IDDSI Level 5 – Minced and Moist – Passing the IDDSI Testing Methods for MM56 Sep 2022
Following on from our insight article on Passing the IDDSI Testing Methods for PU4 we now going to take a look at some of the points of interest relating to passing the IDDSI Testing Methods for MM5.
IDDSI Audit Sheet
As before, we are going to take the IDDSI Audit Sheet for MM5 as our benchmark for the determination of a MM5 food, as is specified by IDDSI. We make note of this as you may find that alternative, descriptive resources are available. Descriptive modes tend to bring more opportunity for subjectivity, and so we are sticking to the objective tests found on the IDDSI Audit Sheet.
The instructions on the IDDSI Audit Sheet for MM5, found at the top of the sheet, set out the critical testing methods that determine a correct food texture.
Appearance + Fork Pressure + Spoon Tilt Test
Combined success in all the tests must be achieved for the food to pass the audit, which is indicated by the + symbols. Where the tools required to carry out the critical tests are unavailable the alternative Finger Test can be used.
Creating a chewed bolus
The next point in the instruction sets out that food at MM5 is ‘intended to mimic a ‘chewed bolus’’. A bolus is the soft, moist, and cohesive ‘ball’ of food that, where an individual is healthy and can manage regular food, can be created from a wide range of food textures so that the food can be easily swallowed.
There is an expression ‘drink your food and chew your liquid’ that suggests food should be chewed until liquid enough to be swallowed. The more you chew, the finer the initial pieces of food become, and as more and more saliva is mixed the bolus becomes more semi-liquid, with some small pieces, that holds together cohesively. A bolus.
So, the purpose of creating food with the defined texture of MM5 is that the results can be easily transported through the mouth and swallowed as a bolus can. The testing methods identify, and define, how a bolus should respond in the mouth, with applied tongue pressure, to move and position the food to be swallowed.
Passing the IDDSI Testing Methods for MM5
Let’s take a look at the critical testing methods from the IDDSI Audit Sheet for MM5.
Critical: Appearance – Lumps less than or equal to 4mm (4x4x15mm) for adults and 2mm (2x2x8mm) for paediatrics; with no separate thin liquids
The preparation of food at IDDSI Level 5 – Minced and Moist is not required to follow a particular order that will bring success. Our ORAL approach allows basic and more advanced techniques to be structured as best suits the context where preparation is being undertaken.
It would certainly be the case that equipment, better suited for the tasks, will allow more freedom in which to order reform processes, resulting in more efficient production methods; saving time, and reducing wastage, for example.
Let’s take a plum, in this case, as an example.
Essentially the 2 factors that matter when preparing a plum for this MM5 IDDSI Testing Method:
- The ripeness of the plum
- The available equipment
If the plum is very ripe, it will be relatively easy to exclude the skin, stone, and stalk (if present) and break up the flesh to size requirements for MM5. There will likely be some excess juice that will need to be dealt with: thickened slightly so there are no separate thin liquids. However, this process could all be carried out with a fork and the use of your fingers, to great success, although a knife and chopping board would bring more control.
If the plum is unripe and very firm a tenderisation process will be needed. If equipment is limited, say we only have a fork available, then by tenderising the plum first, to a similar texture to that of a very ripe plum (poaching, steaming, etc..), then the fork can be used effectively to exclude and resize, as above. If, however, we have better equipment available, a knife and chopping board, then the firm plum can be resized first and then tenderised, which will speed up the process considerably.
Critical: Fork Pressure Test – Food can be easily mashed with a little pressure from a dinner fork (no thumb blanching); easily separates and comes through the prongs of a dinner fork
When testing the sample of food at MM5 its structure must be cohesive, however minimal tongue pressure should cause the bolus to be moved around easily (minimal chewing action).
Here we look at the structural composition, where the MM5 food is moist enough to be held together cohesively, however this should be delicate enough to be able to pass the tests.
Focus here on the thickness of any food or sauce that may take the role of providing cohesion, some dense components (thick starchy foods or nut butters are good examples where issues may lie).
It is also important that the lumps of food that are present in MM5 are not hard, details can be found in the IDDSI Framework section: Food Textures That Pose A Choking Risk, however objectively this can be clarified by ensuring the tenderness is that of SB6.
Critical: Spoon Tilt Test – Holds shape on teaspoon; food slides off spoon with little food left on teaspoon (i.e., not sticky)
Here, again, the cohesive agent of the MM5 food must be considered and if the test fails due to stickiness, then some form of texturisation should limit this issue and give rise to a reduction in stickiness sufficient to pass the test.
As discussed previously, when you want to ensure food is passing the IDDSI Testing Methods for MM5 all tests should be performed on a sample at the time of service. The characteristics defined by the testing methods should persist for the duration of a meal, up to 30 minutes. If you find that the MM5 food sample fails in any of the areas discussed, the initial recipe can be modified to ensure exclude, tenderise, and texturise processes is sufficient to give compliance.
For more details on our health and social care sector training that is now widely used across NHS and private care providers in the UK you can follow this link: Online Dysphagia Diets for IDDSI Course.