Rama bsaf 1.1

Sep 15, 20110 likes370 views

checklist for swallowing rehabilitation evaluation & follow-up รับประกัน หากประเมินครบตามนี้ ข้อมูลก็จะครบถ้วน วางแผนการรักษา ปัญหาการกลืนได้อย่าง มั่นใจ

Version 1.1 released 01-may-06
Ramathibodi Bedside Swallowing Assessment Form (Rama-BSAF)
HN………………………………… …….male ….female
Diagnosis………………………………………………………………………………………… Age……………..Years
Date of onset….................……………/………………/………...……..
Date of assessment........……………../………………./………………. Assessment by……………………………………..

consciousness awake Drowsy stupor poor co-op not tested
training endurance (min) >30 min >10 <10
sitting balance good fair poor
neck control good fair poor

Rt. Lt.
sensory not tested
normal Impaired loss dysesthesia normal Impaired loss dysesthesia
face
Lip
Tongue
Soft palate
Pharynx

Rt. Lt.
Oro-facial motor not tested
normal Impaired loss invol.mo normal Impaired loss Invol.mo.
Neck
Face
Jaw
Lip
Tongue
Soft palate

Resp. control normal Impaired loss not tested
Active respiration
Breath holding
Force expired
Voluntary cough
Voluntary throat clearing

Reflex tests Normal Impaired loss not tested
Cough
Swallowing
Gag

Rt. Lt.
Dry swallowing test not tested
Normal Impaired Loss Normal Impaired Loss
Lip seal
Laryngeal elevation

Water swallowing Anterior Cough Laryngeal elevation wet voice
not tested
test leaking Pre Intra Post Delayed Decreased Pre Post
1/2 Tablespoon
30 cc.drink

0 ท เองไมไดเลย
1 ตองดดแปลงรปร งของอ ห ร
Extended barthel
2 กนอ ห รไดเองโดยไมตองมคนชวย แตตองปรบอปกรณ"ส หรบ กนอ ห ร
index (1 ช,วโมง)
3 ส ม รถใหอ ห รท งส ยย งจมกหร'อหน ทองไดเอง โดยไมตองมคนชวย
4 ท ไดเอง โดยไมตองมคนหร'ออปกรณ"ชวย

Level 1 รบอ ห รท งส ยเท น(น กนอ ห รท งป กไมไดเลย
Level 2 รบอ ห รท งส ยเป)นหลก แตท นอ ห รและน( ท งป กไดเล+กนอย
Level 3 รบอ ห รท งส ยเป)นหลก แตท นอ ห รและน( ท งป กไดบ งอย งสม, เสมอ
Functional oral intake
Level 4 กนอ ห รท งป กไดเฉพ ะอ ห รเน'(อเดยว
scale (FOIS)
Level 5 กนอ ห รท งป กไดหล ยๆเน'(อ แตตองมวธก รเตรยมแบบพเศษ หร'อใชเทคนคก รกล'น
Level 6 กนอ ห รท งป กไดหล ยๆเน'(อ โดยไมตองมก รเตรยมแบบพเศษ แตยงมอ ห รบ งอย งท,ยงกนไดปรม ณนอยๆอย
Level 7 กนอ ห รท งป กไดเหม'อนปรกตทกอย งโดยไมมขอจ กด

Pneumonia in 6 mo. Never Once Twice Three or more

Clinical impression No dysphagia Pre-deglutative Intra-deglutative Post-deglutative

Treatment Plan Restitution Swallowing technique Adaptation
Thermal stimulation Mendelson Feeding position
Brushing Supraglottic Food consistency
Massage Supersupraglottic Adaptive device
Tongue exercise Personal assist
Lip exercise
Neck exercise

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Rama bsaf 1.1

1. Version 1.1 released 01-may-06 Ramathibodi Bedside Swallowing Assessment Form (Rama-BSAF) HN………………………………… …….male ….female Diagnosis………………………………………………………………………………………… Age……………..Years Date of onset….................……………/………………/………...…….. Date of assessment........……………../………………./………………. Assessment by…………………………………….. consciousness awake Drowsy stupor poor co-op not tested training endurance (min) >30 min >10 <10 sitting balance good fair poor neck control good fair poor Rt. Lt. sensory not tested normal Impaired loss dysesthesia normal Impaired loss dysesthesia face Lip Tongue Soft palate Pharynx Rt. Lt. Oro-facial motor not tested normal Impaired loss invol.mo normal Impaired loss Invol.mo. Neck Face Jaw Lip Tongue Soft palate Resp. control normal Impaired loss not tested Active respiration Breath holding Force expired Voluntary cough Voluntary throat clearing Reflex tests Normal Impaired loss not tested Cough Swallowing Gag Rt. Lt. Dry swallowing test not tested Normal Impaired Loss Normal Impaired Loss Lip seal Laryngeal elevation Water swallowing Anterior Cough Laryngeal elevation wet voice not tested test leaking Pre Intra Post Delayed Decreased Pre Post 1/2 Tablespoon 30 cc.drink 0 ท เองไมไดเลย 1 ตองดดแปลงรปร งของอ ห ร Extended barthel 2 กนอ ห รไดเองโดยไมตองมคนชวย แตตองปรบอปกรณ"ส หรบ กนอ ห ร index (1 ช,วโมง) 3 ส ม รถใหอ ห รท งส ยย งจมกหร'อหน ทองไดเอง โดยไมตองมคนชวย 4 ท ไดเอง โดยไมตองมคนหร'ออปกรณ"ชวย Level 1 รบอ ห รท งส ยเท น(น กนอ ห รท งป กไมไดเลย Level 2 รบอ ห รท งส ยเป)นหลก แตท นอ ห รและน( ท งป กไดเล+กนอย Level 3 รบอ ห รท งส ยเป)นหลก แตท นอ ห รและน( ท งป กไดบ งอย งสม, เสมอ Functional oral intake Level 4 กนอ ห รท งป กไดเฉพ ะอ ห รเน'(อเดยว scale (FOIS) Level 5 กนอ ห รท งป กไดหล ยๆเน'(อ แตตองมวธก รเตรยมแบบพเศษ หร'อใชเทคนคก รกล'น Level 6 กนอ ห รท งป กไดหล ยๆเน'(อ โดยไมตองมก รเตรยมแบบพเศษ แตยงมอ ห รบ งอย งท,ยงกนไดปรม ณนอยๆอย Level 7 กนอ ห รท งป กไดเหม'อนปรกตทกอย งโดยไมมขอจ กด Pneumonia in 6 mo. Never Once Twice Three or more Clinical impression No dysphagia Pre-deglutative Intra-deglutative Post-deglutative Treatment Plan Restitution Swallowing technique Adaptation Thermal stimulation Mendelson Feeding position Brushing Supraglottic Food consistency Massage Supersupraglottic Adaptive device Tongue exercise Personal assist Lip exercise Neck exercise

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Rama bsaf 1.1

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