M.Sc (Speech Language Pathology); PhD (Swallowing disorders)
RESEARCH, TEACHING, or OTHER INTERESTS
Speech and Hearing, Geriatrics and Gerontology, Otorhinolaryngology, Rehabilitation
68
Scopus Publications
Scopus Publications
Prevalence of Swallowing-Related Fatigue and Its Association With Self-Perceived Swallowing Impairments Across Phases of Stroke, Site of Lesion, and Stroke Severity Uzair Chilwan, K. Vijaya Kumar, Sudhin Karuppali, Venkataraja U. Aithal, Radish Kumar Balasubramanium American Journal of Speech Language Pathology, 2026 Purpose: This study examined the prevalence of swallowing-related fatigue in individuals with stroke and its association with self-perceived swallowing difficulties. It also explored differences across stroke phases, lesion sites, and severity levels, and examined the association between the Swallowing and Eating-Related Fatigue Scale (SERF) scores and self-reported dysphagia risk (Eating Assessment Tool [EAT-10], Dysphagia Handicap Index [DHI]). Method: A cross-sectional study was conducted with 170 poststroke adults (120 men, 50 women) recruited at a tertiary care hospital. Participants were categorized into early subacute, late subacute, and chronic phases. Stroke severity was measured using the National Institutes of Health Stroke Scale, and lesion site was determined from radiological reports. Swallowing fatigue was assessed using the SERF scale, general fatigue with the Fatigue Severity Scale, and self-reported swallowing difficulties with the EAT-10 and DHI. Analyses included chi-square test, Spearman correlations, Kruskal–Wallis with post hoc comparisons, and logistic regression. Results: Swallowing-related fatigue was most prevalent in the early subacute phase (92%), among individuals with brainstem lesions (84%), and in those with greater stroke severity (72.7%). SERF scores strongly correlated with EAT-10 and DHI, indicating an association with both functional swallowing impairments and psychosocial handicap. Logistic regression identified stroke phase as a significant predictor, with lower prevalence in later phases. Conclusions: Swallowing-related fatigue emerges as a notable and unique complication of stroke, especially prominent in early recovery and among individuals with brainstem involvement. Incorporating the SERF scale into routine assessment may enable early identification of patients at risk of reduced mealtime endurance and guide targeted rehabilitation.
Dysphagia Screening in Acute Stroke: Adaptation and Validation of the Modified Volume-Viscosity Swallowing Test With International Dysphagia Diet Standardization Initiative Standards Muhammed Salman, Preetie Shetty Akkunje, Radish Kumar Balasubramanium, Zulkifli K. Misri Archives of Physical Medicine and Rehabilitation, 2026 OBJECTIVE: To adapt and validate the modified Volume-Viscosity Swallowing Test (MV-VST), aligned with the International Dysphagia Diet Standardization Initiative (IDDSI) framework, and to enhance its applicability in diverse dietary contexts, particularly in lower-middle-income countries. DESIGN: A cross-sectional study. SETTING: The research was carried out at an acute care tertiary hospital. PARTICIPANTS: Seventy patients (N=70) with acute stroke, aged ≥18 years, with a standard education level and no sensory deficits, were included in the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The study consisted of 2 phases. In phase 1, the MV-VST was adapted using IDDSI guidelines with varied viscosities and volumes and validated by 5 experienced swallow specialists. In phase 2, the test was used to screen swallowing safety, swallowing efficacy, and temporal parameters across different consistencies and volumes. In addition, clinical assessment was performed using standardized test batteries (Functional Oral Intake Scale [FOIS] and Eating Assessment Tool [EAT-10]), and a subset of participants underwent a videofluoroscopic swallow study (VFSS). The primary outcome of MV-VST measured parameters were defined as clinical indicators that predict potential deficits, and their correlations with FOIS, EAT-10, and VFSS. Furthermore, the study examined the reliability and validity of the adapted swallowing screening tool, MV-VST. RESULTS: Of the 70 participants, 62.8% experienced dysphagia. The MV-VST demonstrated significant correlations with clinical assessments (FOIS and EAT-10), showing high test-retest and interrater reliability (Cronbach's α=0.994). Sensitivity and specificity were 87.5% and 100% for EAT-10, respectively, and 75% and 100% for VFSS, respectively. The tool demonstrated its ability to predict potential deficits in swallowing safety, efficacy, and temporal aspects, with significant differences observed between participants based on MV-VST outcomes. CONCLUSIONS: The adapted MV-VST, using IDDSI standards, is a reliable and valid tool for the early identification of poststroke dysphagia, facilitating timely intervention. Despite limitations like the single-center design and small sample size, the study underscores the potential of the MV-VST in diverse dietary practices. Future research should focus on larger, multicenter studies and integrating advanced technologies for more precise assessments.
Effect of swallowing related fatigue on eating and drinking behaviors across the age spectrum Uzair Chilwan, K. Vijaya Kumar, Sudhin Karuppali, Venkataraja U. Aithal, Radish Kumar Balasubramanium Peerj, 2026 Background Swallowing related fatigue refers to the decline in swallowing efficiency and safety due to sustained muscular effort over time. It can significantly impact eating and drinking behaviors, potentially leading to aspiration, malnutrition and diminished quality of life. Understanding the effects of swallowing fatigue across the age spectrum can help guide clinical interventions and management strategies. Hence, this study aims to evaluate the effects of swallowing-related fatigue on eating and drinking behaviors in young, middle-aged and older adults. Methods A cross-sectional study was conducted, recruiting 400 healthy individuals divided into three groups consisting of young adults, middle-aged adults and older adults. Participants with speech, language, swallowing, neurological, or cognitive impairments were excluded. The study utilized standardized assessments, including the Swallowing and Eating-Related Fatigue Scale (SERF) to measure swallowing fatigue. Objective swallowing function was evaluated using the Timed Water Swallow Test (TWST) for liquid intake, the Test of Masticating and Swallowing Solids (TOMASS) for solid food consumption, and the Mealtime Assessment Scale (MAS) to assess overall mealtime behaviors. Video recordings of swallowing tasks were analyzed to measure efficiency, speed, and fatigue-related changes. Results Swallowing fatigue was significantly higher in older adults compared to middle-aged and young adults. TWST results showed that older adults exhibited longer swallowing durations, smaller bolus volumes per swallow, and reduced swallowing efficiency, though correlations between TWST parameters and fatigue were weak. In contrast, TOMASS scores revealed moderate associations with swallowing fatigue, as older adults took more bites, had longer mastication durations, and required more swallows per bolus. MAS scores demonstrated moderate to strong correlations with swallowing fatigue across all age groups, indicating that individuals experiencing higher fatigue levels displayed compromised mealtime efficiency and safety. Reliability analyses confirmed excellent test-retest reliability for TWST & TOMASS, with good to excellent interrater reliability. Conclusion This study underscores the impact of swallowing-related fatigue on eating and drinking behaviors, particularly among older adults. While swallowing fatigue had minimal to moderate influence on TWST and TOMASS parameters respectively, MAS demonstrated stronger associations, suggesting that swallowing endurance plays a critical role in overall mealtime performance. These findings highlight the importance of integrating fatigue assessments into clinical dysphagia evaluations, as fatigue-related impairments may increase the risk of nutritional deficits and aspiration. Future research should focus on developing interventions to mitigate swallowing fatigue and improve mealtime efficiency, particularly in aging & clinical populations.
Evaluation of Swallowing in Poststroke Individuals Using the Swallowing Proficiency for Eating and Drinking (SPEAD) Protocol: A Pilot Study Uzair Chilwan, Aswathy Suresh, Sahlah Shameer, Anaan Zohara, Radish Kumar Balasubramanium Neurology Clinical Practice, 2026 BACKGROUND AND OBJECTIVES: Poststroke dysphagia affects 37-78% of stroke survivors, leading to complications such as malnutrition, dehydration, and psychological distress. Current tools for assessing swallowing, such as the Timed Water Swallow Test and Test of Mastication and Swallowing Solids, do not evaluate intermediate consistencies. The Swallowing Proficiency for Eating and Drinking (SPEAD) protocol incorporates thin liquids, solids, and moderately thick liquids, providing a comprehensive evaluation of swallowing function. This study assessed SPEAD's utility in a stroke population and its relationship with stroke severity. METHODS: A cross-sectional study recruited 77 poststroke participants (aged ≥18 years). Swallowing was evaluated using SPEAD for thin liquids, moderately thick liquids, and solids, following International Dysphagia Diet Standardization Initiative guidelines. Parameters recorded included number of swallows, chews, grams consumed, and duration (in seconds), with derived measures such as ingestion speed and SPEAD rate. Stroke severity was assessed using the NIH Stroke Scale, and self-reported swallowing difficulties were screened with Eating assessment Tool (EAT-10). Data were analyzed using analysis of variance (ANOVA), multivariate analysis of variance, and Pearson correlation. RESULTS: < 0.05). A significant correlation was observed between SPEAD and EAT-10 scores, indicating that participants with higher dysphagia burden as perceived through SPEAD also reported greater perceived difficulty with swallowing on EAT-10. DISCUSSION: The SPEAD protocol effectively identifies swallowing impairments in stroke patients, particularly for intermediate consistencies. Its comprehensive approach provides valuable insights for dysphagia management, emphasizing the need for further validation in diverse populations. The study also highlights the value of objective bedside assessments such as SPEAD in conjunction with patient reported outcomes such as EAT-10. Together, they offer a comprehensive understanding of swallowing function poststroke and can guide early intervention strategies.
Caregiver perspectives on feeding and swallowing difficulties in children with developmental disabilities in India Deborah Deanne Athaide, Premalatha. B. Subbarao, Radish Kumar Balasubramanium, Lakshmi Venkatesh, Rajashekhar Bellur Egyptian Journal of Otolaryngology, 2025 Background Understanding pediatric feeding and swallowing disorders from the caregiver’s point of view is essential for effective intervention. This understanding can be suitably gained using qualitative methods. Thus, the present study aimed to explore caregiver perspectives on feeding and swallowing difficulties in children with developmental disabilities in India, a low middle-income country. Methods Ten in-depth interviews with Indian caregivers of children (2 to 5 years) with developmental disabilities who had feeding and/or swallowing difficulties were conducted to explore their perspectives on these difficulties. A six-step process for thematic analysis was performed on the transcription of the interviews to arrive at themes. Results Emergent themes included – perceived causes, deficits, mealtime, dealing with food refusals, concerns beyond mealtime, and the impact on the caregiver. Caregivers struggle with long meal durations, oral-preparatory and sensory deficits, initiating meals, food refusal behaviours, food selectivity, and self-feeding. Caregivers resort to force-feeding and using distractions, especially with screens, to deal with mealtimes. Conclusion Caregiver well-being is affected by the presence of feeding deficits, maladaptive behaviours, and concerns about their child’s development. They are necessitated to cope with guilt, societal expectations, participation restrictions, and time constraints that affect their physical, psychological, and social well-being.
Translation and Validation of Leicester Cough Questionnaire in Kannada Yamini Venkatraman, Vishak Acharya, Sindhu Kamath, Dhanshree R. Gunjawate, Radish Kumar Balasubramanium Journal of Speech Language and Hearing Research, 2025 Purpose: Leicester Cough Questionnaire (LCQ) is a widely used patient reported outcome measure to profile the impact of cough on an individual's quality of life. It has been translated and validated in many languages but is unavailable in Kannada, a South Indian language. This research focused on translating and validating the LCQ in Kannada among individuals with chronic cough. Method: The LCQ-Kannada was cross-culturally adapted using a rigorous, standard translation procedure and validated in a chronic cough cohort. One hundred fifty-nine participants were enrolled based on eligibility criteria. Participants completed three questionnaires: LCQ-Kannada, Cough Symptom Score (CSS), and Cough Visual Analog Scale (CVAS). The translated questionnaire was evaluated for internal consistency, test–retest reliability, concurrent validity, and responsiveness. Results: The LCQ-Kannada obtained a high overall and domain-specific internal consistency with Cronbach's alpha coefficient values between .75 and .93. The repeatability was tested in 10% of the participants, and significant test–retest reliability scores were obtained (intraclass coefficients: .50–.91). The LCQ-Kannada correlated significantly with CVAS and CSS with coefficient values between .61–.74 and .52–.66, respectively ( p < .001). Responsiveness was measured in 26 participants who reported improvement with treatment and had a significant change in LCQ-Kannada scores (mean improvement: 1.74–6.21; p < .001). Conclusion: The LCQ-Kannada is a reliable and valid clinical tool for individuals with chronic cough.
Assessment and management approaches for dysphagia in tracheostomized patients: Practices of speech-language pathologists in India Uzair Chilwan, Smita Caren Mathias, Asif Maitheen, Al Shifa Khan, Radish Kumar Balasubramanium World Journal of Otorhinolaryngology Head and Neck Surgery, 2025 ObjectiveSpeech language pathologists (SLPs) play a crucial role while dealing with tracheostomized patients, particularly in addressing communication impairments and dysphagia. However, in India, there is a lack of standardized guidelines for SLPs in the treatment of tracheostomy patients, resulting in variations in clinical practices and patient care.MethodsAn online survey was conducted among 106 experienced SLPs in India. The survey included questions pertaining to various aspects of assessment and treatment in tracheostomized patients. Survey data were analyzed to identify the level of consensus among SLPs in these areas.ResultsThe survey results revealed varying levels of consensus among SLPs in most of the domains. Most responses fell within the moderate to low consensus range, indicating a lack of standardized practices.ConclusionsThe study highlights the lack of standardized guidelines among SLPs in India when it comes to tracheostomy patient care. Hence, the study recommends collaboration among relevant organizations to enhance knowledge sharing and standardize clinical guidelines to improve the overall quality of care for tracheostomy patients in India.
Effect of an oral stimulation protocol on breastfeeding among preterm infants: a randomised controlled trial Gopalakrishnan Jayapradha, Lakshmi Venkatesh, Prakash Amboiram, Radish Kumar Balasubramanium, Umamaheswari Balakrishnan Archives of Disease in Childhood Fetal and Neonatal Edition, 2025 ObjectivesThe objectives are to assess the effectiveness of a modified and adapted oral sensorimotor intervention (MA-OSMI) protocol for infants in India on the rate and performance of breastfeeding among preterm (PT) infants at discharge.DesignSingle-centre randomised control trial.SettingLevel III B neonatal intensive care unit in a quaternary care hospital in South India.PatientsA total of 76 PT infants born between 26 and 33+6weeks of gestational age, stratified into <30 weeks and 30–33+6weeks, were randomised to intervention group (MA-OSMI) or standard care (SC).InterventionsMA-OSMI in addition to SC versus SC alone. The stimulation included 12 techniques administered by the principal investigator. SC included kangaroo mother care and non-nutritive sucking.Outcome measuresExclusive breastfeeding (EBF) rate and breastfeeding performance at the time of discharge, assessed using standardised tools by clinician and mothers.ResultsInfants in MA-OSMI group (66%) had significantly higher EBF rate compared with the SC group (16%) (OR: 10.25; 95% CI: 3.41 to 30.80). Improved breastfeeding performance was noted as per the clinician’s observation. Significantly lower scores for MA-OSMI groups (63.42±36.43) than SC groups (126.61±60.94) on mothers’ ratings suggested better feeding skills.ConclusionPrefeeding oral stimulation contributed significantly to the achievement of EBF among PT infants at discharge. The present findings may benefit speech–language pathologists, paediatricians/neonatologists and nurses in the intervention of oral feeding among neonates.
Prevalence of swallow fatigue and its relationship with self reported swallowing difficulties among community dwelling older adults in the Indian population Uzair Chilwan, K. Vijaya Kumar, Sudhin Karuppali, Venkataraja U. Aithal, Thejaswi Dodderi, Sahlah Shameer, Radish Kumar Balasubramanium Clinical Epidemiology and Global Health, 2025 <h2>Abstract</h2><h3>Problem considered</h3> Swallowing fatigue significantly impacts older adults, affecting daily activities and increasing the risk of disability. This study explored the prevalence of swallowing fatigue among healthy young, middle-aged, and older adults and its relationship with self-reported swallowing difficulties. <h3>Method</h3> A cross-sectional study was conducted with 389 participants. The Swallowing and Eating-Related Fatigue Scale in Kannada (SERF-K) and self-reported scales (EAT-10K, DHI-K) were used. Reliability was assessed through internal consistency and test-retest reproducibility. <h3>Results</h3> SERF-K demonstrated good internal consistency (Cronbach's α = 0.752), with individual item consistency ranging from 0.729 to 0.849. Older adults had a mean SERF-K score of 12.1, with 41.5 % reporting swallowing fatigue. A moderate correlation (r = 0.56) was observed between swallowing fatigue and self-reported difficulties. <h3>Conclusion</h3> These findings emphasize the necessity of recognizing swallow fatigue as a crucial factor in understanding swallowing difficulties across different age groups. While older adults exhibited a higher prevalence of swallowing fatigue, the presence of this symptom in young and middle aged adults also highlights the importance of early identification and early intervention. Addressing swallowing fatigue can contribute to improving overall quality of life and reducing the risk of disability related to swallowing in the general population.
Translation and validation of Malayalam version of swallowing and eating related fatigue scale Sahlah Shameer, Uzair Chilwan, Radish Kumar Balasubramanium Speech Language and Hearing, 2025 Swallowing-related fatigue is a multifaceted condition that can significantly affect mealtime efficiency and overall quality of life, particularly among older adults. The Swallowing and Eating-Related Fatigue (SERF) scale was developed to assess such fatigue, but no validated Malayalam version existed prior to this study. This research aimed to translate, culturally adapt, and validate the Malayalam version of the SERF scale (SERF-M). Following standardized guidelines, the SERF was translated using a rigorous forward-backward translation process, followed by expert review and pilot testing for linguistic and cultural appropriateness. A total of 250 healthy Malayalam-speaking participants across three age groups (young, middle-aged, and older adults) were included. The participants completed the SERF-M, Fatigue Severity Scale (FSS), and EAT-10M. Concurrent validity was assessed using the Mealtime Assessment Scale (MAS), and test–retest reliability was evaluated in 20% of the sample. The results revealed that 61.6% of the older adults reported swallowing fatigue. The SERF-M demonstrated excellent internal consistency (Cronbach's α = 0.971) and strong test–retest reliability. SERF-M scores correlated significantly with both the EAT-10M and MAS domains, including safety, efficacy, and mealtime duration, indicating good concurrent validity. Compared to the original English and Kannada versions, the Malayalam version had higher mean scores, suggesting cultural or linguistic influences on perceived fatigue. The highest-rated item indicated that fatigue negatively impacts the overall eating experience. In conclusion, the SERF-M is a reliable and valid tool for assessing swallowing-related fatigue in Malayalam-speaking populations. Its clinical utility can be enhanced by integrating it with objective performance-based assessments in future research.
Can the socio-economic status of young children influence their language performance? An Indian study Journal of Indian Association for Child and Adolescent Mental Health, 2018
Assessment of working memory in individuals with stuttering in comparison with individuals with normal fluency Online Journal of Health and Allied Sciences, 2018