Modification of Diet
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Dietary modifications are cited as been overused (Huckabee and Pellitier, 1999). However with this client group many of the compensatory and rehabilitation techniques cannot be carried out due to cognitive impairment. Dietary modifications may be the only appropriate approach.

Solid food
Modification of the consistency, temperature, flavour and amount presented are some of the ways of managing the consumption of solid foods in clients with dysphagia. Certain foods will be more problematic for certain clients and therefore may need to be eliminated from their diet. The assessment of the client should reveal this.
Modification of consistency
NZAT standards for descriptors and standards of modified food consistencies__
A thorough assessment of the client should reveal the consistencies that the clients tend to aspirate on. Consistencies that induce more aspiration should be eliminated from the client’s diet. Individuals who don't have dementia but have suffered from aspiration may eliminate consistencies that induce more aspiration themselves (Rosenvinge and Starked, 2005). However clients with dementia do not have the insight to moderate these themselves, especially in the severe stages. The responsibility is therefore on speech language therapists, other medical professionals and nursing staff in the nursing facilities to monitor and review the client’s dietary and swallowing needs.
Modification of Bolus Size, Temperature and Flavour
Another way to manage dysphagia through dietary modification is modifying the size, temperature and flavour of the bolus presented to the client. Modifying the size of the bolus presented, modifying the temperature and flavour of the bolus are common interventions used with clients with dementia. Temperature and flavour are often used to stimulate the activation of a swallow (Easterling and Robbins, 2008). The use of a sour bolus has been cited as being particularly effective in the literature. This is thought to stimulate a stronger swallow, increase strength of muscle contraction and reduce aspiration (Logemann et al, 1995). Due to the anosmia (loss of sense of smell, resulting in loss of taste) experienced by clients with dementia, they often prefer highly seasoned, flavoured or sweet foods (Easterling and Robbins, 2008). This can help to stimulate their swallow.
Thickening of liquids is a common practice in the treatment of dysphagia. Thicker liquids are considered to lessen the chance of aspiration increase control of the bolus during swallow (Groher and Crary, 2010).
__NZSTA link for descriptors and standards of modified liquids.__
Research has shown that thickening liquids can be effective in decreasing aspiration in clients with dementia. Logemann, et al (2008) studied the short term effectiveness of three treatments – chin-tuck, nectar thickened liquids and honey thickened liquids. They found that significantly more people aspirated with the chin-tuck movement and thin liquids than the nectar thickened or honey thickened liquids. The honey-thickened liquids were the most effective strategy for decreasing aspiration.