Swallowing Safety and Efficiency Impairment Profiles in Individuals with Amyotrophic Lateral Sclerosis.
Raele Robison, Lauren DiBiase, Amy Ashley and 4 others
PMID 34037850WHAT IT FOUND
Swallowing inefficiency is far more common than safety issues in ALS, affecting 73% of patients versus 48% for safety.
Inefficiency often appears first. Clinicians should target residue management early in the disease course rather than waiting for aspiration signs.
Key findings
01Inefficient swallowing was significantly more prevalent than unsafe swallowing, affecting 73% of the cohort compared to 48%.
02Among patients with only one type of impairment, inefficient swallowing with preserved safety was four times more common than unsafe swallowing with preserved efficiency.
03Bulbar disease severity was significantly lower in unsafe swallowers, but global disease severity and duration did not differ between safe and unsafe groups.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was cross-sectional, using only baseline data from a longitudinal cohort, so it cannot definitively prove the temporal order of impairment onset, only infer it from profiles. Participants were recruited from a single academic center, which may limit generalizability. The cohort had moderate disease severity (mean ALSFRS-R of 35), so results may not apply to very early or very late-stage patients. Residue was only measured on three specific bolus trials, not all administered consistencies.
Declared interests
The authors declare they have no conflict of interest. The study was supported by the N.I.H. (Extramural).
The easy way to misread this
Do not assume that a patient with a safe airway (no aspiration) has normal swallowing function. Inefficiency (residue) is more common and often appears first, so a 'safe' PAS score does not rule out significant swallowing pathology that requires management.