Swallowing Disorder Survey

Question Title

* 1. To what extent are the following swallowing scenarios problematic for you?

	0 = Never	l = Amost never	2 = Somewhat	3 = A lot	4 = Severe
My swallowing problems have caused me to lose weight.	My swallowing problems have caused me to lose weight. 0 = Never	My swallowing problems have caused me to lose weight. l = Amost never	My swallowing problems have caused me to lose weight. 2 = Somewhat	My swallowing problems have caused me to lose weight. 3 = A lot	My swallowing problems have caused me to lose weight. 4 = Severe
My swallowing problem interfers with my aility to go out to meals.	My swallowing problem interfers with my aility to go out to meals. 0 = Never	My swallowing problem interfers with my aility to go out to meals. l = Amost never	My swallowing problem interfers with my aility to go out to meals. 2 = Somewhat	My swallowing problem interfers with my aility to go out to meals. 3 = A lot	My swallowing problem interfers with my aility to go out to meals. 4 = Severe
Swallowing liquids takes extra effort.	Swallowing liquids takes extra effort. 0 = Never	Swallowing liquids takes extra effort. l = Amost never	Swallowing liquids takes extra effort. 2 = Somewhat	Swallowing liquids takes extra effort. 3 = A lot	Swallowing liquids takes extra effort. 4 = Severe
Swallowing solids takes extra effort.	Swallowing solids takes extra effort. 0 = Never	Swallowing solids takes extra effort. l = Amost never	Swallowing solids takes extra effort. 2 = Somewhat	Swallowing solids takes extra effort. 3 = A lot	Swallowing solids takes extra effort. 4 = Severe
Swallowing pills takes extra effort.	Swallowing pills takes extra effort. 0 = Never	Swallowing pills takes extra effort. l = Amost never	Swallowing pills takes extra effort. 2 = Somewhat	Swallowing pills takes extra effort. 3 = A lot	Swallowing pills takes extra effort. 4 = Severe
Swallowing is painful.	Swallowing is painful. 0 = Never	Swallowing is painful. l = Amost never	Swallowing is painful. 2 = Somewhat	Swallowing is painful. 3 = A lot	Swallowing is painful. 4 = Severe
The pleasure of eating is affected by my swallowing.	The pleasure of eating is affected by my swallowing. 0 = Never	The pleasure of eating is affected by my swallowing. l = Amost never	The pleasure of eating is affected by my swallowing. 2 = Somewhat	The pleasure of eating is affected by my swallowing. 3 = A lot	The pleasure of eating is affected by my swallowing. 4 = Severe
When I swallow food sticks in my throat.	When I swallow food sticks in my throat. 0 = Never	When I swallow food sticks in my throat. l = Amost never	When I swallow food sticks in my throat. 2 = Somewhat	When I swallow food sticks in my throat. 3 = A lot	When I swallow food sticks in my throat. 4 = Severe
I cough when I eat.	I cough when I eat. 0 = Never	I cough when I eat. l = Amost never	I cough when I eat. 2 = Somewhat	I cough when I eat. 3 = A lot	I cough when I eat. 4 = Severe
Swallowing is stressful.	Swallowing is stressful. 0 = Never	Swallowing is stressful. l = Amost never	Swallowing is stressful. 2 = Somewhat	Swallowing is stressful. 3 = A lot	Swallowing is stressful. 4 = Severe