VFSS Analysis Tools

What does it tell us? How is it implemented? What else should I know? More resources

ASPEKT-C: Pharyngeal physiology, Standardization: Check out this Used with IDDSI Levels 0 through 4. Scoring form,
Analysis of including ROM and step-by-step manual, which includes a treatment planning
timing measures protocol for bolus presentations and The ASPEKT-C has been studied with flow sheet, VFSS best
Swallowing
scoring how-to. several populations and has healthy practice reference
Physiology: Pathophysiology or reference values. sheet, and manual: All
Events, treatment targets? Yes, Ease of use: The ASPEKT-C is a bit located here
Kinematics for pharyngeal deficits, more time-consuming than others, This version was developed specifically for
and Timing but not oral deficits. but is well worth it! You’ll need practicing clinicians with time constraints. Research and reference
(Clinical) software like Image J (which is free) to The FULL ASPEKT Method is available for values: Archived on the
Severity or normality? analyze studies. more comprehensive analysis to assess lab website here
Performance on each many more physiologic components and
component for each Training: The author’s lab website has might be useful if your team is hoping to
Requires
bolus is categorized as a lot of info, including this YouTube publish research with VFSS data.
frame-by-frame
WNL or impaired. tutorial from Dr. Catriona Steele.
analysis

DIGEST: Swallowing efficiency Standardization:The authors suggest It’s validated for IDDSI Levels 0, 4, and 7, Scoring form: here. In
Dynamic (pharyngeal residue) using a standard protocol like the one but many clinicians report use with all IDDSI 2022 the authors made
Imaging Grade and safety (degree of from MBSImP. textures. some changes to the
airway invasion) scoring (but not a new
of Swallowing Ease of use: Easy to learn and score. The DIGEST provides a safety score, an form), which we explain
Toxicity Pathophysiology or Uses the PAS, which many SLPs are efficiency score, and a total score based on in detail here
treatment targets? No. familiar with. You just need buy-in the entire VFSS.
from your team to standardize your More info: here and
Severity or normality? bolus presentations. DIGEST isn’t intended to measure the here
Yes. The total score “biomechanical, kinematic, physiologic, and
ranges from 0 (normal) Training: The DIGEST should be easy temporal parameters of the swallow.” FEES Adaptation: here
to 4 (life-threatening) to score and use with any protocol, Instead, it’s meant to quickly grade
but you can still find courses like this pharyngeal swallow function, useful in
one. making broader treatment decisions with
patients with head/neck cancer, etc.

This download accompanies The Informed SLP’s research review “Tools of the trade: VFSS edition”.
This document and the accompanying review are free to read and share. 1/4
VFSS Analysis Tools
What does it tell us? How is it implemented? What else should I know? More resources

DOSS: Functional status, oral Standardization: You’ll need to define This won’t be the tool you reach for to DOSS ratings (Table 1)
Dysphagia skills, pharyngeal terms like mild, moderate, and severe select treatment targets, but since it and a report format
retention, and airway for you and your coworkers, but describes functional status, the DOSS helps (Table 3): both here
Outcome
protection. otherwise, this tool is straightforward. caregivers and other staff understand the
and Severity functional impact of the patient’s Research: here and
Scale Pathophysiology or Ease of use: This should be quick to dysphagia. here
treatment targets? No use and easy for other disciplines and
caregivers to understand, as long as Some studies have found concerns with
Severity or normality? you’ve standardized terminology with reliability, making standardization between
Yes. 7 levels ranging your team. you and your fellow SLPs essential.
from “Normal Swallow”
to “Severe Dysphagia” Training: None that we could find. For use with all IDDSI levels.

MBSImP: Oral, pharyngeal and Standardization: Training, study Many institutions are using the 17 Research: here, here,
Modified proximal esophageal protocol, interpretation, and report physiologic components as a general and here
swallowing physiology. format are all standardized. outline of what we should comment on in
Barium
reports, but skipping the scoring part. So How to use the results
Swallow Pathophysiology or Ease of use: It can be a bit analysis isn’t standardized, but the reports in treatment: here
Impairment treatment targets? Yes. time-consuming, but most SLPs are are still comprehensive in their
Assesses 17 physiologic familiar with it, which helps with
Profile observations. We’ve all gotta start Certification course:
components in detail. implementation and comparison somewhere, right? here
between studies. You just need admin
Severity or normality? support for the time to interpret and The protocol uses thin, nectar, honey,
Sort of. Higher write it up. pudding, and “solid.” (Specifically, a Lorna
Ability to replay impairment scores
Doone shortbread cookie. Yum.)
and slow down mean greater Training: You must complete (and
studies is impairment, so you can renew!) their course, which is also full
needed infer a level of severity. of info about normal and impaired
swallow function.

This download accompanies The Informed SLP’s research review “Tools of the trade: VFSS edition”.
This document and the accompanying review are free to read and share. 2/4
VFSS Analysis Tools
What does it tell us? How is it implemented? What else should I know? More resources

mVDS: Subjective assessment Standardization: The authors of this This is a re-design of the VDS Research: here and
Modified of oral & pharyngeal tool don’t tell us if it should be scored (Videofluoroscopic Dysphagia Scale) which here
swallowing parameters. based on the entire study, each IDDSI was too ambiguous, so it is a step in the
Video-
level, or each bolus. There’s also no right direction. It’s just not the easiest to Tool: in Table 1 here
fluoroscopic Pathophysiology or operational definition of the implement or most information-rich tool on
Dysphagia treatment targets? Not swallowing events you’re measuring, this list.
Scale really. For example, the so you’d need to explicitly define
tool assesses epiglottic these things with your coworkers for You can use the mVDS with any IDDSI level;
inversion, but not why it this tool to be useful. authors even used it with mixed
might be impaired. consistencies.
Ease of use: The 0-100 score could
Severity or normality? be intuitive for clinicians and families,
A higher score indicates but you’ll need to do the work to
greater diet limitation & choose your own protocol and
more severe dysphagia, definitions for this to be useful.
but there’s no further
Training: None that we could find.
interpretation guidance.

Swallowtail Fully computerized Standardization: There is a Swallowtail’s standard procedure includes Research: here, here,
measurements of standardized procedure (which is thin, nectar, and a Lorna Doone cookie. and here. The
swallow physiology and important since it’s compared to Swallowtail has been
bolus movement. normative data), but there’s also a There are specific software versions for used to obtain VFSS
portion in which the SLP can trial their professors and researchers as well. ratings in dozens of
Pathophysiology or own textures, maneuvers, etc. studies.
treatment targets? Yes!
Fully automated! Ease of use: Once you’ve purchased Purchasing info: here
the software and been trained,
Severity or normality?
analysis is reportedly a breeze.
Includes normative data
for comparisons
Training: Included with the software.

This download accompanies The Informed SLP’s research review “Tools of the trade: VFSS edition”.
This document and the accompanying review are free to read and share. 3/4
VFSS Analysis Tools
What does it tell us? How is it implemented? What else should I know? More resources

VIP: Functionality & swallow Standardization: The reporting form Unlike the other tools here, VIP is not Trainings and the tool:
Video- physiology, with an is standardized and you can create published in a peer-reviewed journal. All found here
emphasis on timing of operational definitions of each However, the tool itself is based on
fluroscopic
LVC and UES opening. physiologic event based on the well-researched principles of swallowing
Interpretation
required trainings, but bolus physiology and the training is comparable
of Physiology Pathophysiology or presentations are not standardized. to some of the others listed here.
treatment targets?
Definitely. The rating Ease of use: The VIP is a The downside is that we don’t have
form requires clinicians spreadsheet-based tool that you can VIP-specific information about reliability (do
to determine why download. You will need the time to you make the same assessment each time or
airway invasion or complete the required trainings and the same assessment as your coworkers did
residue occurred. time to complete frame-by-frame using the tool?) or validity (how accurately
analysis to rate each bolus. does it describe your patient’s dysphagia or
Severity or normality?
predict dysphagia-related outcomes). You’ll
Each swallow is rated as Training: To access VIP, you have to particularly want to keep the reliability in
normal, functional, or purchase Tiers 1 & 2 of this training. mind if you’re implementing the VIP across
disordered, & The required trainings have helpful your SLP team.
supported with information on both normal and
rationale. There are abnormal swallowing, plus how to
normal values for the calculate the timing measures.
Requires timing measures, based However, you are prompted to
frame-by-frame on this study, but the register for related coursework to
analysis bolus type and how to fully understand the physiological
use them is unclear. components measured.

This download accompanies The Informed SLP’s research review “Tools of the trade: VFSS edition”.
This document and the accompanying review are free to read and share. 4/4