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Cerebral Palsy Dysphagia Disorder Survey

The Cerebral Palsy Dysphagia Disorder Survey is a questionnaire that asks about your experiences with dysphagia, or difficulties swallowing. The survey is designed to help researchers better understand the impact of dysphagia on people with cerebral palsy, and to develop new treatments for the condition.

Time to complete

2 minutes

Eligibility

The survey is designed for use with individuals with cerebral palsy.

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Questions for Cerebral Palsy Dysphagia Disorder Survey

1.

How often do you experience dysphagia symptoms?

The answer should be a text input.
2.

How severe are your dysphagia symptoms?

The answer should be a text input.
3.

Do you have difficulty swallowing solid foods, liquids, or both?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
4.

Do you have difficulty chewing food?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
5.

Do you choke on food or liquids?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
6.

Do you cough when eating or drinking?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
7.

Do you have difficulty breathing when eating or drinking?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
8.

Do you drool when eating or drinking?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
9.

Do you have difficulty controlling your saliva?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
10.

. Do you have pain when swallowing?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
11.

. Do you avoid eating or drinking because of your dysphagia symptoms?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
12.

. Do your dysphagia symptoms interfere with your ability to participate in social activities?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
13.

. Do your dysphagia symptoms interfere with your ability to attend school or work?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
14.

. Do you have to change your diet because of your dysphagia symptoms?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
15.

. Do you take medications to manage your dysphagia symptoms?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
16.

. Have you ever been hospitalized because of your dysphagia symptoms?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
17.

. Have you ever had surgery to treat your dysphagia symptoms?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure
18.

. Do you have any other medical conditions that make your dysphagia symptoms worse?

The answer should be a single choice:
  1. Yes
  2. No
  3. Unsure

Similar Ideas

  • Dysphagia Severity Scale
  • Swallowing Quality of Life
  • Dysphagia Outcomes Research Team Scale
  • Bedside Swallowing Evaluation
  • FIM+FAM Swallowing Scale

Here are some FAQs and additional information
on Cerebral Palsy Dysphagia Disorder Survey

What is cerebral palsy dysphagia disorder?

Cerebral Palsy dysphagia disorder is a condition that affects a person's ability to swallow. This can cause problems with eating and drinking, and can lead to aspiration pneumonia and other health problems.

What are the symptoms of cerebral palsy dysphagia disorder?

The symptoms of cerebral palsy dysphagia disorder can vary from person to person, but may include drooling, coughing or choking when eating or drinking, difficulty controlling food or liquid in the mouth, and difficulty swallowing.

What causes cerebral palsy dysphagia disorder?

Cerebral palsy dysphagia disorder is caused by damage to the brain or nervous system. This can be caused by a birth injury, stroke, or other neurological condition.

How is cerebral palsy dysphagia disorder diagnosed?

Cerebral palsy dysphagia disorder is diagnosed by a physical examination and a swallowing study. A swallowing study is an x-ray that shows how well a person can swallow.

How is cerebral palsy dysphagia disorder treated?

There is no cure for cerebral palsy dysphagia disorder, but there are treatments that can help. Treatment may include speech therapy, occupational therapy, and a feeding tube.

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