Current Technological Advances in Dysphagia Screening: Systematic Scoping Review.

BACKGROUND

Dysphagia affects more than half of older adults with dementia and is associated with a 10-fold increase in mortality. The development of accessible, objective, and reliable screening tools is crucial for early detection and management.

OBJECTIVE

This systematic scoping review aimed to (1) examine the current state of the art in artificial intelligence (AI) and sensor-based technologies for dysphagia screening, (2) evaluate the performance of these AI-based screening tools, and (3) assess the methodological quality and rigor of studies on AI-based dysphagia screening tools.

METHODS

We conducted a systematic literature search across CINAHL, Embase, PubMed, and Web of Science from inception to July 4, 2024, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. In total, 2 independent researchers conducted the search, screening, and data extraction. Eligibility criteria included original studies using sensor-based instruments with AI to identify individuals with dysphagia or unsafe swallow events. We excluded studies on pediatric, infant, or postextubation dysphagia, as well as those using non-sensor-based assessments or diagnostic tools. We used a modified Quality Assessment of Diagnostic Accuracy Studies-2 tool to assess methodological quality, adding a "model" domain for AI-specific evaluation. Data were synthesized narratively.

RESULTS

This review included 24 studies involving 2979 participants (1717 with dysphagia and 1262 controls). In total, 75% (18/24) of the studies focused solely on per-individual classification rather than per-swallow event classification. Acoustic (13/24, 54%) and vibratory (9/24, 38%) signals were the primary modality sources. In total, 25% (6/24) of the studies used multimodal approaches, whereas 75% (18/24) used a single modality. Support vector machine was the most common AI model (15/24, 62%), with deep learning approaches emerging in recent years (3/24, 12%). Performance varied widely-accuracy ranged from 71.2% to 99%, area under the receiver operating characteristic curve ranged from 0.77 to 0.977, and sensitivity ranged from 63.6% to 100%. Multimodal systems generally outperformed unimodal systems. The methodological quality assessment revealed a risk of bias, particularly in patient selection (unclear in 18/24, 75% of the studies), index test (unclear in 23/24, 96% of the studies), and modeling (high risk in 13/24, 54% of the studies). Notably, no studies conducted external validation or domain adaptation testing, raising concerns about real-world applicability.

CONCLUSIONS

This review provides a comprehensive overview of technological advancements in AI and sensor-based dysphagia screening. While these developments show promise for continuous long-term tele-swallowing assessments, significant methodological limitations were identified. Future studies can explore how each modality can target specific anatomical regions and manifestations of dysphagia. This detailed understanding of how different modalities address various aspects of dysphagia can significantly benefit multimodal systems, enabling them to better handle the multifaceted nature of dysphagia conditions.