presented by: cindy cysewski, ms.,rd.,ldn standardisation ......director of healthcare international...
TRANSCRIPT
Slide 1
Presented By:
Cindy Cysewski, MS.,RD.,LDN
Director of Healthcare
International Dysphagia Diet
Standardisation InitiativeThe What, When and How
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Slide 2 Objectives…
• List 3 reasons the International Dysphagia Diet
Standardization Initiative came into being.
• Describe the 8 levels of viscosity and texture
modifications recommended.
• Demonstrate how to test viscosity levels and
texture modifications.
• List 3 ways to implement IDDSI in your place of
employment.
• Identify where to go and who to contact for
further information.
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Slide 3
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Slide 4
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Slide 5 Main Objective
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Slide 6 Why do we need a standardized system?
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Slide 7 National Dysphagia Diet (NDD)
Thin
– 0-50 cP
Nectar
– 51-350 cP
Honey
– 351-1750 cP
Pudding
– 1751+ cP
Regular Diet
Advanced
Soft
Mechanical
Soft
Pureed
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Slide 8 1. Safety
• Multiple Labels and Definitions =
CONFUSION
• Between:
– Caregivers
– Healthcare professionals
– Individuals with Swallowing Difficulties
– Food Service
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Slide 9 2. Clinical Efficiency
•Avoids re-assessment to determine safe liquid and diet levels
3. Commercial Implications •“pre-thickened vs in-house”
4. Lack of clinical
development/research•No consistency
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Slide 10 Too many holes…
• How thick is nectar?
• How long do I wait?
• Are nutritional supplements already
nectar-thick?
• Is honey-thick consistency thickened
with honey?
• Is ice cream a thin liquid when it
melts?
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Slide 11 More cracks in the foundation…
• How much more thickener do I need
to make it nectar-thick?
• How thick is too thick?
• Do I need to use measure utensils
every single time?
• This speech therapist prefers different
viscosity, what do I do?
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Slide 12
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Slide 13
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Slide 14
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Slide 15
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Slide 16
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Slide 17 Findings…
• ONLY 40% check for correct consistency before serving
• Food– 4-5 levels of food textures
– 16% use of color, number or scheme to identify TM foods
• Beverage– 3-4 levels of liquid thickness
– 25% use of color, number of scheme to identify thickened liquids
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Slide 18 More Evidence cont’d
• There IS evidence that thickening liquids help those that aspirate on thin liquids
• There IS evidence it is possible to be TOO thick, where residue begins to accumulate
• There IS evidence that thicker consistencies and solid food require greater effort in oral processing/swallowing
• There IS NOT much literature on texture modified foods and management of dysphagia
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Slide 19 Let’s get to the POINT…
We need to create a culturally-sensitive, age-span relevant
framework for classifying
texture modified food and thickened liquids
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Slide 20
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Slide 21
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Slide 22 DRINKS
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Slide 23
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Slide 29
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Slide 30 Flow Test Video
http://iddsi.org/framework/drink-testing-methods/
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Slide 31
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Slide 32 Food
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Slide 35
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Slide 36 Food Testing Methods
• The Fork Drip Test
• Spoon Tilt Test
• Fork or Spoon Pressure Test
• Chopstick Test and Finger Test
http://iddsi.org/framework/food-testing-methods/
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Slide 37 Fork Drip Test
Level 3
Level 4
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Slide 38 Spoon Tilt Test
• Levels 4 & 5
• Measures adhesiveness and cohesiveness
• Sample should:
– Hold shape on spoon
– Full spoonful should slide off easily with no residue when tilted
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Slide 39
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Slide 41
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Slide 42 Transitional Foods
• Foods that start as one texture but
change to another with moisture or
temperature
• Minimal chewing required
• Tongue pressure may be sufficient to
break food down after alteration in
moisture and temperature
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Slide 43
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Slide 44 Implementation = MAPA
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Slide 54
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