Bedside Assessment Protocol and Grading Scale for Dysphagia in Adults: A Preliminary Study

Abstract

Objectives: The present study aimed to construct a bedside assessment protocol and grading scale to assess and grade orophayngeal dysphagia in a heterogeneous sample of the patients. This study also aimed to determine the utility of the constructed assessment and grading scale in terms of reliability and validity. Materials and Methods: The Nair hospital bedside swallowing assessment (NHBSA) and Nair hospital swallowing ability scale (NHSAS) were constructed after reviewing pertinent literature. Fifty individuals with oropharyngeal dysphagia were assessed and graded using the constructed assessment and grading scale. Of the total sample, 10 individuals were subjected to a modified barium swallow (MBS) evaluation. Results: The NHBSA and NHSAS show high reliability and high face and content validity. Comparison with MBS revealed that the NHBSA appears to be promising in accurately identifying dysphagia and aspiration. Also, the NHBSA and MBS diagnosed the same phases of swallowing to be affected in eight out of ten patients. 'Wet-gurgly voice quality,' 'cough after/during swallow,' and 'weak/absent volitional cough' were the clinical indicators that appeared to correctly identify presence of aspiration risk. The NHSAS shows sensitivity to change in swallow function and oral intake overtime. Conclusion: The NHBSA appears to be a simple, quick, reliable and valid clinical assessment that can be used to assess the oropharyngeal dysphagia at the individual's bedside with minimal risk for discomfort or aspiration. Also, the NHSAS appears to be useful tool for clinically grading individuals with dysphagia into categories based on swallowing ability, and enables making recommendations.