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Diet Modification For The Swallowing Impaired

Diet modification is an alteration made on food and drinks which is widely used in the treatment of patients with dysphagia (swallowing disorder). The modification of food or drinks affects the transfer process of what was ingested through the pharynx (food tract) without changing the physiology of the swallowing system.

These modifications are usually effective for patients who are suffering from mild or moderate dysphagia. Changes made may eliminate risk of aspiration (food or drinks entering the airway) for some clients with dysphagia An instrumental assessment of swallowing can be carried out using different diet modification to look into the safe consistency for client’s food and liquid intake

Liquid Consistency Modification

Liquid modification are mostly effective for patients who suffered a stroke or neurological disease. Food thickener is used to change the consistency of a liquid. A thicker consistency will allow the liquid to flow at a slower rate through the pharynx and a lighter consistency will mimick the usual water that we drink daily.

Experts in dysphagia management (e.g. speech-language therapist, dietician, food technologist, nutritional company, etc) recommended a guideline on of the use of commercial food thickeners in thickening food and liquid for consumption (Dysphagia Diet Food Texture Descriptors, 2012; Irish Consistency Descriptors for Modified Fluids and Fluids Consensus Document 2009).

Source: Chemistdirect.co.uk & Remabmart.co.uk

Food thickener may be added to water or other fluids in order to derive the following consistencies:

Consistency

Illustration

Regular drinks with similar consistency

Nectar-like
Fluid flows easily from spoon but leaves a slight residue behind

Barley juice, yoghurt drinks

Honey-like
Fluid flows slowly in large lumps at the end of the spoon

Thick fruit juice

Pudding-like
Fluid remains on spoon without flowing

 

Baby cereal

Food texture modification

Food modification is typically used to help clients with oral phase disorder or difficulties. By modifying the food, It helps to ease the food preparation process and deem suitable for client who have weakness of the oral structures such as tongue, cheeks and jaw or teeth.

Food modification is also used to help clients who have difficulties managing or swallowing food with double consistencies (i.e. food with both solids and fluid in them). It is usually caused by weakness of the swallowing muscles in the throat (pharyngeal area). The following are the food modification that are usually prescribed to clients:

Illustration

Food modification

Other foods with similar texture

Source: Dietician Association of Australia (2007)

Soft Moist diet
Food with naturally soft texture or food that is prepared or cooked to achieve a soft texture.

 

Jelly, cake, steamed vegetables, fish flesh, soaked biscuits or bread

Source: Dietician Association of Australia (2007)

Easy to chew diet
Food that are minced or smashed to achieve a smooth but lumpy texture. Soft, moist food that can be easily mashed with a spoon.

Minced meat or vegetables

Source: Dietician Association of Australia (2007)

Blenderized diet
Food prepared to achieve soft and moist texture without any lumps.

Mashed potatoes, ice cream, blenderized porridge, baby cereal, mushroom soup.

Temperature & taste modification

A change in the food or drinks temperature affects the swallowing system greatly. An extreme temperature of hot or cold will increase a client’s oral sensitivity and swallowing reflex.

It helps clients who have absent swallowing reflex and also elderly clients. Example of temperature modification that can be made are:

Changing the taste to an extreme such as sour will also increase the oral sensitivity. For elderly clients, sweetened drinks may improve their swallowing reflex as compared to drinking plain water.

Quantity modification

Controlling the quantity of food and drinks taken is important in client who have pharyngeal muscle weakness. A less effective swallowing mechanism causes food to collect in the pharynx after swallowing. An excessive amount of residue may increase the risk of aspiration.

A proper drinking technique might control the amount of fluid taken and the rate of which it flows through the pharynx. Drinking through a spoon can reduce the rate of fluid flow. At the same time, it reduces the amount of fluid which makes it easier for a patient to swallow.

Drinking through a straw helps clients who have difficulty drinking due to weakness in their arms, but beware! The use of a straw increases the rate of fluid flow in the pharynx.

 

 

Using a cup

 

Using a straw

 

Using a spoon

Changing the amount of food on a spoon can help clients with difficulties to chew. This technique will also reduce the risk of aspiration for clients who may have food residue in the pharynx after swallow.

 

 

1/3 spoon of rice

 

1/2 spoon of rice

 

1 spoon of rice

Even though diet modification may reduce or eliminate the risk of aspiration, it does not change the physiology of a client’s swallow. Therefore, a client requires rehabilitation techniques recommended by a certified Speech-Language Therapist to help in the process of recovery.

References

  1. Alberta Health Services (2013). Nutrition Guideline Dysphagia Applicable to: Nurses, Physicians and Other Health Professionals. Retrieved  August 1, 2015 from http://www.albertahealthservices.ca/hp/if-hp-ed-cdm-ns-5-2-1-dysphagia.pdf
  2. Jawatankuasa kerja Pegawai Pemulihan Perubatan (Pertuturan), (2014). Prosedur Operasi Standard Penjagaan Pesakit Dengan Kecelaruan Penelanan. Bahagian Sains Kesihatan Bersekutu, KKM
  3. Jeri A. Logemann, (1997). Evaluation and Treatment of Swallowing Disorder. Pro ed.
  4. Lizzy Marks & Deidre Rainbow, (2001). Working With Dysphagia. Speechmark, Publishing Ltd UK

 

Last Reviewed : 07 October 2016
Writer : Marina bt. Abdul Malek
Translator : Siti Suhana Mohd Khalid
Accreditor : Nadwah bt. Onwi