190 CHAPTER 12 | Etiology and Risks of Swallowing Disorders Box 12.8 Tips for Caring for an Individual With Swallowing Difficulties49


Strategy Check tray for proper diet. Help the individual to eat slowly. Sit on the individual’s weaker side.


Present small bites of food. Each bite should be approximately 1 teaspoon or less, as directed by the speech- language pathologist.


Allow sufficient time for the individual to swallow.


Encourage a “double swallow”—that is, first swallow food, then dry swallow once.


Check that the individual’s mouth is empty before continuing. Encourage the individual to use tongue movements.


Make sure that the individual’s head is tilted slightly forward. Create an environment free of distractions.


Guarantee the individual’s dentures are in place and fit well. Ensure adequate lighting, but not glaring light.


Check that food is within 12 inches of reach if the individual is self-feeding.


Present foods, drinks, and medications from the midline position. Alternate food and liquids. Serve food at appropriate temperatures.


Provide adequate time for the individual to eat or to be assisted (up to 45 minutes).


Ensure safety by having suctioning equipment readily available.


Be certain the individual sits upright for 30 minutes aſter the meal.


Perform complete oral hygiene aſter all meals.


Report any choking or coughing to the nursing supervisor or rehabilitation professional.


Actions to avoid Standing to assist individuals, as this causes them to liſt their head and extend their neck.


Assisting the individual if they are lying down or reclining. Rushing the individual or assisting with meals too rapidly.


Assisting the individual when the head is tilted backward (“bird feeding”). Providing medicine during choking or coughing.


Changing the individual’s program without consulting the speech-language pathologist or supervisor.


Positioning tips In most cases, the person should be positioned with the head slightly flexed.


The head should be at a 90-degree angle with the chin tucked just slightly.


Shoulders should be slightly forward. The trunk should be leaning slightly forward. Hips should be flexed at slightly more than 90 degrees. Knees should be flexed at 90 degrees. Feet should be flat on the floor.


The upper extremities should be placed so that the elbows can be used to increase stability if needed.


Spoons with narrow, shallow bowls or glossectomy spoons may help facilitate appropriate swallow in indi- viduals who require assistance in placing food in cer- tain locations in the mouth. These and other adaptive devices promote independence in eating and drinking.


Diet Modification


Diet modification, or altering the consistency of solid and liquid foods, is the primary intervention for indi- viduals with dysphagia.50


However, diet modification


is often associated with reduced acceptability, poor diet adherence, and malnutrition.51


Texture-modified foods may offer a safer mode of consumption, but they


are not equally evaluated for their nutritional value.52 It is important for the nutrition practitioner to ensure that each individual receives the least restrictive diet to simultaneously minimize the risk of malnutri- tion and dehydration and maximize the pleasure of eating. The lack of evidence-based research regarding appropriate diet modifications and dysphagia and ultimately aspiration makes it extremely difficult to determine the best diet alterations in each case. In 2017, the first version of the International Dysphagia Diet Standardisation Initiative (IDDSI) Framework was published. In 2021, the Academy of Nutrition and Dietetics announced that the IDDSI is the only texture-modified diet recognized by the


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