Image credit: New York Times Online.
A lot of people don’t realize that alongside all thing communication, Speech Pathologists also manage swallowing disorders, also known as dysphagia.
There are a number of reasons why a person might have difficulty swallowing. Medical events such as strokes, surgeries or injuries to the head or neck and the general process of ageing can all impact a person’s swallowing. Children with developmental disabilities may also experience difficulty swallowing.
Along with therapy and adjustments to the persons posture or eating environment, one of the ways we manage swallowing difficulties in by modifying the texture of a person’s food and drinks. On one hand, thin liquids, like water or juice, move quickly down our throats and can be hard to manage safely for a person with dysphagia. We can thicken those drinks to different textures to make that easier. Similarly, a tough steak might be a challenge for someone with weakening in their jaw, throat and cheek muscles, and so a softer, cut up, minced or pureed diet might be recommended to alleviate the load on the muscles, and ensure the person can still get enough to eat.
Ultimately though, we modify textures to make it safer and more enjoyable for a person to eat. Swallowing difficulties increase the risk of a person choking – that is a piece of food getting stuck and blocking their airway, which can have serious and even fatal consequences…plus it’s a scary and disconcerting experience! Swallowing difficulties can also lead to aspiration, where liquids or foods “go down the wrong way” and enter the lungs. This can lead to aspiration pneumonia, chest infections, which can be very serious.
There is a balance to strike though. Texture modifications make meals safer, and they can make mealtimes more enjoyable if the person no longer has to worry about choking or coughing fits during mealtimes. On the other hand though, we eat with our eyes, and food is one of life’s great pleasures. If all someone gets to eat is a bland, uninspiring puree, are we really meeting that goal of “safe AND enjoyable mealtimes”?
For the last few years, Japan has been on the forefront of striking that balance between safe and enjoyable. In Yokohama, Japan, Kaze no Oto Chinese restaurant offers an “aged” menu of traditional Chinese meals that staff modify by hand to accommodate patrons with dysphagia. The restaurant is the brainchild of Toshihiko Aizawa, the founder and CEO of a chain of residential aged care facilities, who noticed something his residents were missing. Many of his residents missed being able to eat out, but a combination of mobility limitations and swallowing difficulties meant going out for meals ended up sometimes being more challenging than fun for residents. Now residents visit regularly, dressing up to go out, and sharing tasty meals that cater to their texture needs and palettes.
Across the city, in Mutai nursing home, kitchen staff work closely with a dietitian to experiment and create interesting and appealing meals. For milder cases of dysphagia, soft varieties of fish are served, with veggie sides cooked soft with hard stems removed. For more severe dysphagia diets, individual components of the meals are pureed with thickening agents, then the purees are cast into moulds made to resemble the original food item, allowing staff to create a plate of food that looks visually appealing to the clients, as well as tasting just like the meals their peers are having.
So, what can we take away from Japan’s innovations if we are caring for someone with dysphagia? The most important thing is to remember the joy of eating! Taking the person’s favourite foods and taste preferences into account makes a huge difference. We can also follow the Mutai team’s example and make the food look great! Specially created food moulds can be purchased online from companies like Flavour Creations, that allow minced or pureed foods to be formed into moulds to resemble chicken breast, fish fillets, piles of peas or even wedges of pumpkin!
If you are interested in learning more about modified diets, dysphagia or what you can do to better support a loved one or client in this area, you can contact Southern Highlands Speech Pathology for a consultation or to discuss in-house staff training options.