How is the洼田 test used to assess swallowing disorder grading?

The洼田饮水试验 (Wada drinking test) assesses the severity of swallowing disorders through a water-drinking test, classified into five levels: Level 1 (normal), Level 2 (suspected), Level 3 (mild), Level 4 (moderate), and Level 5 (severe). The classification is based on comprehensive evaluation of coughing and swallowing performance during drinking. If frequent choking, difficulty swallowing, or breathing difficulties occur during the test, prompt medical consultation is recommended.

1. Level 1 – Normal: The person can drink 30 mL of warm water in one attempt smoothly, without coughing or pauses. Swallowing movements are fluent and natural, indicating intact swallowing function that requires no special intervention.

2. Level 2 – Suspected: The person drinks 30 mL of warm water in two attempts, or experiences brief pauses during swallowing, but without coughing. This may indicate mild swallowing coordination issues, requiring further observation.

3. Level 3 – Mild: Choking occurs when attempting to swallow 30 mL of warm water in one go, or choking persists even when drinking in more than two sips. There is mild impairment in swallowing function; care should be taken to avoid eating too quickly.

4. Level 4 – Moderate: Frequent choking occurs while drinking 30 mL of warm water. The person cannot swallow the water in one attempt, and some liquid may leak from the mouth or nose. Swallowing efficiency is significantly reduced, necessitating modification of food textures.

5. Level 5 – Severe: The person cannot swallow 30 mL of warm water effectively, experiences severe choking, or is completely unable to swallow. Liquid easily enters the airway, posing a high risk of aspiration and suffocation, requiring immediate intervention.

For daily meals, choose pureed or semi-liquid foods to reduce the risk of choking from thin liquids. Eat slowly with small bites and thorough chewing. Clean the mouth promptly after meals. Maintain a seated or semi-reclined posture during eating, and remain in this position for at least 30 minutes afterward to minimize the risk of aspiration.