In this article, you’ll find step-by-step instructions for how to trial liquids and solids during a Clinical Bedside Swallowing Assessment—plus a free PDF!

Handouts, Worksheets, Treatment Guides, Goal Banks, Assessment Templates, Documentation Guides, and much more!

Dysphagia Series:

• Swallowing Exercises and Strategies
• Oral Mechnism Examination
• How to Palpate a Swallow
• Swallowing Examination Recommendations

First Things First

Evaluating and treating dysphagia require high levels of training and skill.

This article is intended for Speech-Language Pathologists or other qualified therapists with the appropriate training and competency to work with adults with dysphagia.

* If at any time you suspect any pharyngeal or esophageal involvement, contact the patient’s Primary Care Provider (PCP) and request an instrumental evaluation as soon as possible.

Liquid and Solid Trials

Review these instructions before completing the Clinical Bedside Swallowing Evaluation. Consider printing them out or otherwise having them handy during your evaluation.

If the patient is NPO, refer to the instrumental evaluation report prior to PO trials.

Liquid Trials

• Begin with patient’s current liquid consistency.
  
  
• Start small and gradually provide larger boluses.
  • Teaspoon
  • Tablespoon
  • Regulated straw sips
  • Cup sips
  • Consecutive cup sips
    
    
• Observe the following:
  • Labial closure while liquid is in mouth
  • Hyolaryngeal speed and elevation
  • Signs and symptons of dysphagia:
    • Possible bolus holding
    • Anterior leakage
    • Multiple swallows
    • Coughing and/or throat clearing
    • Respiration changes
    • Gurgly or wet vocal quality (“Say ahhh” and “Say eee”)
    • Fatigue
      
      
• Introduce safe swallowing strategies as needed
  
  
• Attempt thinner consistencies if the patient demonstrates no or minimal signs of dysphagia
  
  
• Attempt thicker consistencies if the patient demonstrates signs or symptoms of dysphagia—including aspiration—with current liquid consistency

Solid Trials

Dysphagia handouts, illustrated exercises, and therapist treatment guides

• Begin with the patient’s current diet texture
  
  
• Start small and gradually provide larger boluses
  
  
• Observe the following:
  • Mastication adequacy (inadequate, within normal limits, effortful, prolonged)
  • Labial closure
  • Hyolaryngeal speed and elevation
  • Signs and symptoms of dysphagia:
    • Possible bolus holding
    • Anterior leakage
    • Multiple swallows per bolus
    • Coughing and/or throat clearing
    • Respiration changes
    • Gurgly or wet vocal quality (“Say ahhh” and “Say eee”)
    • Fatigue
      
      
• Introduce safe swallowing strategies as needed
  
  
• Attempt more advance diet textures if the patient demonstrates no or minimal signs of dysphagia
  
  
• Attempt less advanced diet textures if the patient demonstrates signs or symptoms of dysphagia—including aspiration—with current diet texture

Free Printable (PDF):

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