Appendix 1.

Mann Assessment of Swallowing Ability – Cancer (MASA-C)

Auditory comprehension / 1
No response to speech / 2
Occasional motor response if cued / 3
Follows simple conversation with repetition / 4
Follows ordinary conversation with little difficulty / 5
WNL /
Chest Status / 2
Severe COPD or chest infection / 4
Coarse basal creps/ ronchi / 6
Fine basal creps/ ronchi / 8
Sputum upper airway
other condition / 10
Chest clear /
Neck Palpation / 2
Very marked density, retraction and fixation / 4
Definitely increased density and firmness / 8
Just palpably increased density / 10
WNL /
Mouth Opening / 2
15mm / 4
16-30mm / 8
31-45mm / 10
>45 mm /
Taste / 1
No taste / 3
Reduced taste / 5
WNL /
Smell / 1
No smell / 3
Reduced smell / 5
WNL /
Current Diet / 1
Tube dependent / 3
Modified diet or fluids (including oral supplements only) / 5
Normal diet- no restriction /
Dysarthria / 1
Unable to assess / 2
Speech unintelligible / 3
Speech intelligible but obviously defective / 4
Slow with occasional hesitation / slurring / 5
WNL /
Oral mucous membrane / 2
Confluent ulceration >50% + infection requiring narcotics / 5
Patchy ulceration <50% may require analgesia / 8
Erythema + edema of the mucosa <50% / 10
WNL /
Saliva / 2
Complete dryness + gingivitis & inflammation, + candidiasis /hemorrhage interferes with oral function / 4
Significant oral dryness, fissured lobulated tongue dorsum + gingivitis and erythemia interferes with oral function / 6
Moderate dryness with discomfort, thick sticky saliva, dry thin pale oral mucosa with no glistening / 8
Mild mouth dryness, slightly thicker/stringy saliva but not altering feeding behavior / 10
WNL /
Lip seal / 1
No closure
unable to assess / 2
Incomplete seal / 3
Unilaterally weak poor maintenance / 4
Mild impairment
occasional leakage / 5
WNL /
Tongue movement / 2
No mov’t/ unable to assess / 4
Minimal mov’t / 6
Incomplete mov’t / 8
Mild impairment in range / 10
Full ROM /
Tongue strength / 2
Gross weakness/ unable to assess / 5
Unilateral weakness / 8
Minimal weakness / 10
WNL /
Tongue coordination / 2
No mov’t /unable to assess / 5
Gross incoordination / 8
Mild incoordination / 10
WNL /
Oral preparation / 2
Unable to examine / 4
No bolus formation
no attempt / 6
Minimal chew thrust
gravity assisted / 8
Lip or tongue seal
bolus escape / 10
WNL /
Weight loss / 1
Severe > 20% total body weight / 2
Significant >10% total body weight / 3
Moderate 7% total body weight / 4
Mild 3-5% total body weight / 5
WNL /
Palate / 2
No spread or elevation / 4
Minimal mov’t/
nasal regurgitation / air escape / 6
Unilaterally weak / 8
Slight asymmetry
mobile / 10
WNL /
Bolus clearance / 2
No clearance/no attempt / 5
Some clearance/ residue / 8
Significant
clearance / minimal residue / 10
Fully cleared /
Oral transit / 2
No mov’t observed / 4
Delay > 10 secs / 6
Delay > 5 secs / 8
Delay > 1 sec / 10
WNL /
cough voluntary / 2
No attempt / unable to assess / 5
Attempt inadequate / 8
Attempt bovine- suggesting VC paresis / 10
WNL /
Voice / 2
Aphonic /
unable to assess / 4
Wet / gurgling/dysphonic / 6
Hoarse / 8
Mild impairment
slight huskiness / 10
WNL /
Trache / 2
Trache / cuffed with O2 support / 3
Cuffed trach – deflation inconsistent / 4
Permanent / cuffless trach/ deflation tolerated for extended periods / 5
No trache /
Pharyngeal phase / 2
No swallow
unable to assess / 5
Pooling / gurgling
laryngeal elevation incomplete / 8
Laryngeal elevation mildly restricted slow initiation
incomplete clearance / 10
Immediate laryngeal elevation
clearance of material /
Pharyngeal response / 1
Not coping /gurgling / 5
Cough before/ during / after swallow / 10
WNL /
Diet recommendation / NBM
risk too great / Thick/ Puree diet / Mechanical/minced soft / Soft / Normal /
fluid recommendation / NBM / Thick fluid (pudding thick) / Thick (honey) / Thick (nectar) / Normal (thin) /
Swallow integrity
dysphagia
Aspiration / definite
dysphagia
aspiration / probable
dysphagia
aspiration / possible
dysphagia
aspiration / unlikely
dysphagia
aspiration /

Total =