Dysphagia pp 507-518 | Cite as

The Dietitian’s Role in Diagnosis and Treatment of Dysphagia

  • S. Burton
  • A. Laverty
  • M. Macleod
Part of the Medical Radiology book series (MEDRAD)


This chapter aims to provide an overview of the registered dietitian’s role and the commonplace feeding dilemmas presented at the practical level when applying the modified textured prescription for food and fluids in adults with dysphagia. The dietitian is one of a range of professionals involved in service provision, and there is an increased emphasis on an interdisciplinary and transdisciplinary team approach to care for people with dysphagia at both the acute and the community level. The role of the dietitian can be wide-ranging, from traditional nutritional management to a whole-systems approach encompassing screening, assessment, diagnosis and organisation of the modified textures within a dynamic nutritional framework. A person-centred approach is essential to provide nutrition in a mode which not only sustains nutrition and hydration integrity but also serves to enhance the individual’s quality of life.


Fluid Loss Registered Dietitian Fluid Requirement Oral Nutritional Supplement Texture Modification 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Anderson D (2008) Training support staff to modify fluid consistancy for adults with learning disabilities and dysphagia: an efficacy study. Diet Today 44:14Google Scholar
  2. Atherton M, Bellis-Smith N, Chichero JAY, Suter M (2007) Texture-modified foods and thickened fluids as used for individuals with dysphagia:Australian standardised labels and definitions. J Hum Nutr Diet 64S:523–576Google Scholar
  3. British Association of Parenteral and Enteral Nutrition (2003) Drug administration via enteral feeding tubes: a guide for general practitioners and community pharmacists. Accessed 19 Feb 2011
  4. Beauchamp TL, Childress JF (2004) Principles of biomedical ethics, 5th edn. Oxford University Press, OxfordGoogle Scholar
  5. Bhattacharyya N, Kotz T, Shapiro J (2003) The effect of bolus consistency on dysphagia in unilateral vocal cord paralysis. J Otolaryngol Head Neck Surg 129:632–636CrossRefGoogle Scholar
  6. British Dietetic Association (2002) National descriptors for texture modification in adults. Joint working party of the British dietetic association and the royal college of speech and language therapists. British Dietetic Association, BirminghamGoogle Scholar
  7. Brody RA, Touger-Decker R, VonHagen S, Maillet JO (2000) Role of registered dietitians in dysphagia screening. J Am Diet Assoc 101:179–180CrossRefGoogle Scholar
  8. Brotherton A, Abbott J, Aggett P (2006) Tne impact of percutaneous endoscopic gastrostomy feeding upon daily life in adults. J Hum Nutr Diet 19:355–367PubMedCrossRefGoogle Scholar
  9. Burton S, Cox S, Sandham SM (2009) Nutrtion, hydration and weight. In: Pawlyn J, Carnaby S (eds) Profound intellectual and multiple disabilities. Wiley-Blackwell, OxfordGoogle Scholar
  10. Burton S, McIntosh P, Jurs A, Laverty A, Macleod M, Morrison L, Robinson N (2011) Weight management for adults with a learning disability living in the community. British Dietetic Association, BirminghamGoogle Scholar
  11. Butt K, Lam P (2005) The role of the registered dietitian in dysphagia assessment and treatment. J Can Diet Pract Res 66:91–94CrossRefGoogle Scholar
  12. Clave P, De Kraa M, Arreola V, Girvent M, Farre R, Palomera E, Serra-Prat M (2006) The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther 24:1385–1394PubMedCrossRefGoogle Scholar
  13. Copeman J, Hyland K (2007) Dysphagia. In: Thomas B, Bishop B (eds) Manual of dietetic practice, 4th edn. Blackwell, OxfordGoogle Scholar
  14. Crawford C (2009) Dysphagia and people with profound intellectual and multiple disabilities. In: Pawlyn J, Carnaby S (eds) Profound intellectual and multiple disabilities. Wiley-Blackwell, OxfordGoogle Scholar
  15. Davies S (2002) An interdisciplinary approach to the management of dysphagia. Prof Nurs 18:22–25CrossRefGoogle Scholar
  16. Department of Health (2005) Mental Capacity Act 2005: code of practice. Department of Constitutional Affairs. Accessed 7 Feb 2011
  17. Department of Health, Social Services and Public Safety (2003) Seeking consent: working with people with learning disabilities. Department of Health, Social Services and Public Safety, BelfastGoogle Scholar
  18. Dickerson RN, Brown RO, Gervasio JG, Hak EB, Hak LJ, Williams JE (1999) Measured energy expenditure of tube-fed patients with severe neurodevelopmental disabilities. J Am Coll Nutr 18:61–68PubMedGoogle Scholar
  19. Dickerson RN, Brown RO, Hanna DL, Williams JE (2003) Energy requirements of non-ambulatory tube-fed adult patients with cerebral palsy and chronic hypothermia. Nutrition 19:741–746PubMedCrossRefGoogle Scholar
  20. DMR Health Standard 07-1 (2011) Guidelines for identification and management of dysphagia and swallowing risks attachment A. Accessed 14 Feb 2011
  21. Dunne P (2008) Balancing act. Nursing in the Community 9:19–20Google Scholar
  22. Dyer JA (2003) Multidisciplinary, interdisciplinary and transdisciplinary educational models and nursing education. Nurs Educ Perspect 24:186–188PubMedGoogle Scholar
  23. Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P (2002) Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 17:139–146PubMedCrossRefGoogle Scholar
  24. Elia M, Stratton R, Russell C, Green C (2005) The cost of disease related malnutrtion in the UK and economic considerations for the use of nutritional supplements (ONS) in adults. British Association of Parenteral and Enteral Nutrition, WorcesterGoogle Scholar
  25. Fairclough J, Burton S, Craven J, Ditchburn L, Laverty A, Macleod M (2008) Home enteral tube feeding for adults with a learning disability. British Dietetic Association, BirminghamGoogle Scholar
  26. Finestone HM, Foley NC, Woodbury MG, Greene-Finestone L (2001) Quantifying fluid intake in dysphagic strok patients: a preliminary comparison of oral and nonoral strategies. Arch Phys Med Rehab 82:1744–1746CrossRefGoogle Scholar
  27. Garcia JM, Chambers E IV (2010) Managing dysphagia through diet modifications. Am J Nutr 110:26–33Google Scholar
  28. Garcia JM, Chambers E IV, Matta Z, Clark M (2005) Viscosity measurement of nectar and honey thick liquids: product, liguid, and time comparisons. Dysphagia 20:325–335PubMedCrossRefGoogle Scholar
  29. Garcia JM, Chambers E IV, Matta Z, Clark M (2008) Serving temperature viscosity comparisons of nectar and honey-thick liquids: product, liquid and time comparisons. Dysphagia 23:65–75PubMedCrossRefGoogle Scholar
  30. Garcia JM, Chambers E IV, Clark M, Helverson J, Matta Z (2010) Quality of care issues for dysphagia: modifications involving oral fluids. J Clin Nurs 19:1618–1624PubMedCrossRefGoogle Scholar
  31. Gervasio JM, Dickerson RN, Brown RO, Matthews JB (1997) Chronic hypothermia and energy expenditure in a neurodevelopmentally disabled patient: a case study. Nutr Clin Pract 12:211–215CrossRefGoogle Scholar
  32. Ginocchio D, Borghi E, Schindler A (2009) Dysphagia assessment in the elderly. Nutr Ther Metabol 27:9–15Google Scholar
  33. Goulding R, Bakheit AMO (2000) Evaluation of the benefits of monitoring fluid thickness in the dietary management of dysphagic stoke patients. Clin Rehabil 14:119–124PubMedCrossRefGoogle Scholar
  34. Hanson B, O’Leary M, Smith C (2011) The effect of saliva on the viscosity of thickened drinks. Dysphagia. doi: 10.1007/s00455-011-9330-8
  35. Heiss CJ, Goldberg L, Dzarnoshi M (2010) Registered dietitians and speech and language pathologists: an important partnership in dysphagia management. J Am Diet Assoc 110:1290–1293PubMedCrossRefGoogle Scholar
  36. ICDA (2008) Dietitians around the world: their education and their work. Accessed 22 Feb 2011
  37. Ickenstein GW(2011) Diagnosis and treatment of neurogenic dysphagia. UNI-MED, BremenGoogle Scholar
  38. Irish Nutrition and Dietetic Institute (2009) Irish consiststency descriptors for modified fluids and foods. Accessed 12 Feb 2011
  39. Kemp S (2001) Restoring pleasure:nutritional management of dysphagia. Br J Community Nurs 6:284–289PubMedGoogle Scholar
  40. Khlemeier KV, Palmer JB, Rosenberg D (2001) Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia 16:119–122CrossRefGoogle Scholar
  41. Lee HA (1974) Composition of some body external secretions. In: Lee HA (ed) Parenteral nutrition in acute metabolic illness. Academic, LondonGoogle Scholar
  42. Logemann J (2008) A randomize study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease. J Speech Lang Hear R 51:173–183CrossRefGoogle Scholar
  43. Longton V, Chunn SS, Chambers E IV, Garcia JM (2003) Texture and flavor characteristics of beverages containing commercial thickening agents for dysphagia diets. J Food Sci 68:1537–1541CrossRefGoogle Scholar
  44. Matta Z, Chambers E IV, Garcia JM (2006) Sensory characteristics of beverages prepared with commercial thickeners used for dysphagia diets. J Am Diet Assoc 106:1049–1054PubMedCrossRefGoogle Scholar
  45. Mehanna H, Nankivell PC, Moledina J, Travis J (2009) Refeeding syndrome––awareness, prevention and management. Accessed 3 Feb 2011
  46. National Dysphagia Diet Task Force (2002) National dysphagia diet. American Dietetic Association, ChicagoGoogle Scholar
  47. National Patient Safety Agency (2007) Ensuring safer practice for adults with learning disabilities who have dysphagia. Accessed 24 Feb 2011
  48. Nazarko E (2007) Nutrition part 5: dysphagia. Br J Healthcare Assistants 3:228–232Google Scholar
  49. Nazarko E (2009) The clinical management of dysphagia in primary care. Br Community Nutr 13:258–264Google Scholar
  50. National Institute for Health and Clinical Excellence (2006) Nutrition support in adults:oral nutrition support;enteral tube feeding and parenteral nutrition. Accessed 20 Feb 2011
  51. Nowson CA, Sherwin AJ, McPhee JG, Wark JD, Flicker L (2003) Energy, protein, calcium, vitamin D and fibre intakes from meals in resedential care establishments in Australia. Asia Pac J Clin Nutr 12:172–177PubMedGoogle Scholar
  52. NPSA Dysphagia expert reference group (2011) Dysphagia diet food texture descriptors. Accessed 1 Jun 2011
  53. Panther K (2005) The Frazier free water protocol. Swallowing and swallowing disorders. Dysphagia 14:4–9Google Scholar
  54. Pelletier CA (1997) A comparison of consistency and taste of five commercial thickeners. Dysphagia 12:74–78PubMedCrossRefGoogle Scholar
  55. Penman JP, Thomson M (2008) A review of the textured diets developed for the management of dysphagia. J Hum Nutr Diet 11:51–60CrossRefGoogle Scholar
  56. Perry L, Love CP (2001) Screeing for dysphagia and aspiration in acute stroke: a systematic review. Dysphagia 16:7–18PubMedCrossRefGoogle Scholar
  57. Queensland Health Dietitians (2007) Thickened fluids. Accessed 19 Feb 2011
  58. Robbins J, Gensler G, Hind J, Logemann J, Lindblad A, Brandt D, Baum H, Lilienfeld D, Kosek S, Lundy D, Dikeman K, Kazandjian M, Gramigna G, McGarvey-Toler S, Gardner PJM (2008) Comparison of 2 interventions for liquid aspiration on pneumonia incidence. Ann Intern Med 148:509–519PubMedGoogle Scholar
  59. Royal College of Physicians, British Society of Gastroenterology (2010) Oral feeding difficulties and dilemmas: a guide to practical care, particularly towards the end of life. Royal College of Physicians, LondonGoogle Scholar
  60. Scottish Parliament (2000) Adults with Incapacity (Scotland) Act. The Stationery Office, EdinburghGoogle Scholar
  61. Stewart L (2003) Development of the nutrition and swallowing checklist, a screening tool for nutrition risk and swallowing risk in people with intellectual disability. J Int Dev Dis 28:171–187CrossRefGoogle Scholar
  62. Todorovic V, Micklewright A (2007) A pocket guide to clinical nutrition, 4th edn. Parenteral and Enteral Nutrition Group, NottinghamGoogle Scholar
  63. Vivanti AP, Campbell KL, Suter MS, Hannan-Jones MT, Hulcombe JA (2009) Contribution of thickened drinks, food and enteral parenteral fluids to fluid intake in hospitalised patients with dysphagia. J Hum Nutr Diet 22:148–155PubMedCrossRefGoogle Scholar
  64. Whelan K (2001) Inadequate fluid intake in dysphagic stroke. Clin Nutr 20:423–428PubMedCrossRefGoogle Scholar
  65. White R, Bradnam V (2007) Handbook of drug administration via enteral feeding tubes. Pharmaceutical Press, LondonGoogle Scholar
  66. White GN, O’Rourke F, Ong BS, Cordato DJ, Chan DKY (2008) Dysphagia:causes, assessment, treatment, and management. Geriatrics 63:15–20PubMedGoogle Scholar
  67. Wright L, Cotter D, Hickson M (2005) The effectivensss of targetted feeding assistance to improve the nutritional intake of elderly dysphagic patients in hospital. J Hum Nutr Diet 21:555–562CrossRefGoogle Scholar
  68. Wright L, Cotter D, Hickson M, Frost G (2008) Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet. J Hum Nutr Diet 18:213–219CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg  2011

Authors and Affiliations

  1. 1.Abteilung Neurologiem&i-Fachklinik Bad HeilbrunnBad HeilbrunnGermany

Personalised recommendations