Partnerships That Make a Difference

Eliminating Risks Associated with Swallowing Disorders

Rosemary Martino, Associate Chair, Associate Professor

With funding support from the Canadian Stroke Network (CSN), our research was the first to systematically develop and then validate a screening test to detect swallowing problems in patients who suffered a stroke. Our screening test is titled the Toronto Bedside Swallowing Screening Test (TOR-BSST©). As part of this research, we developed and standardized a 4-hour course to train any health care professional to be a competent screener for swallowing problems using the TOR-BSST©. In order to obtain the TOR-BSST© along with the 4-hour training course, speech-language pathologists attend a webinar course offered by my lab staff and me. The aim of this webinar course is to review the literature on swallowing problems and stroke, explain the research that developed the TOR-BSST©, and provide guidance on how to successfully implement the TOR-BSST© screening program in their hospital. To date, this tool has been distributed to approximately 210 speech-language pathologists in 11 countries across 4 continents. Approximately 6,000 screeners have been trained to administer the TOR-BSST© worldwide.

Following presentation of our research findings at the International Stroke Conference (Feb. 2007), we released the TOR-BSST© to speech-language pathologists for clinical use. Interest and inquiry from the clinical community is self-generated from our publications of this work and the talks we give, both nationally and internationally. We have established a link on our lab website to facilitate communication with the clinical community:

The presence of swallowing difficulty in patients with stroke is associated with aspiration pneumonia, malnutrition and even death. From research in our lab, we know that patients with swallowing problems are 3 times more likely to develop pneumonia than stroke patients without swallowing problems. Stroke guidelines inCanadaand beyond recommend a brief initial exam, such as the TOR-BSST©, to accurately detect patients with possible unsafe swallows so that they may be referred for earlier extensive testing by a speech-language pathologist and therefore reduce the likelihood of experiencing these unnecessary medical complications.

Internationally, there is a shortage of speech-language pathology swallowing experts so they cannot be available to conduct testing to all newly admitted stroke patients. Therefore, there is a practical and economic value of a screening test that rules out swallowing problems early and refers to speech-language pathology only those at high risk. The benefits will be realized in all countries but more so where healthcare resources are most limited.

Having established the TOR-BSST© to be a reliable and accurate screen for swallowing problems, we have worked with our international partners to translate the English form of the TOR-BSST© into French, Spanish, Italian, Chinese and German. We are currently working with new partners to finalize the Portuguese and Thai translations. Our next steps will be to validate the newly translated versions of the TOR-BSST© to ensure their reliability and validity. These findings will further expand implementation of TOR-BSST© to non-English speaking patients acrossCanada, theUSAand beyond, thereby serving to strengthen its already burgeoning worldwide up-take. Considering that the TOR-BSST© adheres to published provincial, national and international stroke guidelines, its availability in various languages will be the first to offer a reliable and valid standardized dysphagia screening program for the global stroke community.