[Dysphagia] Mild, moderate etc

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

Actually - the ASHA NOMS is not based on, nor does it require, a VFSS.
It can be used based on clinical assessment without a VFSS.  In the same
way, the SWAL-QOL questions can help you better assess pt's perspective
without necessarily a videoswallow.  Such subjective, self-rated
questions include "I fear I may start choking when I eat food" or "My
swallowing problem frustrates me."  Again, this helps to better
understand the pt (or family member's) perspective of the problem. 

Other measures that are not based on VFSS would include RIC's Functional
Assessment Scale item 'Chewing/Swallowing.'  It is another 1-7 scale
from 'Normal' to 'Severe Impairment.'  Per the scale it states it is
adapted from Chenny et al.'s Clinical Evaluation of Dysphagia, 1986.  

Another option would be using the ICF system: CHAPTER 5 FUNCTIONS OF THE
DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS: Functions related to the
digestive system (b510-b539); b510 Ingestion functions and using the
qualifiers set up by the ICF.

My understanding of the original post was questions on classifying mild,
moderate, severe dysphagia.  My intent was not to get into the validity
of the VFSS, but rather provide some options for classifications.  

Thanks.

Tom S 

-----Original Message-----
From: Irene Campbell-Taylor [mailto:eripley at yahoo.com] 
Sent: Sunday, March 04, 2007 7:59 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
Exclusive Distributor:
www.interactivetherapy.com
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