Video fluoroscopic swallowing study (modified barium swallow) Preferred diagnostic test; more accurate than bedside swallow assessment for detection of aspiration and allows for more precise treatment recommendations44,45 Performed by radiologist and speech-language pathologist in video fluoroscopy suite46 Fiber-optic endoscopic evaluation Supplementary tool to video fluoroscopic swallowing study; good correlation in detection of aspiration and bolus residue in the pharynx and pharyngeal-laryngeal area Trial of compensatory maneuvers using different viscosities (thin liquid, thick liquid, puree, solid food) to potentially improve swallowing effectiveness Performed by speech-language pathologist in outpatient/bedside setting with physician review; easy to perform and well tolerated46 Bedside swallow assessment Structured observation of eating and drinking by speech-language pathologist or other trained observer Trial swallows using different viscosities (thin liquid, thick liquid, puree, solid food): check for coughing, choking, “wet” voice, or piecemeal swallowing (i.e., multiple swallows per bolus) Water-swallowing test (5 to 30 mL) or repetitive saliva-swallowing test: check for coughing, choking, or “wet” voice Pulse oximetry combined with trial swallows or water-swallowing test: check for oxygen desaturation > 2% to 3% Patient self-evaluation: selected questionnaires to assess health status, dysphagia severity, and quality of life Eating Assessment Tool47 Single question (“What about swallowing?”) may be as effective as more detailed screening tools22 Swallowing Quality of Life questionnaire48 Sydney Swallow Questionnaire49