MASA and mMASA Screening Tool for Aspiration Risk

Mann Assessment of Swallowing Ability (MASA)

  • developed in 2002
  • screening tool for identifying eating and swallowing disorders in stroke
  • used to quantify aspiration risk via bedside test
  • predicting dysphagia in stroke – Sn 71% Sp 72%
  • predicting aspiration in stroke – Sn 93% Sp 55%
  • now used for various diseases
  • 24 clinical items
  • 4 main components
    • general patient examination (alertness, cooperation, auditory comprehension, aphasia, apraxia, and dysarthria)
    • oral preparation phase (saliva, lip seal, tongue movement, tongue strength, tongue coordination, oral preparation, respiration, and respiratory rate for swallowing)
    • oral phase (gag reflex, palatal movement, bolus clearance, and oral transit time)
    • pharyngeal phase (cough reflex, voluntary cough, voice, tracheostomy, pharyngeal phase, and pharyngeal response)
  • 5-point to 10-point rating scale
  • total score: 200 points
  • cutoff is 177 points
    • no abnormality (≥178)
    • mild dysphagia (168–177)
    • moderate dysphagia (139–167)
    • severe dysphagia (≤138)
  • risk of aspiration
    • no abnormality (≥170)
    • mild (149–169)
    • moderate (141–148)
    • severe (≤140) (14)

modified MASA (mMASA)

  • simplified version of MASA
  • 2010
  • prediction of dysphagia – Sn 92% Sp 83%
  • 12 items
  • total score 100 points
  • cutoff value of dysphagia as 94
  • evaluates alertness, cooperation, respiration, expressive dysphasia, auditory comprehension, dysarthria, saliva, tongue movement, tongue strength, gag reflex, voluntary cough, and palatal movements
  • “no response” added as a possible response in auditory comprehension


Antonios, N., Carnaby-Mann, G., Crary, M., Miller, L., Hubbard, H., & Hood, K. et al. (2010). Analysis of a Physician Tool for Evaluating Dysphagia on an Inpatient Stroke Unit: The Modified Mann Assessment of Swallowing Ability. Journal Of Stroke And Cerebrovascular Diseases19(1), 49-57. doi: 10.1016/j.jstrokecerebrovasdis.2009.03.007

Kwon, S., Sim, J., Park, J., Jung, Y., Cho, K., & Min, K. et al. (2019). Assessment of Aspiration Risk Using the Mann Assessment of Swallowing Ability in Brain-Injured Patients With Cognitive Impairment. Frontiers In Neurology10. doi: 10.3389/fneur.2019.01264

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