What are the steps involved in the ASPEKT Method?

The ASPEKT Method is a process for analyzing swallowing at the single bolus level. The steps for analyzing a single bolus are as follows:

  1. The bolus clip is reviewed and the number of swallows for that bolus are counted. A swallow is defined as an event in which bolus material passes through the upper esophageal sphincter (UES).
  2. Swallowing safety is rated for each swallow using the 8-point Penetration-Aspiration Scale (Rosenbek et al., 1996).

ALL remaining steps of the ASPEKT Method are performed for the initial swallow of the bolus only:

  1. The integrity of laryngeal vestibule closure (LVC) is recorded as complete, partial or incomplete.
  2. The frame numbers for a series of key events are documented:
    • Bolus passing mandible (BPM)
    • Onset of the Hyoid Burst (HYB)
    • The first frame of Upper Esophageal Sphincter opening (UESO)
    • The first frame of most-complete laryngeal vestibule closure (LVC)
    • The frame of maximum UES diameter
    • Peak antero-superior (XY) hyoid position
    • Maximum pharyngeal constriction
    • UES Closure behind the bolus
    • LVC Closure behind the bolus
    • Swallow Rest
  3. Timing measures are calculated based on the interval (i.e., number of frames) between key events
  4. Anatomically-referenced pixel-based measures are performed as follows:
    • Hyoid position (X, Y and XY) is measured relative to the anterior-inferior corner of the C4 vertebra, in a coordinate system with the y-axis defined by a line running between the anterior-inferior corners of the C2 and C4 vertebrae (and the x-axis derived perpendicular to the y-axis). Hyoid position measures are normalized to a cervical spine scalar defined as the length of the line running between the anterior-inferior corners of the C2 and C4 vertebrae, i.e., %(C2-4).
      • Hyoid XY Speed is calculated by calculating the difference in hyoid position between the frames of Peak XY Hyoid Position and Hyoid Burst Onset and dividing this distance by the interval between the frames of Peak XY Hyoid Position and Hyoid Burst Onset.
    • Maximum UES Diameter is measured and normalized to the C2-C4 scalar reference, i.e., %(C2-4).
    • Pharyngeal area at rest (PhAR) is measured as follows:
      • The C2-4 reference scalar is measured, defined as the distance (in pixels) between the anterior-inferior corners of the C2 and C4 vertebrae;
      • A second line, perpendicular to the C2-C4 scalar reference is then drawn and moved upwards, to align with the anterior-superior corner of the C2 vertebra;
      • The area of unobliterated pharyngeal space is traced (including both air and any visible bolus material) between the following boundaries: superiorly, the top of the C2 vertebra; posteriorly, the posterior pharyngeal wall; inferiorly, the pit of the pyriform sinuses; and anteriorly, the base of tongue, pharyngeal surface of the epiglottis, aryepiglottic folds and anterior wall of the pyriform sinus;
      • The pharyngeal area measure is converted into %(C2-4)2 units by dividing the area measure by the (C2-4)2 reference scalar and multiplying by 100%.
    • Pharyngeal area is measured on the frame of maximum pharyngeal constriction (PhAMPC) using the same procedures described above for measures of pharyngeal area at rest.
    • Residue area is measured in the valleculae, pyriform sinuses and elsewhere in the pharynx and normalized to the squared length of the C2-C4 scalar reference, i.e., %(C2-4)2. Residue measures may be summed across these locations for a composite measure of Total Pharyngeal Residue.

Next: Which parameters are included in the ASPEKT Method?

Updated January 3, 2023