Elucidating inconsistencies in dysphagia diagnostics: Redefining normal

Speech-language pathologists (SLPs) are the primary healthcare providers responsible for the evaluation and treatment of dysphagia. Fundamental to this role is the ability to make accurate clinical judgements to distinguish between normal versus disordered swallowing for subsequent treatment planning. In this review, we highlight recent data collected from practising clinicians in the USA that reveal low levels of agreement across clinicians and poor to moderate levels of accuracy for making binary diagnostic ratings (normal vs. disordered). We then propose and discuss barriers that may represent challenges to practising SLP's understanding of normal swallowing physiology. Proposed barriers include: (1) an educational focus on the disordered system; (2) system 1 processing; (3) complexity of the swallowing system; (4) inability to directly visualise the swallowing process; (5) degree of variability of normal swallowing; and (6) high clinical productivity requirements. This article concludes with suggestions for reducing identified educational and clinical barriers to ultimately improve diagnostic decision-making practices and to benefit patient-related outcomes in dysphagia management.