Holistic Parenting: Dysphagia and Swallowing Therapy and Treatment, Diet and Liquid Consistency

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I. Swallowing therapy/treatment

Conventional therapy for dysphagia typically employs

Compensatory strategy techniques

· diet changes

· head positioning

· modifying bolus size

Specific techniques aimed at improving the coordination and strength of the swallowing muscles

· thermal stimulation

· biofeedback

· mendelssohn maneuver

· supraglottic swallow

VitalStim Therapy is the use of electrical stimulation for activation of muscles. Research shows that the combination of electrical stimulation and traditional treatment techniques is very effective at restoring swallowing function.

http://www.empi.com/empi_products/detail.aspx?id=222

II. The standardized diet, consistencies and general guidelines

The American Dietetic Association (ADA), the United States' largest organization of food and nutrition professionals, in January 2012 officially changed its name to the Academy of Nutrition and Dietetics, developed guidelines for the National Dysphagia diet published in “The National Dysphagia Diet: Standardization for Optimal Care”

http://webdietitians.org/cps/rde/xchg/ada/hs.xsl/shop_1344_ENU_HTML.htm

The standardized diet consistencies and general guidelines are:

Level I - Dysphagia Pureed

A. Guidelines:

This diet consists of pureed, homogenous, and cohesive foods.

Food should be:

"Pudding-like"
No coarse textures, raw fruits or vegetables
No oatmeal or unprocessed wheat bran stirred into cereals
Any foods that require bolus formation, controlled manipulation, or mastication are excluded.

NOTE: Smooth chocolate candy (plain) is allowed if thin liquids allowed.

B. Purpose
This diet is designed for people who have moderate to severe dysphagia, with poor oral phase abilities and reduced ability to protect their airway. Close or complete supervision and alternate feeding methods may be required.

Level II - Dysphagia Mechanically Altered

A. Guidelines:
Consists of foods that are:

Moist, soft-textured, and easily formed into a bolus
Meats are ground or are minced no larger than onequarter-inch pieces; they are still moist, with some cohesion
All foods from NDD Level 1 are acceptable at this level.
Avoid rice, bacon, hard cooked eggs, potato chips/French fries, and fibrous cooked vegetables

B. Purpose
This diet is a transition from the pureed textures to more solid textures. Some chewing ability is required. The textures on this level are appropriate for individuals with mild to moderate oral and/or pharyngeal dysphagia. Patients should be assessed for tolerance to mixed textures. It is expected that some mixed textures are tolerated on this diet.

Level III - Dysphagia Advanced

A. Guidelines consist of:

Food of nearly regular textures with the exception of very had, sticky, or crunchy foods.
Avoid French bread, fresh apples, pears or grapes, and cooked corn.
Foods still need to be moist and should be in “bite-size” pieces at the oral phase of the swallow.

B. Purpose
This diet is a transition to a regular diet. Adequate dentition and mastication are required. The textures of this diet are appropriate for individuals with mild oral and/or pharyngeal phase dysphagia. Patients should be assessed for tolerance of mixed textures. It is expected that mixed textures are tolerated on this diet.

Liquid Consistency Controversy

Liquid consistencies:

thin
nectar
honey
spoon or pudding thick

With dysphagia patients we use:

Pre-thickened liquids or food
Instant food & beverage thickeners:

Please watch a video to learn more how to use a thickener.
http://www.dmes.com/p-13369-simplythick-how-to-mix-video.aspx

· Thick-It manufactured by Milani
http://www.woodburyproducts.com/thickit_powder.htm?gclid=CNrY3_jeoK8CFUbe4Aod7lTamA