{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T01:51:59Z","timestamp":1791424319407,"version":"4.3.3"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["K01HD111680"],"award-info":[{"award-number":["K01HD111680"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01CA271223"],"award-info":[{"award-number":["R01CA271223"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000055","name":"National Institute on Deafness and Other Communication Disorders","doi-asserted-by":"publisher","award":["K24DC012801"],"award-info":[{"award-number":["K24DC012801"]}],"id":[{"id":"10.13039\/100000055","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Dysphagia"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) rating method was developed in head and neck cancer populations to describe severity of aspiration and residue. The purpose of this study was to assess criterion validity of DIGEST in a post-stroke cohort. In this retrospective analysis, two raters (using version two criteria) performed DIGEST\n                    <jats:sub>V2<\/jats:sub>\n                    rating on recordings of modified barium swallow studies (MBSS) from 88 post-stroke patients that were extracted from a larger de-identified database. Modified Barium Swallow Study Impairment Profile (MBSImP) scores and Functional Oral Intake Scale (FOIS) scores were used to determine criterion validity. Inter-rater and intra-rater reliability for overall DIGEST\n                    <jats:sub>V2<\/jats:sub>\n                    grade were substantial (\u0199\u2009=\u20090.69 and 0.73, respectively), however inter-rater reliability for efficiency were only moderately reliable (\u0199\u2009=\u20090.52). Reliability for MBSImP scoring was excellent for Pharyngeal Total (PT) scores (ICC\u2009=\u20090.81\u20130.93). Overall DIGEST\n                    <jats:sub>V2<\/jats:sub>\n                    grades were significantly associated with PT scores in the expected direction (\u03c4\u2009=\u20090.51,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001), and there was no association between Oral Total (OT) and DIGEST grade (\u03c4\u2009=\u2009-0.01,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.889). Pairwise comparisons using PT scores indicated significant differentiation between DIGEST\n                    <jats:sub>V2<\/jats:sub>\n                    grades 0 from all other grades (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001), with overlap in intermediate grades (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.102\u20130.711). Functional Oral Intake Scale (FOIS) scores were significantly associated with DIGEST\n                    <jats:sub>V2<\/jats:sub>\n                    grade in the anticipated direction (\u03c4\u2009=\u2009-0.43,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001). Expected psychometrics and acceptable reliability for DIGEST\n                    <jats:sub>V2<\/jats:sub>\n                    grading were shown in this post-stroke cohort. A larger dataset would clarify mid-grade differentiation and potential influence of oral phase impairments in this sub-population.\n                  <\/jats:p>","DOI":"10.1007\/s00455-025-10857-9","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T07:34:12Z","timestamp":1755156852000},"page":"96-104","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Preliminary Validation of Dynamic Imaging Grade of Swallowing Toxicity (DIGESTV2) for Characterizing Swallow Safety and Efficiency in Post-Stroke Populations"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0469-9181","authenticated-orcid":false,"given":"Brittany N.","family":"Krekeler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Hopkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Vollman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Davidson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Broderick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mekibib","family":"Altaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Tabangin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie","family":"Martin-Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Hutcheson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"issue":"4","key":"10857_CR1","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1007\/s00455-008-9185-9","volume":"23","author":"B Martin-Harris","year":"2008","unstructured":"Martin-Harris B, et al. MBS measurement tool for swallow impairment\u2014MBSImp: Establishing a standard. Dysphagia. 2008;23(4):392\u2013405.","journal-title":"Dysphagia"},{"key":"10857_CR2","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1007\/s40141-013-0033-y","volume":"1","author":"R Martino","year":"2013","unstructured":"Martino R, et al. A systematic review of current clinical and instrumental swallowing assessment methods. Curr Phys Med Rehabilitation Rep. 2013;1:267\u201379.","journal-title":"Curr Phys Med Rehabilitation Rep"},{"issue":"2S","key":"10857_CR3","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1044\/2020_AJSLP-19-00063","volume":"29","author":"KL Garand","year":"2020","unstructured":"Garand KL, et al. Assessment across the life span: the clinical swallow evaluation. Am J Speech-Language Pathol. 2020;29(2S):919\u201333.","journal-title":"Am J Speech-Language Pathol"},{"issue":"6","key":"10857_CR4","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1044\/2022_PERSP-22-00128","volume":"7","author":"JM Pisegna","year":"2022","unstructured":"Pisegna JM. What\u2019s the evidence? A commentary on FEES research. Perspect ASHA Special Interest Groups. 2022;7(6):1941\u201359.","journal-title":"Perspect ASHA Special Interest Groups"},{"key":"10857_CR5","unstructured":"Association AS-L-H. Scope of practice in speech-language pathology. 2016."},{"key":"10857_CR6","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1007\/s00455-018-9918-3","volume":"34","author":"K Swan","year":"2019","unstructured":"Swan K, et al. Psychometric properties of visuoperceptual measures of videofluoroscopic and fibre-endoscopic evaluations of swallowing: a systematic review. Dysphagia. 2019;34:2\u201333.","journal-title":"Dysphagia"},{"issue":"2","key":"10857_CR7","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.radi.2019.10.011","volume":"26","author":"E Boaden","year":"2020","unstructured":"Boaden E, et al. Clinical practice guidelines for videofluoroscopic swallowing studies: A systematic review. Radiography. 2020;26(2):154\u201362.","journal-title":"Radiography"},{"issue":"7","key":"10857_CR8","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.1044\/2017_JSLHR-S-16-0117","volume":"60","author":"R Jordan Hazelwood","year":"2017","unstructured":"Jordan Hazelwood R, et al. Identification of swallowing tasks from a modified barium swallow study that optimize the detection of physiological impairment. J Speech Lang Hear Res. 2017;60(7):1855\u201363.","journal-title":"J Speech Lang Hear Res"},{"issue":"2S","key":"10857_CR9","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1044\/2020_AJSLP-19-00189","volume":"29","author":"B Martin-Harris","year":"2020","unstructured":"Martin-Harris B, et al. Best practices in modified barium swallow studies. Am J speech-language Pathol. 2020;29(2S):1078\u201393.","journal-title":"Am J speech-language Pathol"},{"issue":"1","key":"10857_CR10","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1002\/cncr.30283","volume":"123","author":"KA Hutcheson","year":"2017","unstructured":"Hutcheson KA, et al. Dynamic imaging grade of swallowing toxicity (DIGEST): scale development and validation. Cancer. 2017;123(1):62\u201370.","journal-title":"Cancer"},{"issue":"5","key":"10857_CR11","doi-asserted-by":"publisher","first-page":"1659","DOI":"10.1044\/2022_JSLHR-21-00554","volume":"65","author":"AE Clain","year":"2022","unstructured":"Clain AE, et al. Structural validity, internal consistency, and rater reliability of the modified barium swallow impairment profile: breaking ground on a 52,726-patient, clinical data set. J Speech Lang Hear Res. 2022;65(5):1659\u201370.","journal-title":"J Speech Lang Hear Res"},{"issue":"7","key":"10857_CR12","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1002\/cncr.34079","volume":"128","author":"KA Hutcheson","year":"2022","unstructured":"Hutcheson KA, et al. Refining measurement of swallowing safety in the dynamic imaging grade of swallowing toxicity (DIGEST) criteria: validation of DIGEST version 2. Cancer. 2022;128(7):1458\u201366.","journal-title":"Cancer"},{"key":"10857_CR13","doi-asserted-by":"crossref","unstructured":"Hutcheson KA et al. Clinical Implementation of DIGEST as an Evidence-Based Practice Tool for Videofluoroscopy in Oncology: A Six-Year Single Institution Implementation Evaluation. Dysphagia, 2024: pp. 1\u201311.","DOI":"10.1007\/s00455-024-10721-2"},{"issue":"9","key":"10857_CR14","doi-asserted-by":"publisher","first-page":"105971","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105971","volume":"30","author":"S Hota","year":"2021","unstructured":"Hota S, et al. Outcomes of dysphagia following stroke: factors influencing oral intake at 6 months after onset. J Stroke Cerebrovasc Dis. 2021;30(9):105971.","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"4","key":"10857_CR15","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1161\/01.STR.30.4.744","volume":"30","author":"G Mann","year":"1999","unstructured":"Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;30(4):744\u20138.","journal-title":"Stroke"},{"issue":"6","key":"10857_CR16","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1007\/s00455-017-9824-0","volume":"32","author":"SK Daniels","year":"2017","unstructured":"Daniels SK, et al. The relationship between lesion localization and dysphagia in acute stroke. Dysphagia. 2017;32(6):777\u20137841432.","journal-title":"Dysphagia"},{"key":"10857_CR17","first-page":"101685","volume-title":"Mapping acute lesion locations to physiological swallow impairments after stroke","author":"J Wilmskoetter","year":"2019","unstructured":"Wilmskoetter J, et al. Mapping acute lesion locations to physiological swallow impairments after stroke. Volume 22. NeuroImage: Clinical; 2019. p. 101685."},{"key":"10857_CR18","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.physbeh.2018.05.010","volume":"194","author":"J Wilmskoetter","year":"2018","unstructured":"Wilmskoetter J, et al. Differences in swallow physiology in patients with left and right hemispheric strokes. Physiol Behav. 2018;194:144\u201352.","journal-title":"Physiol Behav"},{"issue":"1","key":"10857_CR19","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/S1052-3057(96)80023-1","volume":"6","author":"SK Daniels","year":"1996","unstructured":"Daniels SK, et al. Lesion site in unilateral stroke patients with dysphagia. J Stroke Cerebrovasc Dis. 1996;6(1):30\u20134.","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"10857_CR20","doi-asserted-by":"crossref","unstructured":"Daniels SK, et al. Defining and measuring dysphagia following stroke. American Journal of Speech-Language Pathology; 2009.","DOI":"10.1044\/1058-0360(2008\/07-0040)"},{"issue":"1","key":"10857_CR21","doi-asserted-by":"publisher","first-page":"54","DOI":"10.12786\/bn.2014.7.1.54","volume":"7","author":"WH Jeon","year":"2014","unstructured":"Jeon WH, et al. Association between location of brain lesion and clinical factors and findings of videofluoroscopic swallowing study in subacute stroke patients. Brain Neurorehabilitation. 2014;7(1):54\u201360.","journal-title":"Brain Neurorehabilitation"},{"issue":"4","key":"10857_CR22","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/0899-7071(94)00060-P","volume":"19","author":"H Irie","year":"1995","unstructured":"Irie H, Lu CC. Dynamic evaluation of swallowing in patients with cerebrovascular accident. Clin Imaging. 1995;19(4):240\u20133.","journal-title":"Clin Imaging"},{"issue":"5","key":"10857_CR23","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1159\/000016094","volume":"10","author":"G Mann","year":"2000","unstructured":"Mann G, Hankey GJ, Cameron D. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis. 2000;10(5):380\u20136.","journal-title":"Cerebrovasc Dis"},{"issue":"9","key":"10857_CR24","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1212\/WNL.38.9.1359","volume":"38","author":"J Homer","year":"1988","unstructured":"Homer J, et al. Aspiration following stroke: clinical correlates and outcome. Neurology. 1988;38(9):1359\u20131359.","journal-title":"Neurology"},{"issue":"12","key":"10857_CR25","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1016\/0003-9993(93)90082-L","volume":"74","author":"J Robbins","year":"1993","unstructured":"Robbins J, et al. Swallowing after unilateral stroke of the cerebral cortex. Arch Phys Med Rehabil. 1993;74(12):1295\u2013300.","journal-title":"Arch Phys Med Rehabil"},{"issue":"8","key":"10857_CR26","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1016\/j.apmr.2004.11.049","volume":"86","author":"MA Crary","year":"2005","unstructured":"Crary MA, Mann GDC, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):1516\u201320.","journal-title":"Arch Phys Med Rehabil"},{"issue":"2","key":"10857_CR27","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/PL00009592","volume":"14","author":"SK Daniels","year":"1999","unstructured":"Daniels SK, Brailey K, Foundas AL. Lingual discoordination and dysphagia following acute stroke: analyses of lesion localization. Dysphagia. 1999;14(2):85\u201392.","journal-title":"Dysphagia"},{"issue":"4","key":"10857_CR28","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1097\/PHM.0b013e318269d935","volume":"92","author":"T Park","year":"2013","unstructured":"Park T, Kim Y, McCullough G. Oropharyngeal transition of the bolus in post-stroke patients. Am J Phys Med Rehabil. 2013;92(4):320\u20136.","journal-title":"Am J Phys Med Rehabil"},{"issue":"1","key":"10857_CR29","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1007\/BF02406275","volume":"3","author":"J Robbins","year":"1988","unstructured":"Robbins J, Levine RL. Swallowing after unilateral stroke of the cerebral cortex: preliminary experience. Dysphagia. 1988;3(1):11\u20137.","journal-title":"Dysphagia"},{"issue":"13","key":"10857_CR30","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1044\/persp2.SIG13.129","volume":"2","author":"B Martin-Harris","year":"2017","unstructured":"Martin-Harris B, Humphries K, Garand KL. The modified barium swallow impairment profile (MBSImP\u2122\u00a9)\u2013innovation, dissemination and implementation. Perspect ASHA Special Interest Groups. 2017;2(13):129\u201338.","journal-title":"Perspect ASHA Special Interest Groups"},{"issue":"3","key":"10857_CR31","doi-asserted-by":"publisher","first-page":"276","DOI":"10.11613\/BM.2012.031","volume":"22","author":"ML McHugh","year":"2012","unstructured":"McHugh ML. Interrater reliability: the kappa statistic. Biochemia Med. 2012;22(3):276\u201382.","journal-title":"Biochemia Med"},{"issue":"2S","key":"10857_CR32","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1044\/2020_AJSLP-19-00080","volume":"29","author":"J Beall","year":"2020","unstructured":"Beall J, et al. Classification of physiologic swallowing impairment severity: A latent class analysis of modified barium swallow impairment profile scores. Am J speech-language Pathol. 2020;29(2S):1001\u201311.","journal-title":"Am J speech-language Pathol"},{"key":"10857_CR33","doi-asserted-by":"crossref","unstructured":"Landis JR, Koch GG. The measurement of observer agreement for categorical data. biometrics, 1977: pp. 159\u2013174.","DOI":"10.2307\/2529310"},{"key":"10857_CR34","doi-asserted-by":"crossref","unstructured":"Ryan Burdick JW, Terp C, Gustafson S, Yee J, Rogus-Pulia N, Hutcheson K. Does standardized inclusion of thickened liquids in the modified barium swallow (MBS) study bolus protocol change dynamic imaging grade of swallowing toxicity (DIGEST) grades? Dysphagia Research Society Meeting; 2024.","DOI":"10.1007\/s00455-025-10874-8"},{"issue":"2","key":"10857_CR35","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.apmr.2006.11.002","volume":"88","author":"J Robbins","year":"2007","unstructured":"Robbins J, et al. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007;88(2):150\u20138.","journal-title":"Arch Phys Med Rehabil"},{"issue":"1","key":"10857_CR36","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.jdsr.2009.03.004","volume":"45","author":"K Matsuo","year":"2009","unstructured":"Matsuo K, Palmer JB. Coordination of mastication, swallowing and breathing. Japanese Dent Sci Rev. 2009;45(1):31\u201340.","journal-title":"Japanese Dent Sci Rev"},{"key":"10857_CR37","doi-asserted-by":"crossref","unstructured":"Kallambettu V, et al. Validation of the dynamic imaging grade of swallowing toxicity for amyotrophic lateral sclerosis. Neurogastroenterology & Motility; 2025. p. e70008.","DOI":"10.1111\/nmo.70008"}],"container-title":["Dysphagia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00455-025-10857-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00455-025-10857-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00455-025-10857-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T09:13:03Z","timestamp":1772269983000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00455-025-10857-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,14]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10857"],"URL":"https:\/\/doi.org\/10.1007\/s00455-025-10857-9","relation":{},"ISSN":["0179-051X","1432-0460"],"issn-type":[{"value":"0179-051X","type":"print"},{"value":"1432-0460","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,14]]},"assertion":[{"value":"3 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Kate Davidson receives MBSImP royalties from Northern Speech Services; Consultant, NIH\/NIDCD 2K24DC012801-0, Data Science; Applications in Communication and Swallowing Disorders, 2013\u20132024; Bonnie Martin-Harris receives MBSImP royalties from the Medical University of South Carolina and Northern Speech Services; nonfinancial disclosure includes MBSImP owner and license guarantor to Northern Speech Services; Principal Investigator, NIH\/NIDCD K23DC005764; Standardized assessment of swallowing impairment, 2003\u20132010; Principal Investigator, NIH\/NIDCD 2K24DC012801-0, Data Science; Applications in Communication and Swallowing Disorders, 2013\u20132024.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}