$89.00 USD

99% rating - reviews

0.2  ASHA CEUs

The Penetration-Aspiration Scale: Standardizing Airway Protection Judgments From MBS Studies #e298


Presenter: James L. Coyle, PhD, CCC-SLP, BCS-S, ASHA Fellow

Application of the Penetration-Aspiration Scale (PAS).


"I like that this course went through how the PAS was created and reason for it. We use PAS in our MBSS notes, but no one has had any further education on it, so I wasn't sure if we were even using it correctly!"

– M.G., prior course participant

Read more comments about this course!

The penetration-aspiration scale was published more than 25 years ago and has been in widespread use in both clinical and research settings. It was designed to limit the seemingly infinite ways of describing airway compromise events on MBS/VFSS videos into a comprehensive and manageable set of descriptors, to provide an ordinal method of rating severity of airway protection impairment, and to help establish the answer to "what is normal airway protection" for healthy individuals.

This course presents the motivation and rationale behind development of the PA Scale. It overviews anatomic landmarks denoting separation between critical airway subdivisions of the pharynx, larynx and trachea, and provides examples of each PAS score in MBS/VFS images. Learn which PAS scores are typically occurring, especially for older individuals. Common judgment errors and methods of resolving uncertainties in score selection will be discussed, along with a handy decision-making algorithm for using the PAS. Course focus is the adult population.

Course is offered for 0.2 ASHA CEUs – 2 contact hours.

Course Overview – Run Time 02:11:13

  • Accurately use the Penetration-Aspiration Scale on all swallows of a videofluoroscopic swallowing study.
  • Identify which PAS scores are typically occurring, especially for older individuals.
  • Apply PAS scores in examination interpretation.
  • Apply PAS results in treatment planning.
  • Describe how NOT to use PAS scores.

Stop and re-start the course at any point. Learners retain access to course content after completion for ongoing reference and review.

"I feel after watching this course that I can immediately apply it in therapy today. Can easily bridge the research-to-clinical practice gap with this knowledge."

– H.H., prior course participant

Read more comments about this course!

The content of this online CE course does not focus exclusively on any specific proprietary product or service. Presenter financial and non-financial disclosures may be found in the Presenter & Disclosures area.

Video PowerPoint presentation with author narration & downloadable handout. Stop and re-start the course at any point. Learners retain access to course content after completion for ongoing reference and review.

Reviews

"Discussing how to utilize the PAS scale in everyday practice was beneficial. I liked the descriptions." A.R. (Feb. 2024)

"Thorough explanation of what the PAS was intended for and how to incorporate it into report writing." B.R. (Feb. 2024)

"The discussion on the purpose of the PAS and how to use it correctly when analyzing a patient's swallow function on VFSS was helpful. I enjoyed the visuals and the presenter's style of teaching." E.G. (Feb. 2024)

"Beneficial usage and understanding of the PAS. I liked the visuals/handouts." J.L. (Feb. 2024)

"Discussing the anatomy of TVFs was beneficial. I always pictured them as flat! I like the unlimited access to content." E.S. (Feb. 2024)

"It was beneficial to discuss the anatomical breakdown and connecting that to precision with scoring on the PAS - eg, determining that material has reached the vocal folds when they can't be seen on VFSS. Very relevant to clinical practice despite basis in research." N.S. (Jan. 2024)

"How to report PAS scores was beneficial to discuss. I liked the explanation of how to differentiate between shallow and deep laryngeal penetration." B.W. (Jan. 2024)

"The justification for the scoring was helpful. The course was convenient." B.B. (Jan. 2024)

"The anatomical references and detailed description of best practices in scoring were helpful. I like that this course is an available education to help build inter-rater reliability across our system of SLPs." N.W. (Dec. 2023)

"Beneficial topics were scoring each swallow separately, and aspiration is 1 factor among many when recommending a diet. I liked the ability to complete at my own pace and review." D.B. (Dec. 2023)

"I liked the specifics of each score and learning the development of the scale." M.S. (Dec. 2023)

"The discussion that an MBS tells a story, it is not a sentence, was beneficial. I liked the review of anatomy." P.G. (Dec. 2023)

"Discussing PAS was beneficial. I liked the MBS videos." S.C. (Dec. 2023)

"I liked the breakdown of the anatomy pertaining to the scale." A.H. (Dec. 2023)

"Well-organized course. Discussing the pros and cons of the PA scale was beneficial." D.P. (Nov. 2023)

"Discussing how to use and interpret PAS scores in conjunction with the narrative description was helpful. I enjoyed the important information given in several contexts, repeated, shown in charts, diagrams, etc." G.S. (Nov. 2023)

"I liked the speaker's ability to keep it interesting and realistic. The rationale re: the scale and appropriate applications/use was beneficial." M.G. (Nov. 2023)

"The description of each level of the scale was beneficial. I enjoyed the inclusion of video with anatomical drawing." C.G. (Nov. 2023)

"Very clear content. Landmarks and real video examples were helpful. The quiz was also helpful in the way it was phrased to help consolidate learning." M.B. (Nov. 2023)

"The anatomy review was beneficial." M.T. (Nov. 2023)

"The sections about how NOT to use the PAS were helpful. This course clarified a lot of my points of confusion regarding the purpose and administration of this scale." N.A. (Nov. 2023)

"I liked the clinical relevance. And discussion of the appropriate use of the PAS." J.R. (Oct. 2023)

"The presenter was very knowledgeable & used many visuals with detailed explanations and landmarks." A.H. (Oct. 2023)

"Learning how to correctly score each swallow was beneficial. I liked the discussion of the limitations of scores and the importance of describing the pattern." C.B. (Oct. 2023)

"I liked the images of MBS with multiple arrows showing anatomical differences in structure. Review of anatomy was beneficial." N.C. (Oct. 2023)

"Good examples and review of application of scale in clinical practice." N.A. (Oct. 2023)

"I liked the examples of each score. It was beneficial to understand the severity of scores." K.S. (Oct. 2023)

"The practical application of the PAS and how to document the results using the PAS to judge treatment efficacy was beneficial. I liked the flexibility to watch this course at anytime and anywhere. Easy to stop and repeat so I could avoid misunderstanding." B.A. (Sep. 2023)

"Easy to follow course that kept my attention. The test was adequate to recall knowledge. I liked the ease of use." C.O. (Sep. 2023)

"Loved watching the MBS examples. Anatomy review was fantastic. Really appreciated how speaker continued to address/review/point out anatomy throughout multiple examples." C.L. (Sep. 2023)

"Anything Dr. Coyle presents is extremely useful! Discussing how to "tell a story" in narrative form on reports and surrogate anatomical landmarks was helpful." L.G. (Sep. 2023)

"PAS scoring criteria was beneficial. I liked the speaker." K.K. (Aug. 2023)

"All of it was great. Very valuable in practice." V.W. (Aug. 2023)

"I liked the sample videos for each score. It was beneficial to learn how to describe what I see, penetration & aspiration, and to what degree." M.D. (Jul. 2023)

"This course was current, thorough, and very well done! I LOVED the explanations with diagrams of the anatomy." W.H. (Jul. 2023)

"Great course, very useful. I've been using the PA scale for years, and this course provided some great additional information and clarification on how it should be used. I liked everything." A.L. (Jul. 2023)

"Learning about the landmarks used to make judgments on PAS scores was beneficial. I liked having the diagrams and VF images to illustrate the different PAS scores." N.H. (Jun. 2023)

"The guidelines for using PAS when reviewing MBSS images were beneficial. I liked the clarification for PAS use guidelines and the anatomical refresher." L.I. (Jun. 2023)

"Very informative course and great anatomy review. I liked the specific PAS scoring." K.V. (Jun. 2023)

"Discussion of whether or not to use PAS scores in reports was beneficial. I liked the tent analogy for VF's." A.J. (May 2023)

"This course went into depth of anatomy on the VFSS. The video examples of PAS were beneficial." T.P. (May 2023)

"I benefited from the review of the anatomical structures visible via MBS images. I liked the various examples of each PAS score." M.M. (May 2023)

"How to use the PAS in my evaluation and reports was beneficial. It's all about judgment and nuances." C.T. (May 2023)

"This was fantastic!! Defining the PAS and pairing it with the anatomy was great. Presenter's speaking manner was engaging and informative." L.D. (May 2023)

"Anatomy and landmarks were beneficial! I liked learning how to comprehensively use the PAS score." R.P. (Apr. 2023)

"I liked the anatomical examples, the descriptions of PA scores, format to describing these, and patterns in reports was useful. I liked the interaction from the presenter - highlighting/drawing on slides whilst talking. The visual elements were clear and useful - diagrams and anatomical images, etc." T.K. (Mar. 2023)

"It was beneficial to review anatomy on MBSS, so when reading reports or viewing the videofluoroscopy, I am more clear on what I am observing. I liked the videos and anatomy pictures as I am a visual learner." B.G. (Mar. 2023)

"The whole course was very informative and easy to follow along! It will help standardize how we rank scores during MBSS." K.V. (Mar. 2023)

"I always love learning from Dr. Coyle. I liked the penned-in examples he provided. Anatomical landmarks were beneficial." A.P. (Mar. 2023)

"I liked the expertise of the presenter, and the visual material was clear and helpful. Some anatomical notions and vocabulary that have been clarified in my mind were beneficial as well as the research results about what's normal in swallowing and how to judge PAS when the cough is NOT spontaneous." A.P. (Mar. 2023)

"Course was to the point. I liked the anatomy review and the understanding to not use the score as a descriptor number, but to use the number as a reference for myself to develop descriptions of the patient’s swallow." J.H. (Mar. 2023)

"Review of anatomy and practice videos were beneficial." J.V. (Mar. 2023)

"The presenter was thorough and clear. I enjoyed the presentation. The use of the PAS and the discussion about how it was developed was interesting. I also liked how the study gave us a perspective of the normal PAS scores." L.S. (Mar. 2023)

"I feel after watching this course that I can immediately apply it in therapy today. Can easily bridge the research-to-clinical practice gap with this knowledge." H.H. (Mar. 2023)

"Liked viewing VFSS and the application to report writing. Many examples and thorough explanations of landmarks." S.G. (Mar. 2023)

"All of this content is beneficial to my practice." L.M. (Mar. 2023)

"Learned ways to use PENASP scale in practice." R.M. (Feb. 2023)

"I liked the review of the anatomy with where to look for deep and shallow penetration." S.P. (Feb. 2023)

"Concise information. Using PAS scores to determine a pattern." M.K. (Feb. 2023)

"Scoring parameters and clinical judgment/reasoning of results were beneficial. The presentation used alternate references to anatomical structures facilitating greater comprehension." D.B. (Feb. 2023)

"I liked the presenter's clear presentation style and specificity of examples. Discussion about how to score the PAS and use descriptions, not necessarily scores." C.K. (Feb. 2023)

"Importance of identifying and describing patterns in airway invasion characterized by frequency, depth, residue, and patient response. Review of anatomical landmarks and limitation on x-ray." D.Z. (Feb. 2023)

"Further discussion of anatomy/physiology, explanations of valid ways to interpret the data. I thought the course was nicely paced and organized." E.W. (Feb. 2023)

"Anatomical boundaries for judgement of P/A scores. Discussion of identification and use of anatomical structures to aid PAS score decisions was beneficial." R.S. (Feb. 2023)

"Using anatomical landmarks to determine PAS score." T.L. (Feb. 2023)

"Highly relevant to my practice and will be utilized daily." J.W. (Feb. 2023)

"Good clarity and standardization. I liked the detailed identification of anatomical markers in identifying aspiration/penetration and the functional application to diagnosing and treating dysphagia. Many times other clinicians assume everyone is able to identify these things as they have been doing it for years, but when learning from several mentors at a time, it can become a gray area as to how things are interpreted." J.N. (Feb. 2023)

"I liked the videos showing what each score would look like." L.D. (Jan. 2023)

"Course was extremely thorough and very well laid out. I liked the review of the anatomy to discuss the differences between deep laryngeal penetration and aspiration." A.R. (Jan. 2023)

"Dr. Coyle was very organized, had a nice calm presentation and with good examples." P.M. (Jan. 2023)

"I liked the anatomical structures (refresher) during MBSS. Appropriate use of PAS. Presented well." R.J. (Jan. 2023)

"Excellent speaker; enjoyable to listen to. Anatomical landmarks used in scoring the PAS were beneficial. I liked the pace of the presentation; speaker was very thorough." S.D. (Jan. 2023)

"I have been waiting for this course since I started doing videofluoroscopy!" A.S. (Jan. 2023)

"Loved the critical thinking and how to use PAS scale scores in clinical practice versus research. Anything that Dr. Coyle presents is wonderful. He is a talented speaker and makes complex information digestible." J.K. (Jan. 2023)

"Learning the development and functional use of the scale was beneficial. I find all of James Coyle's courses to be practical and applicable to daily practice and interventions." A.P. (Jan. 2023)

"Learning proper way to use the tool, nuances to ensure accuracy of scoring. Speaker was knowledgeable and engaging." K.S. (Dec. 2022)

"Anatomy review was beneficial. I liked the video examples and explanations." H.B. (Dec. 2022)

"The discussion of what the borders are to count the bolus as being penetrated or aspirated was beneficial. I liked the sample narrative to show how the scores should be summarized. I liked how specific course was and how immediately the information/methods could be utilized. I liked that it went into detail with all the anatomy which is absolutely necessary to accurately score for the PA scale." K.L. (Dec. 2022)

"Good clarity of information presented." D.D. (Dec. 2022)

"The whole thing: this was a very clear, well-organized course. We don't use the scale at my place of work, but it is occasionally used in hospital charts I have seen and this is an excellent explanation of the chart. I loved the video examples of each score, and "woahed" out loud to see the number 6 video example." C.K. (Dec. 2022)

"I liked the refresher on the anatomy portions! I like that this course went through how the PAS was created and reason for it. We use PAS in our MBSS notes, but no one has had any further education on it, so I wasn't sure if we were even using it correctly!" M.G. (Dec. 2022)

Course Objectives

  1. Accurately use the Penetration-Aspiration Scale on all swallows of a VFSS.
  2. Identify what PAS scores are typically occurring, especially for older individuals.
  3. Apply PAS scores in examination interpretation.
  4. Apply PAS results in treatment planning and repeat baselines to measure change.
  5. Describe how NOT to use PAS scores.

Presenter & Disclosures

James L. Coyle, PhD, CCC-SLP, BCS-S, ASHA Fellow, is a Professor in the Department of Communication Science and Disorders at the University of Pittsburgh where he teaches courses in the Master's Program in Speech-Language Pathology and courses in the SLP Clinical Doctorate Program. He also supervises undergraduate and graduate student dysphagia research. Dr. Coyle evaluates patients and teaches clinical practicum at the University of Pittsburgh Medical Center hospitals and is funded by the NIH to investigate the use of technology and signal processing in the screening and treatment of dysphagia. Other research includes the effects of exercise in relating dysphagia caused by radiation therapy for head and neck cancer and investigation of brain networks related to swallowing function. He's a Fellow of ASHA and received the University of Pittsburgh Chancellor's Distinguished Teaching Award in 2016.

Speaker Disclosures:

Financial — James Coyle is a presenter of CE seminars and online CE courses sponsored by Northern Speech Services; receives speaking fees and royalties.

Nonfinancial — James Coyle has no relevant nonfinancial relationships to disclose.

Intended Audience/Accreditation

asha ce approved provider

This program is offered for 0.2 ASHA CEUs (Intermediate Level; Professional Area).

Intended Audience

  • SLP

ASHA CEUs: NSS online courses are registered with ASHA and are offered for ASHA CEUs. The number of ASHA CEUs is noted above. Note that 0.1 ASHA CEU = 1 contact hour = equals 1 CEE.

ASHA CE Registry: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.

ASHA CEUs: Attendees must meet at least one of the following conditions in order to be eligible to earn ASHA CEUs:

  • Current ASHA Member
  • ASHA Certificate of Clinical Competence (CCC) Holder
  • Licensed by a state or provincial regulatory agency to practice speech-language pathology (SLP) or audiology
  • Credentialed by a state regulatory agency to practice SLP or audiology
  • Credentialed by a national regulatory agency to practice SLP or audiology
  • Engaged in a Clinical Fellowship under the supervision of an individual with their ASHA CCC
  • Currently enrolled in a masters or doctoral program in SLP or audiology

If an attendee is not an ASHA member or CCC holder but meets any of the above criteria, they may inform the ASHA CE Registry of their eligibility by visiting this site.

Licensing Boards: Most state licensing boards DO accept CEUs earned online (usually classified as home-study credits). Some state boards do, however, place a limit to the number of credits that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any credit limits related to home-study courses prior to registering for this course.

Additional accrediting agencies by which Northern Speech is an approved CE provider:

  • California: NSS is approved as a provider of continuing education by the California Speech-Language Pathology & Audiology Board. Provider #PDP4. Online CEU limits may apply; please contact SLPAHADB for current online CEU acceptance policies.
  • Iowa: NSS is approved as a provider of continuing education by the Iowa Board of Speech Pathology and Audiology Examiners. Provider #169.
  • Kansas: NSS is approved as a provider of continuing education by the Kansas Department of Health and Environment. Provider #LTS-S0005.

Frequently Asked Questions



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You have unlimited time to complete our online courses. You may log off and log on as often as you’d like to in order to complete all sections of a course.

However, completion dates are based on Eastern Standard Time. Therefore, if you need your CEUs by a certain date, be sure to complete the course test before 11:59pm EST on that date. For example, if you need CEUs before January 1st, you will need to complete the course test before 11:59pm EST on December 31st.

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ASHA CE Registry Submission:

During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.

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Our Online Courses consist of video, audio, and/or text content and are offered for ASHA CEUs. Unlike a webinar, which requires participants to be logged on and at a computer at specific times, our Online Courses are available to you at any time, from any device, via your NorthernSpeech.com online account. You may work at your own pace and start and stop your course as you wish. Your course will conclude with a short post test. On successful completion of the post test (>80%), a printable certificate of completion is presented to you.

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NSS is an ASHA CE Provider and most state licensing boards DO accept ASHA CEUs earned online (usually classified as home-study credits). Some boards do, however, place a limit to the number of CEUs that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any CEU limits related to home-study courses prior to enrolling in an online course.

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A purchased online course can be exchanged, refunded, or transferred to another individual if contact is made with NSS (via phone or email) within 30 days of purchase and the course materials have not been viewed or downloaded. 

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