How to Read a Speech and Language Therapist’s Swallowing Report

When a Speech and Language Therapist (SLT) assesses a patient’s swallowing, the findings are summarised in a written report. This report contains clinical findings, a formal diagnosis, and — critically — specific dietary and liquid recommendations that must be correctly implemented to keep the patient safe.

For nurses, care workers, occupational therapists, and family members, being able to read and act on an SLT swallowing report correctly is an essential skill. Misunderstanding a single recommendation — giving a patient thin liquids when the report specifies thickened, or offering hard food to someone on a puréed diet — can cause aspiration and aspiration pneumonia.

This guide explains the key sections you will encounter in an SLT swallowing report and how to use them in practice.

Section 1: Reason for Referral and Background

This section summarises:

• Who referred the patient and why
• Primary diagnosis — the neurological or structural condition causing dysphagia
• Relevant medical history — recent hospitalisations, medications, weight changes
• Current diet at the time of assessment

What to do: Check that the background information is accurate. If the patient’s condition has changed since the report was written, flag this to the SLT before implementing recommendations.

Section 2: Assessment Findings

This is the clinical evidence that supports the recommendations. It typically includes:

Oral Mechanism Findings

Descriptions of tongue strength, lip closure, facial symmetry, dentition, and saliva. For example:

• “Reduced tongue elevation and right-sided lip weakness” — suggests oral phase impairment
• “Adequate lip seal; tongue range of motion intact” — oral phase relatively preserved

Clinical Swallowing Evaluation

Observations during bolus trials. You may see:

• “Coughing observed on thin liquid” — the patient coughed when given water; this is a penetration or aspiration sign
• “Wet/gurgly voice quality noted after 10 mL water” — material is pooling on or near the vocal folds post-swallow
• “Multiple swallows required to clear 5 mL puree” — post-swallow residue; reduced pharyngeal clearance
• “No overt signs of difficulty on Mildly Thick liquid” — clinically safe on Level 2

Instrumental Assessment Results

If VFSS or FEES was performed, you may see:

• “PAS 8 on thin liquid” — silent aspiration (material entering the trachea without coughing). PAS 8 is the highest-risk finding.
• “PAS 2 on Moderately Thick” — material entered laryngeal vestibule but was ejected safely
• “Post-swallow residue: moderate in bilateral pyriform sinuses on puree” — food remains in the pharynx after the swallow; risk of overflow aspiration

The Penetration-Aspiration Scale (PAS) runs from 1 (material does not enter airway) to 8 (silent aspiration). Scores of 6, 7, 8 indicate material below the vocal folds.

Section 3: Diagnosis / Summary

A summary sentence such as:

• “Moderate oropharyngeal dysphagia characterised by delayed pharyngeal swallow initiation and reduced laryngeal elevation, resulting in penetration on thin liquids and aspiration on rapid sequential thin liquid swallows.”

This tells you: what is wrong, why it happens, and what triggers aspiration.

Section 4: IDDSI Diet and Liquid Recommendations

This is the most immediately actionable section. It specifies the IDDSI food texture level and IDDSI liquid thickness level the patient requires.

Understanding IDDSI Levels

The IDDSI framework (2019) uses numbers and colour-coded names:

Liquids (Drinks):

Foods:

A typical recommendation might read: “IDDSI Level 5 (Minced & Moist) for solid foods. IDDSI Level 2 (Mildly Thick) for all liquids including water, tea and soup.”

This means every drink must be thickened to Level 2 — including medication flushes, water with meals, and any supplement drinks.

Mixed Consistencies

Watch for specific guidance on mixed textures — for example, “avoid mixed consistencies; no soup containing noodles or dumplings; ensure all components of the meal are at the prescribed IDDSI level before serving.”

Mixed consistencies (thin liquid plus solid pieces) are a common aspiration hazard because the liquid component may reach the pharynx before the solid is processed.

Section 5: Compensatory Strategies

The report may specify postural or behavioural strategies to be used during all meals:

• “Chin tuck posture” — patient should flex the head slightly forward (chin toward chest) during swallowing; this widens the valleculae and reduces the risk of premature thin liquid spillage
• “Head rotation to the right” — turns the affected (right) pharyngeal side away from the bolus pathway, routing swallowing down the stronger left side
• “Double swallow after each mouthful” — swallow twice per bolus to clear pharyngeal residue
• “Small bolus sizes — no more than one teaspoon per mouthful”
• “Sit upright for 30 minutes after eating”

These are safety strategies, not optional suggestions. They should be implemented consistently at every meal.

Section 6: Oral Hygiene Recommendations

Many reports include an oral hygiene component, e.g.: “Oral hygiene to be completed twice daily with electric toothbrush; dentures to be removed and cleaned overnight; use of chlorhexidine 0.12% oral rinse advised given confirmed aspiration.”

Oral hygiene is one of the most evidence-based interventions for preventing aspiration pneumonia. It is not cosmetic — the oral bacteria that colonise dental plaque are the pathogens that cause pneumonia when aspirated.

Section 7: Follow-Up Plan

The report will typically specify:

• Review date — when the SLT will reassess
• Conditions for re-referral — e.g., “re-refer if recurrent chest infections, weight loss >2 kg, or caregiver concern about deterioration”
• Who to contact with questions

What To Do With the Report

1. Read the full report before the patient’s next meal
2. Share with the kitchen team (for IDDSI preparation guidance) and all care staff
3. File it where all staff can access it — most residential care homes clip it to the care plan or mealtime profile
4. If the recommendation is different from current practice, implement it immediately — not at the next mealtime
5. If you have questions about any recommendation, contact the SLT directly; do not guess or revert to previous practice

For further information about working with SLTs, see The Role of the Speech and Language Therapist in Dysphagia Management and When to Refer to a Speech and Language Therapist.

References

1. American Speech-Language-Hearing Association. Adult Dysphagia Practice Portal. https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/
2. National Institute for Health and Care Excellence. Stroke Rehabilitation in Adults (CG162). https://www.nice.org.uk/guidance/cg162
3. IDDSI. The IDDSI Framework. https://www.iddsi.org/framework
4. Logemann JA, et al. (2015). Disorders of deglutition. Handbook of Clinical Neurology, 129, 465–487. PMID: 26315994