We appreciate the questions and comments made by Laupacis and Biem. We will address them in order as follows.Our patients were seated upright in their wheelchairs or hospital beds. All patients studied were resident on an inpatient stroke rehabilitation unit and were, hence, prescreened to exclude those who were stuporous or tetraplegic. All patients examined were alert enough to hold a cup in the unaffected hand and drink from it. They were asked to drink the 3 oz of water "without interruption." No other instructions were given.The 3-oz water swallow test was scored prior to the Modified Barium Swallow (MBS) evaluation. Observers scoring the results of the MBS evaluation were not blinded to the results of the 3-oz water swallow test. The MBS evaluation is an objective means of documenting aspiration, and, hence, it is relatively independent of observer bias. The results of the neurologic examination
DePippo K, Holas M, Reding M. Hard to Swallow Test-Reply. Arch Neurol. 1994;51(2):119–120. doi:10.1001/archneur.1994.00540140021007
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