# Identifying Patterns of FEES-Derived Swallowing Trajectories Using Group-Based Trajectory Model

## TL;DR

This study uses a statistical model to identify distinct swallowing patterns in patients with swallowing difficulties, helping to classify those who need specific medical attention.

## Contribution

The study introduces the use of group-based trajectory modeling to classify swallowing patterns in dysphagic patients.

## Key findings

- GBTM identified distinct swallowing trajectories with varying levels of impairment across seven trials.
- Severe impairment was most common in delayed pharyngeal reflex and postswallow pooling.
- Highly impaired swallowing patterns were stable, while intermediate patterns were more variable.

## Abstract

The present study delineates and visualizes swallowing trajectories along seven swallow trials in dysphagic patients using group-based trajectory modeling (GBTM). This model facilitates the recognition of swallowing functional categories, estimates their frequency of occurrence, and enhances the understanding of swallowing dynamics. Two hundred and five dysphagic patients underwent a standardized FEES examination protocol. Five ordinal variables were blindly assessed for each swallow by two observers independently. GBTM analysis was conducted to find and characterize trajectories of FEES responses. For most FEES outcome variables, trajectories were qualitatively distinct in degree and kind (level of impairment and how this changed over the seven swallow trials). Two FEES outcome variables—delayed initiation of the pharyngeal reflex and postswallow pyriform sinus pooling—showed the highest prevalence of severe swallowing impairment. Highly impaired categories were more stable throughout the different swallow trials. Intermediate trajectories, by contrast, were erratic, responding more sensitively to shifts in bolus consistency. GBTM can identify distinct developmental trajectories of measured FEES variables in patients with oropharyngeal dysphagia. In clinical practice, classification into distinct groups would help to identify the subgroup of dysphagic patients who may need specific medical attention.