2 minutes
The survey is designed for use with individuals with cerebral palsy.
How often do you experience dysphagia symptoms?
How severe are your dysphagia symptoms?
Do you have difficulty swallowing solid foods, liquids, or both?
Do you have difficulty chewing food?
Do you choke on food or liquids?
Do you cough when eating or drinking?
Do you have difficulty breathing when eating or drinking?
Do you drool when eating or drinking?
Do you have difficulty controlling your saliva?
. Do you have pain when swallowing?
. Do you avoid eating or drinking because of your dysphagia symptoms?
. Do your dysphagia symptoms interfere with your ability to participate in social activities?
. Do your dysphagia symptoms interfere with your ability to attend school or work?
. Do you have to change your diet because of your dysphagia symptoms?
. Do you take medications to manage your dysphagia symptoms?
. Have you ever been hospitalized because of your dysphagia symptoms?
. Have you ever had surgery to treat your dysphagia symptoms?
. Do you have any other medical conditions that make your dysphagia symptoms worse?