Evaluation of Swallowing in Poststroke Individuals Using the Swallowing Proficiency for Eating and Drinking (SPEAD)...

Poststroke dysphagia affects 37-78% of stroke survivors, leading to complications such as malnutrition, dehydration, and psychological distress. Current tools for assessing swallowing, such as the Timed Water Swallow Test and Test of Mastication and Swallowing Solids, do not evaluate intermediate consistencies. The Swallowing Proficiency for Eating and Drinking (SPEAD) protocol incorporates thin liquids, solids, and moderately thick liquids, providing a comprehensive evaluation of swallowing function. This study assessed SPEAD's utility in a stroke population and its relationship with stroke severity.

A cross-sectional study recruited 77 poststroke participants (aged ≥18 years). Swallowing was evaluated using SPEAD for thin liquids, moderately thick liquids, and solids, following International Dysphagia Diet Standardization Initiative guidelines. Parameters recorded included number of swallows, chews, grams consumed, and duration (in seconds), with derived measures such as ingestion speed and SPEAD rate. Stroke severity was assessed using the NIH Stroke Scale, and self-reported swallowing difficulties were screened with Eating assessment Tool (EAT-10). Data were analyzed using analysis of variance (ANOVA), multivariate analysis of variance, and Pearson correlation.

Participants with moderately severe strokes demonstrated slower ingestion speeds and increased effort across all consistencies. Significant differences were observed in SPEAD parameters between consistencies, with solids requiring higher ingestion times and effort. Stroke severity correlated moderately with SPEAD measures (r = -0.45 to -0.62, p < 0.05). A significant correlation was observed between SPEAD and EAT-10 scores, indicating that participants with higher dysphagia burden as perceived through SPEAD also reported greater perceived difficulty with swallowing on EAT-10.

The SPEAD protocol effectively identifies swallowing impairments in stroke patients, particularly for intermediate consistencies. Its comprehensive approach provides valuable insights for dysphagia management, emphasizing the need for further validation in diverse populations. The study also highlights the value of objective bedside assessments such as SPEAD in conjunction with patient reported outcomes such as EAT-10. Together, they offer a comprehensive understanding of swallowing function poststroke and can guide early intervention strategies.