A complete swallow and aspiration-safety assessment addresses each of the following each visit for at-risk patients, and compares each finding to baseline.
Swallow screen — coughing or throat-clearing with intake, a wet or gurgly voice after swallowing, pocketing of food, multiple swallows per bolus, and prolonged meals.
Aspiration signs — coughing or choking with meals, post-meal shortness of breath, a wet voice, recurrent respiratory infections, or low-grade fevers after eating.
IDDSI adherence — whether the food and liquid textures being consumed match the ordered IDDSI level, and whether thickened liquids are prepared correctly.
Positioning and feeding technique — upright at ninety degrees, small bites and sips, pacing, and the caregiver’s technique.
Oral-phase sensation and control — the ability to sense and manage a bolus, and oral residue after swallowing.
Taste and smell change — its effect on appetite and intake (cross-reference Nutrition).
Cognition and alertness at meals — the level of alertness required to eat safely (cross-reference Cognitive).
The neurologic context — stroke, Parkinson disease, dementia, or other conditions driving neurogenic dysphagia (cross-reference Neurological).
The respiratory status as it bears on aspiration and its consequences (cross-reference Respiratory).
The speech-language-pathology plan and any recommended maneuvers or diet level.
