Diet Modification and Therapy Flashcards
Diet Modifications
- # 1 thing we do to help pt. is modify the diet
- Anytime you modify the diet it can be liquid or textures or NPO (nothing by mouth)
- Usually the last thing we should do is change the diet, but it is really one of the first things we do.
- Can involve food texture and/or liquid viscosity modifications.
- Can be extreme or minor
- May be temporary or permanent
- Has been suggested to be the last treatment option, owing to poor patient acceptance (Logemann, 1993)
*** We modify liquids and solids
[x] diet (solid) + [x] liquids
Liquid modifications (4)
- Thin
- Nectar thick (slightly thick-V8 juice)
- Honey thick (honey consistency, flows more slowly, spoon should almost stand up)
- Pudding thick (really puree food, very thick)
Solid modifications (6)
- Puree (thin and thicker)
- Dental soft- mechanical soft (chopped up meats and veggies that are fork mashable (soft carrots, chopped broccoli)
- No mixed consistency (cohesive- you can form the bolus and hold it together) (not foods that leak out liquid)
- Smooth
- Slick- extra moisture (if pt. has difficulty moving food through the esophagus)
- Regular
Dietary considerations (5)
Consistent Carbs Calorie restriction Fluid restriction Healthy Heart Others
Benefits of dietary modifications
- Can allow the continued pleasure of sharing a meal with friends and family.
- Can mark time in a day for confused patients.
- Withholding of food considered unacceptable in some religions (Shoemaker, 1997)
- Meals are social and cultural
- May improve quality of life due to avoidance of tube placement.
- Patients may accept modifications as they are rehabilitating their swallowing skills.
Reasons for reduced acceptance (5)
- Poor texture
- Poor taste
- Poor appearance
- Cost
- Inconvenience
***These factors may lead to dehydration or malnutrition
Terminology differences between SLPs and dietitians
- SLP’s – looking at mechanics of the swallow
- RD’s - looking at nutrient issues
Terminology differences- Regular diet
- Dietitians: No nutrient restrictions
- SLP: No texture/viscosity restrictions because the strength of the swallow is WFL
Terminology differences: Mechanical soft
- Dietitians: Elimination of foods difficult to digest in the GI tract
- SLP’s: Foods easily chewed into cohesive bolus.
Terminology differences: Puree
- Dietitians: used with patients who do not have teeth.
- SLP’s: used with patients unable to process solid food due to oral and/or pharyngeal stage dysphagia.
Terminology differences: Therapeutic diet
- Dietitians: nutrient modifications
- SLP’s: Specific texture/viscosity modifications and feeding techniques.
Viscosity-thickness
- Defined as the resistance of a substance to flow under an applied force.
- Usually refers to liquids
- Affected by temperature, the concentration and molecular weight of a solute, and the amount of suspended matter in the fluid. (pulp in oj)
- Clinicians must learn to control and understand a liquid’s inherent chemical properties, temperature, mixing technique, standing time, and flavor.
- Ice cream is a thin liquid
Understanding Viscosity
- Liquids are described in centipoise.
- Thin: 1 – 50 cP
- Nectar: 51 – 350 cP
- Honey: 351 – 1750 cP
- Solid & spoon thick: >1750 cP
- To determine thickness, you need a viscometer.
- A line spread test can also be used. (Draw concentric circles on plastic and put liquid in the middle and then you time it (how fast they move is how thin they are)
- Water is thinner than milk and oj with pulp is thicker than milk
Thickeners
- Starch based
- Advantages of xanthan (gum)
Starch based or gum (xanthan)based commercial products.
- Most prevalent in facilities
- Best when freshly mixed – not stable over time
- Tend to “lump up” when mixing - Stability over time
- Heat stable
- Can be frozen
- If aspirated, clears from the lungs more readily than starch.
- Due to cellulose backbone, passes through the body like fiber.
- Adds no calories.
Other thickeners
- unflavored gelatin
- cornstarch
- instant potato flakes
- baby cereal
- cracker crumbs
- instant pudding in milk