| Variable | Clinician’s judgment |
---|---|---|
Water swallow test (5 ml) | Extra oral loss | Water does not escape from the lips, manages bolus adequately - pass |
Difficulty in managing bolus, presents drooling/spillage from the mouth - fail | ||
Oral transit time | Swallows the bolus within 4 seconds - pass | |
Takes longer than 4 seconds to swallow bolus or does not swallow - fail | ||
Nasal reflux | Water does not escape from the nasal cavities - pass | |
Water comes out from the nasal cavities - fail | ||
Multiple swallows per bolus | Presents one swallow per bolus - pass | |
Presents more than one swallow per bolus, presents drooling/spillage from the mouth, needs cues to complete the task - fail | ||
Laryngeal elevation (monitored by positioning the index and middle fingers over the hyoid bone and the thyroid cartilage) | Reaches an average elevation of two fingers of the examiner - pass | |
Does not present laryngeal elevation or presents average elevation of less than two fingers of the examiner - fail | ||
Cervical auscultation (a stethoscope is placed at the lateral aspects above the cricoids cartilage in front of the sternocleidomastoid muscle and large vessels) | Presents the three characteristic sounds indicating that the bolus has gone through the pharynx - two clicks followed by an expiratory sound - pass | |
Does not present any sound or sounds other than those described above - fail | ||
Oxygen saturation (baseline oxygen saturation registered prior to the swallowing test using a monitor or pulse oximetry) | Does not present changes in oxygen saturation in more than 4 units - pass | |
Presents changes in oxygen saturation in more than 4 units - fail | ||
Voice quality | Does not present any alterations within the first minute after swallowing - pass | |
Voice becomes gurgly (‘wet’) within the first minute after swallowing - fail | ||
Cough | Does not cough within the first minute after swallowing - pass | |
Presence of cough (voluntary or not) followed or not by throat clearing within the first minute after swallowing - fail | ||
Choking | Does not choke after swallowing - pass | |
Chokes during and/or after swallowing - fail | ||
Other signs (cardiac and respiratory frequencies) | Does not present significant changes in cardiac frequency (60–100 beats per minute) and in respiratory frequency (12–20 breaths per minute) - pass | |
Presents signs of cyanoses, bronchospasm and significant alterations of the vital signs - fail | ||
Puree/solid swallow test (3, 5, 10 ml; half a piece of bread) | Extra oral loss | Bolus does not escape from the lips, manages bolus adequately - pass |
Difficulty in managing the bolus, presents spillage from the mouth - fail | ||
Oral transit time | Swallows the bolus within 20 seconds - pass | |
Takes longer than 20 seconds to swallow the bolus or does not swallow - fail | ||
Nasal reflux | The bolus does not escape from the nasal cavities - pass | |
The bolus comes out from the nasal cavities - fail | ||
Oral residue | Presents absence or up to 25% of bolus residue in the oral cavity - pass | |
Presents more than 25% of bolus residue in the oral cavity - fail | ||
Multiple swallows per bolus | Presents one to three swallows per bolus - pass | |
Presents more than three swallows per bolus, presents drooling/spillage from the mouth, needs cues to complete task - fail | ||
Laryngeal elevation (monitored with the positioning of the index and middle fingers over the hyoid bone and the thyroid cartilage) | Reaches an average elevation of two fingers of the examiner - pass | |
Does not present laryngeal elevation or presents average elevation of less than two fingers of the examiner - fail | ||
Cervical auscultation (a stethoscope is placed at the lateral aspects above the cricoids cartilage in front of the sternocleidomastoid muscle and large vessels) | Presents the three characteristic sounds indicating that the bolus has gone through the pharynx - two clicks followed by an expiratory sound - pass | |
Does not present any sound or sounds other than those described above - fail | ||
Oxygen saturation (baseline oxygen saturation registered prior to the swallowing test using a monitor or pulse oximetry) | Does not present changes in oxygen saturation in more than 4 units - pass | |
Presents changes in oxygen saturation in more than 4 units - fail | ||
Voice quality | Does not present any alterations within the first minute after swallowing - pass | |
Voice becomes gurgly (‘wet’) within the first minute after swallowing - fail | ||
Cough | Does not cough within the first minute after swallowing - pass | |
Presence of cough (voluntary or not) followed or not by throat clearing within the first minute after swallowing - fail | ||
Choking | Does not choke after swallowing - pass | |
Chokes during and/or after swallowing - fail | ||
Other signs (cardiac and respiratory frequencies) | Does not present significant changes in cardiac frequency (60–100 beats per minute) and in respiratory frequency (12–20 breaths per minute) - pass | |
Presents signs of cyanoses, bronchospasm and significant alterations of the vital signs - fail |