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.