The Dysphagia Toolbox
I’ve written about the Dysphagia Toolbox before. It used to be a website that offered links to standardized, reliable tools you could use in dysphagia assessment and reassessment.
Think of it as your go-to collection for assessing and treating dysphagia.
Why a “Toolbox”?
One thing I often wonder is why we call it a “toolbox.” Do most of you actually carry around a toolbox full of your must-have dysphagia assessment and treatment equipment?
Mine is usually jammed into my lab coat pockets or perched precariously on top of my clipboard, if I remember to bring that with me at all! Still, I can’t help but imagine SLPs running down hospital corridors with toolboxes in hand.
Dysphagia “Apron”?
Maybe calling it a dysphagia “apron” would be more accurate?
Recently, I even saw an SLP fanny pack, which, honestly, could work too.
Anyway… I digress.
Outcome Measures
There are several outcome measures freely available to add to your Dysphagia Toolbox.
Outcome measures should be taken at baseline (when therapy is initiated) and can be repeated at reassessment or discharge to document progress.
Some tools are self-rating assessments completed by the patient, while others are clinician-administered.
Self-Rating Assessments
- Eating Assessment Tool-10 (EAT-10) – 10 items where the patient rates their swallowing to determine the impact of dysphagia on daily function.
Research: Article 1, Article 2, Article 3
Pediatric EAT-10: Article 1, Article 2 - Sydney Swallow Questionnaire – 17 items rated from “rarely” to “always” on a visual scale.
Research: Article 1 - Dysphagia in Multiple Sclerosis (DYMUS) – 10 yes/no questions about swallowing. You can read more about the DYMUS here.
- Swallowing Disturbance Questionnaire – 15 items rated 0–3 for frequency of swallowing-related issues.
Research: Article 1 - Swallowing After Total Laryngectomy Questionnaire (SOAL) – Assists patients in rating swallowing after total laryngectomy.
- MD Anderson Dysphagia Inventory (MDADI) – Measures swallowing difficulty in head and neck cancer.
- Swal-QOL – Measures quality of life with dysphagia.
(Link to Scribd; free 30-day membership required for download) - Visual Analog Scale (VAS) – Patient marks a point on a 10-cm line; scored 0–100 mm. Higher score = greater difficulty.
Research: Article 1, Article 2, Article 3, Article 4 - PILL-5 Screening Questionnaire – 5 items on pill-swallowing difficulty.
- Oral Frailty 5 (OF-5) – Checklist for oral frailty in older adults (teeth, chewing, swallowing, xerostomia, articulatory skills).
- FACT-E (Functional Assessment of Cancer Therapy – Esophagus) – Quality of life for esophageal cancer.
- Dysphagia Symptom Questionnaire (DSQ) – Daily self-rating for eosinophilic esophagitis. Original version here.
Clinician-Administered Measures
- FOIS (Functional Oral Intake Scale) – Rates diet level 1–7. Also available as an app.
- ASHA NOMS – Similar to FOIS; requires training for use/reporting.
- MASA (Mann Assessment of Swallowing Ability) – Numeric score up to 200; severity ratings for dysphagia and aspiration.
Research: Article | Scoring Guidelines | Modified MASA - MASA-C – Cancer-specific version of MASA. There is a link to scoring guidelines as there is with the MASA (with severity ratings just scroll down towards the bottom of the page).
Research: Scoring Guidelines, Article 1, Article 2, ESSD Poster
- Yale Swallow Protocol – Screening tool for need of further dysphagia evaluation. More here.
- Dysphagia Screening Questionnaire – Post-stroke screening tool.
- Reflux Symptom Index – 9-item scale to help identify possible reflux-related swallowing issues.
- Volume Viscosity Swallow Test (V-VST) – Screens for impaired swallowing during a CSE.
Research: Article 1, Article 2, Article 3 - Gugging Swallowing Screen – Uses liquids, solids, and semi-solids; rates severity and guides diet modification.
Research: Article 1 - NorthWestern Dysphagia Patient Check Sheet – Screening tool.
Research: Article - Massey Bedside Swallowing Screen – Includes 1 sip + 60 cc water; supported by research.
- TOR-BSST (Toronto Bedside Swallowing Screening Test) – Stroke-specific dysphagia screen; training required. Article, Training link
- Metro Health Dysphagia Screen – (Can be found in article link) ER-based, stroke-specific; 5 questions, pass/fail.
- GUSS ICU – (Protocol can be found in article link.) Post-extubation screening.
- Barnes Jewish Hospital Stroke Dysphagia Screen – 5-item pass/fail; failed screen = NPO and speech consult.
- Oral Health Assessment Tool (OHAT) – Oral cavity assessment.
Research: Article 1, Article 2 | - PSS-HN (Performance Status Scale for Head & Neck Cancer) – Interview format for diet/eating out.
Research: Article 1, Article 2, Article 3 - Burke Dysphagia Screen – Pass/fail; any single failed item = fail.
Research: Article 1, Article 2 - Dysphagia Screening Tool – For trained physicians/nurses; includes instructions.
- BOHSE (Kayser-Jones Brief Oral Health Status Examination) – Oral health protocol/instructions.
- TOMASS (Test of Masticating and Swallowing Solids) – Quantitative measure of solid bolus ingestion.
Research: Article 1, Article 2, Peds Article - Xerostomia Questionnaire – For patients with head and neck cancer. Research here
- MDASI-HN (MD Anderson Symptom Inventory – Head & Neck) – Predicts mucositis. Buy here, Sample Tool
Research: Article 1, Article 2, Poster, Article 3 - Dysphagia Stress Test (Rapid Assessment for Esophageal Conditions) – Assesses swallowing of various textures/liquids for difficulty and pain.
- FILS (Food Intake LEVEL Scale) – Similar to FOIS. Article here
Residue & Imaging Scales (MBSS/VFSS/FEES)
- Normalized Residue Ratio Scale – Quantifies vallecular/pyriform residue.
Research: Article 1, Article 2 - ASPEKT Method – Detailed MBSS/VFSS physiology/kinematics analysis. Worksheet | Score Sheet | Step-by-Step Instructions | TIMS
Lab website | Reference tables | Handouts/Scoring Tools1 - Yale Pharyngeal Residue Severity Rating Scale – Measures residue during FEES. Tool with pictures available here. Book available.
Research: Article 1, Article 2 - Murray Secretion Scale – Rates secretion severity during FEES.
Research: Article - Penetration-Aspiration Scale – Quantifies penetration/aspiration depth and clearance.
- MBSImP (Modified Barium Swallow Impairment Profile) – Standardized MBSS scoring; training required. My experience here
- Boston Residue and Clearance Scale – FEES residue rating across 3 regions.
Research: Article 1, Article 2, Article 3, Article 4, Article 5 - DIGEST (Dynamic Imaging Grade of Swallowing Toxicity) – MBSS/VFSS grading for oncology trials.
Research: Article 1, Article 2, Article 3, Article 4
Looking for Reviews?
- Systematic Review of Current Clinical and Instrumental Swallowing Assessment Methods
- Review of Evidence-Based Nursing Protocols for Dysphagia Assessment
Final Thoughts
This list only makes a small dent in the outcome measures available to us. Always look for tools that are valid and reliable, not all measures meet the same standard.
Research links and downloadable forms are provided where possible so you can review each tool and decide whether it fits your clinical needs.
Remember: all current assessments are essentially a series of screeners.
Outcome measures let us clearly state where the patient started and where they finished, essential for both clinical accuracy and Medicare documentation.
Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!
Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation? Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care? You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes. You can get your copy here.
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