Emma writes...

There is a range of approaches to manage dysphagia that aim to keep the person safe, support nutritional intake, support rehabilitation where possible, or provide compensation strategies if required.

Speech and language therapists play a key role in the assessment and management of swallowing difficulties. Alongside this, dietitian support with the assessment of dietary requirements ensures nutritional adequacy within the dysphagia management strategy.

Typical management strategies include: [2,3,5-8]

1. Texture modified diet – Altering the texture of the food can support the preparation of food for swallowing, for example, where there are challenges with chewing or there is an oesophageal limitation such as a narrowing or blockage.

2. Altered fluid consistency – Liquids can be difficult to control in the mouth and as they pass through the oesophagus to the stomach. They move fast, which can be a safety concern. Thickening drinks means that they are more viscous and slower moving throughout this process. It allows effective swallowing, giving time for the trachea to close, protecting the airway and reducing the risk of aspiration (liquid penetrating the lungs).

3. Seating and posture techniques / supportive equipment – advice on sitting or being positioned in an upright position during and after eating and drinking is often provided for safety and comfort. Supportive equipment such as specialist dysphagia cups and cutlery may be used to manage the amount of food or drink administered per mouthful. These may be used in conjunction with support from a carer if the person experiences difficulties when feeding themselves.

4. Swallowing exercises – techniques to strengthen muscles in the mouth and throat which can support rehabilitation and prevent further swallowing problems.

It’s a standard approach to describing the characteristics of food and drinks from the perspective of a person with dysphagia. That is, it is a way to classify a food or a drink into one of eight categories:[9]

• Level 0: Thin drinks

• Level 1: Slightly thick drinks

• Level 2: Mildly thick drinks

• Level 3: Moderately thick drinks and pureed foods

• Level 4: Extremely thick drinks and minced foods

• Level 5: Soft foods

• Level 6: Soft and bite-sized foods

• Level 7: Regular texture foods

This system not only allows consistency in the description of food and drinks, but it also includes methods for testing to 'confirm the flow or textural characteristics of a particular product at the time of testing'.[9]

The testing is designed to support confirmation of which classification a food and drink falls into, which may be consumed by a person who has swallowing difficulties.

You can read more about IDDSI testing methods here.

Testing foods and drinks requires competency and should be completed by a trained individual. IDDSI recommend that testing should only be conducted on foods and drinks under their intended serving conditions, that is, at the temperature and consistency that the person with swallowing difficulties will be consuming them.

It can be challenging to classify some foods and drinks as they may alter in texture and consistency under shifting conditions, for example, frozen foods when defrosting or foods when heated from chilled or ambient temperatures.

The standard only describes food and drinks; it is not intended to be used to select what level(s) of food and drinks are appropriate for a person. Choosing foods from certain IDDSI levels may play a role in alleviating symptoms,[9] but it remains the responsibility of the healthcare professional who’s managing the person’s needs to ensure that any recommended food and drinks are safe, appropriate and manageable for the person to consume.