Skip to main content

Advertisement

SpringerLink
Log in

Oropharyngolaryngeal Disorders in Scleroderma: Development and Validation of the SLS Scale

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Systemic sclerosis (SSc) is a multisystemic disorder characterized by functional and structural abnormalities of small blood vessels and fibrosis of the skin and internal organs. Eighty percent of subjects with SSc have orofacial manifestations. No tests for oral manifestations have been validated for this pathology, and in the literature there are few studies of speech therapy for subjects with SSc. These facts suggested the need for an exhaustive assessment of mouth mobility and muscle strength, and also of swallowing and voice, in order to plan a targeted and effective speech therapy. The Scleroderma Logopedic Scale (SLS) has been developed to assess disorders in five domains: Impairment, Swallow, Voice, Multifield, and Quality of Life. Perception of these disorders was assessed in 84 subjects with SSc and in 40 healthy subjects. After the first draft, a shorter form (39 items) was obtained after statistical analysis. This scale showed good discriminant and concurrent validity. Internal consistency was good: three of five subscales had a Cronbach α coefficient higher than 0.8. The test/retest coefficient for the total score was 0.94. Thirty-six percent of examined subjects showed moderate to severe oropharyngolaryngeal disorders. Swallowing disorders and impairment of mouth (e.g., decrease in mobility and strength) were the most commonly reported problems. Conversely, the change of voice due to the pathology was not perceived as a problem. Fifty-five percent of subjects reported a decreased level of quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ntoumazios SK, Voulgari PV, Potsis K, Koutis E, Tsifetaki N, Assimakopoulos DA. Esophageal involvement in scleroderma: gastroesophageal reflux, the common problem. Semin Arthritis Rheum. 2006;36:173–81. doi:10.1016/j.semarthrit.2006.08.002.

    Article  PubMed  Google Scholar 

  2. Rout PG, Hamburger J, Potts AJ. Orofacial radiological manifestations of systemic sclerosis. Dentomaxillofac Radiol. 1996;25:193–6.

    CAS  PubMed  Google Scholar 

  3. Ferri C, Valentini G, Cozzi F, Sebastiani M, Michelassi C, La Montagna G, et al. Systemic Sclerosis Study Group of the Italian Society of Rheumatology, (SIR-GSSSc): systemic sclerosis: demographic, clinical, and serologic features and survival in 1,012 Italian patients. Medicine. 2002;81:139–53. doi:10.1097/00005792-200203000-00004.

    Article  PubMed  Google Scholar 

  4. Valentini G, Black C. Systemic sclerosis. Best Pract Res Clin Rheumatol. 2002;16:807–16. doi:10.1053/berh.2002.0258.

    Article  PubMed  Google Scholar 

  5. Pizzo G, Scardina GA, Messina P. Effects of a nonsurgical exercise program on the decreased mouth opening in patients with systemic scleroderma. Clin Oral Investig. 2003;7:175–8. doi:10.1007/s00784-003-0216-5.

    Article  CAS  PubMed  Google Scholar 

  6. Menditti D, Palomba F, Rullo R, Minervini G. Progressive systemic sclerosis (scleroderma): oral manifestations. Arch Stomatol. 1990;31:537–48.

    CAS  Google Scholar 

  7. Scardina GA, Mazzullo M, Messina P. Early diagnosis of Progressive Systemic Sclerosis: the role of orofacial phenomena. Minerva Stomatol. 2002;51:311–7.

    CAS  PubMed  Google Scholar 

  8. Nagy G, Kovács J, Zeher M, Czirják L. Analysis of the oral manifestations of systemic sclerosis. Oral Surg Oral Med Oral Pathol. 1994;77:141–6. doi:10.1016/0030-4220(94)90276-3.

    Article  CAS  PubMed  Google Scholar 

  9. Terzioğlu A, Ciğşar B, Aslan G. Surgical correction of microstomia in a patient with scleroderma. Ann Plast Surg. 2002;49:222–3. doi:10.1097/00000637-200208000-00028.

    Article  PubMed  Google Scholar 

  10. Naylor WP, Douglass CW, Mix E. The nonsurgical treatment of microstomia in scleroderma: a pilot study. Oral Surg Oral Med Oral Pathol. 1984;57:508–11. doi:10.1016/0030-4220(84)90309-8.

    Article  CAS  PubMed  Google Scholar 

  11. Poole JL, Brewer C, Rossie K, Good CC, Conte C, Steen V. Factors related to oral hygiene in persons with scleroderma. Int J Dent Hyg. 2005;3:13–7. doi:10.1111/j.1601-5037.2004.00108.x.

    Article  CAS  PubMed  Google Scholar 

  12. Biotto C (2006) Sclerosi Sistemica: elaborazione e somministrazione di un protocollo di valutazione logopedica. Analisi e sintesi dei dati raccolti. Bachelor’s Thesis, University of Milan, November 2006

  13. Enderby P, John A, Petherham B. Therapy Outcome Measures manual: physiotherapy, occupational therapy, rehabilitation nursing. San Diego, CA: Singular; 1998.

    Google Scholar 

  14. Yorkston KM, Bombardier C, Hammer V. Dysarthria from the view point of individuals with dysarthria. In: Till JA, Yorkston KM, Beukelman DR, editors. Motor speech disorders. Advances in assessment and treatment. Toronto: Brooks Publishing; 1994.

    Google Scholar 

  15. De Bodt MS, Wuyts FL, Van de Heyning PH, Croux C. Test-retest study of the GRBAS scale: influence of experience and professional background on perceptual rating of voice quality. J Voice. 1997;11:74–80. doi:10.1016/S0892-1997(97)80026-4.

    Article  PubMed  Google Scholar 

  16. Apolone G, Mosconi P. The Italian SF-36 health survey: translation, validation and norming. J Clin Epidemiol. 1998;51:1025–36. doi:10.1016/S0895-4356(98)00094-8.

    Article  CAS  PubMed  Google Scholar 

  17. Haynes BF, Soderberg KA, Fauci AS. Disorders of the immune system, connective tissue, and joints. In: Harrison, editor. Principi di medicina interna. 14th ed. Milan: McGraw-Hill; 1999. p. 2153–62.

  18. Scorza R, Caronni M, Mascagni B, Berruti V, Bazzi S, Micallef E, et al. Effects of long-term cyclic iloprost therapy in systemic sclerosis with Raynaud’s phenomenon. A randomized, controlled study. Clin Exp Rheumatol. 2001;19:503–8.

    CAS  PubMed  Google Scholar 

  19. No authors listed, Appendix. Manual of signs, symptoms, methods and procedures for the assessment of the patient with SSc. Clin Exp Rheumatol 2003; 21:S49–S56

    Google Scholar 

  20. McHorney CA, Bricker DE, Kramer AE, Rosenbek JC, Robbins J, Chignell KA, et al. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development. Dysphagia. 2000;15:115–21.

    CAS  PubMed  Google Scholar 

  21. McHorney CA, Bricker DE, Robbins J, Kramer AE, Rosenbek JC, Chignell KA. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: II. Item reduction and preliminary scaling. Dysphagia. 2000;15:122–33.

    CAS  PubMed  Google Scholar 

  22. McHorney CA, Robbins J, Lomax K, Rosenbek JC, Chignell K, Kramer AE, et al. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia. 2002;17:97–114. doi:10.1007/s00455-001-0109-1.

    Article  PubMed  Google Scholar 

  23. Roe JW, Leslie P, Drinnan MJ. Oropharyngeal dysphagia: the experience of patients with non-head and neck cancers receiving specialist palliative care. Palliat Med. 2007;21:567–74. doi:10.1177/0269216307082656.

    Article  PubMed  Google Scholar 

  24. McHorney CA, Martin-Harris B, Robbins J, Rosenbek J. Clinical validity of the SWAL-QOL and SWAL-CARE outcome tools with respect to bolus flow measures. Dysphagia. 2006;21:141–8. doi:10.1007/s00455-005-0026-9.

    Article  PubMed  Google Scholar 

  25. Deary IJ, Webb A, Mackenzie K, Wilson JA, Carding PN. Short, self-report voice symptom scales: psychometric characteristics of the voice handicap index-10 and the vocal performance questionnaire. Otolaryngol Head Neck Surg. 2004;131:232–5. doi:10.1016/j.otohns.2004.02.048.

    Article  PubMed  Google Scholar 

  26. LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA Jr, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol. 1998;15:202–5.

    Google Scholar 

  27. Medsger TA Jr, Bombardieri S, Scorza R, Della Rossa A, Bencivelli W. Assessment of disease severity and prognosis. Clin Exp Rheumatol. 2003;21(Suppl 29):S42–6.

    PubMed  Google Scholar 

  28. Streiner DL, Norman GR. Health measurement scales. A practical guide to their development and use. 2nd ed. New York: Oxford University Press; 1996.

    Google Scholar 

  29. Anselmino M, Zaninotto G, Costantini M, Ostuni P, Ianniello A, Boccú C, et al. Esophageal motor function in primary Sjögren’s syndrome: correlation with dysphagia and xerostomia. Dig Dis Sci. 1997;42:113. doi:10.1023/A:1018845323765.

    Article  CAS  PubMed  Google Scholar 

  30. Helm JF. Role of saliva in esophageal function and disease. Dysphagia. 1989;4:76–84. doi:10.1007/BF02407149.

    Article  CAS  PubMed  Google Scholar 

  31. Sonies BC, Ship JA, Baum BJ. Relationship between saliva production and oropharyngeal swallow in healthy, different-aged adults. Dysphagia. 1989;4:85–9. doi:10.1007/BF02407150.

    Article  CAS  PubMed  Google Scholar 

  32. Karkos PD, Yates PD, Carding PN, Wilson JA. Is laryngopharyngeal reflux related to functional dysphonia? Ann Otol Rhinol Laryngol. 2007;116:24–9.

    PubMed  Google Scholar 

  33. Makhadoom N, Abouloyoun A, Bokhary HA, Dhafar KO, Gazzaz ZJ, Azab BA. Prevalence of gastroesophageal reflux disease in patients with laryngeal and voice disorders. Saudi Med J. 2007;28:1068–71.

    PubMed  Google Scholar 

  34. Portney LG, Watkins MP. Foundations of clinical research; application to practice. Upper Saddle River, NJ: Prentice Hall Health; 1999. p. 560–8.

    Google Scholar 

  35. Montesi A, Pesaresi A, Cavalli ML, Ripa G, Candela M, Gabrielli A. Oropharyngeal and esophageal function in scleroderma. Dysphagia. 1991;6:219–23. doi:10.1007/BF02493531.

    Article  CAS  PubMed  Google Scholar 

  36. Beretta L, Astori S, Ferrario E, Caronni M, Raimondi M, Scorza R. Determinants of depression in 111 Italian patients with systemic sclerosis. Reumatismo. 2006;58:219–25.

    CAS  PubMed  Google Scholar 

  37. Cossutta R, Zeni S, Soldi A, Colombelli P, Belotti Masserini A, Fantini F. Evaluation of quality of life in patients with systemic sclerosis by administering the SF-36 questionnaire. Reumatismo. 2002;54:122–7.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgment

This work was supported by the GILS (Gruppo Italiano Lotta alla Sclerodermia).

Author information

Authors and Affiliations

  1. Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S, Via Capecelatro 66, 20148, Milan, Italy

    Chiara Vitali, Elisa Borghi, Arianna Napoletano, Francesca Polini, Paola Ammenti & Davide Cattaneo

  2. UOC Immunology Clinical Unit, I.R.C.C.S. Foundation, Ospedale Maggiore Policlinico Mangiagalli Regina Elena, Via F. Sforza 28, 20122, Milan, Italy

    Monica Caronni

  3. Servizio riabilitazione neurologica adulti (ext. 282), Don Gnocchi Foundation I.R.C.C.S, Via Capecelatro 66, 20148, Milan, Italy

    Chiara Vitali

Authors
  1. Chiara Vitali
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elisa Borghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arianna Napoletano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesca Polini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Monica Caronni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paola Ammenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Davide Cattaneo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chiara Vitali.

Appendix: Abbreviated Item Content in the Long and Short Form of the Scale

Appendix: Abbreviated Item Content in the Long and Short Form of the Scale

58-Item scale

39-Item scale

Item content

Impairment

1

29

Xerostomia

2

1

Gingival resorption

3

–

Face tingling

4

–

Mouth inflammation

5

–

Taste

6

–

Smell

7

2

Mouth opening

8

3

Mouth opening

9

4

Mouth opening

10

5

Lip resorption

11

–

Muscle rigidity

12

6

Muscle rigidity

13

7

Muscle rigidity

14

8

Muscle weakness

15

–

Muscle weakness

16

–

Muscle weakness

Disability

Swallowing

    17

14

Biting

    18

15

Chewing

    19

16

Chewing

    20

–

Chewing

    21

–

Chewing

    22

17

Swallowing

    23

18

Tongue mobility

    24

19

Food characteristics

    25

20

Food characteristics

    26

21

Food characteristics

    27

22

Duration of meal

    28

23

Food leaking from mouth

    29

24

Bolus transit

    30

25

Bolus transit

    31

26

Bolus sticking

    32

27

Xerostomia

    33

28

Aspiration

    34

–

Aspiration

Voice

    35

9

Running out of air

    36

10

Loudness

    37

11

Roughness

    38

12

Fatigue

    39

–

Weariness

    40

13

Loudness

    41

–

Running out of air

    42

–

Xerostomia

Multifield

43

30

Gastroesophageal reflux

44

31

Mouth opening

45

–

Mouth opening

46

–

Mouth opening

47

32

Oral hygiene

48

–

Face tingling

49

33

Facial expression

50

34

Muscle rigidity

Quality of life

51

35

Facial expression

52

36

Eating pleasure

53

37

Oropharyngolaryngeal symptoms

54

38

Oropharyngolaryngeal symptoms

55

39

Quality of life

56

–

Eating pleasure

57

–

Eating pleasure

58

–

Speaking pleasure

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vitali, C., Borghi, E., Napoletano, A. et al. Oropharyngolaryngeal Disorders in Scleroderma: Development and Validation of the SLS Scale. Dysphagia 25, 127–138 (2010). https://doi.org/10.1007/s00455-009-9235-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-009-9235-y

Keywords

Search

Navigation