The Northwestern Dysphagia Patient Check Sheet is a screening procedure consisting of 28 items found in patients with dysphagia. The check sheet was developed at Northwestern University in Illinois.



(1) medical history variables: 4 items

(2) behavioral variables: 6 items

(3) gross motor function: 2 items

(4) oral motor test results: 9 items

(5) observation during trial swallows: 7 items


Each item is graded as either "safe" or "unsafe".


Medical history variables:

(1) history of recurrent pneumonia

(2) frequent temperature spikes

(3) question of aspiration pneumonia

(4) long-term intubation (> 1 week) or tracheostomy (>= 6 months)


Behavioral variables:

(1) alertness

(2) cooperativeness/agitation

(3) attention and interaction ability

(4) awareness of problems with swallowing

(5) awareness of secretions

(6) ability to manage secretions


Gross motor function:

(1) postural control

(2) fatigability


Oral motor test results:

(1) oral, pharyngeal, laryngeal anatomy and physiology

(2) ability to follow directions

(3) dysarthria

(4) facial weakness

(5) oral apraxia

(6) oral sensation

(7) pharyngeal wall contraction on gag

(8) saliva swallowing

(9) voluntary cough and throat clearing


Observation during trial swallows (1 mL thin liquid, 1 mL pudding, a quarter Lorna Doone cookie if able to chew):

(1) apraxia of swallow

(2) oral residue

(3) coughing and/or throat clearing

(4) delayed pharyngeal swallow

(5) reduced layrngeal elevation

(6) gurgly voice

(7) multiple swallows per bolus


total number of unsafe observations =

= SUM(unsafe observations over the 28 items)


total number of unsafe observations in behavioral and gross motor function =

= (number of unsafe observations in behavioral variables) + (number of unsafe observations in gross motor function)


total number of unsafe observations in oral motor and during oral swallow trial =

= (number of unsafe observations in oral motor function) + (number of unsafe observations during the oral swallow trial)



• minimum number of unsafe observations: 0

• The greater the number of unsafe observations, the greater the risk to the patient.


The 3 variables most significant for aspiration on a modified barium swallow were:

(1) coughing and throat clearing on trial swallows (best single predictor)

(2) reduced laryngeal elevation trial swallows

(3) history of recurrent pneumonia

An accuracy of 71% in patient classification was noted when 2 or more of these were present.


The presence of dysarthria was the best single predictor of an oral stage disorder (sensitivity 69%, specificity 75%, accuracy 75%).


The presence of 2 or more of the following predicts pharyngeal delay with a sensitivity 71%, specificity 73%, accuracy 72%:

(1) > 8 of the 28 items identified as unsafe

(2) delay in swallow on trial swallow

(3) facial weakness


The presence of reduced laryngeal elevation in the swallowing trials was the best single predictor of a pharyngeal stage swallowing disorder (sensitivity 672%, specificity 67%, accuracy 70%).


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