1. Reduced Lip Closure
 a. Can’t hold food in mouth anteriorly
 b. Drooling
 c. Material falls into anterior sulcus
 d. Stasis in anterior sulcus

2. Reduced buccal/cheek tone
 a. Material falls into lateral sulcus
 b. Stasis or residue in lateral sulcus after the swallow

3. Reduced tongue function/coordination
 a. Can’t form cohesive bolus
 b. Premature loss of bolus into pharynx
 c. Can’t chew solids adequately
 d. Abnormal hold position
 e. Residue on floor of mouth

4. Reduced tongue function/coordination (cont)
 a. Disorganized A-P tongue movement
 b. Repetitive lingual rolling (Parkinson’s)
 c. Delayed oral transit (>1 second)

5. Reduced tongue elevation
 a. Food catching in mouth - worse with solids
 b. Slowed oral transit times
 c. Residue on hard palate and/or tongue surface
 d. Residue on tongue surface may also be due to scar tissue

6. Apraxia of Swallow/Reduced oral sensation
 a. Delayed onset of oral phase of the swallow
 b. Searching tongue movements

7. Tongue Thrust
 a. Tongue moves forward to start the swallow
 b. In severe cases, tongue extends between lips

8. Piecemeal deglutition
 a. Normal on larger boluses
 b. If seen on small bolus used in evaluation, may indicate fear of swallowing

9. Pharyngeal delay (also called  Delayed swallow reflex or Increase in duration of stage transition)
 b. Bolus reaches valleculae prior to initiation of pharyngeal phase
 c. Pooling of bolus in valleculae and/or pyriform sinuses before the swallow
 d. Penetration/aspiration of bolus prior to initiation of pharyngeal swallow
 e. Etiology
 
 
 

 f. Does “delay” always indicate abnormality?
 
 
 
 
 
 

10. Reduced velopharyngeal closure
 a. Nasal penetration/regurgitation

11. Reduced pharyngeal contraction
 a. The pressure produced along a horizontal plane by the pharyngeal constrictors and applied directly to the bolus in the hypopharynx
 b. Residue along pharyngeal walls after the swallow
 c. Residue in a depression along the pharyngeal wall usually indicates scar tissue or a pharyngeal pouch at that location
 d. If residue is substantial, risk of aspiration after the swallow

12. Reduced posterior movement of tongue base
  a.. Reduction in tongue driving force
 b. Pressure produced by the tongue and applied directly to the bolus in the oropharynx
 c. Vallecular residue - material remains in the valleculae after the swallow
 d. Risk of aspiration after the swallow

13. Reduced laryngeal elevation/pharyngeal shortening
 a. Residue remaining in pyriform sinuses or at top of the airway after the swallow
 b. Risk is for aspiration after swallow is completed
 c. Residue in pyriform sinuses with all other aspects of swallow being normal may indicate cricopharyngeal dysfunction

14. Reduced closure of airway
 a. Penetration - passing of material into the laryngeal inlet(vestibule) without passing below the level of the true vocal folds
 b. Aspiration - passage of material below the level of the true vocal folds
 c. Etiologies of penetration
 
 
 

 d. 8-point penetration-aspiration scale (Rosenbek, et al, 1996)

15. Generalized reduction in pressure
 a. Residue throughout the pharynx including valleculae, pyriform sinuses and along the pharyngeal walls