[Dysphagia] Mild, moderate etc

[Sather.Tom at mayo.edu (Sather, Tom)]

It's in the Dysphagia journal, Volume 14, Number 3 / May, 1999; Pages
139-145.  Authors are: Karen H. O'Neil, Mary Purdy, Janice Falk, Lanelle
Gallo 

TS

-----Original Message-----
From: Pressman, Hilda [mailto:pressmah at sjhmc.org] 
Sent: Tuesday, March 06, 2007 8:49 AM
To: Irene Campbell-Taylor; Sather, Tom; dysphagia at b9.com
Subject: RE: [Dysphagia] Mild, moderate etc

Tom can you give us the citation for this scale?  Hilda Pressman

-----Original Message-----
From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com]On
Behalf Of Irene Campbell-Taylor
Sent: Sunday, March 04, 2007 8:59 AM
To: Sather, Tom; dysphagia at b9.com
Subject: Re: [Dysphagia] Mild, moderate etc


My concern with all of these measures is that they are based on VFSS
findings and as such must be regarded as suspect.  The VFSS is an
unnatural situation, has been shown to provide quite different results
from real life, include such things as mixing food with barium (a
practice I shall never understand) etc.etc. The relative "severity"
depends on the patient's ability to maintain adequate
nutrition/hydration p.o.  Many with apparently "mild to moderate" can't
do this so, if I were to use an adjective, I would classify them as
"severe" .  Such designations actually have no practical application
since every patient is different..

"Sather, Tom" <Sather.Tom at mayo.edu> wrote:  The Dysphagia Outcome and
Severity Scale is quite useful (K.H. O'Neil et al). A 1-7 scale with
relatively detailed descriptions at each level.
A couple examples from the scale: 

Level 7 = Normal in all situations, normal diet, no strategies or extra
time needed. 

Level 5 = Mild dysphagia: distant supervision, may need one diet
consistency restricted. May exhibit one or more of the following:
aspiration of thin liquids only but with strong reflexive cough to clear
completely, airway penetration midway to cords with one or more
consistency....and so on. 

I've found clinicially that the DOSS takes more of the whole picture of
swallowing into account and the ratings and definitions give a more
detailed account of the swallow (textures, usefulness of strategies,
need for non-oral, etc.) 

In terms of gauging severity of the swallow, you could also use the ASHA
NOMS Swallowing scale.

SWAL-QOL has usefulness in many ways, one of which is in gauging the
pt's perspective on the impact of swallowing difficulties. Therefore the
patient may perceive a much greater (or far less) impact of their
swallowing functioning than a clinician, family member, MD, etc. 

Tom S

-----Original Message-----
From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On
Behalf Of Irene Campbell-Taylor
Sent: Saturday, March 03, 2007 7:45 PM
To: dysphagia at b9.com
Subject: [Dysphagia] Mild, moderate etc

The only thing I know of is the Penetration Aspiration Scale:

The 8-Point Penetration Aspiration Scale


1. Material does not enter the airway

2. Material enters the airway, remains above the vocal folds, and is
ejected from the airway

3. Material enters the airway, remains above the vocal folds, and is not
ejected from the airway

4. Material enters the airway, contacts the vocal folds, and is ejected
from the airway

5. Material enters the airway, contacts the vocal folds, and is not
ejected from the airway

6. Material enters the airway, passes below the vocal folds, and is
ejected into the larynx or out of the airway

7. Material enters the airway, passes below the vocal folds, and is not
ejected from the trachea despite effort

Material enters the airway, passes below the vocal folds, and no effort
is made to eject Rosenbek, J. C., Robbins J., Roecker E. V., Coyle, J.
L., & Woods, J.
L. (1996). A Penetration-Aspiration Scale. Dysphagia, 11, 93-98, 1996.

Daniels et al applied it thus:

No Risk
1 Normal: No airway invasion.

2 Mild : Bolus enters into airway with clearing.

Risk of Aspiration 

3 Moderate: Bolus enters into airway without clearing.
4 Moderate Bolus: contacts vocal cords with airway clearing.
5 Moderate Bolus: contacts vocal cords without airway clearing.

Positive Aspiration

6 Severe :Bolus enters trachea and is cleared into larynx or out of
airway.
7 Severe: Bolus enters trachea and is not cleared despite attempts.
8 Severe: Bolus enters trachea and no attempt is made to clear.

I've never found it particularly useful.


Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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Dr I Campbell-Taylor
Clinical Neuroscientist
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www.interactivetherapy.com
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