Although modifying diets, by thickening liquids and modifying the texture of foods, to reduce the risk of aspiration has become central to the current management of dysphagia, the effectiveness of this intervention has been questioned. This narrative review examines, and discusses possible reasons for, the apparent discrepancy between the widespread use of modified diets in current clinical practice and the limited evidence base regarding the benefits and risks of this approach. There is no good evidence to date that thickening liquids reduces pneumonia in dysphagia and this intervention may be associated with reduced fluid intake. Texture-modified foods may contribute to undernutrition in those with dysphagia. Modified diets worsen the quality of life of those with dysphagia, and non-compliance is common. There is substantial variability in terminology and standards for modified diets, in the recommendations of individual therapists, and in the consistency of diets prepared by healthcare staff for consumption. Although use of modified diets might appear to have a rational pathophysiological basis in dysphagia, the relationship between aspiration and pneumonia is not clear-cut. Clinical experience may be a more important determinant of everyday practice than research evidence and patient preferences. There are situations in the management of dysphagia where common sense and the necessity of intervention will clearly outweigh any lack of evidence or when application of evidence-based principles can enable good decision making despite the absence of robust evidence.
Thin drinks that have not been thickened. Thin liquids include any solids that melt in the mouth or at room temperature and become liquid such as frozen malts, milk shakes, frozen yogurt, eggnog, nutritional liquids, Popsicles, ice cream, sherbet, and regular or sugar-free gelatin. Thickened liquids should be smooth, without lumps or pulp. You may need to make naturally thick liquids even thicker such as tomato juice, eggnog or nutrition drinks to get the right texture. If your therapist wants you to drink thickened liquids, you should avoid thin liquids. Smooth, creamy well-cooked cereals. Cereals should have a pudding-like texture. You may add just enough milk to make cereal moist. Sour cream, mayonnaise, cream cheese, whipped cream, butter, margarine and smooth gravy with no pieces of meat. Strained soups or soups that have been pureed in a blender.
Long term disability is the most frequent post stroke complication. Some of this poor nutrition is caused by limited ability to swallow food, and many stroke survivors require special diets to prevent or reverse this deficit. Dysphagia is difficulty with swallowing. In the case of a loved one with a stroke, it was caused by the nerve and brain damage of the stroke. The damage may have also affected the ability to chew or move food around with the tongue. There are actually different stages of swallowing see the diagram above.
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