Here are the step-by-step guidelines for conducting the Gugging Swallowing Screen (GUSS): -Preliminary Assessment (Indirect Swallowing Test) Patient Preparation: Position the patient in an upright sitting position (at least 60°). -- Vigilance Check: Ensure the patient is awake and alert (minimum of 15 minutes). Tick "Yes" on the GUSS sheet to score 1 point if criteria are met. --Coughing/Throat Clearing Assessment: Ask the patient to cough hard or clear their throat. Score 1 point if the cough or throat clearing is strong enough to transport a foreign body. --Saliva Swallowing Check: (1)Assess if the patient can swallow saliva. (2) Drooling of Saliva (3) Voice Change Score one point if YES/NO Total the points from the preliminary assessment. If the total is less than 5 points, stop the examination and recommend an NPO diet (nothing by mouth). If 5 points are achieved, proceed to the direct swallowing test. -Direct Swallowing Test --Semisolid Swallowing Trial: (Prepare thickened water (pudding consistency) using a food thickener.) Offer 1/3 to 1/2 teaspoon as the first bolus, followed by five more half-teaspoons. Observe for aspiration signs (deglutition, cough, drooling, voice change) after each spoonful. Abort the test if any aspiration signs are present. --Liquid Swallowing Trial: Start with 3 mL of distilled water in a beaker. Observe closely while swallowing; if successful, increase amounts to 5 mL, 10 mL, and finally 20 mL. The last task involves drinking 50 mL of water as quickly as possible. --Solid Swallowing Trial: Begin with a small piece of dry bread (1.5 x 1.5 cm). The patient should chew and swallow within 10 seconds; if not, score for delayed swallowing. Repeat this test five times, observing for aspiration signs after each swallow. --- If all tests are successful without aspiration signs, score accordingly. Final Assessment: Evaluate based on deglutition, coughing, drooling, and voice change after each subtest. If any aspiration signs occur during any part of the test, stop immediately and recommend further evaluation. By following these guidelines systematically, clinicians can effectively assess swallowing ability and aspiration risk in patients using the GUSS.