The+Dysphagia+Outcome+and+Severity+Scale

= The Dysphagia Outcome and Severity Scale = = = The Dysphagia Outcome and Severity Scale, (DOSS), is a simple, easy-to-use, 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. Intra- and interjudge reliabilities of the DOSS was established by four clinicians on 135 consecutive patients who underwent a modified barium swallow procedure at a large teaching hospital,( O'Neil,, Purdy,Falk,Gallo,1999).

The Dysphagia outcome and severity Scale (all capitalised?) (check below spacing and spelling again)

 * 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) ||

Below is a table that shows the National Dysphagia Diet levels that are recommeded at each level of the Dysphagia Outcome and Severity Scale. This table is taken from "NDD. Standardisation for Optimal Care, (2002).

This table was compiled from interviews undertaken by the NDD task force with fifty Speech and Language Pathologists who had experience in the field of dysphagia at an experienced or intermediate level, (National Dysphagia Task Force, 2002).
 * DOSS levels || 1 || 2 || 3 || 4 || 5 || 6 || 7 ||
 * Recommended NDD Diet Levels || 1 || 1&2 || 2&3 || 3&4 ||  || 4 || 4 ||

Important Note
Again as previously stated, it is not realistic to assume that a severity scale will automatically match up with a particular diet. Every patient is different and every patient with dysphagia will present with their own unique difficulties in the swallowing mechanism. In our case our patient has had a partial glossectomy and is currently undergoing radiotherapy. Unfortunatly for the SLT you cannot match up a severity rating with a particular diet to solve a swallowing problems that may occur within this patient population. The National Dysphagia diet and its tips about food textures and modifications, and severity rating scales, (the DOSS included) are just supplementary tools for the clinican. The SLT should only base these tools in adjunct to his/her own clinical judgement, experience and a comprehensive clinical and instrumental assessment. As an extra bit of information the followng link is to a Dysphagia cookbook on the amazon website, "Dysphagia Cookbook, (Achilles,E.,2004), filled with delicious, nutricious and varied redipes for those who have to have a modified diet. []#_