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What is Dysphagia?
This condition can range from mild discomfort such as a feeling that there
is a lump in your throat, to severe inability to control the muscles needed
for chewing and swallowing.
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How does swallowing occur?
Food must be chewed thoroughly, then it is moved to the back of the mouth by
tightening the cheek muscles and pressing the tongue against the roof of the mouth.
From this point the process should be automatic. The food enters the pharynx and into
the esophagus, while the body automatically closes the epiglottis.
If this process fails and the foods and fluids switch direction and go through the trachea
into the lungs, side effects are choking and pulmonary aspiration.
The human body has an automatic response when eating and swallowing, it will temporally
close the epiglottis as swallowing is occurring.
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Signs and Symptoms of Dysphagia:
Symptoms:
• Food and drink leaking from mouth
• Gurgling voice after eating and drinking
• Coughing during or after eating
• Extra effort or time needed to complete meals
• Frequent pneumonia
• Weight loss
• Dehydration
• Repetive swallowing or progressive need to clear throat
• Clear liquid discharge from nose
• Weakness or lack of control of head or neck muscles
• Fullness or tightness in throat
• Pressure or pain in the chest
• Frequent heart burn 4
What can cause Dysphagia?
Dysphagia can also be the result of localized trauma or muscle damage to the
esophagus muscle,a tumor or swelling that can partially obstruct
the passage of food.
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Types of Dysphagia:
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Consequences of Dysphagia
• Malnutrition
• Dehydration
• Embarrassment
• Social Isolation
• Decreased enjoyment from eating
• Anger/ Agitation
• Lung Infections
• Urinary Tract Infections
• Slower wound Healing
• Depression
• Weight Loss
• Increase risk for skin wounds
• Decline in ADL functioning
• Increase risk of death
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Dysphagia Diagnosis
Evaluations can start tableside as patient is monitored and evaluated eating and
drinking different food textures and liquid consistencies. If dysphagia diagnosis is
suspected, often additional formal swallowing tests are performed in a hospital
called a Modified Barium Swallow test, a patient is observed with an x-ray
as they chew and swallow different foods and fluid consistencies that are coated with
a barium substance that can be seen on the x-ray clearly, to evaluate if swallowing
or aspiration difficulty is noted.
Upon diagnosis an appropriate safe food and fluid consistency will be recommended
per the SLP or MD.
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Dysphagia treatment:
Long term goals are rehabilitation, which focuses on helping the patient or resident recover
the ability to swallow sufficient amounts of food and drink to assure adequate nutrition.
There are different stages of swallowing. Each patient case is particular and an appropriate
diet consistency is extremely important.
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What is a Mechanically Altered Diet?
They consist of foods and fluids that can be safely and successfully swallowed.
Foods are altered by whipping, blending, cutting, chopping, grinding or mashing, so they
are easy to chew and swallow.
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Levels of Dysphagia
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National Dysphagia Level 2 : Mechanically Altered Nutrition Therapy
This diet is a transition from pureed textures to more solid textures. Chewing ability is required
Foods are moist, soft and easily formed into a bolus.
• Meats are ground or minced with additional moisture from gravy and sauces provided.
Meat pieces should not exceed ¼ inch cube and need to be tender. Dry tough meats
such as bacon, sausage and hot dogs should be eliminated. Protein salads such as tuna, chicken
and egg salad should be without large chunks and moist. AVOID casseroles that contain rice.
• Canned fruits and ripe banana are allowed. Eliminate all fresh and frozen fruits, unless
pureed. (omit pineapple canned or fresh)
• Vegetables are cooked well and cut into ¼ diced pieces. Fibrous vegetables are omitted or served
puree. (corn, peas, broccoli, cauliflower, asparagus, Brussel sprouts). Omit all raw vegetables.
• Bread products need to be pureed or slurried. Soft pancakes well moistened with syrup are allowed.
Cooked cereals should have little texture. Some dry cereals are allowed as long as they are well
moistened and with little texture. (Rice Krispy, corn flakes, bran flakes) NO dried fruits, coconut,
or nuts to be added to hot or cold cereal. 12
National Dysphagia Level 3 Advanced Nutrition Therapy
This diet is a transition to a regular diet. Cohesive, moist semisolid food which requires
some chewing. Foods are nearly regular textures with the exception of a very hard, sticky
or crunchy foods. Menu items still need to be moist and should be bite size pieces at the
oral phase of swallowing.
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Thickened Liquids
Dysphagia may not only affect ability to eat, but often can effect an individuals
ability to drink.
Often straws or carbonated beverages are avoided to ease swallowing, however at times
changes to the liquids consistency is necessary for safe swallowing.
3. Honey Liquids- Liquids are honey consistency, and should NOT be able to be sipped
through a straw.
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4. Pudding Liquids- Liquids are pudding thick, and must be taken with a spoon.
Anything that is liquid at room temperature is considered a liquid.
This includes (ice cream, ice cubes, sherbet, popsicles, water ices,
cream ices, soups and broths.
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• Generally most thickening agents need to sit at least 2-3 minutes to
set to appropriate thickness.
Common Thickeners
-Banana Flakes
-Cooked cereal (cream of wheat, rice)
-Cornstarch
-Gravy
-Instant Potato Flakes
-Mashed Potatoes
-Unflavored Gelatin powder
-Pureed fruits and Vegetables
-Pureed Meats
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References
3. McCallum . SL (2003)
The National Dysphagia Diet : Implementation at a regional rehabilitation
center and hospital system.
Journal of American Dietetic Association