Mealtime+Guidelines+for+modifying+fluid,food+intake

=﻿The National Dysphagia Diet=



The National Dysphagia Diet,( NDD) was introduced in 2002 in an attempt to standardise menus and decsion processes in the application of modified diets for adults with dysphagia, ( Groher & Crary,2010). The NDD was devised up entirely by a group of professional volunteres who had an ongoing clinical and professional interest in diagnosing and treating orpharyngeal dysphagia. (NDD Task Force,2002). Four levels of food semisolid/solid food segment of the NDD were developed. THese are (National Dysphagia Task Force,2002)
 * 1) Dysphagia Pureed( homogenous,very cohesive, pudding like, requiring bolus control, no chewing required.
 * 2) Dysphagia Mechanically Altered,( cohesive, moist, semisolid foods requiring chewing ability)
 * 3) Dysphagia Advanced,( soft -solid foods that required more chewing ability)
 * 4) Regular ( all foods allowed)



In total the group identified 15 key food textures as having plausible roles in dysphagia management.Among these eight,were considered the most significant. These eight were:
 * Adhesivneness:**the work required to overcome the attractive forces between the surface of a food and another surace to which it has contact e.g the amount of work required to remoe peanut butter adhering to the palate.


 * Cohesiveness:** The degree to which the food defores rather then shears hen compressed as when a moist bolus of salt crackers is compressed between the tongue and the palate


 * Firmness:** The force required to compress a semi solid food. An example is compressing pudding between the tongue and the palate


 * Fractureability: ( Biteability):**The force that causes a solid food smaple to break. An example is biting peanut brittle with the incisors


 * Hardness:**The force required to compress a solid food to attain a certain deformationAn example is chewing a hot dogjust prior to when it begins shearing


 * Springiness:** The rate a sample returns to its origional shape after being compressed. An example would be a marshmallow being compressed and released between the tongue and hard palate.


 * Viscosity:**the rate of flow per unit force.An example is the rate at which a milkshake is drawn through a straw by suction.

The NDD decided to concentrate on these eight textures because they were deemed to be the most significant for dysphagia (ref from book). The group then worked to establish how best these different textures would fit in within different food groups in a dysphasics diet.
 * Yield Stress:**The minimimum amount of shear stress that must be applied to a food before flow begins.An example is the force required to get ketchup to flow out of a bottle.

NDD Continued : How to decide on optimal diet for the patient?