Translation and Validation of a Swallowing Assessment Scale for Neurogenic Dysphagia

Neurogenic dysphagia is a swallowing disorder resulting from neurological diseases, primarily characterized by alterations in the oral and pharyngeal phases. Neurogenic dysphagia is a very common disorder, affecting 40-70% of individuals who have had a stroke and 60-80% of those with neurodegenerative diseases in Physical Medicine and Rehabilitation and Neurorehabilitation settings. The main complications of dysphagia are aspiration pneumonia, malnutrition, and dehydration, which can worsen the clinical picture and compromise the patient's quality of life. To identify swallowing disorders early and prevent complications, it is recommended to use standardized screening protocols and clinical evaluation by a speech therapist. If clinical questions remain, further investigation with instrumental exams such as videofluoroscopy (VFS) and/or fibroscopy is indicated. Within clinical evaluation, it is advisable to use outcome scales to objectively determine the severity of the disorder, describe the functional level of swallowing abilities, and monitor the evolution of the function over time.

The Munich Swallowing Score (MUCSS) [Bartolome G, 2021] is a clinical tool used to assess the functional level of saliva/secretions, liquids, and food swallowing. It consists of two scales, each with eight levels: the Munich Swallowing Score-Saliva (MUCSS-S), which evaluates the management of saliva/secretions, and the Munich Swallowing Score-Nutrition (MUCSS-N), which focuses on nutrition.

In the literature, the assessment of saliva/secretions management is still insufficiently explored. Difficulties in swallowing and managing saliva/secretions significantly affect the clinical progress of the patient and their quality of life. In this sense, a scale that considers both saliva/secretions swallowing and the presence of a cannula, in addition to liquid/food swallowing, represents an innovative and useful tool in clinical practice.

The MUCSS is a scale sensitive to the evolution of swallowing abilities, allowing an objective and repeatable evaluation of the management of secretions as well. The translation into Italian and validation of the MUCSS scale would provide an important contribution to the assessment and, consequently, the management of patients with neurogenic dysphagia.

Inclusion criteria

Neurological etiology including stroke, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, cerebrovascular infection, spinocerebellar ataxia, myasthenia gravis, anoxia, brain tumor, or traumatic brain injury Diagnosed oropharyngeal dysphagia (OD) confirmed by a neurologist Age ≥ 18 years

Exclusion criteria

Inability to maintain a stable sitting position during endoscopy Contraindications to Fiberoptic Endoscopic Evaluation of Swallowing (FEES), including fever or agitation that compromises participation