FOIS Scale
Functional Oral Intake Scale — Functional Assessment of Oral Intake in Dysphagia
Assessment Result
See the full description of the levels in the table below
Interpretation of FOIS Levels
The FOIS (Functional Oral Intake Scale) was developed by Crary, Mann, and Groher in 2005 as a simple, objective, and validated tool to document the functional level of oral intake in patients with dysphagia. It is widely used by Speech and Language Therapists (SLTs) in hospital, outpatient, and rehabilitation settings to monitor swallowing progression, guide therapeutic decisions, and assist in discharge planning.
| Level | Description | Clinical Interpretation |
|---|---|---|
| 1 | Nothing by mouth | Exclusively tube-fed |
| 2 | Tube dependent with minimal oral intake | Initial swallowing attempts; nutrition still via tube |
| 3 | Tube dependent with consistent oral intake | Regular but insufficient oral intake; tube maintained |
| 4 | Total oral intake of a single consistency | Exclusively oral feeding, but restricted to one texture |
| 5 | Total oral intake of multiple consistencies, but requiring special preparation | Varied diet with modifications (thickening, adapted texture) |
| 6 | Total oral intake of multiple consistencies, without special preparation, but with restrictions | Near-normal diet; avoids only specific foods |
| 7 | Total oral intake with no restrictions | Normal functional swallowing; no dietary limitations |
Clinical Applications of the FOIS
The FOIS is widely used by Speech and Language Therapists to:
- Objectively document the patient's oral feeding status
- Monitor swallowing rehabilitation progress over time
- Facilitate communication between members of the multidisciplinary team
- Assist in decisions regarding removal or continuation of enteral feeding tubes
- Establish clear and measurable therapeutic goals
- Evaluate the effectiveness of SLT interventions
- Provide objective data for research and studies on dysphagia
Important Considerations for Assessment
Key points for correct application of the scale:
- The FOIS documents the FUNCTIONAL level of oral intake (what the patient actually does day-to-day), not theoretical capacity
- Patients at levels 2 and 3 remain predominantly dependent on tube feeding for adequate nutrition and hydration
- The transition from level 3 to level 4 represents a critical milestone: complete independence from alternative feeding routes
- Special preparations (level 5) include: fluid thickening, texture modification of solids, use of postural strategies or swallowing manoeuvres
- Progression between levels should be based on careful clinical assessment and, where indicated, instrumental examinations (videofluoroscopy or videoendoscopy)
- The scale does not replace comprehensive clinical and instrumental swallowing assessments
References
- 1. Crary MA, Mann GD, Groher ME. "Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients." Arch Phys Med Rehabil. 2005;86(8):1516–1520. PubMed ↗