Speech-Language Pathologists’ Estimates of Bolus Sizes Used During Dysphagia Evaluations

Dysphagia evaluations play an important role in the assessment and treatment of people with swallowing problems. Protocols and methods for assessment vary greatly among clinicians, however, all assessments involve trials of food and liquid boluses given across different consistencies and in varying amounts. Thin and thick liquids, thin puree, thick puree or pudding, and solid consistencies are widely utilized for dysphagia evaluations. The amounts of food and liquids that are given drive therapeutic recommendations for bite and sip sizes. It is unknown if the bite and sip sizes used during dysphagia assessments also vary among SLPs and/or if these amounts accurately measure the intended volume. The purpose of the study was two-fold: 1) to determine what amounts/consistencies SLPs use in dysphagia evaluations; and 2) are SLPs accurate in estimating food/liquids amounts. Fourteen certified, licensed, and experienced SLPs who routinely perform dysphagia evaluations were included in this study. Actual weight in grams was calculated for exact volumes of thin and thick liquids, thinned puree (applesauce), and thick puree (pudding) in 5 milliliters, 10 milliliters, and 15 milliliter amounts. These were compared to the observed amounts of these volumes that were estimated by the participants. The results suggest that the average estimation of each amount made by the SLPs was significantly different from the actual amount. Participants who used measuring spoons weekly were more accurate estimators than those with less experience. Finally, a comparison of the reported protocols showed the most variability for the non-instrumental assessment, the clinical swallowing examination