Retrospective Analysis of the Clinical Utility of a Protocol for Baseline Clinical Swallow Examination

Abstract

Objective: The Bilancio Logopedico Breve (BLB)-swallowing subtest is a non-validated baseline Italian protocol widely used for clinical swallow examination (CSE). The aim of the study was to critically analyze the clinical utility of the items of BLB based on 5-years clinical experience in an intensive rehabilitation facility. Methods: In this retrospective study, 407 patients with different diagnoses were included. Clinical data, BLB assessment at admittance and discharge, signs of dysphagia during fiberoptic endoscopic evaluation of swallowing (FEES) and diet recommendations were extracted. A univariate analysis was performed to investigate the items associated with the decision of nutrition method and diet type, the presence of penetration or aspiration on FEES, and an improvement in diet type during the hospital stay. Results: Oral motor skills, dentition, voluntary cough, gag reflex, swallow trigger and signs of aspiration with liquid and/ or puree consistencies items showed significant associations with the decision of oral nutrition and/or to the type of oral diet, and with an evolution in the diet type. Gag reflex, swallow trigger and signs of aspiration with liquid and/or puree consistencies were significantly associated with penetration or aspiration at FEES. Pathological reflexes, lip sealing during swallowing, laryngeal excursion and oral residue items displayed poor associations with the clinical outcomes considered. Conclusion: The present findings support the use of BLB in the clinical practice as a guideline for CSE despite its limitations. Results should guide the revision of the protocol, preliminary to an advisable validation process of the tool.