dr jill lesic & associates speech...

Dr Jill Lesic & AssociatesSpeech Pathology

Copyright Dr Jill Lesic & AssociatesSpeech Pathology (03) 9836 8542

Dr Jill Lesic & Associates

Speech Pathology

• No chewy meats or

dry, hard or crumbly

solids

• Easy to chew

• Has some lumps

• Little to no chewing

required

• Moist

• Vitamised

• No lumps or bits

• No chewing required

• Moist


Speech Pathology


Speech Pathology

Copyright 2016 - Used with permission from IDDSI


Speech Pathology


Mapping to IDDSI- Foods

Australian IDDSI Steering Commi�ee: Die��ans Associa�on of Australia, Speech Pathology Australia, Ins�tute of Hospitality in Healthcare, Interna�onal Dysphagia Diet Standardisa�on Ini�a�ve,Nestlé Health Science, Precise ThickN, Flavour Crea�ons Email: [email protected]


Speech Pathology


Mapping to IDDSI- Liquids

Australian IDDSI Steering Commi�ee: Die��ans Associa�on of Australia, Speech Pathology Australia, Ins�tute of Hospitality in Healthcare, Interna�onal Dysphagia Diet Standardisa�on Ini�a�ve,Nestlé Health Science, Precise ThickN, Flavour Crea�ons Email: [email protected] Jill Lesic & Associates

Speech Pathology

TESTING WITHIN THE IDDSI

FRAMEWORK

• Flow Test (Liquids Levels 0-3)

• Fork Drip Test (Liquids and Food Levels 3, 4

& 5)

• Spoon Tilt Test (Liquids and Foods Levels 3,

4 & 5)

• Fork Test Particle size (Minced Moist Level

5)

• Fork Pressure Test (Minced Moist Level 5

and Soft & Bite Sized Level 6)


Speech Pathology

IDDSI Flow test – Comparison of Levels 1-4

Copyright December 2017 -Used with permission from IDDSI


Speech Pathology

IDDSI FORK DRIP TEST


Speech Pathology



Speech Pathology

• Normal, everyday foods of various textures that are

developmentally and age appropriate

• Any method may be used to eat these foods

• Foods may be hard and crunchy or naturally soft

Includes hard, tough, chewy, fibrous, stringy, dry, crispy, crunchy or

crumbly bits

• Includes food that contains pips, seeds, pith inside skin, husks or

bones


Speech Pathology

EASY TO CHEW

• For people who do not have Dysphagia or choking risk but prefer softer foods

• IDDSI: many foods served as part of Regular Diet in Residential Aged Care will

be Easy to Chew

• Avoid chewy, hard, crunchy foods such as raw carrots, pips, seeds and sticky

foods such as candy and lollies

• Must pass the Fork Pressure Test (used to test suitability for Soft and Bite Sized)

• Bread with advice from Speech Pathologist

• Rice: no restrictions on rice

• For people who don’t require supervision (if supervision is required, this level is

not suitable)


Speech Pathology

EASY TO CHEW

AVOID

1. Dry food such as dry bread or toast

2. Bread only with advise from Speech Pathologist (crusts off, soft

filings)

3. Tough fibrous foods such as steak or Pineapple

4. Chewy foods such as dried fruit or sticky lollies

5. Crispy/spikey/crunchy foods such as cornflakes or corn chips

6. Stringy foods such as green beans

NB This is not the complete list. For full list of food to avoid please see

Easy to Chew Consumer Handouts on the IDDSI website under

Resources


Speech Pathology

Description

‘Bite-sized’ pieces as appropriate for size and oral processing

skills

15 mm = 1.5 cm pieces

o Foods that do not require biting but do require

chewing

o Foods that can be broken down or mashed with a fork

o Soft, moist and tender throughout but with no separate

liquids

o Meat will need to be minced if pieces are too big or not

tender enough


Speech Pathology

Testing

Spoon or Fork Pressure Test

• Pressure from a spoon or fork held on its side can be used

to cut or break into smaller pieces

• When a sample the size of a thumb nail (~1.5 cm x1.5 cm)

is pressed with the fork or bowl of a spoon, the sample

squashes and changes shape, and does not return to its

original shape when the spoon is removed.


Speech Pathology

EXAMPLES:

Meat: tender and chopped no bigger than 1.5cm; if not soft enough must be

minced

Fish: soft and pieces no bigger than 1.5cm

Fruit: Drain excess liquid. Soft. 1.5cm

Vegetables: soft and cut up 1.5cm

Cereal: Weetbix or porridge; no excess liquid; soft; 1.5cm (no cornflakes)

Rice: requires a sauce to moisten and hold together; NOT sticky, gluey or

separate into individual grains


Speech Pathology

Avoid

• Foods with husks or skins (grapes, peas, corn kernels)

• Stringy foods eg Beans

• Bread

• Chewy of pieces of meat larger than 1.5x1.5cm. If too large or not

tender, the meat in a Soft & Bite-Sized diet will need to be minced for

that meal

• Mixed Texture food (with thick and thin) eg watery soup with solid

pieces; milk on cereal

• ‘Juicy Food’: where juice separates from the food in the mouth eg

watermelon: will need individual assessment

NB This is not the complete list. For full list of food to avoid please see Soft &

Bite-sized Consumer Handouts on the IDDSI website under Resources


Speech Pathology

TRANSITIONING FROM CURRENT SOFT DIET TEXTURE A

Most residents currently on SOFT DIET TEXTURE A would transition to

SOFT & BITE-SIZED Level 6.

Residents currently on SOFT DIET TEXTURE A who:

• don’t have dysphagia

• are not a choking risk

• who are already eating bread with Speech Pathology approval

• who do not need their food cut up

but are on this diet for other reasons (personal choice, dexterity

reasons, fatigue) may be appropriate to transition to EASY to CHEW

Level 7.

If NOT SURE, book Speech Pathologist for Assessment


Speech Pathology

CANNOT HAVE BREAD MUST BE CUT UP

If in doubt, please have Speech Pathology assessment before

upgrading to Easy to Chew Level 7.

To allow additional of Bread and non cut-up food, residents will

need to be a assessed by Speech Pathology as NON-CHOKING

risk BEFORE being upgraded to Easy to Chew Level 7


Speech Pathology


Speech Pathology

Description

• Can be eaten with a fork or spoon

• Can be scooped and shaped (eg into a ball shape)

on a plate

• Biting is not required and only minimal chewing is

required before swallowing

• Soft and moist throughout but with no separate thin

liquid

• Small lumps visible within the food

Adult, 4mm lump size

• Lumps are easy to squash with tongue


Speech Pathology

Testing

Fork Test (Particle Size): Lumps around 4mm or size between standard fork slots

Fork Pressure Test

• When pressed with a fork the particles should easily be separated between and come

through the tines/prongs of a fork

• Can be easily mashed with little pressure from a fork [pressure should not make the

thumb nail blanch to white]

Fork Drip Test

• A scooped sample sits in a pile or can mound on the fork and does not easily or

completely flow or fall through the tines/prongs of a fork

Spoon Tilt Test

• Cohesive enough to hold its shape on the spoon

A full spoonful must slide/pour off the spoon if the

• spoon is tilted or turned sideways or shaken lightly; the sample should slide off easily

with very little food left on the spoon; i.e. the sample should not be sticky

• A scooped mound may spread or slump very slightly on a plate


Speech Pathology

Food Specifics

Meat: Finely minced or chopped, tender mince; 4mm lump

size; serve in extremely thick, smooth, non-pouring sauce

or gravy

*if meat texture cannot be minced to a level that passes the

food test for Minced & Moist it must be pureed

Fruit and vegetables: finely mashed or minced

Cereal: no lumps bigger than 4mm; no free milk: mix

through or drain off excess fluid

Rice: requires a sauce to moisten and hold together; NOT

sticky, gluey or separate into individual grains


Speech Pathology

Avoid

• Foods with husks or skins (grapes, peas, corn

kernels)

• No free liquid in fruit or cereal; avoid juicy food

eg watermelon

• No Bread

NB These are examples and not the complete list. For full list of food to

avoid please see Minced & Moist Consumer Handouts on the IDDSI

website under Resources


Speech Pathology

Description

• Usually eaten with a spoon (a fork is possible)

• Cannot be drunk from a cup

• Cannot be sucked through a straw

• Does not require chewing

• Can be piped, layered or moulded

• Shows some very slow movement under gravity but cannot

be poured

• Falls off spoon in a single spoonful when tilted and

continues to hold shape on a plate

• No lumps

• Not sticky

• Liquid must not separate from solid


Speech Pathology

Testing

Fork Pressure Test

• The tines/prongs of a fork can make a clear pattern on the

surface, and/or the food retains the indentation from the fork

• No lumps

Fork Drip Test

• Sample sits in a mound/pile above the fork; a small amount may

flow through and form a tail below the fork tines/prongs, but it

does not flow or drip continuously through the prongs of a fork


Speech Pathology

Testing continued:

Spoon Tilt Test

• Cohesive enough to hold its shape on the spoon

• A full spoonful must plop off the spoon if the spoon is titled or turned

sideways; a very gentle flick may be necessary to dislodge the sample

from the spoon, but the sample should slide off easily with very little

food left on the spoon; i.e. the sample should not be firm and sticky

• May spread out slightly or slump very slowly on a flat plate

• Food is too thick if it does not fall off the spoon when tilted and sticks to

the spoon

IDDSI FLOW TEST: No flow or drip through a slip tip syringe after 10 sec


Speech Pathology

Avoid

• Any solid, tough, chewy, crispy food

• Foods with husks or skins (grapes, peas, corn kernels)

• Mixed Texture food (with thick and thin) eg watery soup with solid

pieces; milk on cereal

• ‘Juicy Food’: where juice separates from the food in the mouth eg

watermelon: will need individual assessment

NB These are examples and is not a complete list. For full list of food to avoid please see

Pureed and Extremely Thick Consumer Handouts on the IDDSI website under Resources


Speech Pathology

Description

• Can be drunk from a cup

• Some effort is required to suck through a standard

bore or wide bore straw

• Cannot be piped, layered or moulded on a plate

• Cannot be eaten with a fork because it drips slowly in

dollops through the prongs

• Can be eaten with a spoon

• No oral processing or chewing required – can be

swallowed directly

• Smooth texture with no ‘bits’ (lumps, fibres, bits of

shell or skin, husk, particles of gristle or bone)


Speech Pathology

Testing

IDDSI Flow Test:

• Test liquid flows through a 10 ml slip tip syringe leaving

between 8-10 ml in the syringe after 10 seconds

Fork Drip Test:

• Drips slowly in dollops through the prongs of a fork

• Tines/Prongs of a fork do not leave a clear pattern on the

surface

• Spreads out if spilled onto a flat surface

Spoon Tilt Test:

• Easily pours from spoon when tilted; does not stick to

spoon


Speech Pathology

Food/liquid Examples:

Runny Pureed fruit

Sauces

Gravy

Fruit syrup


Speech Pathology

Description

• Flows off a spoon

• Sipp-able, pours quickly from a spoon, but slower

than thin drinks

• Effort is required to drink this thickness through

standard bore straw

Testing

IDDSI Flow Test: Test liquid flows through a 10 mL slip

tip syringe leaving 4 to 8 ml in the syringe after 10

seconds


Speech Pathology

Description

• Thicker than water

• Requires a little more effort to drink than thin liquids

• Flows through a straw, syringe, teat/nipple

• Similar to the thickness of commercially available ‘Anti-

regurgitation’ (AR) infant formula

TestingIDDSI Flow Test: Test liquid flows through a 10 mL slip tip

syringe leaving 1-4 mL in the syringe after 10 seconds


Speech Pathology

Description

Flows like water

Fast flow

Can drink through any type of cup, teat or straw as appropriate for

age and skills

TestingIDDSI Flow Test: Test liquid flows through a 10 mL slip tip syringe

completely within 10 seconds, leaving no residue


Speech Pathology

TRANSITIONAL FOODS

• Foods that start as one texture and change into another when

moisture is added or when a change in temperature occurs

• Examples: icecream and jelly (change to liquid with warm

temperature

• Examples: wafers and cheese and bacon balls: become soggy

with moisture

• Transitional Foods are only to used by people on TEXTURE

MODIFIED DIET with advise from Speech Pathologist

• Transitional Foods that turn to liquid must NOT be used for

people on modified fluids


Speech Pathology



Speech Pathology


Dr Jill Lesic

Speech Pathology

RESOURCES AVAILABLE on the IDDSI website:

• Posters

• Cards: how to test fluids and food including Spoon tilt test, Fork

pressure test, Minced/moist particle size guide and IDDSI Flow

Test

• Consumer Handouts Fluid

• Consumer Handouts Diet


Speech Pathology

A few final words...

• All Speech Pathology recommendations will always include both DIET and

FLUIDS: ie one for DIET and one for FLUID (even if they are both the same).

• Anyone on Thickened Fluids cannot have foods that melt to liquid (ice-cream

and jelly) and cannot have free liquids in their food

• Anyone on Modified food cannot have foods with liquids separating from solid

foods

• Level 6 Soft and Bite Sized food should be cut up prior to leaving the service

area

• Some supplement drinks MIGHT be thick enough for Level 1 Slightly Thick

Fluids but some WON’T be. IDDSI Flow text to check

• People with Dysphagia and on modified diets are at risk of becoming

compromised with hydration and nutrition. Please seek advise from Dietitian


Speech Pathology

Your care at mealtimes makes a difference

Dr Jill Lesic & Associates Speech Pathology03 9836 8542 or 1300 821 [email protected]

mailto:[email protected]

http://www.jilllesicspeechpathology.com.au/

dr jill lesic & associates speech...

Documents