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    DOSS

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    Kathie-Lee Petsch

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    DOSS

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    Kathie-Lee Petsch
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    1K views1 page

    DOSS

    Uploaded by

    Kathie-Lee Petsch

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    Dysphagia outcome and severity scale—DOSS

    Level 7: Normal in all situations


    ▪ Normal diet
    ▪ No strategies or extra time needed
    Level 6: Within functional limits/modified independence
    ▪ Normal diet, functional swallow
    ▪ Patient may have mild oral or pharyngeal delay, retention or trace epiglottal undercoating but
    independently and spontaneously
    ▪ compensates/clears
    ▪ May need extra time for meal
    ▪ Have no aspiration or penetration across consistencies
    ▪ Full P.O: Modified diet and/or independence
    Level 5: Mild dysphagia: Distant supervision, may need one diet consistency restricted
    ▪ Aspiration of thin liquids only but with strong reflexive cough to clear completely
    ▪ Airway penetration midway to cords with one or more consistency or to cords with one consistency but
    clears spontaneously
    ▪ Retention in pharynx that is cleared spontaneously
    ▪ Mild oral dysphagia with reduced mastication and/or oral retention that is cleared spontaneously
    Level 4: Mild–moderate dysphagia: Intermittent supervision/cueing, one or two consistencies restricted
    May exhibit one or more of the following
    ▪ Retention in pharynx cleared with cue
    ▪ Retention in the oral cavity that is cleared with cue
    ▪ Aspiration with one consistency, with weak or no reflexive cough
    ▪ Or airway penetration to the level of the vocal cords with cough with two consistencies
    ▪ Or airway penetration to the level of the vocal cords without caught with one consistency
    Level 3: Moderate dysphagia: Total assist, supervision, or strategies, two or more diet consistencies
    restricted
    ▪ Moderate retention in pharynx, cleared with cue
    ▪ Moderate retention in oral cavity, cleared with cue
    ▪ Airway penetration to the level of the vocal cords without cough with two or more consistencies
    ▪ Or aspiration with two consistencies, with weak or no reflexive cough
    ▪ Or aspiration with one consistency, no cough and airway penetration to cords with one, no cough
    ▪ Nonoral nutrition necessary
    Level 2: Moderately severe dysphagia: Maximum assistance or use of strategies with partial P.O. only
    (tolerates at least one consistency safely with total use of strategies)
    ▪ May exhibit one or more of the following
    ▪ Severe retention in pharynx, unable to clear or needs multiple cues
    ▪ Severe oral stage bolus loss or retention, unable to clear or needs multiple cues
    ▪ Aspiration with two or more consistencies, no reflexive cough, weak volitional cough
    ▪ Or aspiration with one or more consistency, no cough and airway penetration to cords with one or more
    consistency, no cough
    Level 1: Severe dysphagia: NPO: Unable to tolerate any P.O. safely
    ▪ Severe retention in pharynx, unable to clear
    ▪ Severe oral stage bolus loss or retention, unable to clear
    ▪ Silent aspiration with two or more consistencies, nonfunctional volitional cough
    ▪ Or unable to achieve swallow

    Karen H. O’Neil, Mary Purdy, Janice Falk, & Lanelle Gallo. (1999). The Dysphagia Outcome and Severity Scale.

    DOI: 10.1007/PL00009595 · Source: PubMed

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