Table 1 shows the psychometric tool and diagnostic instruments for dietary and swallowing issues

Oropharyngeal Dysphagia Scale (ODS)

Clinical Assessment

ODS is a psychometric measure developed primarily to assess the severity of oropharyngeal dysphagia in people who have difficulty swallowing. It has ten items, each addressing a distinct component of swallowing function, such as bolus management, aspiration risk, pharyngeal residue, and swallowing start. Each issue is rated on a scale of 0 to 3, with higher scores indicating more dysfunction [32]

Eating and Drinking Ability Classification System (EDACS)

Clinical Assessment

The EDACS evaluates the functional capacity to eat and drink in people with CP. It has five levels, with Level I signifying complete independence and Level V requiring full help. This measure assesses overall swallowing safety and efficiency, taking into account motor control, posture, and food texture adjustments to facilitate safe and effective intake [33]

Feeding Swallowing Impact Survey (FSIS)

Clinical Assessment

The FSIS is a 33-item scale that assesses the impact of feeding and swallowing issues on the quality of life for children and caregivers. It addresses issues such as physical pain, emotional effects, and social elements of eating. Responses are assessed on a 5-point Likert scale, making it an effective tool for examining the larger implications of feeding concerns [34]

Clinical Dysphagia Scale (CDS)

Clinical Assessment

The CDS is an 8-item scale that assesses the severity of dysphagia using clinical observations during swallowing. It evaluates characteristics including cough, voice alteration, and oral and pharyngeal residue. Each question is rated on a scale of 0 to 4, allowing doctors to assess the severity of dysphagia and guide treatment planning [35]

Penetration-Aspiration Scale (PAS)

Instrumental Assessment

The PAS is an 8-point scale that assesses the severity of debris entering the airway when swallowing. The scores range from 1 (no penetration or aspiration) to 8 (silent aspiration) and serve as a measure of swallowing safety. This scale is commonly used in videofluoroscopic swallowing investigations to evaluate the risk of aspiration-related problems [36]

Functional Oral Intake Scale (FOIS)

Clinical Assessment

The FOIS determines the level of oral intake in people with swallowing difficulties. It has seven levels, ranging from no oral consumption (Level 1) to entire oral intake without limits (Level 7). The FOIS is very beneficial for tracking patient improvement and assessing the need for dietary changes [37,38,39]

Videofluoroscopic Swallowing Studies (VFSS)

Instrumental Assessment

VFSS is a tool for visualizing the swallowing process using X-rays. It assesses all stages of swallowing and detects anomalies such as aspiration or residue in various food and beverage consistencies. VFSS is crucial for identifying dysphagia and creating personalized treatment programs [40,41,42,43]

Videofluoroscopic Dysphagia Scale (VDS)

Instrumental Assessment

The VDS is a 14-item scale used to measure the severity of dysphagia using videofluoroscopic images. Each question assesses a specific element, such as pharyngeal transit time and aspiration, with scores reflecting overall swallowing performance. This scale helps to track progress and guide dysphagia therapy [44, 45]

Dysphagia Management Staging Scale (DMSS)

Clinical Assessment

The DMSS divides dysphagia management requirements into phases to help guide therapeutic actions. It assesses elements such as feeding assistance and nutrition modification, ranging from independent (Stage 1) to entirely reliant on specialist intervention (Stage 5). This scale helps doctors design suitable dysphagia management techniques [46]

Swallow Function Scales (SFS)

Clinical Assessment

The SFS is a series of measures used to evaluate functional elements of swallowing, such as bolus control and airway protection. Items are rated on a scale of 0 to 4, with higher scores indicating more disability. The SFS offers a formal framework for evaluating and monitoring swallowing function throughout time [47]

Food Intake Level Scale (FILS)

Clinical Assessment

The FILS is a 10-point scale for measuring oral meal intake in people with swallowing difficulties. Levels range from no oral intake (Level 1) to complete consumption of a typical diet (Level 10). The FILS is useful for assessing food limitations and tracking changes in swallowing function [48]

Fibreoptic Endoscopic Evaluation of Swallowing (FEES)

Instrumental Assessment

The FEES utilizes a flexible fiberoptic endoscope to directly observe the swallowing process, and is commonly used for diagnosis. It offers thorough information on the anatomy and physiology of the pharyngeal swallowing phase, aiding clinicians in detecting problems like aspiration, penetration, and residue. This approach is especially successful in assessing individuals with neurological conditions, structural irregularities, or unclear swallowing issues. FEES is a low-impact procedure, radiation-free, and enables multiple real-time evaluations [49]

Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST)

Instrumental Assessment

It is a diagnostic procedure used to assess swallowing function and laryngeal sensory function. A thin, flexible endoscope is passed through the nose to visualize the pharynx and larynx during swallowing. In addition to observing the swallowing mechanism, FEESST involves delivering air pulses to the aryepiglottic folds to test the laryngeal adductor reflex, providing information about sensory function in the larynx. This helps identify sensory deficits that may contribute to swallowing difficulties [49]

Pediatric Dysphagia Risk Screening Instrument (PDRSI)

Clinical Assessment

The PDRSI is a handy screening tool created to identify initial signs of dysphagia in children's groups. It evaluates various factors such as eating habits, physical symptoms (such as coughing, choking), and past illnesses to pinpoint children who could be in danger. Healthcare professionals can easily use the device in clinical or educational environments due to its user-friendly interface. The PDRSI enables timely referrals for more thorough evaluations or interventions by detecting issues early [50]

Pediatric version of the Eating Assessment Tool-10 (PEDI-EAT-10)

Clinical Assessment

The PEDI-EAT-10 questionnaire is a validated tool designed for children, based on the adult Eating Assessment Tool. Caregivers complete it to evaluate how often and how severe children have swallowing and feeding issues. The tool consists of ten items that address problems like rejecting food, trouble swallowing, and extended feeding durations. It’s simple structure makes it a dependable tool for tracking symptoms longitudinally and informing medical judgments. The PEDI-EAT-10 is especially beneficial for recognizing kids with functional or neurological feeding issues [51]

Behavioral Assessment Scale of Oral Functions in Feeding (BASOFF)

Clinical Assessment

The BASOFF is a comprehensive evaluation instrument made to assess oral motor abilities and feeding habits in children facing feeding problems. It offers a organized system for evaluating important elements of oral functions such as chewing, swallowing, and coordinating oral movements. The tool is especially useful for detecting developmental delays or neurological issues that impact feeding. Its thorough scoring system enables clinicians to identify particular areas of dysfunction and monitor improvement as time goes on [52]

Signaleringslijst Verslikke (SV)

Clinical Assessment

The SV is a screening tool from the Netherlands that is made to identify people who may be at risk of aspiration while swallowing. It assesses visible signs like coughing, choking, and voice alterations post-swallowing, along with clinical indications of complications related to aspiration. The tool is especially beneficial for individuals with neurological conditions like CP, stroke or Parkinson’s disease, as well as in older patients. By pinpointing individuals at high risk, the SV enables prompt referrals for advanced diagnostic tests like FEES or videofluoroscopy. It also assists in creating customized management plans to avoid aspiration pneumonia [53]

Choking Risk Assessment (CRA) [54]

Clinical Assessment

The CRA is a specific instrument employed to assess the likelihood of choking while eating, specifically in people who have issues with swallowing. Factors such as food texture, swallowing mechanics, and the feeding environment are considered. The CRA plays a crucial role in recognizing individuals with a high risk, like those with neurological disorders, developmental delays, or structural abnormalities in the upper airway. The tool helps to identify possible choking risks, enabling the creation of safety measures for meals, like changing food textures or using particular feeding methods. Using it can greatly decrease the chances of dangerous choking situations, leading to improved safety for patients [54]

Nutrition and Swallow Checklist (NSC) [55]

Clinical Assessment

The NSC is a thorough assessment tool created to evaluate the nutritional status and swallowing function of people of all ages. It assesses various factors such as involuntary weight loss, indicators of difficulty swallowing, and food consumption. The checklist is easy to use, making it perfect for both clinical and home settings. The NSC helps by detecting people who are vulnerable to malnutrition or dehydration, allowing for early actions like adjusting diets or receiving swallowing treatments [55]

Screening Tool of Feeding Problems Scale (STEP) [56]

Clinical Assessment

The STEP is a reliable tool created to pinpoint feeding challenges in children, especially those with developmental disabilities or medical issues. It evaluates feeding habits, ability to use mouth muscles, and parent worries with a thorough survey. The STEP offers helpful information on the root causes of feeding issues, like sensory aversions or motor difficulties, which helps clinicians create specific interventions [56]

Dysphagia Disorders Survey (DDS)

Clinical Assessment

It evaluates various stages of swallowing, from the oral phase (tongue and lip movements) to the pharyngeal phase (bolus passage through the pharynx) and finally the esophageal phase (bolus passage through the esophagus). The DDS can involve direct observation, reflex testing, and the administration of foods and liquids of different consistencies to observe the patient's response. It is a valuable tool for pinpointing the location and severity of the swallowing disorder. It's important to note that while used with adults, modified versions may exist or components may be adapted for pediatric use [57]

Parent-reported Feeding and Swallowing Questionnaire (FSQ)

Clinical Assessment

This questionnaire relies on the observations of parents or caregivers, who are key figures in a child's feeding. Questions may cover the frequency of coughing or choking during meals, difficulty chewing or swallowing foods of certain textures, meal duration, the presence of regurgitation or vomiting, and the child's attitude towards food. The FSQ provides valuable insights into the child's eating behavior in their natural environment [58]

Dysphagia Risk Assessment Protocol (PARD)

Clinical Assessment

The PARD is not a diagnostic test but a screening tool to identify individuals at risk of developing dysphagia. This protocol considers factors such as age, the presence of neurological diseases (CP, stroke, Parkinson's, etc.), head or neck surgeries, prolonged intubation, and other medical conditions that may predispose someone to dysphagia. Early identification of risk allows for timely preventive or diagnostic interventions [59]

Volume Viscosity Swallowing Test (V-VST)

Clinical Assessment

This test focuses on assessing the patient's ability to manage different volumes and consistencies of food and liquids. The patient is offered small amounts of liquids (e.g., 5 ml) and then larger amounts (e.g., 10 ml, 20 ml) of varying viscosities (water, nectar, honey, pudding). The clinician observes for coughing, wet voice, difficulty managing the bolus, and other signs of swallowing difficulty. The V-VST helps determine the safest diet for the patient [60]

Functional Dysphagia Scale (FDS)

Instrumental Assessment

This scale evaluates the impact of dysphagia on the patient's daily life. It considers the ability to eat independently, the need for assistance during meals, the presence of complications such as aspiration pneumonia, and the patient's quality of life. The FDS is useful for monitoring patient progress during rehabilitation [61]

Oral Hygiene Index Simplified (OHIS)

Clinical Assessment

While not specifically a dysphagia test, the OHIS is important in the context of dysphagia management. Poor oral hygiene increases the risk of lung infections, particularly aspiration pneumonia, which is a serious complication of dysphagia. The OHIS assesses the amount of plaque and tartar present on the teeth, providing an indication of the patient's oral hygiene level [62]

Nordic Orofacial Test-Screening (NOT-S)

Clinical Assessment

This is a quick and easy-to-administer screening tool designed to identify potential orofacial dysfunction in individuals of all ages, though it's particularly useful in pediatric populations. It assesses various aspects of oromotor function, including lip closure, tongue mobility and strength, jaw movements, and facial sensitivity. The NOT-S provides a standardized method for observing and scoring these functions, allowing clinicians to quickly identify individuals who may require further, more in-depth assessment of their feeding and swallowing abilities [63]

Multichannel intraluminal impedance (MII)

Instrumental Assessment

is a technique used to evaluate esophageal function by measuring changes in electrical impedance within the esophagus. These changes reflect the passage of a bolus (food or liquid) through the esophagus. Unlike pH monitoring, which only detects acid reflux, MII can detect all types of refluxes, including non-acid reflux (e.g., liquid or gas). This is particularly important for individuals with dysphagia who may experience reflux of non-acidic contents that can irritate the esophagus and contribute to swallowing problems. MII is often used in conjunction with esophageal manometry (a test that measures esophageal muscle contractions) and pH monitoring to provide a comprehensive assessment of esophageal function [64]

Viking Speech Scale (VSS)

Clinical Assessment

It is a valuable tool for assessing speech production, particularly in individuals with dysarthria (motor speech disorders). Dysarthria can often co-occur with dysphagia because both conditions involve impairments in the muscles used for speech and swallowing. The VSS evaluates various aspects of speech, including articulation (the clarity of speech sounds), phonation (voice production), resonance (the quality of the voice), and prosody (the rhythm and intonation of speech). By assessing these speech components, clinicians can gain insights into the individual's oral motor control and coordination, which can be relevant to swallowing function [65]

Ultrasound Imaging of Swallowing (SWUS)

Instrumental Assessment

SWUS is a non-invasive and radiation-free imaging technique that uses high-frequency sound waves to create real-time images of the oral phase of swallowing. It allows clinicians to visualize tongue movements, hyoid bone excursion (the movement of a bone in the neck that is important for swallowing), and bolus formation and transport. SWUS is particularly useful for assessing oral motor dysfunction and can be used to provide biofeedback during therapy. However, it has limitations in visualizing the pharyngeal and esophageal phases of swallowing, as these structures are obscured by bone and air [66]

Cervical Auscultation (CA)

Clinical Assessment

It is a simple and inexpensive method of assessing swallowing by listening to the sounds produced during swallowing using a stethoscope placed on the neck. Clinicians listen for specific sounds, such as the timing of the swallow, the presence of wet or gurgly sounds (which may indicate aspiration), and the presence of stridor (a high-pitched whistling sound that may indicate airway obstruction). While CA can provide some clues about swallowing function, it is a subjective method and has limitations in its accuracy and reliability. It should not be used as a standalone diagnostic tool but rather as a component of a comprehensive swallowing assessment [67]