I’ll be honest and say that until 2016 or 2017, I wasn’t regularly using standardized tools for swallowing. The budget never covers the wish list, and I just wasn’t aware of these free swallow assessment tools.
As with my earlier post linking to free cognitive assessment tools, I’ve done my best to ensure that I’m not violating copyright law. I’ve also taken care to credit authors and provide links to published articles or other sources.
Free DIRECT download: 9 free swallow assessment tools (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- Patient questionnaires.
- Rating scales completed by the clinician.
- Assessment of oral mechanism.
- Direct assessment of swallowing.
- Related Eat, Speak, & Think posts.
- Share this list of free swallow assessment tools.
Patient questionnaires
The Eating Assessment Tool (EAT-10) was developed by Peter C. Belafsky, MD, PhD, and colleagues and published in the Annals of Otology, Rhinology, & Laryngology in 2008. Adults rate their own experience of ten different possible swallowing problems. You can consider a score of 3 or higher abnormal. The EAT-10 is a valid outcome measure for dysphagia therapy. The National Foundation of Swallowing Disorders has provided an online version.
The M.D. Anderson Dysphagia Index (MDADI) is a valid, reliable questionnaire for people with head and neck cancer. Amy Chen, MD, MPH and colleagues developed this quality of life measurement tool, which was published in 2001. The 20-question tool may be used to show change over time. I included scoring information and a word about interpretation based on my reading of the research.
Rating scales completed by the clinician
The Functional Oral Intake Scale (FOIS) was originally developed for stroke patients. Michael A. Crary, PhD, and colleagues published it in the Archives of Physical Medicine and Rehabilitation in 2005. The FOIS is a valid tool to measure changes in swallowing ability over time.
The Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) is a reliable quality of life assessment tool. Marcy A. List, Ph.D., and colleagues published it in 1990 and
Assessment of oral mechanism
The Kayser-Jones Brief Oral Health Status Examination (BOHSE) is a valid, reliable assessment tool developed for nurses to be used with adults in nursing homes, hospitals, and the community. Jeanie Kayser-Jones and colleagues published this tool in 1996. This PDF was published by The Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing and is used with permission. See their website for other tools in their Try This: ®Series.
The Oral Health Assessment Tool (OHAT) is also known as the Modified BOHSE, which was shared above. J. Chalmers and colleagues simplified the BOHSE into a screening tool that can be administered by “a range of residential care staff from Registered Nurses to Personal Care Attendants” (p. 192). You can sign up for a free account at the University of Iowa’s Geriatric Education Center to access step-by-step training with pictures(!) and practice scoring. You can also download a free PDF of the tool with additional resources.
Direct assessment of swallowing
The Gugging Swallowing Screen (GUSS) was developed by Michaela Trapl, Ph.D. (an SLP!) and her colleagues in 2007. The GUSS is designed for stroke nurses and therapists to assess patients with acute stroke and was validated with FEES assessment. This screening tool includes assessing awareness, coughing ability, saliva management, and trials of liquids and solids. The instructions are available in a free PDF download on Guss Group International’s website. If you read through the manual, you’ll see that it is a limited standardized bedside swallow exam. The team is modifying the GUSS to be applied to assessment of post-extubation assessment. The PDF of the GUSS is shared here with permission from Michaela Trapl. You can follow her group on Twitter (NeuroGUSS_DUK) to learn about updates.
The Test of Masticating and Swallowing Solids (TOMASS) is a standardized, normed test focused on the oral phase of swallowing. Maggie-Lee Huckabee and colleagues published the TOMASS with normed data for adults aged 20-80 years in the International Journal of Language and Communication Disorders in January 2018.
The Yale Swallow Protocol, or 3-ounce water test, is a reliable, validated screening tool for adults and children. This protocol was developed by Steven B. Leder, PhD, CCC-SLP and Debra M. Suiter, PhD, CCC-SLP and has been extensively researched and written about. The screening tool may be used in any setting. The PDF is included with permission from John R. Ashford, PhD, SA Swallowing Services, PLLC.
Related Eat, Speak, & Think posts
- Single-use swallow evaluation folders.
- 10 factors that increase risk of aspiration pneumonia.
- Take the guesswork out of thickening liquids with the IDDSI flow test.
- A practical guide to pureed food at home.
Share this list of free swallow assessment tools
Please share this list of resources with other SLPs you know. If you know of other free swallow assessment tools, please share in the comments.
Free DIRECT download: 9 free swallow assessment tools (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Featured image by rawpixel on Unsplash.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
You can also search for the “Reflux Symptom Index” for another free patient rating scale.
So informative website 👌
Thank you!!
Mam/sir, I am M. Sc. Nursing student. I like to do swallowing assessment test for CVA patients with Dysphagia. So kindly give permission to use GUSS scale
Abisha,
I don’t have any affiliation with the group that created the GUSS.
However, I don’t believe you need their permission to use it. Here’s a video from their website, specifically for nurses: https://youtu.be/luck9Rs4hes
Thank you mam
Is there a severity rating for the TOMASS?? Also, why is there an exception/allowance for thickened liquids “per precautions” but not for purees?? Is there any assessment that allows for rating dependent on/allowing for admission diet texture order? It is extremely rare that I feel comfortable giving a pt solids day 1 at eval who has a puree order.
If by “severity rating” you mean min/mod/severe impairment, then I don’t believe so. The paper I linked to above involves healthy adults.
I’m not sure where you’re seeing the part about allowance for thickened liquids “per percautions”, but that sounds like an excellent question to ask the corresponding author, Maggie-Lee Huckabee. Her email address is on the bottom of the first page of the paper linked above, which is freely available.
It sounds like you work in a hospital? As I work in home health, I’m not in a situation where I’m upgrading a patient from puree to solids in the context of acute illness. (And I almost always get instrumental data first.) You may want to ask a hospital-based SLP or a dysphagia specialist that question. You may find Theresa Richards (Swallow Your Pride podcast) or Tiffani Wallace (Dysphagia Ramblings blog) or Dr. Ianessa Humbert (Down the Hatch podcast) helpful.
Hi, I might be going a little bit away from the topic, but are there any scales that are available to rate the functioning of articulators involved in the oral phase of the swallow. For example
: scales to assess jaw opening, or scales to assess lip closure
Hi Yaalini,
Great questions! As for jaw opening, CranioRehab lists the Maximum Intercisal Opening/Distance or Range of Motion for normal, mild trismus, moderate trismus, and severe trismus: https://www.craniorehab.com/human-jaw-structure-function-opening.html
As for lip closure, a device such as the IOPI can measure lip strength: https://iopimedical.com/normal-values/
I need help in developing an assessment protocol of dysphagia targeting both adults and children as my assignment.
Hi Khalipha,
That sounds like an ambitious project! Do you mean that your assignment is to design the flow of assessment activities, such as taking a history, assessing the oral mechanism, and providing food and liquid trials?
If so, you may find this page on ASHA’s website helpful: https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/#collapse_5
ASHA also has a free swallow evaluation template that you can download if you search “ASHA Clinical Swallowing Evaluation”.
I hope that helps!
Lisa
HI ma’am I am a MSc nursing student i need the EAT 10 TOOL for the assessment of dysphagia among Head and neck cancer patients. so please give me permission to use tool or related information
Hi, I’m simply sharing what is already available online. I don’t own the copyright or anything like that.
Hi madam,
We are planning to conduct a research programme on swallowing difficulty in head and neck cancer patients undergoing radiation therapy. We plan to use the GUSS tool for the study but we don’t know to get the copyright consent. Please help us on this ma’am.
Hi Anupama,
I don’t have any affiliation with the group that created the GUSS.
However, I don’t believe you need their permission to use it. Here’s a video from their website, specifically for nurses: https://youtu.be/luck9Rs4hes
Thankyou for your concern. 🙂
I personally think I have a swallowing problem but because I am an otherwise healthy & functioning adult, my providers don’t take me seriously. My issues are 2 The first is that certain hard foods, especially raw carrots, get caught up the back of my throat & can sometimes go into my nose to the point that I won’t eat them. My other issue is that I regularly have issues swallowing thin liquids all on the left side. Fortunately, I still have a strong cough altho it sometimes can be exhausting & other times have alarmed my witnesses. I have come to the point that if I cough when I have a companion, I make a joke about being my age & not yet learning the difference between swallowing & breathing.
This always feels like it is on my left side and that is also where I have had cleft lip[ & palate repairs. I wonder if the nerve innervation has been compromised by the deformity. My question is: besides reducing the embarassment, is there anything I can do to improve function on that side before I do have a stroke & end up with a double whammy?
Hi, thank you for your question. I would suggest that you ask your doctor for a referral to a speech-language pathologist to have an assessment done. I think it is likely that they’ll be able to provide at least some help. I’m sorry I can’t offer specific suggestions as I can’t offer treatment advice directly to specific people online.
Good luck,
Lisa
Hey, could you give share inputs on free assessment tools for children with feeding difficulties? Especially to assess their chewing. I would really appreciate that!
Hi SAK,
Thanks so much for your request. Unfortunately, I don’t work with children, so I don’t know what’s available.
But perhaps another reader would like to respond to your comment with recommendations?
Lisa
Hi, I’ve been looking to gain permission to include FOIS (Crary et al 2005) in our new electronic documentation for FEES and VF recording… I’ve been unable to find somewhere to request this permission but see you have included it in this list of free resources. Would be really grateful if you could confirm that permission is not required (and the source of this information if possible!)
Huge thanks : )
According to eProvide by the Mapi Research Trust, the FOIS is “free access – please cite the initial publication in any work” – scroll down to Conditions of Use. It also lists contact information in case you have further questions.
https://eprovide.mapi-trust.org/instruments/functional-oral-intake-scale
My apologies for the delayed response. I just saw your comment now.