The International Dysphagia Diet Standardisation initiative continues to roll out in preparation for the official release on May 1, 2019.
In the third awareness session Dr. Julie Cichero demonstrated the tests developed for level 3 and 4 on the new framework.
It should be noted that the test for Level 3 and 4 drinks and Level 3 and 4 foods are the same.
It is also important to note, residents on level 3 or 4 for food and/or drink require a prescription from a qualified clinician, such as a speech pathologist.
Dr. Julie Cichero gives the following example:
Mrs. Jones is on Level 3 Moderately thick drinks and Level 5 Minced & Moist Food. When it comes to her soup she will need that at Level 3 Liquidised (because it is a liquid food), but her solid food will need to meet Minced & Moist criteria. If she has a sauce over her meat or vegetables, it should ideally be Level 3 liquidised consistency. For her breakfast cereal, if there is milk with it, the milk will need to be Level 3 moderately thick. Basically, anything that is a ‘liquid’ that she needs, would need to meet the Level 3 requirements, and then any solid food needs to meet the Level 5 Minced & Moist requirements.
The International Dysphagia Diet Standard test for Level 3 and 4 liquids.
As with the flow tests for liquids, Levels 0 - 3, the standardisation adheres to the organisation’s mandate to keep the test easy to perform, with basic tools which are commonly available.
Level 3 drink and food - Flow test and fork drip test.
As for Level 0 - 2, the test for Level 3 moderately thick drink or liquidised foods uses the flow test, and is the last level to use it. If a drink does not meet the Level 3 flow test requirements, it should be tested using the fork drip, Level 4 test and the spoon tilt test.
View flow test instructions
Alternatively, for liquidised foods and moderately thick drinks, the fork drip test may be used for Level 3 textures.
Images for Level 3 - Liquidised/Moderately Thick are shown below.
Level 3 Fork drip and Spoon tilt video
It is very important to note that a food or drink at Level 3 and 4 of texture modification may not clearly fit either category. It is recommended the food or drink be adjusted or remade to the level required and re-tested to ensure the resident is not receiving a texture they are not able to easily consume.
Level 4 drink and food - Fork drip test and spoon tilt test.
Level 4 covers pureed food and extremely thick drink. The test is very similar to the Level 3 fork drip test; however, you are looking for slightly different indicators.
The spoon tilt test - Level 4
When talking about Level 4 texture modification for food and drink, the degree of stickiness of the food or drink is also very important.
The spoon tilt test was developed to easily discern how sticky a particular food might be. For example, a dollop of Greek yoghurt and a dollop of peanut butter would both pass the Level 4 fork drip test. The yogurt, when placed on a spoon and tilted to 90 degrees, would slip off in one lump and leave no or very little residue on the spoon. The peanut butter would likely not even fall off the spoon if it were turned upside down. Therefore the peanut butter would be far too sticky for someone on Level 4 food or drink to easily consume.
Level 4 fork drip and spoon tilt video
As with the flow test food and drink is to be tested at the temperature it will be consumed at.
All images used with permission of IDDSI.