Summary of "IDDSI 201 Testing Methods for Food Service Workers"

This webinar, presented by Carrie, a volunteer from the United States IDDSI Reference Group (US IRG), provides detailed training on the International Dysphagia Diet Standardisation Initiative (IDDSI) testing methods for food service workers. It builds on the foundational knowledge from the IDDSI 101 webinar and focuses on practical, objective, and reliable testing techniques to classify food and liquid textures according to IDDSI levels.

Main Ideas and Concepts

IDDSI Framework Overview:
- IDDSI standardizes terminology and testing for dysphagia diets.
- There are 8 levels:
  - Level 7: Regular (black) and Easy to Chew (black)
  - Level 6: Soft and Bite-Sized (blue)
  - Level 5: Minced and Moist (orange)
  - Level 4: Pureed / Extremely Thick (green)
  - Level 3: Liquidized / Moderately Thick (yellow)
  - Level 2: Mildly Thick (pink)
  - Level 1: Slightly Thick (gray)
  - Level 0: Thin (white)
- The webinar covers testing methods for all levels.
Purpose of Testing:
- Ensures food/liquid textures match clinical recommendations.
- Reduces choking risk by objectively measuring size, texture, and thickness.
- Uses inexpensive, practical, and portable tools suitable worldwide.

Detailed Testing Methodologies and Instructions

1. Food Size Testing (Safety Against Choking)

Tools: Standard dinner fork, adult thumbnail, centimeter ruler.
Soft and Bite-Sized (Level 6):
- Maximum size: 1.5 cm x 1.5 cm (approx. thumbnail or fork width).
- Pieces must be small enough to fall through the airway without blocking it.
Minced and Moist (Level 5):
- Particle size for adults: 4mm x 4mm x ≤15mm length.
- Particle size for pediatrics: 2mm x 2mm x ≤8mm length.
- Food should fit between fork tines.
- Food must be moist and cohesive; adding gravy is necessary if crumbly.

2. Spoon Tilt Test (Moisture and Cohesiveness)

Purpose: Checks if food is moist, cohesive, and not sticky.
Tools: Spoon.
Method:
- Scoop food (pureed, minced and moist, or extremely thick).
- Tilt spoon sideways; food should slide or plop off with minimal residue.
- A gentle flick of finger/wrist may be used to dislodge food.
- Fail if food sticks excessively (e.g., butterscotch pudding).
- Important for individuals with dysphagia who have difficulty forming a moist bolus.

3. Fork Pressure Test (Food Firmness)

Tools: Fork (spoon not recommended).
Method:
- Press fork into bite-sized food until thumbnail blanches white (approx. 17 kPa pressure).
- Food should squash easily, break apart, change shape, and not return to original form.
- Food should not stick to fork.
Interpretation:
- Level 5 (minced and moist) requires less pressure, no blanching.
- Levels 6 and 7 require enough pressure to blanch thumbnail.

4. Fork Spoon Separation Test (Ease of Breaking Food)

Tools: Fork, spoon, chopsticks, or fingers (depending on cultural context).
Purpose: Tests if food is soft enough to be broken into smaller pieces easily.
Used for: Levels 6 (soft and bite-sized) and 7 (easy to chew).
Method:
- Food should break apart easily with the side of fork or spoon.
- Alternative tools for cultures without forks/spoons.

5. Flow Test (Liquid Thickness/Viscosity)

Tools: 10 ml syringe or funnel-shaped syringe, stopwatch.
Method:
- Fill syringe to 10 ml line, release flow by removing finger from nozzle.
- Time liquid flow for 10 seconds, measure remaining volume.
Interpretation:
- Amount left determines liquid level (thin to moderately thick).
- Extremely thick liquids (Level 4) cannot be tested with flow test.
Additional Notes:
- Temperature affects viscosity (colder = thicker).
- Different thickeners (cornstarch vs xanthan gum) behave differently over time and with saliva contamination.
- Facilities should test pre-thickened liquids.