5, In the last rmonih, how often have the following statements about communication
 applied to you because of your swallowing problem?


1 All of"
I the time


(circle one number on each line)
SMost of Some of A little of None of
the time the time the time the time


People hase a hard time
understanding me 1 3 4. 5
It s been difficult to r'ie to
speak clearly 1 2 3 4 5


6. Below are some concerns tnst people with swallowing problems sometimes
 mention. In the last month, how often have you experienced each feeling?

 (circle one number on each line)
 Almost Often Sometimes Hardly Never
 always ever
 I fear I may sTart choking when I 1 2 3 4 5
 eat food.
 I worry about getting neumonia 1 2 ? 4 5
 I am afraid of choking when 1 rink
 Equids. 1 2 3 4 5
 I never know when I am going to 1 2 3 4 5
 choke.


 7. In the last month, how often have the following statements been true for you because
 of your swallowing problem?


F'


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