A Cross-Sectional, Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Amyotrophic Lateral Sclerosis.
Ashley A Waito, Emily K Plowman, Carly E A Barbon and 5 others
PMID 32310713WHAT IT FOUND
Thickened liquids reduced unsafe swallows compared to thin liquids without increasing residue.
ALS patients showed delayed airway closure and reduced pharyngeal constriction, even when they reported no swallowing symptoms. This supports instrumental assessment over symptom reporting for early detection.
Key findings
01Individuals with ALS had significantly longer time-to-laryngeal vestibule closure and a higher proportion of partial or incomplete airway closure compared to healthy reference data.
02Thickened liquids (IDDSI Level 4) resulted in fewer unsafe swallows than thin liquids, with no significant increase in pharyngeal residue or number of swallows per bolus.
03Objective physiological measures of swallowing fell outside healthy reference ranges for some participants who denied experiencing any bulbar or swallowing symptoms.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample was small (n=19) and heterogeneous, with a higher proportion of bulbar-onset cases than expected in the general ALS population due to recruitment strategy. Reference data were from healthy adults younger than the ALS cohort (mean age 34 vs 62), which may confound comparisons of swallowing kinematics that naturally change with age. Findings are cross-sectional and limited to the first swallow per bolus, so they do not generalize to clearing swallows or long-term disease progression. The study observed acute swallowing safety during the exam and cannot predict long-term outcomes like aspiration pneumonia.
Declared interests
Funding was provided by the National Institute on Deafness and Other Communication Disorders. No conflicts of interest were declared.
The easy way to misread this
Do not assume thickened liquids are universally safe or effective for all ALS patients. This study showed reduced aspiration risk with thick liquids in this specific sample, but other research has found increased residue with thickened textures. Individual instrumental assessment is required before prescribing thickening.