Repetitive Saliva Swallowing Test: Norms, Clinical Relevance and the Impact of Saliva Secretion.
Emmelie Persson, Inger Wårdh, Per Östberg
PMID 30132122WHAT IT FOUND
Saliva-swallow counts varied by age and gender, not dry mouth or medicines.
In stroke patients, the test flagged 69% of SSA-S risk cases, so a normal score cannot rule out swallowing problems.
Key findings
01Among non-patients, mean RSST swallows were 7.90 in younger adults, 7.70 in middle-aged adults, and 6.45 in older adults.
02In stroke patients, mean RSST swallows were 1.23 for those with SSA-S risk, 3.67 for those without SSA-S risk, and 6.45 for older controls.
03RSST flagged 69% of patients with SSA-S dysphagia risk and 93% of patients without risk; overall it correctly predicted 85%.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Non-patients were recruited by convenience sampling from hospital staff and personal contacts, so norms may not represent all healthy adults. Only 13 of 40 stroke patients were at risk of dysphagia by SSA-S, so the estimate of how often RSST flags risk cases is based on a small number. Patients with severe aphasia affecting understanding, impaired cognition, or inability to consent were excluded, so the test may not apply to stroke patients who are at risk but cannot follow the verbal cue to swallow saliva. SSA-S was used as the reference test instead of instrumental assessment such as video-fluorography or FEES, and SSA-S itself has been validated only partly against clinical judgement. All testing after the pilot was performed by the first author, and no blinding is reported.
The easy way to misread this
Do not use RSST alone to clear stroke patients for oral intake. It flagged 69% of SSA-S risk cases, so a normal RSST score cannot rule out dysphagia risk.