Noninvasive detection of thin-liquid aspiration using dual-axis swallowing accelerometry

Aspiration (the entry of foreign contents into the upper airway) is a serious concern for individuals with dysphagia and can lead to pneumonia. However, overt signs of aspiration, such as cough, are not always present, making noninstrumental diagnosis challenging. Valid, reliable tools for detecting aspiration during clinical screening and assessment are needed. In this study we investigated the validity of a noninvasive accelerometry signal-processing classifier for detecting aspiration. Dual-axis cervical accelerometry signals were collected from 40 adults on thin-liquid swallowing tasks during videofluoroscopic swallowing examinations. Signal-processing algorithms were used to remove known sources of artifact and a classifier was trained to identify signals associated with penetration-aspiration. Validity was measured in comparison to blinded ratings of penetration-aspiration from the concurrently recorded videofluoroscopies. On a bolus-by-bolus basis, the accelerometry classifier had a 10 % false-negative rate (90 % sensitivity) and a 23 % false-positive rate (77 % specificity) for detecting penetration-aspiration. We conclude that accelerometry can be used to support valid, reliable, and efficient detection of aspiration risk in patients with suspected dysphagia.