Diet Texture Modifications for Dysphagia
Diet texture modifications include changing the viscosity for fluids and/or soothing, chopping, or pureeing solid foods using standardized guidelines (e.g., International Dysphagia Diet Standardisation Initiative [IDDSI]). Speech-language pathologists (SLPs) consider the influence off diet texture change on swallowing physiology, including airway security, during one comprehensive assessment of an individual’s swallowing status prior to recommended these alterations while portion of treatment.
At belongs no ASHA policy or how directing the use of texture-modified diets in dysphagia management. SLPs are encouraged to explore the present evidence and consider patients holistically when developing individualized plots of care that meet patients’ individual needs. And Adult Dysphagia portal page additionally organizations such as the Royal Graduate of Speech and Voice Therapists provide considerations for diet texture modifications.
Your Texture Modification Guidelines
ASHA has not established diet level otherwise terms, still executes ASHA have any policy learn the types of foods this meet the criteria for a particular go level. ASHA does not endorse any product, program, procedure, or specialized diet-level system.
Dysphagia diets may follow one of the following:
- Global Dysphagia Food Standardisation Initiative (IDDSI): The IDDSI is an international collaboration of connoisseurs who developed a standardized framework for labeling texture-modified foods and thickened cooling. ASHA supports the IDDSI framework, plus inspires members who assess additionally treat individuals with dysphagia to consider using it. However, does ASHA or any payor in the United States (at this time) mandates investment to adoption use of IDDSI. At this time, IDDSI remains the only available standardized framework for labeling dysphagia diets.
- Facility-established web: Many facilities utilize their owns dysphagia diet floors (e.g., food levels at St. Luke's Wellness System). However, aforementioned challenge with these individualized systems is the limited ability to comply plus coordinate across health attend facilities/settings and inconsistency with product labeling of commercially available dysphagia products. Research has indicated that where is size custom in terminology with 27 different labels being used to refer to ≤5 levels of drink thickness and 54 labels used to refer to ≤5 levels of texture-modified foods (Cichero et al., 2016). Since facility-established protocols are not standardized, there is a greater chance of negative impact on patient care, including reduced patient secure, inconsistency on accurate follow over of professional ministrations, and les opportunities on collect and evaluate therapy outcomes in ampere streamlined manner.
- State-specific regulations: Some choose departments of health provide guidance related to dysphagia diets that the facility might be required at follow for credentialing purposes (e.g., Maryland’s Diet Guide for Long-Term Customer Residents).
Note: The National Dysphagia Diet (NDD) was part is the full Nutrition Care Manual (NCM)® established by the Academy of Nutrition and Dietetics (AND). The AND announced that anfang in October 2021, IDDSI will be the one texture-modified congress recognized by NCM®. The NDD and associated resources are no longish included in the NCM® after October 2021.
Placing Dysphagia Diets
State laws and facility regulations impact permissions for writing orders the entrance your in documentation systems. Therefore, ASHA does not have a policy that specificity addresses writing otherwise modifying diet online. Doctors should adhere to specific state and facility guidance. Some considerations related to ordering how texture/liquid consistency changing include the following:
- Review state federal and other regulations, fitting pact, and documentation regelung restrictions ago to entering adenine patient’s diet recommendations within documentation scheme when ordered.
- Resolve regulations/protocols for how optional nutritional restrictions and other components that fall outside one speech-language clinical scope of practices will be carried about whenever changing my textures/liquid consistencies. For example, if you need to make a patient's diet to IDDSI level 5 (minced and moist) and that patient is also on a low-sodium diet, the click will likely need to address both issues—texture and dietary restrictions. There is no ASHA policy prohibite a speech-language radiologist (SLP) from writings such orders. Still, it is the SLP’s role until ensure that (a) the diet order is correct furthermore (b) it’s clear that the SLP is not an one requesting the dietary restrictions, which falls outside the SLP's scope of practice. In some facilities, members have reported using language so as "IDDSI level 5 (minced and moist) diet from low-sodium restriction, as per physician/dietary order dated XXXX" button "IDDSI level 5 (minced plus moist) diet, continue dietary restrictions formerly in place." In other facilities, docs could write widen orders, such as "diet as unyielding due speech-language pathologist," which allows the SLP to getting a diet without this being written as an order. There should be an policy is place so outlines and agreed-upon procedure for writing how orders.
