# Development and Pilot Test of a Clinical Swallowing Examination (CSE) Protocol for Telerehabilitaion Delivery of SLP Services

> **NIH VA I21** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2020 · —

## Abstract

Purpose: The overarching goal of this study is to improve access to timely clinical swallowing
examination (CSE) and dysphagia treatment in veterans with stroke. The purpose of this study
is to establish a CSE protocol (CSEP) that can be used for speech-language pathology (SLP)
telerehabilitation services, Significance: A timely CSE is critical to prevent dysphagia related
mortality, morbidity, prolonged length of hospitalization, and increased healthcare costs. Delays
in SLP services will occur when stroke patients present after business hours, on weekends or
during holidays. Telerehabilitation for SLP services has great potential to eliminate all access
barriers in dysphagia assessment and management for stroke survivors. Specific Aims: The
study will address 3 specific aims: 1) Develop/refine a CSEP for tele-SLP practice using the
Mann Assessment of Swallowing Ability (MASA) with input from a multidisciplinary team of
SLPs, stroke ward nurses, and telestroke consultants; 2) Establish preliminary inter-rater
reliability between a tele-SLP administering and scoring the MASA via mHealth technology with
bedside nurse facilitation, versus an on-site SLP simultaneously and independently scoring the
MASA; and 3) Pilot the tele-SLP CSEP within a VA NTSP facility to refine mHealth delivery
processes and to establish feasibility, acceptability, recruitment strategies and outcome
measurements for ‘timely CSE services. Methods: This is an exploratory study using both
qualitative and quantitative methods. The study will be conducted at the Michael E. DeBakey VA
Medical Center, with virtual partners at the VA National TeleStroke Program facility in
Murfreesboro, Tennessee. Participant will include SLPs (N=3), registered nurses (N=20) and
veterans (N=55) admitted with stroke. Data Collection/Analysis Procedures: The CSEP for tele-
SLP practice will be developed using the MASA, the only validated, standardized CSE for stroke
patients. Iterative simulation and debrief methods will be applied to establish and document
optimal techniques for mHealth delivery of each MASA item. Basic content analysis will be
applied to code debrief session notes and observations. Once a CSEP for tele-SLP practice is
established, a tele-SLP and a nurse facilitator, at the patient’s bedside, will complete the CSEP
on veterans admitted with stroke (N=50). An on-site SLP will also be at the bedside and will
make simultaneous but independent clinical judgements concerning patient responses to all
MASA questions/tasks using the operational definitions provided by the MASA. Preliminary
inter-rater reliability will be established between a tele-SLP administering and scoring the MASA
via mHealth technology with bedside nurse facilitation and an on-site SLP simultaneously and
independently scoring the MASA. Cohen’s weighted kappa will be calculated for each MASA
item including dysphagia risk, aspiration risk, as well as recommendations for diet and
instrumental assessment. Iterative refine...

## Key facts

- **NIH application ID:** 9891292
- **Project number:** 1I21RX003329-01
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** Jane Ann Anderson
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2019-11-01 → 2021-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9891292

## Citation

> US National Institutes of Health, RePORTER application 9891292, Development and Pilot Test of a Clinical Swallowing Examination (CSE) Protocol for Telerehabilitaion Delivery of SLP Services (1I21RX003329-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9891292. Licensed CC0.

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