Dysphagia Outcome Scales

In this current healthcare climate i've started to realise that i need to use more recognised/stardardised empirical measures and standardised outcome measures to proove the worth of my interventions. One area i feel i've neglected is dysphagia. I write detailed observations and goals but need a static scale or measure to clearly demonstrate change after intervention. I've chosen one impairment based scale and one functional scale. I've decided to try and incorporate the following scales into my practice:


The Dysphagia Outcome and Severity Scale , (DOSS) - a 7-point scale developed to systematically rate the functional severity of dysphagia based on objective assessment and make recommendations for diet level, independence level, and type of nutrition. (O'Neil, Purdy,Falk,Gallo,1999).

Level 7: Normal in all situations

Level 6: Within functional limits/ Modified idependance

Level 5: Mild Dysphagia:Distant supervision. May need one diet consistency restricted

Level 4: Mild Moderate Dysphagia .Intermittent supervision /cueing; One to two diet consistecies restricted

Level 3: Moderate Dysphagia. Total assisstence , supervision or strategies;2 or more diet cosistencies restricted

Level 2: Moderate Severe Dysphagia: Maximum assisstance or maximum use of strategies with partial PO only

Level 1:Severe Dysphagia: NPO: Unable to tolerate any PO safely (National Dysphagia Diet Task force,American Dietetic Association,2002)

The Functional Oral Intake Scale (FOIS)

Crary MA, Carnaby GD, Groger ME. (2005) Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Archive of physical medicine and rehabilitation. 86, 1516-20.

TUBE DEPENDENT (levels 1-3) 

1 No oral intake  

2 Tube dependent with minimal/inconsistent oral intake 

3 Tube supplements with consistent oral intake 

TOTAL ORAL INTAKE (levels 4-7) 

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