This diet is a transition from the pureed textures to more solid textures. Chewing ability is required. The textures on this level are appropriate for individuals with mild to moderate oral and/or pharyngeal dysphagia. Patients should be assessed for tolerance to mixed textures. It is expected that some mixed textures are tolerated on this diet.
As a speech language pathologist working with persons with dysphagia (difficulty swallowing) over the past 25 plus years, I find that I do a lot of counseling with people when their diet needs to be changed to accommodate to their difficulties. Sometimes it is hard for those I counsel to picture how to do this in a practical, day to day basis.
This diet is designed for people who have moderate to severe dysphagia, with poor oral phase abilities and reduced ability to protect their airway. Close or complete supervision and alternate feeding methods may be required.
This diet consists of pureed, homogenous, and cohesive foods. Food should be “pudding-like.” No coarse textures, raw fruits or vegetables, nuts, and so forth are allowed. Any food that require bolus formation, controlled manipulation, or mastication are excluded.
You have been diagnosed with a severe chewing and/or swallowing problem by the healthcare professionals treating you. You will need to puree your foods until your physician and other healthcare professionals feel comfortable advancing the texture of your diet. Be sure that any pureed foods prepared in advance are the consistency of pudding or moist mashed potatoes and are smooth and free of lumps.
By Jan C. Pryor M.A., CCC-SLP, BRS-S
Exercise of the Month: The “Effortful” Swallow (aka the Modified Valsalva maneuver, or the “Hard Swallow”)
Sometimes the best practice for swallowing is swallowing itself. How you do it, can make all the difference. The exercise is just as the name implies, you swallow with effort or HARD! That’s right, with GUSTO. The goal of this technique is to recruit more motor units, increase the demand and create a muscle training/strengthening effect. This technique is used to protect the airway. How does using this technique protect the airway? When there is muscle weakness due to various conditions, such as head and neck cancer, stroke or general de-conditioning, the muscles of the tongue and pharynx may not be doing their part to push, lift or squeeze to propel food out of the mouth and throat. The result of a weak muscle contraction(s) is often that food or liquids “pool” in the mouth or pharynx (throat) after the swallow. After swallowing, residual food and liquid in the mouth and throat are likely to overflow into the unprotected airway and cause what is known as aspiration.