Among people who have suffered from a head injury, stroke or Parkinson's disease, 20 to 50 percent have a swallowing disorder.

Swallowing disorders are characterized by pain or a feeling of difficulty when attempting to pass food or drink from the mouth to the stomach. Individuals with a swallowing disorder may cough before or after swallowing, have trouble starting to swallow, experience a sensation of food sticking in the throat or feel as if they are choking while swallowing.

Common causes include gastroesophageal reflux disease, a digestive disorder that affects the muscle connecting the esophagus with the stomach; head or neck cancer; muscle weakness due to stroke, or other physiological problems in the muscles and tissues that aid in the swallowing process.

As patients with swallowing disorders attempt to avoid certain foods or modify their eating habits to compensate for pain or discomfort, they may suffer from dehydration, nutritional deficiencies, pneumonia or chest infections. Swallowing disorders can have psychological consequences as well.

Now, a University of Florida researcher has developed the first standardized test that determines the presence and severity of swallowing disorders and measures a patient's swallowing ability over time.

The Mann Assessment of Swallowing Ability (MASA), designed by Giselle Mann, Ph.D., a visiting assistant professor in the UF College of Health Professions' communicative disorders department and a core faculty member in UF's Florida Dysphagia Institute, provides a simple, noninvasive method for evaluating a patient's swallowing function.

The one-page MASA test instructs health-care professionals to rate patients' performance when completing a series of swallowing tasks. Once an overall score has been assigned to the patient's performance, it can be used to categorize them as having a mild, moderate or severe swallowing disorder, following the parameters defined by Mann.

The manual accompanying the MASA test also includes a user's guide on how to measure results in patients and use the instrument for outcomes data collection and monitoring patient status.

"The MASA score guides treatment decisions and allows health care practitioners to evaluate a patient's treatment progress over time as they are retested," Mann said. "Their MASA score can easily be transferred to other facilities if treatment is continued elsewhere."

"Swallowing difficulties have a negative societal impact," Mann said. "Patients may feel embarrassed to dine with family or friends if they know they may not be able to swallow their food."

In the past, methods of diagnosing and evaluating swallowing difficulties have varied among health-care institutions and health care providers. Mann developed MASA because she recognized the need for a standardized measurement procedure that could be used by health care practitioners who treat individuals with swallowing disorders, providing a common frame of reference when discussing a patient's swallowing ability. Along the way, she conducted research on hundreds of patients with swallowing disorders and assessed existing evaluation methods.

"Using talents derived from her unique background in statistical design research and rich clinical experience, Dr. Mann has provided us with a tool to assist us in the formation of a hypothesis regarding the nature of a patient's swallowing impairment and its level of severity," said Robert Miller, Ph.D., a clinical associate professor of rehabilitation medicine and otolaryngology/head and neck surgery, and a lecturer in speech and hearing services at the University of Washington.

"Dr. Mann gives us what we need -- an assessment tool that allows experienced clinicians to document and share credible data," he added.

Common treatments for swallowing disorders include exercises to increase swallowing muscle strength, changes in diet, medication, behavioral strategies and biofeedback.

MASA is being used with patients at the UF Speech and Hearing Center, and has been incorporated into UF clinical trials involving head and neck cancer patients and rehabilitation research being conducted with stroke patients.

MASA is available from Delmar Learning, a division of New York-based Thomson Learning Inc., an educational publishing company dedicated to lifelong learning products and services.

13-May-2002