Celebrating National Speech-Language-Hearing Month
By Lorana Ard MS, CCC-SLP Area Rehab Director WA3
Each May, we recognize National Speech-Language-Hearing Month. This time of year provides us an opportunity to raise awareness of the critical role SLPs play in providing life-altering treatment with communication, cognition, and especially swallowing. This year, we’re spotlighting an essential focus area: diet modification and the use of the International Dysphagia Diet Standardisation Initiative (IDDSI) in managing dysphagia.
What Is Dysphagia?
I am sure all of you have heard this term thrown around in your communities. Dysphagia is a medical term for difficulty swallowing, which can affect individuals of all ages, though it’s most common among the elderly and people with neurological or structural impairments. It can lead to serious complications, including malnutrition, dehydration, and aspiration pneumonia. I am certain each of you can pinpoint a patient that has experienced these complications. In fact, probably more patients than you recognize are afflicted with Dysphagia to some degree, with up to 68% of residents impacted in long-term care settings (National Institute on Deafness and Other Communication Disorders, n.d.; Steele et al., 1997).
SLPs play a key role in the evaluation and management of dysphagia, working closely with interdisciplinary teams, even our PT and OT colleagues, to ensure that individuals can eat and drink safely and comfortably.
Why Diet Modification Matters
When a person has difficulty swallowing safely, modifying the texture of food and the thickness of liquids can reduce the risk of aspiration, other cascading events, and improve overall safety and quality of life. However, without a standardized system, terminology like “nectar thick” or “pureed” may be interpreted differently between caregivers, facilities, and providers, increasing the risk for error and therefore patient risk. Many SLPs have seen a “nectar thick” drink mixed by an unskilled provider, and it more closely resembles concrete than a beverage. Not so appetizing right?
That’s where IDDSI comes in.
What Is IDDSI?
Founded in 2013, the International Dysphagia Diet Standardisation Initiative (IDDSI) is a globally recognized framework that provides standardized terminology and definitions for texture-modified foods and thickened liquids in all ages, care settings and cultures. The framework has been translated into 27 different languages, with more than 10 other languages in progress.
IDDSI categorizes foods and drinks on a scale from Level 0 to Level 7:
- Level 0: Thin liquids (e.g., water)
- Level 1–4: Varying levels of drink thickness (slightly thick, mildly thick, moderately thick, and extremely thick) and food textures like liquidised pureed.
- Level 5–7: Minced & Moist, Soft & bite sized and regular textures/easy to chew.
Each level has objective testing methods, such as the IDDSI Flow Test, Spoon Tilt Test, Fork Drip Test and Fork Pressure Test, helping clinicians ensure consistency and safety in recommendations.
How IDDSI Improves Patient Care
- Enhances safety: Reduces the risk of aspiration and choking by ensuring the appropriate texture/consistency is consistently provided.
- Improves communication: Standardized language across healthcare providers, caregivers, and kitchen staff eliminates confusion.
- Empowers care teams: Everyone from dietary services to nursing can better understand and implement SLP recommendations.
- Supports person-centered care: IDDSI levels can be adapted to suit individual needs and preferences while maintaining safety.
What Can You Do?
- Be familiar with IDDSI: Whether you’re in therapy, nursing, dietary services, or administration, understanding the basics of IDDSI helps promote safe care.
- Collaborate with your SLPs: If you’re unsure about a diet recommendation, ask! Open communication ensures patients receive the safest and most appropriate nutrition.
- Advocate for best practices: Encourage your team to adopt IDDSI testing methods and terminology in day-to-day practice.
For more information, please feel free to browse the plethora of guides, resources, and FAQs located on https://www.iddsi.org/.
References:
American Speech-Language-Hearing Association. (n.d.). Adult Dysphagia. (Practice Portal). Retrieved April, 22, 2025, from www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/.
International Dysphagia Diet Standardisation Initiative. (n.d.). IDDSI framework. https://iddsi.org/
Steele, C., Greenwood, C., Ens, I., Robertson, C., & Seidman-Carlson, R. (1997). Mealtime difficulties in a home for the aged: Not just dysphagia. Dysphagia, 12(1), 43–50. https://doi.org/10.1007/PL00009517
