Resource Directory Central Pennsylvania Health Care Quality Unit Dysphagia 2 Dysphagia Resource Directory Disclaimer The information and educational resources included in this Dysphagia Resource Directory* are designed as general information only and are not all inclusive or intended to replace physical, dental or behavioral health advice. The samples and examples included are not all-inclusive of every situation and should not be followed strictly as described. They are to be used solely as a reference and resource. If you believe that you, or someone you support, has physical, dental or behavioral health issues related to dysphagia, please seek professional advice for specific recommendations. Every person’s situation is unique. ________ *The Southeast Region Dysphagia Summit Task Force Committee Philadelphia Coordinated Health Care Central Pennsylvania Health Care Quality Unit (HCQU) Becky Dorner & Associates, Inc. Office for People With Developmental disabilities (OPWDD) 3 4 Table of Contents What is Dysphagia? ....................................................................................................................... 7 Swallowing Phases.......................................................................................................................... 8 Medical Conditions That May Be Associated with Swallowing Disorders ................................... 8 Other Conditions That May Cause Difficulty with Swallowing .................................................... 9 Some Signs and Symptoms of Possible Swallowing Problems .................................................... 10 Dysphagia Eating, Drinking and Swallowing Checklist Screening Form .................................... 11 Red Flags for Swallowing Difficulty ............................................................................................ 15 Risk Assessment ........................................................................................................................... 17 Medications ................................................................................................................................... 19 Medications Which May Cause Problems With Swallowing ....................................................... 19 Medications and Dysphagia/Swallowing Risks ............................................................................ 21 Dysphagia as a Side Effect of Medication .................................................................................... 21 Dysphagia as a Complication of the Therapeutic Action of the Medication ................................ 22 Medications That Can Cause Esophageal Injury and Increase Risk ............................................. 23 How to Obtain a Dysphagia Evaluation ........................................................................................ 24 Diagnosis....................................................................................................................................... 25 Role of the Speech-Language Pathologist .................................................................................... 25 Tips on How to Make Sure an Individual Benefits From a Swallowing Evaluation: ................... 26 Creating an Appropriate Plan of Support...................................................................................... 27 Dining Plan ................................................................................................................................... 29 Dining Plan2 .................................................................................................................................. 30 Dysphagia Diets ............................................................................................................................ 31 Converting to New Terms ............................................................................................................. 31 National Dysphagia Diets ............................................................................................................. 32 Dysphagia Puree Diet (Level 1) .................................................................................................... 32 Dysphagia Mechanically Altered Diet (Level 2) ......................................................................... 36 Dysphagia Advanced Diet (Level 3) ............................................................................................. 40 Dysphagia Regular Diet (Level 4) ................................................................................................ 43 Doctor Notification of National Dysphagia Diet .......................................................................... 45 5 Skills Observation Checklist – Dysphagia Diet ............................................................................ 47 Sample Daily Meal Plan for Well Balanced Dysphagia Diets ..................................................... 49 Keep Nutrition in Mind When Modifying Foods ......................................................................... 50 Tips to Increase Nutritional Density of Food ............................................................................... 51 Tips to Decrease Caloric Density of Food .................................................................................... 51 Food Consistency Terminology .................................................................................................... 55 Preparing Pureed Foods ................................................................................................................ 56 Method for Preparing Pureed Foods ............................................................................................. 57 Commercially Prepared Pureed Foods.......................................................................................... 57 Techniques for Improving Acceptance ......................................................................................... 57 Commercial Thickeners ................................................................................................................ 59 Guidelines for Thickening Liquids ............................................................................................... 59 Foods That Melt at Room Temperature ........................................................................................ 61 Treatment ...................................................................................................................................... 62 Overview of Dining Problems ...................................................................................................... 63 Ways to Help the Person with Eating Problems ........................................................................... 65 Feeding Adaptations ..................................................................................................................... 67 Sit for Safety! ................................................................................................................................ 69 Guidelines for Writing a Dysphagia Policy .................................................................................. 70 Choking Prevention ...................................................................................................................... 71 Choking Precautions ..................................................................................................................... 71 General Mealtime Strategies ......................................................................................................... 72 Choking and High Risk Foods ...................................................................................................... 73 Aspiration ...................................................................................................................................... 74 Complications as a Result of Dysphagia ...................................................................................... 77 Guide to Levels of Risk of Negative Health Consequences from Dysphagia .............................. 77 Alternative Means of Feeding ....................................................................................................... 84 Oral Hygiene for People with Swallowing Difficulty/Dysphagia ................................................ 84 Dysphagia Resources .................................................................................................................... 86 Index ............................................................................................................................................. 87 Notes ............................................................................................................................................. 89 6 What is Dysphagia? Pronounced: (dis Fay juh or dis Fah juh) In simple terms, dysphagia is difficulty chewing and/or swallowing. Most of us swallow 1,000 or more times a day without thinking about it, however the swallowing process is quite complicated. Approximately one million people annually receive a new diagnosis of dysphagia including many people with developmental disabilities (DD)*. Swallowing is a difficult, sometimes impossible, task for some people with DD. In fact, choking and aspiration pneumonia are among the leading causes of death in adults with ID/DD. NORMAL SWALLOW SWALLOWING DIFFICULTY Air Food Air to lungs Food to stomach Food enters trachea by mistake Trachea or windpipe Esophagus 7 Swallowing Phases Swallowing