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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4464_Библиотеки_им_академика_М_И_Перельмана.pdf
Burke Dysphagia Screening Test
Patient Name:
ID Number:
Date of Evaluation:
Appendix
3
1. Bilateral stroke __________
2. Brainstem stroke __________
3. History of pneumonia following acute stroke phase __________
4. Coughing associated with feeding or during a 3-oz water swallow test __________
5. Failure to consume one-half of meals __________
6. Prolonged time required for feeding __________
7. Nonoral feeding program in progress __________
Presence of one or more of these features is scored as failing the Burke Dysphagia Screening Test.
Results: Pass Fail Signature __________________________________
333
Appendix
4
The MD Anderson Dysphagia Inventory
This questionnaire asks for your views about your swallowing ability. This information will help us
understand how you feel about swallowing.
The following statements have been made by people who have problems with their swallowing.
Some of the statements may apply to you.
Please read each statement and circle the response that best reflects your experience in the
past week.
My swallowing ability limits my day-to-day activities.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
E2. I am embarrassed by my eating habits.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
F1. People have difficulty cooking for me.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
P2. Swallowing is more difficult at the end of the day.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
*E7. I do not feel self-conscious when I eat.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
E4. I am upset by my swallowing problem.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
P6. Swallowing takes great effort.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
continues
335
336 CLINICAL MANAGEMENT OF SWALLOWING DISORDERS
The MD Anderson Dysphagia Inventory continued
E5. I do not go out because of my swallowing problem.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
F5. My swallowing difficulty has caused me to lose income.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
P7. It takes me longer to eat because of my swallowing problem.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
P3. People ask me, “Why can’t you eat that?”
Strongly Agree Agree No Opinion Disagree Strongly Disagree
E3. Other people are irritated by my eating problem.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
P8. I cough when I try to drink liquids.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
F3. My swallowing problems limit my social and personal life.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
*F2. I feel free to go out to eat with my friends, neighbors, and relatives.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
P5. I limit my food intake because of my swallowing difficulty.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
P1. I cannot maintain my weight because of my swallowing problem.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
E6. I have low self-esteem because of my swallowing problem.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
P4. I feel that I am swallowing a huge amount of food.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
F4. I feel excluded because of my eating habits.
Strongly Agree Agree No Opinion Disagree Strongly Disagree
Thank you for completing this questionnaire!
Scoring: All items, except for E7 and F2, are scored as 1 point for “strongly agree” and 5 points for “strongly
disagree.” Items E7 and F2 are scored as 5 points for “strongly agree” and 1 point for “strongly disagree.”
Eating Assessment Tool (EAT-10)
Date: ____________________________
Name: MR#:
Height: Weight:
Please briefly describe your swallowing problem.
Appendix
5
Please list any swallowing tests you have had, including where, when, and the results.
To what extent are the following scenarios problematic for you?
Circle the appropriate response 0 = No problem; 4 = Severe problem
1. My swallowing problem has caused me to lose weight. 0 1 2 3 4
2. My swallowing problem interferes with my ability to go
out for meals.
3. Swallowing liquids takes extra effort. 0 1 2 3 4
4. Swallowing solids takes extra effort. 0 1 2 3 4
5. Swallowing pills takes extra effort. 0 1 2 3 4
6. Swallowing is painful. 0 1 2 3 4
7. The pleasure of eating is affected by my swallowing. 0 1 2 3 4
8. When I swallow, food sticks in my throat. 0 1 2 3 4
9. I cough when I eat. 0 1 2 3 4
0 1 2 3 4
10. Swallowing is stressful. 0 1 2 3 4
Total EAT-10:
337
Dysphagia Handicap
Index (DHI)
Please place a check in the box that describes your swallowing difficulty.
1P. I cough when I drink liquids.
Appendix
6
Never Sometimes Always
2P. I cough when I eat solid food.
3P. My mouth is dry.
4P. I need to drink fluids to wash food down.
5P. I’ve lost weight because of my swallowing problem.
1F. I avoid some foods because of my swallowing problem.
2F. I have changed the way I swallow to make it easier to eat.
1E. I’m embarrassed to eat in public.
3F. It takes me longer to eat a meal than it used to.
4F. I eat smaller meals more often due to my swallowing problem.
6P. I have to swallow again before food will go down.
2E. I feel depressed because I can’t eat what I want.
3E. I don’t enjoy eating as much as I used to.
5F. I don’t socialize as much due to my swallowing problem.
6F. I avoid eating because of my swallowing problem.
7F. I eat less because of my swallowing problem.
4E. I am nervous because of my swallowing problem.
continues
339
340 CLINICAL MANAGEMENT OF SWALLOWING DISORDERS
Dysphagia Handicap Index (DHI) continued
5E. I feel handicapped because of my swallowing problem.
6E. I get angry at myself because of my swallowing problem.
7P. I choke when I take my medication.
7E. I’m afraid that I’ll choke and stop breathing because of my
swallowing problem.
8F. I must eat another way (eg, feeding tube) because of my
swallowing problem.
9F. I’ve changed my diet due to my swallowing problem.
8P. I feel a strangling sensation when I swallow.
9P. I cough up food after I swallow.
1 2 3 4 5 6 7
Never Sometimes Always
Normal Moderate
Problem
Please circle the number that matches the severity of your swallowing difficulty
(1 = no difficulty at all; 4 = somewhat of a problem; 7 = the worse problem you could have).
Severe
Problem
Appendix
7
Voice Handicap Index-10
(VHI-10)
Instructions: These are statements that many people have used to describe their voices and the effects
of their voices on their lives. Circle the response that indicates within the past month how frequently
you have the same experience.
0 = Never; 1 = Almost Never; 2 = Sometimes; 3 = Almost Always; 4 = Always
1. My voice makes it difficult for people to hear me. 0 1 2 3 4
2. People have difficulty understanding me in a noisy room. 0 1 2 3 4
3. My voice difficulties restrict personal and social life. 0 1 2 3 4
4. I feel left out of conversations because of my voice. 0 1 2 3 4
5. My voice problem causes me to lose income. 0 1 2 3 4
6. I feel as though I have to strain to produce voice. 0 1 2 3 4
7. The clarity of my voice is unpredictable. 0 1 2 3 4
8. My voice problems upset me. 0 1 2 3 4
9. My voice makes me feel handicapped. 0 1 2 3 4
10. People ask, “What’s wrong with your voice?” 0 1 2 3 4
Total:
341