2. Study methods
Nasal feeding and tracheotomy status were lasting after the surgery.
During the period, no swallowing rehabilitations were introduced to the
patients. On the day before oral feeding, modified GUSS and VFSS were
carried out to evaluate the swallowing function respectively. In
addition, the performers of examinations were all different, and did not
know the scores of other examinations.
2.1 Modified GUSS 6
GUSS is divided into the indirect swallowing test and direct swallowing
test that consists of semisolid、liquid and solid swallowing trials in
sequence. These 4 subtests must be performed sequentially. Higher scores
mean better performance, and the full score of each subtest is 5 points.
Each subtest has several repetitions that must be completed
successfully, and then the patient could reach the full score that must
be attained to continue to the next subtest. Once the result of a
subtest is less than 5 points, the examination must be stopped, and VFSS
or FEES is recommended.
The sequence of the direct swallowing test was revised to
solid、semisolid and liquid swallowing trials, and other evaluation
measures remained invariant. The patient at beside swallowed solid food
(dry bread) about 1cm × 1cm × 0.5cm, semisolid food manufactured by
mixing water and Resource Espesante® (Nestle, Germany)
according to International Dysphagia Diet Standardisation Initiative
(IDDSI) level 4 (pureed/extremely thick),12 and liquid
food in sequence. During the examination, the possible compensatory
position of the patient’s body was selected in order to reduce the
aspiration, and the testing was stopped if there was a severe
aspiration. The procedures of all cases were executed and the data were
evaluated by two trained ENT nurses independently.