Component

7: Soft Palate Elevation

Soft palate elevation represents the contact between the soft palate and posterior pharyngeal wall and is
scored at the height or maximum displacement of the soft palate. On this component and several others
the height of the swallow represents the point of maximal contraction of the structure in question. Soft
palate to pharyngeal wall contact is based on the presence of contrast or air between the two structures.
If the patient uses a palatal appliance, continue to base judgments on the effectiveness of VP closure. In
the case of the sequential swallowing task, each swallow is considered in formulating the OI score.

IMPORTANT STRUCTURES
When scoring soft palate elevation and retraction, keep the following structures/regions in mind:



1) Soft Palate
2) Pharyngeal Wall
3) Nasopharynx
4) Nasal Cavity
5) Nostril

SCORING EXAMPLES
The following images are intended to help you differentiate between impaired Soft Palate Elevation
scores 0-4:

(0) No contrast between the soft palate and pharyngeal wall:

(1) Trace column of air or contrast between the soft palate and pharyngeal wall:

(2) Escape of contrast material to the level of the nasopharynx:
This is represented by contrast material between the soft palate and pharyngeal wall that is greater than
“trace”. One can parallel this amount to a “collection” described for residue scores.

(3) Escape of contrast material that progress to the level of the nasal cavity:

(4) Escape of contrast progressing to the level of the nostril with or without nasal emission:

COMMON SCORING ERRORS
Timing the Score
The onset of first soft palate elevation/retraction is an early component of the pharyngeal swallow, and
complete or maximum elevation/retraction represents the full contact of the soft palate and posterior
pharyngeal wall as viewed on the lateral viewing plane. Score soft palate elevation only when the soft
palate is at its fully contracted position and not during rise or fall of the structure. In the image below, the
soft palate can be seen rising at 0:01.64, reaching maximum contraction at 0:01.97 and returning to rest
at 0:02.52. You would rate soft palate elevation at 0:01.97 when the soft palate is at the height of
elevation. The patient below should receive a score of (0) as there is no contrast or air visible between the
soft palate and pharyngeal wall.

Contrast Along the Tongue Base
Do not confuse contrast on the back of the tongue as being in the nasopharyngeal space (between the
soft palate and posterior pharyngeal wall).