Mealtime+Guidelines+for+Modifying+Diet

= Mealtime Guidelines for Modifying Diet  = "How can one make friends without exquisite dishes! It is mainly through the table that one governs"..Jean Jaques Regis de Cambaceres,(no date).

==== Mealtimes are very social, personal occasions where friends and family get together to enjoy a favourite meal, discuss the days events, have a glass of wine or a bottle of beer to wash down a favourite desert. It is a common event that everyone takes for granted. Can you imagine how it would feel if you knew that this social event was no longer posible for you? That special considerations would have to be made on your behalf to participate, maybe even special devices used? The SLT should keep these thoughts very close to their minds when making mealtime guidelines for people with Dysphagia. Guidelines should always be delivered tentatively and with respect for the patient. As aforementioned there are tips in the NDD handbook on how to make food more palatable for patients. Also at the end of this section you will find a link to a Dysphagia Cookbook. These could be useful tools when helping to plan mealtime guidelines. ====



The National Dysphagia Diet ,( NDD), was introduced in 2002 in an attempt to standardise menus and decision processes in the application of modified diets for adults with dysphagia ( Groher & Crary,2010). The NDD was devised entirely by a group of professional volunteers who had an ongoing clinical and professional interest in diagnosing and treating orpharyngeal dysphagia (NDD Task Force, 2002). Four standardised levels of diet modifications were developed based on the assessment of food textures. In the report information is given about standard assessment tools, food preparation advice for food on each level, foods to avoid on each level, and food preparation approaches. There is advice in the on how to enhance patient acceptance of modified diets. The Four levels of food semisolid/solid food segments of the NDD that were developed are:


 * 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.

(National Dysphagia Task Force,2002)



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 surface to which it has contact e.g the amount of work required to remove 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 deformation. An example is chewing a hot dog just prior to when it begins shearing.

<span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**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.

<span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**Viscosity**: The rate of flow per unit force. An example is the rate at which a milkshake is drawn through a straw by suction.

<span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**Yield Stress:**The minimum 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.

<span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">As an aid to help understand these textural terms, Donald Tymchuck,MS, Arranged a series of "similar anchor foods" on rating scales (in figure 1.2 semisolid/solid food measurement scale), in the NDD hand book (NDD Task Force,2002). This rating scale of foods can be found in the following word document:

<span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 14px;">

====<span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">The NDD decided to concentrate on these eight textures because they were deemed to be the most significant for dysphagia (National Dysphagia Task Force,2002). The group then worked to establish how best these different textures would fit in within different food groups in a a person with dysphagia's diet. ====

** How to Decide on an Appropriate Diet? **