Table 1. Categorizations/Sub-Categorizations of Common Recommendations Made by Speech-Language Pathologists (SLP) During Inpatient Dysphagia Evaluations^a, ^b.

Dietary recommendations and restrictions

Food recommendations

General/normal/regular diet

Mechanical soft diet/chopped/diced

Mechanical soft dysphagia diet

Ground/crushed/minced food

Pureed diet/semisolid diet

Moist food products/add gravy, sauces, condiments

Allow special/specific food that patient enjoys

NOS “dietary food recommendation”

Food restrictions

No dry/tough/hard foods (e.g., nuts, granola, dry meats, etc.)

No foods that crumble (e.g., rice, cake, etc.)

No foods with mixed consistencies (e.g., fruit cocktail, etc.)

No sticky foods (e.g., peanut butter, taffy, etc.)

No starches or “starchy” foods

NOS food restriction

Foods and liquids that stimulate sensation

Foods with intense flavor

Favor tasty/appealing foods/favor patient’s favorite foods

Favor hot or cold foods/no room-temperature foods

NOS recommendation to consume foods that stimulate senses

Liquid recommendations

Thin liquids/general liquids

Nectar-thick liquids

Honey-thick liquids

Pudding-thick liquids

Thick or thickened liquids

Clear liquids diet

Water-only diet

Favor carbonated beverages, soda, pop, soft drinks

NOS recommendation for consumption of liquids or hydration

Liquid restrictions

No thin liquids

No liquids

Liquids by spoon only

Liquids with cup only; do not use straws

Use straw while drinking

Do not use cup while drinking

No carbonated beverages, soda, pop, soft drinks

NOS liquid restriction or drinking tool recommendation

Nutritional advice

Calorie counts

Diet supplements

Temporary alternative means of nutrition

Long-term alternative means of nutrition

[Unspecified duration] alternative means of nutrition

Oral feeding with tube supplement

Tube feeding with oral supplement

NOS nutritional recommendation

Tube feeding

Dobhoff/nasogastric (NG) tube

Gastrostomy tube

J-tube

TNA/TPN

Discontinue (d/c) or hold tube feeding (TF)

NOS tube feeding recommendation

No intake by mouth (NPO)

No food/liquid by mouth (NPO), or discontinue meals/food intake (PO)

Postural and compensatory techniques

Body positioning

90-degree angle/upright posture during consumption

90-degree angle/upright posture after consumption

Lean to left while eating

Lean to right while eating

Lie on left side while eating

Lie on right side while eating

Lie on [unspecified] side while eating

Lean [to unspecified] side while eating

NOS body-positioning recommendation for during or after consumption

Head adjustments

Chin tuck

Rotate/turn head to left while eating

Rotate/turn head to right while eating

Rotate/turn head [to unspecified side] while eating

Tilt head to left while eating

Tilt head to right while eating

Tilt head [to unspecified side] while eating

Jaw thrust/extension while eating

NOS head adjustment recommendation

Oral-pharyngeal strategies

Place food on back of tongue

Place food at most sensitive part of mouth

Apply pressure or sensory stimulation before presenting foods

Present boluses to left side of mouth

Present boluses to right side of mouth

Present boluses to [unspecified] side of mouth

Lingual or finger sweep on left side

Lingual or finger sweep on right side

Lingual or finger sweep [on unspecified side]

Effortful swallow (during eating)

Press on cheek with hand to close off left side of mouth

Press on cheek with hand to close off right side of mouth

Press [unspecified] cheek with hand to close [unspecified] side of mouth

Airway protection techniques (e.g., throat-clear)

Multiple swallows per bite (e.g., double swallow)

Focus on and/or try to improve timing of swallow

NOS recommendation to perform compensatory maneuver/technique

Rehabilitative techniques

Practice movements related to eating/bolus manipulation

Base of tongue exercises

Tongue/lingual protrusion or tongue/lingual resistance exercises

Tongue lateralization exercises

Tongue hold and swallow

NOS tongue/lingual exercise recommendation (include improving ROM)

Lip protrusion and/or lip retraction exercises

Laryngeal elevation/falsetto techniques

Vocal fold adduction exercises

Speech, talking, or voice exercises

Effortful swallowing performed as therapy exercise (not while eating)

Yawning exercises

Gargling with saliva or water

Shaker exercise

NOS recommendation to strengthen range of motion (ROM)

NOS instruction to perform rehabilitation exercise

External electronic stimulation therapy

Pacing, sizing, and procedural techniques

Procedural and sizing recommendations

Alternate solids and liquids

One course of food at a time

One bite at a time

1/2 tsp. bolus size

1 tsp. bolus size

Small/controlled bites

Small or single sips of liquid; no gulps of liquid

Eat/drink slowly, decreased rate of feeding

Avoid small food particles

Finger foods

NOS procedural or sizing recommendation

Meal scheduling

Eat frequent meals with small portion size, favor snacks/small meals

Maintain regular/routine eating schedule

Eat at peak of med cycle

Use necessary aids (e.g., dentures) at all times while eating

Eat only when wide awake/alert and oriented

Eat only when physically ready for swallowing/eating

NOS recommendation for when to consume meals

Medications - pill recommendations

Crush/split/grind/chop pills

Take pill with puree (e.g., applesauce)

NOS instruction to take pill with food

Place pill on back of tongue

One pill at a time

Take pill with fluid (e.g., with water)

Liquefy pills

Favor pills instead of liquid medications, or avoid liquid meds

Favor liquid medications instead of pills, or avoid pills

NOS recommendation for consuming pills

Care provider and communication recommendations

Supervision, monitoring, and assistance

One to one supervision during meals

Maintain intermittent or periodic supervision

Supervision during feeding

One to one feeding assistance

Assist with feeding, food selection, meal setup, or therapy

Monitor for signs of aspiration (e.g., cough, wet voice, etc.)

Monitor for oral residual or pocketing on left side

Monitor for oral residual or pocketing on right side

Monitor for oral residual or pocketing [in unspecified area of oral cavity]

Monitor patient for difficulties, monitor patient status

Swallowing and/or exercises performed in presence of SLP, MD, clinician

NOS recommendation to ensure safety of patient while eating

Other provider recommendations

Cue/remind/reinforce swallowing/feeding techniques

Recommendation giving care provider permission to evaluate patient’s diet

Discontinue (d/c) or stop tube feedings (TFs) at a future date

Use simple/concise directions to increase comprehension

Oral care before/during/after meals

Food on left side of plate/tray

Food on right side of plate/tray

Food on [unspecified] side of plate/tray

NOS tray-setup recommendation

Follow recommendations posted on patient’s bed, door, or wall

Patient to work on achieving independence

Work with patient on “compliance” or “adherence” to recommendation

NOS care provider recommendation

Future services with health experts

Reconsult, re-refer, readmit with any concerns, difficulties, or as needed

Follow-up evaluation by SLP

Future evaluation by health expert

[Unspecified type of] referral requested [by unspecified specialist]

NOS care provider communication instruction

Environment/other

Limit or avoid distractions during meals

Ensure ideal external environment

NOS recommendation to ensure optimal environmental conditions

^aBold text indicates category; italic text indicates sub-category; normal text indicates specific recommendation

^bSLP = Speech-language pathologist, NOS = not otherwise specified