Identifying Patterns of FEES-Derived Swallowing Trajectories Using Group-Based Trajectory Model

Area of Science:

• Otorhinolaryngology
• Neurology
• Speech-Language Pathology

Background:

• Dysphagia, or difficulty swallowing, affects a significant patient population, necessitating accurate functional assessment.
• Understanding swallowing dynamics and identifying distinct patient subgroups is crucial for targeted interventions.
• Fiberoptic Endoscopic Evaluation of Swallowing (FEES) provides valuable insights into the physiological aspects of swallowing.

Purpose of the Study:

• To delineate and visualize swallowing trajectories in dysphagic patients over seven swallow trials.
• To identify and characterize distinct functional swallowing categories using group-based trajectory modeling (GBTM).
• To enhance the understanding of swallowing dynamics and their variability in oropharyngeal dysphagia.

Main Methods:

• Two hundred and five dysphagic patients participated in a standardized Fiberoptic Endoscopic Evaluation of Swallowing (FEES) protocol.
• Five ordinal FEES outcome variables were independently assessed by two blinded observers for each swallow.
• Group-based trajectory modeling (GBTM) was employed to analyze and categorize swallowing response trajectories.

Main Results:

• GBTM identified qualitatively distinct swallowing trajectories, varying in degree and type of impairment over trials.
• Delayed pharyngeal reflex initiation and postswallow pyriform sinus pooling were the most prevalent severe impairments.
• Severely impaired trajectories demonstrated stability across swallows, whereas intermediate trajectories were sensitive to bolus consistency changes.

Conclusions:

• GBTM effectively identifies distinct developmental trajectories of FEES variables in patients with oropharyngeal dysphagia.
• The identified trajectories provide a framework for classifying dysphagic patients based on their swallowing patterns.
• This classification can aid clinicians in identifying specific patient subgroups requiring tailored medical attention and management.