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Dietary modification Dietary modification is the key component in the general treatment program of dysphagia. A diet of pureed foods is recommended for patients who have difficulties with the oral preparatory phase of swallowing, who pocket food in the buccal recesses, or who have significant pharyngeal retention of chewed solid foods. As patients' swallowing function improves, their dysphagic diet may be advanced to the next level of soft and semisolid foods with regular consistencies. Recommend to patients that they alternate bites with sips, bite or sip size, and the number of swallows per size. Viscosity and texture If oral feedings are determined to be appropriate, the viscosity and texture of the food should be considered, because patients vary in their ability to swallow thin and thick liquids. Liquids can be thickened with various thickening agents. Many commercially available, starch-based food thickeners are used to increase the consistency of food, and prethickened water, juice, coffee, and other products are available. Food viscosity is defined as frictional resistance to shear. Viscosity of the diet for dysphagia is frequently described in a nonobjective manner. For example, tomato juice, nectar, honey, and pudding have been referred to as fluids. Viscosity can be objectively determined by using a device called a viscometer. A uniform and viscous bolus of food or beverage enables a patient with a delayed swallow reflex to control mastication and transport. It also allows the individual to swallow with less risk of aspirating residue material, because there is a reduced tendency for the material to fall over the base of the tongue before the swallow mechanism is triggered. Viscosity also influences the swallowing reflex and peristaltic activity. Another objective method is a line-spread test.11,12 Diluted mix is placed on a circle marked on a glass plate and is allowed to stream for 5 minutes. Lengths of the 4 stream directions are measured, and their mean is determined. Food texture is defined as the group of physical properties derived from the structure of the food that can be sensed by touch. Touch usually is performed by elements of the oral and pharyngeal cavities. Food and liquid textures play important roles in the care of patients with dysphagia. Sample classification of dysphagia diet according to viscosity The dysphagia diet can be classified according to viscosity, as follows: Level I - pudding, crushed potato, and ground meat


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