ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
VISUAL ANALYSIS OF SWALLOWING EFFICIENCY AND SAFETY (VASES)
2
VASES (Curtis et al., 2022) was used to guide standardized interpretation of pharyngeal residue, penetration, and aspiration during FEES. The 'Results' columns represent the raw VASES ratings. The 'Norms (%)' columns represent comparison to normative reference values (Curtis et al., 2023), expressed as percentile rankings, whereby 25-75% are considered 'normal', 75-94% and 6-25% are considered 'mildly atypical', and ≥ 95% or ≤ 5% are considered extremely atypical. Results below that are extremely atypical are indicated in bold red.
3
SWALLOW CONDITIONNumber of
Swallows		Oropharyngeal Residue (0-100+)Hypopharyngeal Residue (0-100+)Laryngeal Vestibule Residue (0-100)Vocal Fold
Residue (0-100+)		Subglottic
Residue (0-100+)		Penetration-Aspiration Scale (PAS; 1-8)
4
ResultsNorms (%)ResultsNorms (%)ResultsNorms (%)ResultsNorms (%)ResultsNorms (%)ResultsNorms (%)ResultsNorms (%)
5
5 mL, Green, Thin, SingleNot tested
6
5 mL, White, Thin, SingleNot tested
7
10 mL, Green, Thin, SingleNot tested
8
20 mL, White, Thin, SingleNot tested
9
SSV, Green, Thin, NaturalNot tested
10
SSV, White, Thin, NaturalNot tested
11
90 mL, White, Thin, UninterruptedNot tested
12
5 mL, Blue, Pudding, SingleNot tested
13
5 mL, Blue, Pudding, SingleNot tested
14
1/4, Cracker, Single (1.75 g)Not tested
15
1/4, Cracker, Single (1.75 g)Not tested
16
Maximum Across All Trials000000000000
17
SIZE OF SSV SIPS AND BITESResultsPercentile
18
Sip size for Green, Thin, Natural (mL)Not tested
19
Sip size for White, Thin, Natural (mL)Not tested
20
Bite size for Cracker, Single (g)Not tested
21
Bite size for Cracker, Single (g)Not tested
22
Notes
23
The Penetration-Aspiration Scale (PAS) used above is an 8-point scale as follows:
1 = no airway invasion
2 = penetration into the laryngeal vestibule, ejected completing out of the vestibule
3 = penetration into the laryngeal vestibule, not ejected completing out of the vestibule
4 = penetration to the vocal folds, ejected completing off of the vocal folds and out of the vestibule
5 = penetration to the vocal folds, not ejected completing off of the vocal folds and out of the vestibule
6 = aspiration into the subglottis, ejected completing out of the subglottis (but may be remaining in the larynx)
7 = aspiration into the subglottis, but not ejected out of the subglottis despite effort
8 = aspiration into the subglottis, but not ejected out of the subglottis with no attempt to eject (silent aspiration)
24
Abbreviations: self-selected/patient-preferred volume (SSV); milliliters (mL); grams (g); percentile rankings (%); single swallow instruction (single); natural swallow instruction (natural); slow and steady but without stopping (uninterrupted)
25
Normative reference values for VASES (Curtis et al., 2023) were derived from 39 healthy adults (584 swallows), aged 27-83 years. Normative data are expressed as percentile rankings (i.e., "percent of healthy adult swallows with ratings less than or equal to that of the current swallow"). Percentiles were calculated separately for thin liquids (IDDSI 0), pudding (IDDSI 4), and cracker (IDDSI 7). Percentiles for thin liquids were calculated separately for white coating contrast and green opaque contrast, but sumarized across all liquid bolus volumes. Percentiles for epiglottic, laryngeal vestibule, vocal fold, and subglottic residue were calculated only when residue was present (> 0).
26
DYNAMIC IMAGING GRADE OF SWALLOWING TOXICITY FOR FEES (DIGEST-FEES)
27
DIGEST-FEES (Starmer et al., 2021) was used to facilitate standardized interpretation of severity impairments in swallowing safety, swallowing efficiency, and total swallow function. DIGEST-FEES grades were derived using VASES ratings and a standardized protocol of 9 trials. Levels of impairment include 0 (normal), 1 (mildly atypical), 2 (moderately atypical), 3 (severe impairment), and 4 (profound impairment). DIGEST-FEES ratings were made using the standardized protocol outlined above. Results are outlined below, with grades other than 'normal' indicated in red.
28
Pharyngeal Swallow FunctionDIGEST Grades
(0-4)		Interpretation
29
Total Swallowing Function3Severely Impaired
30
Swallowing Safety3Severely Impaired
31
Swallowing Efficiency (Pharyngeal)0No Impairment
32
This document was developed for clinical use by Dr. James Curtis, PhD, CCC-SLP, BCS-S. Please provide credit when using this form, by including this line in clinical documental. Please notify him if errors in the document are detected.
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100