Visual Analysis of Swallowing Efficiency and Safety (VASES)
Visual Analysis of Swallowing Efficiency and Safety (VASES) is a standardized approach for rating pharyngeal residue, penetration, and aspiration during FEES. It establishes clearly defined anatomic and temporal boundaries within which to rate functional swallowing outcomes. VASES is intended to increase the transparency, sensitivity, reliability, and generalizability of FEES ratings and analysis for clinical and research purposes. For written instructions on how to interpret FEES using VASES, please refer to the original publication (copy-edited version; free self-archived version) and the free supplemental training document to learn more. After you have read the aforementioned material, you may consider viewing the below videos.
VASES Training Webinar
How to Use VASES in Clinical Practice
Ideally, each bolus that is part of your standardized FEES protocol should be rated using VASES. However, as you first begin to use VASES and balance FEES interpretation with workflow, you may consider starting off with rating just one swallowing condition (e.g., all trials of a patient preferred volume of thin liquid cup sips) or one trial for each swallowing condition (e.g., the first trial of each bolus volume and consistency). As you get faster and more efficient with ratings, you should consider rating every swallowing trial. On average, it is estimated that rating all seven outcome measures with VASES will take ~1 minute to complete. See the below video of me interpreting a FEES video clip using VASES using an (older version) unofficial VASES scoring sheet. Note that the time to rate the video clip is less than two minutes when including the viewing time of the entire video clip ~1 minute when considering only the amount of time it took to rate VASES.
To assist with rating FEES using VASES and writing up reports, you may consider downloading an unofficial VASES scoring sheet (updated February 20th, 2022) and a written report FEES template (uploaded March 15th, 2022). Just click File > Download. Check back periodically for updates as errors and modifications are inevitable.
Below is a 60-minute video where I review with some graduate interns that I am supervising how to use the unofficial scoring (developed October 2021). In the video, I also review the anatomic and temporal boundaries of VASES. Please note that views expressed during this video are my own, as I am casually discussing FEES interpretation with graduate interns that I am training.
Below is a video you can use to further practice FEES interpretation using VASES. In this video, you will hear a few graduate students, who are relatively new to VASES, and myself talk discuss VASES ratings for several FEES video clips. This was recorded in October 2021 immediately after the "VASES Unofficial Scoring Sheet Overview" video above. Be aware that typical VASES rating goes much quicker, but that the ratings in this video are much slower to allow for discussion with the trainees. Also note that views expressed during this video are my own, as I am casually discussing FEES interpretation with graduate interns that I am training.
The following are updated/additional VASES rules not previously outlined in the original VASES manuscript. Last updated January 30th, 2022.
Curtis, J.A., Borders, J.C., Perry, S.E., Dakin, A.E., Seikaly, Z.N., Troche, M.S. (2021). Visual Analysis of Swallowing Efficiency and Safety (VASES): A standardized approach to rating pharyngeal residue, penetration, and aspiration during FEES. Dysphagia. DOI: 10.1007/s00455-021-10293-5
Curtis, J.A., Borders, J.C., Troche, M.S. (2022). Visual Analysis of Swallowing Efficiency and Safety (VASES): Establishing Criterion-Referenced Validity and Concurrent Validity. American Journal of Speech-Language Pathology. DOI: 10.1044/2021_AJSLP-21-00116