Item
0 = no problem
4 = severe problem
1. I have lost weight due to my swallowing disorder.
0
1
2
3
4
2. I cannot eat out due to my swallowing disorder.
0
1
2
3
4
3. I exert too much effort swallowing while consuming liquid foods.
0
1
2
3
4
4. I exert too much effort swallowing while consuming solid foods.
0
1
2
3
4
5. I exert too much effort while taking pills.
0
1
2
3
4
6. I feel pain during swallowing.
0
1
2
3
4
7. My swallowing condition impacts the pleasure I take while eating.
0
1
2
3
4
8. Food gets held (stuck) in my throat while swallowing.
0
1
2
3
4
9. I cough while I eat.
0
1
2
3
4
10. Swallowing creates tension on me (swallowing stresses me out).
0
1
2
3
4
Functional Oral Intake Scale (FOIS)
The FOIS is an instrument utilized to document clinician recommendations for safe oral feeding based on instrumental findings and patient cofactors such as comorbidity, functional status, history of pneumonia and malnutrition, and individual accepted risk (Table 8.2) . It is a 7-item scale ranging from no oral intake to total oral intake with no restrictions. The scale is useful to quantify the level of dietary restrictions recommended to a patient. It can help assess the initial level of patient disability and monitor treatment efficacy. The main utility of the FOIS is that it is a primary endpoint of the comprehensive dysphagia workup. Its limitation is that it does not reflect the etiology and pathophysiology of the swallowing dysfunction. It is necessary to distinguish between the FOIS recommended by the clinician and the actual diet consumed by the patient .
Table 8.2
Functional Oral Intake Scale
Level | Description |
|---|---|
1 | No oral intake |
2 | Tube dependence with minimal/inconsistent oral intake |
3 | Tube supplements with consistent oral intake |
4 | Total oral intake of a single consistency |
5 | Total oral intake of multiple consistencies requiring special preparation |
6 | Total oral intake with no special preparation, but must avoid specific foods or liquid items |
7 | Total oral intake with no restrictions. |
Penetration Aspiration Scale (PAS)
In 1996, Rosenbeck and colleagues developed the PAS to assign a numerical score to the degree of penetration and aspiration witnessed during VFSS. This eight-point scale assesses depth of bolus passage into the airway and the patient’s response to the bolus (Table 8.3) . A score of 1 represents the absence of penetration and increasing scores reflect more severe dysfunction to a maximum score of 8 that identifies silent aspiration (Figs. 8.1–8.6) .
Table 8.3
Penetration aspiration scale
Score | Description |
|---|---|
1 | Material does not enter the airway |
2 | Material enters the airway, remains above the vocal folds, and is ejected from the airway (Fig. 8.1) |
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 (Fig. 8.2) |
5 | Material enters the airway, contacts the vocal folds, and is not ejected from the airway (Fig. 8.3) |
6 | Material enters the airway, passes below the vocal folds, and is ejected into the larynx or out of the airway (Fig. 8.4) |
7 | Material enters the airway, passes below the vocal folds, and is not ejected from the trachea despite effort (Fig. 8.5) |
8 | Material enters the airway, passes below the vocal folds, and no effort is made to eject (Fig. 8.6) |
Fig. 8.1
Lateral fluoroscopic view of (a) penetration (black arrow) just over arytenoid complex, remaining above vocal folds. The subject reflexively coughs (b) and expels the material from the laryngeal vestibule. This represents a PAS score of 2
Fig. 8.2
Lateral fluoroscopic view of (a) penetration (black arrow) to vocal folds (dotted black line). Following a reflexive cough (b), the material is completely ejected from the laryngeal vestibule. This represents a PAS score of 4
Fig. 8.3
Lateral fluoroscopic view demonstrating (a) penetration (black arrow) to level of vocal folds (black dotted line). An attempt is made at ejecting material (b) but contrast remains in laryngeal vestibule at level of vocal folds (black arrow). This represents a PAS score of 5
