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International Dysphagia Diet Standardisation Initiative (IDDSI) Framework and Rationale, Part 2

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1.  In classifying liquids, IDDSI
  1. Uses viscosity measures (centipoise) to identify level of thickness
  2. Recommends testing with the line spread test to identify level of thickness
  3. Utilizes gravity flow testing with a slip tip syringe to identify level of thickness
  4. Looks at how much liquid is left in the syringe after 20 second flow time
2.  In testing liquids, you
  1. Must test immediately following stirring the thickener into the liquids to avoid overthickening
  2. Can test liquids at any temperature as that should have no impact on level of thickness
  3. Utilize the 20 mL slip tip syringe to use the gravity flow principle
  4. Should test at the intended serving temperature
3.  IDDSI
  1. Is a mandatory protocol
  2. Is prescriptive
  3. Is descriptive
  4. None of the above
4.  Slightly thick level 1 liquids
  1. Have less than 1 mL remaining in 10 mL syringe after 10 seconds of flow
  2. Are similar in thickness to most commercially available anti-regurgitation infant formulas
  3. Should not be considered for adults as it is similar to infant formula
  4. Do not flow through nipples
5.  In comparing liquids and solids
  1. There is no overlap between any level of liquids or solids
  2. Liquidized diets are comparable to extremely thick liquids
  3. Liquid levels end at level 4 and food levels begin at level 5
  4. Puree diets are comparable to extremely thick liquids
6.  The rationale for minced and moist diet includes
  1. Tongue force alone can separate soft small particles
  2. Easiest to control if tongue control significantly reduced
  3. Should be ordered/recommended if there is an increased risk of oral and/or pharyngeal residue
  4. Suitable for individuals with ability to bite, chew and orally process soft foods long enough to form swallow ready soft cohesive bolus without tiring easily
7.  Thumbnail blanching pressure is used as a test for diet
  1. Level 6
  2. Level 5
  3. Level 4
  4. Level 2
8.  The rationale for the new level 7 easy to chew includes
  1. Suitable for individuals with ability to bite, chew and orally process soft foods long enough to form swallow ready soft cohesive bolus without tiring easily
  2. Bite size of 1.5 x 1.5 cm to avoid choking risk
  3. Chewing required but not biting and bit size minimizes choking risk
  4. Minimal chewing required
9.  Transitional foods
  1. Are appropriate for individuals on level 4 through 7
  2. Are recommended to provide more nutrition
  3. Require a tongue pressure of 20kP to break down
  4. Start as one texture and change to another with the addition of saliva/water or temperature change
10.  Medications
  1. Are not a concern with the IDDSI diet as applesauce is often utilized as a food medium for easy swallowing
  2. Including tablets and capsules are appropriate for only individuals on Level 7
  3. Such as pills and capsules are considered a choking risk if the recommended diet is level 4
  4. Are not impacted by cutting or crushing for ease of swallowing

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