Table 2.

American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) swallowing level scale

Level 1	Individual is not able to swallow safely by mouth. All nutrition and hydration is received through non-oral means (for example nasogastric tube).
Level 2	Individual is not able to swallow safely by mouth for nutrition and hydration but may take some consistency with consistent maximal cues in therapy only. Alternative method of feeding is required.
Level 3	Alternative method of feeding is required as individual takes less than 50% of nutrition and hydration by mouth, and/or swallowing is safe with consistent use of moderate cues to use compensatory strategies and/or requires maximum diet restriction.
Level 4	Swallowing is safe but usually requires moderate cues to use compensatory strategies, and/or individual has moderate diet restriction and/or still requires tube feeding and/or oral supplements.
Level 5	Swallow is safe with minimal diet restriction and/or occasionally requires minimal cueing to use compensatory strategies. May occasionally self cue. All nutrition and hydration needs are met by mouth at mealtime.
Level 6	Swallowing is safe, and individual eats and drinks independently and may rarely require minimal cueing. Usually self cues when difficulty occurs. May need to avoid specific food items (for example popcorn and nuts), or requires additional time (due to dysphagia).
Level 7	Individual’s ability to eat independently is not limited by swallow function. Swallowing would be safe and efficient for all consistencies. Compensatory strategies are effectively used when needed.