Evaluation of effortful swallow in patients with post stroke dysphagia using visual analysis of swallowing efficiency and safety (VASES) protocol

The effortful swallow (ES) maneuver is widely used in clinical practice, designed to enhance the safety and efficiency of swallowing. Despite its common use in clinical practice, there have been relatively few research studies exploring the impact of effortful swallowing in clinical populations with dysphagia. To evaluate the application of the ES maneuver in post-stroke patients with dysphagia through a structured, protocol-based approach utilizing the Visual Analysis of Swallowing Efficiency and Safety tool (VASES). This cross-sectional study involved 34 adults with poststroke dysphagia. Each patient underwent a flexible endoscopic evaluation of swallowing (FEES) in the dysphagia clinic of a tertiary care hospital’s phoniatrics unit. An ES maneuver was incorporated into the FEES procedure. The VASES protocol was employed to systematically assess the FEES results. The effect of the ES maneuver was quantified by calculating Cohen’s d for pre- and post-maneuver measurements from the VASE protocol. Largest residue reductions were found in 10 cc of thin fluids (oropharyngeal: pre-ES d = 1.32, post-ES effect size d = 1.57; hypopharyngeal: pre-ES d = 1.39, and post-ES effect size d = 1.93). The application of an ES maneuver significantly improves pharyngeal clearance and airway protection for larger and more complex bolus volumes.