes. Additionally, the correlations between the participants' TWST scores and GUSS scores were examined using the Spearman correlation coefficient. Results The normative TWST data of healthy participants are tabulated and presented and their average swallowing capacity was found 13.73 ml/s. Furthermore, the mean swallowing capacity of stroke survivors was found 4.61 ml/s. As a result of validity analyses, a statistically strong and significant relationship was found between GUSS and TWST parameters (r = 0.775, p < 0.001). Intraclass correlation coefficient (ICC) and correlation values were found between moderate to good agreement between test-retest measurement (ICC = 0.563 to 0.891, p < 0.05). Also, the agreement between the raters was found to be significant (ICC = 0.949 to 0.995, p < 0.05). Conclusion TWST is a valid and reliable screening tool to evaluate dysphagia on given population. Although the test's performance on healthy individuals is adequate, more research is still needed to confirm that it can be used as a screening tool for stroke.Öğe The Turkish version of the cognitive assessment scale for stroke patients (CASP-TR): a reliability and validity(Routledge, 2024) Öge-Daşdöğen, Özlem; Bengisu, Serkan; Yıldız, Hatice Yelda; Krespi, YakupBackground: Stroke, a prevalent neurological condition globally, is associated with a high mortality and often affects cognitive function. The Cognitive Assessment Scale for Stroke Patients (CASP) was developed to quickly identify and measure primary cognitive deficits, focusing particularly on stroke survivors. Within the Turkish context, there is a limited availability of validated cognitive screening tests for use after stroke. Aims: The study aimed to translate CASP into Turkish (CASP-TR) and validate it in stroke patients. Methods and procedures: After the translation of the CASP items into culturally appropriate Turkish versions, a pilot testing of the pre-final version was administered to post-stroke patients and healthy controls by two raters. Following completion of the final version of CASP-TR, 40 stroke patients were consecutively enrolled in validation process. Three blinded raters conducted all assessments with intervals of 1- or 2 days between evaluation sessions. The accuracy of CASP-TR was assessed using sensitivity, specificity, predictive values, likelihood ratios, and area under curve. CASP-TR performance in post-stroke patients with and without cognitive dysfunction was compared using the Mini-Mental State Examination (MMSE). CASP-TR data obtained by two raters were compared based on the presence of aphasia. Outcomes and results: The study assessed inter-rater agreement using intraclass correlation coefficient (ICC), yielding a score of 0.92 (95% CI 0.85-0.96) between raters. Across subtests, moderate to good agreement was observed in most domains. Correlation analyses showed a strong positive relationship (r = 0.80) between mean CASP-TR and MMSE scores. CASP-TR and MMSE scores were stratified based on the presence of aphasia. CASP-TR scores from both raters were notably lower in the aphasia group compared to the non-aphasia group (p < 0.001). Similarly, MMSE scores were significantly lower in the aphasia group (p < 0.001). The patients were also classified into cognitive dysfunction and non-cognitive dysfunction groups based on MMSE scores. No statistically significant score differences were found between examiners in the cognitive dysfunction group (p = 0.267) or non-cognitive dysfunction group (p = 0.156) (p > 0.05). CASP-TR demonstrated a sensitivity of 82.4%, specificity of 78.6%, positive predictive value of 87.5%, negative predictive value of 68.7%, a positive likelihood ratio of 3.77, a negative likelihood ratio of 0.25, and an area under curve of 0.88. Conclusions: This study proposes that CASP-TR is a valuable cognitive screening tool for assessing cognitive deficits in stroke patients, and it also demonstrates sensitivity to cognitive deficits in stroke patients with aphasia. The thorough validation within the acute post-stroke Turkish population demonstrates remarkably good accuracy and very good Area Under Curve (AUC) values.Öğe Translation and validation of the TOR-BSST Into Turkish for stroke patients(John wiley and sons inc, 2025) Bengisu, Serkan; Öge-Daşdöğen, Özlem; Martino, RosemaryPurposeThe most common cause of death in Turkey is attributed to vascular diseases, including stroke. Dysphagia stands out as one of the prevalent and life-threatening complications that often follow a stroke. Within the Turkish context, the availability of validated bedside screening tests for assessing dysphagia remains limited. The primary objective of this study was to undertake the translation of the TOR-BSST into Turkish and subsequently validate this newly translated Turkish version.MethodOnce the translation of the TOR-BSST into Turkish was accomplished, 60 stroke patients were consecutively enroled in the validation process. The enroled patients were evaluated using the TOR-BSST-TR, administered by a speech and language pathologist (SLP) trained in TOR-BSST screener training. On the screening day, each patient underwent a videofluoroscopic swallowing study (VFSS), administered by another SLP blinded to the patient's medical information and TOR-BSST-TR results. The VFSS images were recorded for independent analysis by the second SLP who conducted the VFSS, and a third SLP, also blinded to the TOR-BSST-TR findings, using the Penetration Aspiration Scale (PAS) to measure airway invasion severity, and Dysphagia Severity Rating Scale (DSRS) to measure overall dysphagia severity. The reliability of the gold standard VFSS ratings was assessed using the intra-class correlation coefficient (ICC). The accuracy of the new TOR-BSST-TR was assessed using sensitivity, specificity, predictive values and likelihood ratios.ResultsOf all the 60 patients, 35 (58.3%) failed the TOR-BSST-TR, and 33 (55%) were identified with some degree of dysphagia from VFSS imaging scores. The overall inter-rater reliability (in ICC, 95% CI) for the gold standard ratings were as follows: PAS semi-solids (0.98, 0.95-0.99), PAS liquids (0.75, 0.58-0.85) and overall DSRS (0.70, 0.32-0.85). Based on the total screening score of the TOR-BSST-TR, the sensitivity, specificity, positive and negative predictive values along with positive likelihood ratio were as follows: 93.9%, 85.2%, 90.5%, 90.4% and 6.34, respectively.ConclusionThe TOR-BSST was successfully translated into Turkish, and the resulting TOR-BSST-TR demonstrated high accuracy in the acute stroke phase using videofluoroscopy as the gold standard. Specifically, the new TOR-BSST-TR screening tool yielded excellent sensitivity, specificity and predictive values in this patient population. The clinical implementation of this validated screening tool has the potential to enhance early detection of dysphagia, thereby triggering early management and ultimately improving patient outcomes and reducing the burden of complications from vascular diseases, such as stroke. Further research and widespread adoption of the TOR-BSST-TR could contribute to more standardized and effective dysphagia assessment protocols in clinical practice.WHAT THIS PAPER ADDSWhat is already known on the subject Dysphagia, prevalent in over half of stroke survivors, poses severe complications, including aspiration pneumonia. While Turkey faces high stroke mortality, limited validated dysphagia screening tools exist. Recent cultural adaptation studies focus on tools like The Barnes-Jewish Hospital Stroke Dysphagia Screen, The Gugging Swallowing Screen Test and The Mann Assessment of Swallowing Ability. The Toronto Bedside Swallow Screening Test (TOR-BSST), a water-swallowing test for stroke patients, demonstrates accuracy. Adapting it to Turkish is crucial for effective bedside screening and managing dysphagia, offering significant benefits. This study translated TOR-BSST into Turkish, aiming to evaluate its validity and reliability in acute stroke patients, addressing a critical need in the Turkish stroke population. What this paper adds to the existing knowledge This study addresses the pressing issue of dysphagia, a life-threatening complication following strokes in Turkey, where validated bedside screening tests are limited. The research translates and validates the TOR-BSST into Turkish, involving 60 stroke patients. The TOR-BSST-TR form, administered by trained speech-language pathologists, demonstrated high sensitivity (93.9%) and good specificity (85.2%) in comparison to videofluoroscopy, the gold standard. Inter-rater reliability was satisfactory, showcasing the tool's effectiveness in identifying dysphagia. The study contributes valuable insights into dysphagia assessment, offering a reliable and culturally adapted screening tool for stroke patients in Turkey. What are the potential or actual clinical implications of this work? The clinical implications of this study are significant for stroke patients in Turkey facing dysphagia. The successful translation and validation of the TOR-BSST into Turkish offer healthcare professionals a culturally adapted and reliable bedside screening tool. This tool demonstrates high sensitivity and good specificity in identifying dysphagia, providing a valuable resource for early detection and effective management. The study's findings imply that the TOR-BSST-TR can be a practical and accurate instrument for clinicians, aiding in timely intervention, reducing complications and improving patient outcomes. Incorporating this tool into routine clinical practice may enhance dysphagia screening, leading to better patient care and quality of life.WHAT THIS PAPER ADDSWhat is already known on the subject Dysphagia, prevalent in over half of stroke survivors, poses severe complications, including aspiration pneumonia. While Turkey faces high stroke mortality, limited validated dysphagia screening tools exist. Recent cultural adaptation studies focus on tools like The Barnes-Jewish Hospital Stroke Dysphagia Screen, The Gugging Swallowing Screen Test and The Mann Assessment of Swallowing Ability. The Toronto Bedside Swallow Screening Test (TOR-BSST), a water-swallowing test for stroke patients, demonstrates accuracy. Adapting it to Turkish is crucial for effective bedside screening and managing dysphagia, offering significant benefits. This study translated TOR-BSST into Turkish, aiming to evaluate its validity and reliability in acute stroke patients, addressing a critical need in the Turkish stroke population. What this paper adds to the existing knowledge This study addresses the pressing issue of dysphagia, a life-threatening complication following strokes in Turkey, where validated bedside screening tests are limited. The research translates and validates the TOR-BSST into Turkish, involving 60 stroke patients. The TOR-BSST-TR form, administered by trained speech-language pathologists, demonstrated high sensitivity (93.9%) and good specificity (85.2%) in comparison to videofluoroscopy, the gold standard. Inter-rater reliability was satisfactory, showcasing the tool's effectiveness in identifying dysphagia. The study contributes valuable insights into dysphagia assessment, offering a reliable and culturally adapted screening tool for stroke patients in Turkey. What are the potential or actual clinical implications of this work? The clinical implications of this study are significant for stroke patients in Turkey facing dysphagia. The successful translation and validation of the TOR-BSST into Turkish offer healthcare professionals a culturally adapted and reliable bedside screening tool. This tool demonstrates high sensitivity and good specificity in identifying dysphagia, providing a valuable resource for early detection and effective management. The study's findings imply that the TOR-BSST-TR can be a practical and accurate instrument for clinicians, aiding in timely intervention, reducing complications and improving patient outcomes. Incorporating this tool into routine clinical practice may enhance dysphagia screening, leading to better patient care and quality of life.WHAT THIS PAPER ADDSWhat is already known on the subject Dysphagia, prevalent in over half of stroke survivors, poses severe complications, including aspiration pneumonia. While Turkey faces high stroke mortality, limited validated dysphagia screening tools exist. Recent cultural adaptation studies focus on tools like The Barnes-Jewish Hospital Stroke Dysphagia Screen, The Gugging Swallowing Screen Test and The Mann Assessment of Swallowing Ability. The Toronto Bedside Swallow Screening Test (TOR-BSST), a water-swallowing test for stroke patients, demonstrates accuracy. Adapting it to Turkish is crucial for effective bedside screening and managing dysphagia, offering significant benefits. This study translated TOR-BSST into Turkish, aiming to evaluate its validity and reliability in acute stroke patients, addressing a critical need in the Turkish stroke population. What this paper adds to the existing knowledge This study addresses the pressing issue of dysphagia, a life-threatening complication following strokes in Turkey, where validated bedside screening tests are limited. The research translates and validates the TOR-BSST into Turkish, involving 60 stroke patients. The TOR-BSST-TR form, administered by trained speech-language pathologists, demonstrated high sensitivity (93.9%) and good specificity (85.2%) in comparison to videofluoroscopy, the gold standard. Inter-rater reliability was satisfactory, showcasing the tool's effectiveness in identifying dysphagia. The study contributes valuable insights into dysphagia assessment, offering a reliable and culturally adapted screening tool for stroke patients in Turkey. What are the potential or actual clinical implications of this work? The clinical implications of this study are significant for stroke patients in Turkey facing dysphagia. The successful translation and validation of the TOR-BSST into Turkish offer healthcare professionals a culturally adapted and reliable bedside screening tool. This tool demonstrates high sensitivity and good specificity in identifying dysphagia, providing a valuable resource for early detection and effective management. The study's findings imply that the TOR-BSST-TR can be a practical and accurate instrument for clinicians, aiding in timely intervention, reducing complications and improving patient outcomes. Incorporating this tool into routine clinical practice may enhance dysphagia screening, leading to better patient care and quality of life.
