Patent Publication Number: US-2006019012-A1

Title: Dysphagic dietary treatment

Description:
FIELD OF THE INVENTION  
      This invention relates to the medical field and more particularly to food for those afflicted with dysphagia.  
     BACKGROUND OF THE INVENTION  
      Those afflicted with dysphagia have a difficult time swallowing whole food. Foods to “thin”, e.g., viscous, can cause the patient to aspirate, taking the liquid into their lungs. Foods to “thick” or solid pose a serious choking hazard. The appropriate thick/thin balance needs to be found with respect to each food and beverage provided to a dysphagic patient.  
      Dysphagia is an infliction of varying degrees. The medical field currently identifies four different levels of severity, for treatment purposes, although it is generally understood that these are not levels, but rather points along a continuim used for regulating dietary treatment.  
      Those with the most serious infliction, level 1 dysphagic patients, need all foods to be in a liquid form, having a consistency at or about that of honey. To achieve this level of precision in balancing the thickness/thinness all foods are pureed, adding liquids where necessary. For instance, a slice of bread is pureed, perhaps with milk, and served in a bowl. Eaten with a spoon, a ham sandwich lacks the enjoyment not inflicted persons experience. This methodlogy, while the standard in the industry, fails because some patients find their favorite foods unpalatable and unattractive appearance. Not surprisingly, these patients commonly have severe weight loss problems, finding themselves taking dietary supplements and in the most severe cases, being fed via a tube.  
      Some work has been done in the area of meats, which lack porousity. U.S. Pat. No. 6,458,395 (Mitsu) discloses a gelatinous food product including water, saccharide, lipid, protein, organic emulfying agent, organic acid salt, gelling agent as a food product for patients dyshagia. U.S. Pat. No. 6,607,776 (Howard et al.) discloses a protein enhanced gel generally in the form of a dessert gel containing soy protein isolate, soy protein concentrate, whey and sodium caseinate. U.S. Pat. No. 6,461,589 (Robbins) discloses a gelled whey protein, a carbohydrate source, minerals and vitamins. Meat is perhaps the food group that is to be consumed the least and generally is non-pourous.  
      Perhaps the food group that is to be consumed the most is grains, such as that found in bread. What is needed is a dysphagic deitary food based upon breads. This food should be transformable into a variety of recipes, including main courses, such as sandwiches, pizza, and the like and in desert forms such as doughnuts, cakes, and other pastries. This food should formable such that it can be presented in a standard form for the food type, e.g. a pizza appears as a pizza not a slurry served in a bowl. The food should also have a thickness/thinness balance within the bounds that dysphagic patients can consume.  
     SUMMARY OF THE INVENTION  
      The present invention relates to a method for manufacturing of formable food for dysphagia. The method includes measuring bread crumbs, corn starch, powder milk, cup sugar and mixed. Water is brought to a boil. Gelatin is dissolved in cold water. The dissolved gelatin is added to the boiling water. The bread crumb mixture is added to the boiling water and poured into a mold pan and let set. The present invention can be used beneficially with all levels of dysphagia patients.  
      Advantageously, the present invention is based upon breads, a major source of grains.  
      As yet a further advantage, the present invention, is formable into standard forms represented by the food, providing psychological support to those suffering from dysphagia.  
      As still yet a further advantage, the present invention is incorporatable into a wide variety of recipes, including main courses and deserts.  
      As still yet another advantage, the food is of a precision thickness/thinness balance that the food is consumable by those with the most severe infliction of dysphagia.  
      That is the present invention advantageously is designed for Level I (Pureed Diet), II (Semi-solid Pureed Diet), III (Soft Diet), and IV (Soft Diet) Dysphagia Diets provides food that is of a consistency that will facilitate ease in chewing and swallowing. The food is for use in the Level V (Regular Transitional Diet) to provide a transition between the Dysphagia IV and Regular Diet. The Level I, II, III, IV and V Dysphagia Diets are for patients with mechanical or pathological impairment of chewing or swallowing.  
      These advantages and additional advantages are found throughout the description and are discernable from the description to those of ordinary skill in the art.  
     DEFINITIONS  
      The following definitions are intended to apply throughout the description and claims:  
      Level I Dysphagia (or dysphagic diet)—are those patients who must have a precise balance of thickness and thinness of food. Suitable foods are typically of a blended/pureed consistency. All beverages must be of a syrup/nectar, honey consistency with no thin liquids allowed. Any thin liquids (i.e. —water, juices, etc) are to be thickened to a syrup consistency. Soups (broth or cream) are allowed if they, too, are of a honey consistency with no whole pieces of any kind added.  
      Level II Dysphagia (or dysphygic diet)—are those patients that can have a slightly broader flexibility in the balance of thickness and thinness of food as compare to Level 1 and more restrictive than that of Level 3. Specifically, food is typically blended/pureed or semi-solid such as pureed bread, crackers soaked in milk with thin liquid drained off; meats and fish ground; fruits cooked and diced; vegetables, including potatoes, fully cooked and mashed or finally diced. Fruits can be canned, well-cooked and diced or diced bananas.  
      Level III Dysphagia (or dysphagic diet)—are those patients that can have a slightly broader flexibility in the balance of thickness and thinness of food as compare to Level 2 and more restrictive than that of Level 4. Typical diets include those items of Level II with the additions of bread or toast with soft crust, pancakes/French toast soaked in syrup, plain muffins or doughnuts. Pumpkin pie, cheesecake (both without crusts), soft cakes and cookies, candy bars. Meats can be ground, baked fish, canned salmon or tuna, ground meat casseroles and chopped luncheon meats.  
      Level IV Dysphagia (or dysphagic diet)—are those patients that can have a slightly broader flexibility in the balance of thickness and thinness of food as compare to Level 3 and more restrictive than that of Level 5. Typical diets include chopped meat rather than ground or pureed, and the addition of crushed pineapple and fruit cocktail added to the fruit list. Soups are made the same in I, II, III and IV, but in Level IV small well-cooked pieces of vegetable may be added. Chili may have well-cooked beans. Meats are of the same consistency as Level III. At this level, fruit crisps and cherry layer dessert is added as is jelly beans, gum drops, marshmallows and chewing gum. The beverages are still of the thickened consistency.  
      Level V Dysphagia (or dysphagic diet)—are those patients that can have a slightly broader flexibility in the balance of thickness and thinness of food as compare to Level 4 and more restrictive than that of normal diets. This is the transitional diet prior to a regular diet. This food can be easily chewed and swallowed with all raw fruits and vegetables still omitted together with any fruit or vegetable with tough membranes, small seeds or skins. All meat is allowed as well as all soups. Breads and cereals containing whole grain flour, bran, nuts, raisins or seeds are still avoided. Also avoided at this level are potato chips, any foods containing coconut, dried fruits, nuts or seeds; chunky peanut butter, popcorn, olives, relish or pickles.  
      Water—water is intended to have a broader meaning than H 2 O. Water means water based liquids, having a viscosity similar to that of H 2 O, including but not limited to milk, fruit juices, tea, coffee, inoculated drinks such as energy drinks, sport drinks, etc. 
    
    
     DETAILED DESCRIPTION OF THE PRESENT INVENTION  
      This invention relates to a method for the manufacturing of food formable for people with Level 1 dysphagia. In carrying out the invention in its simplest form one measures 30% to 44% by volume, bread crumbs; 54% to 68% by volume, water; to 2% by volume, powdered gelatine. Dry ingredients used in bread such as powdered milk and sugar may be partially substituted for bread crumbs. Starch may be used to thicken access water and/or to cause the solution to fully thicken in less time.  
      The above percentages are the preferred ranges for level 1 disphagic patients. With the aid of starch or other thickener, the water concentration can tend higher and would be considered an equivalent. With the aid of an absorbent inhibitor, such as shortening, water concentrations can tend lower and would be considered an equivalent. More tolerant levels of disphagic patients can consume foods with broader ranges of bread crumbs and water. When the water concentration is high, the mixture tends to set too slow for commercial application and when the water concentration is low, the mixture tends to become to sticky, e.g. thick.  
      The most preferred ratio of bread crumbs to water to gelatine is 36:62:2, which yields a presetting thickness approximate to that of the first preferred embodiment described below. Once set, the mixture appears to have a structure most similar to that of bread.  
      The mixture is allowed to set at which point it appears as a solid bread structure, substantially distinct in appearance as bread that may otherwise be served to dysphagic patients in a bowl to be eaten with a spoon. The solid bread structure, crumbs or disintegrates, representative of the viscosity of thickened liquids, when placed in the mouth of a Level I dysphagic patient, and is suitable for consumption by such patient.  
     The Preferred Embodiments  
     EXAMPLE I  
      PUREED BREAD (This is the base recipe used in all the following recipes)  
     
         
          The following ingredients were measured:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups water to a boil  
          Poured gelatine into 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water, mixing well.  
          Poured in bread crumb mixture stirring until mixed  
          Poured into a jelly roll pan and let set.  
       
    
      CASE STUDY 1 This recipe has been tested on people with dysphagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing. A ninety eight year old female resident with dementia was resistive to feeding, eating very slowly, taking up to one hour per meal. In November, 2002, her weight was 103 lbs and had declined. She was started on dessert items made according to the present invention and is now 100 years old and weighed 118 lbs as of February, 2004.  
      CASE STUDY 2 A sixty one year old male with severe retardation weighed in at 126 lbs in November, 2002. With the present invention as part of his pureed diet, he weighed 137 lbs as of February, 2004.  
      CASE STUDY 3 A ninety two year old female with Alzheimers, weighing 84 lbs in November 2002, was very selective of her foods, therefore eating very little. Her goal was to reach 100 lbs and to be able to go home. She was started on the present invention dessert items and her appetite perked right up. She returned to her home weighing 103 lbs.  
      CASE STUDY 4 A ninety one year old female with extreme confusion was admitted at 130 lbs and would not eat most of her meal. Her weight dropped to 124 lbs in November, 2002. She would eat desserts according to the present invention and by March 2003 she was up to 140 lbs. By then her overall meal intake had improved which indicates that the present invention invigorated her appetite and interest in food.  
      CASE STUDY 5 A ninety year old resident with senile dementia refused to eat a pureed diet with thickened liquids. With the present invention added to her menu, she went from 118 lbs in April, 2003, to 136 lbs as of February, 2004.  
      CASE STUDY 6 A forty eight year old resident with Multiple Sclerosis was admitted, weighing in at 200 lbs and refused to eat anything on his mechanical soft diet. He was quite non-verbal and immobile at that time. He was offered the present invention along with his pureed diet with thickened liquid, jump starting his appetite so his meal intake was greatly improved. He now weighs 204-206 lbs, showing no further weight loss. He is verbal, up and about, and frequently thanks the kitchen staff, saying, “Thank you” and “Good”! 
     EXAMPLE II  
      BANANA CHOCOLATE MUFFIN  
     
         
          The following ingredients were measured:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups water to a boil  
          Poured gelatine into 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water, mixing well.  
          Poured in bread crumb mixture stirring until mixed  
          Added 2 teaspoons of banana extract and ½ cup chocolate syrup.  
          Lined muffin tins with paper baking cups  
          Filled muffins tins with ¼ cup mixture. Let set.  
          Garnished with chocolate syrup and whipped cream.  
       
    
      The mixture, once set, appeared as a solid crushable structure of sufficient character to be consumed by level 1 dysphagic patients. This recipe has been tested on people with dysphagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing.  
     EXAMPLE III  
      MINT CHOCOLATE MUFFIN  
     
         
          Measured the following:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups water to a boil  
          Poured gelatine into 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water, mixing well.  
          Poured in bread crumb mixture stirring till mixed  
          Added 2 teaspoons of mint extract and ½ cup chocolate syrup.  
          Lined muffin tins with paper baking cups  
          Prepared bread mix. Added mint extract and chocolate syrup  
          Mixed well, filled muffin tins with ¼ cup mixture. Let set.  
          Garnished with chocolate syrup and whipped cream  
       
    
      The mixture, once set, appeared as a solid crushable structure of sufficient character to be consumed by level 1 dysphagic patients. This recipe has been tested on people with dysphagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing.  
     EXAMPLE IV  
      CHOCOLATE CRUSH  
     
         
          The following ingredients were measured:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups of water to a boil.  
          Poured gelatine into 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water  
          2 pounds of chocolate pudding  
          ½ cup modified corn starch  
          ½ cup sugar  
          Chocolate syrup  
          Combined the pudding and corn starch, mixing well.  
          Lined muffin tins with paper baking cups  
          Prepared bread mix. Added sugar stirring well  
          Filled muffin tins with ¼ cup of mix. Let set  
          Removed paper from muffin and placed in center of plate  
          Poured ¼ cup pudding mixture over muffin  
          Taking a second muffin, placed it on top of pudding  
          Garnished with 1 tablespoon of pudding, whipped cream and chocolate syrup.  
       
    
      The mixture, once set, appeared as a solid crushable structure of sufficient character to be consumed by level 1 dysphagic patients. This recipe has been tested on people with dysphagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing.  
     EXAMPLE V  
      LEMON CRUSH  
     
         
          The following ingredients were measured:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups water to a boil  
          Poured gelatine into 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water, mixing well.  
          Poured in bread crumb mixture stirring until mixed  
          2 pounds lemon pudding  
          ½ cup modified corn starch  
          ½ cup sugar  
          Lemon Sauce  
          Mixed pudding and cornstarch, stirring well  
          Lined muffin tins with paper baking cups  
          Prepared bread mix add sugar stir well  
          Filled muffin tins with ¼ cup of mixture. Let set  
          Removed paper from muffin and placed in center of plate  
          Poured ¼ cup pudding mix on top of muffin  
          Taking a second muffin, placed it on top of first muffin  
          Garnished with 1 tablespoon of pudding, whipped cream and lemon sauce.  
       
    
      The mixture, once set, appeared as a solid crushable structure of sufficient character to be consumed by level 1 dysphagic patients. This recipe has been tested on people with dyshagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing.  
     EXAMPLE VI  
      RASPBERRY CRUSH  
     
         
          The following ingredients were measured:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups water to a boil  
          Poured gelatine into 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water, mixing well.  
          Poured in bread crumb mixture stirring until mixed  
          2 pounds pureed raspberries  
          Modified corn starch  
          ½ cup sugar  
          Raspberry Sauce  
          Thickened pureed raspberries with corn starch to pudding consistency.  
          Lined muffin tins with paper baking cups  
          Prepared bread mix adding the sugar and stirring well  
          Filled muffin tins with ¼ cup of mixture. Let set  
          Removed paper from muffin and placed in center of plate  
          Poured ¼ cup raspberry pudding over muffin  
          Taking a second muffin, placed it on top of first muffin  
          Garnished with 1 tablespoon of raspberry pudding, whipped cream and raspberry sauce.  
       
    
      The mixture, once set, appeared as a solid crushable structure of sufficient character to be consumed by level 1 dysphagic patients. This recipe has been tested on people with dysphagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing.  
     EXAMPLE VII  
      BANANA CRUSH  
     
         
          The following ingredients were measured:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups water to a boil  
          Poured gelatine into 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water, mixing well.  
          Poured in bread crumb mixture stirring till mixed  
          2 pounds banana pudding  
          ½ cup modified corn starch  
          ½ cup sugar  
          White chocolate Sauce  
          Lined muffin tins with paper baking cups  
          Prepared bread mixture and added sugar stirring well  
          Filled muffin tins with ¼ cup of mixture. Let set  
          Removed paper from muffin and set in center of plate  
          Poured ¼ cup pudding mixture over muffin  
          Placed a second muffin on top of first muffin  
          Garnished with 1 tablespoon of pudding, white chocolate sauce and whipped cream.  
       
    
      The mixture, once set, appeared as a solid crushable structure of sufficient character to be consumed by level 1 dysphagic patients. This recipe has been tested on people with dysphagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing.  
     EXAMPLE VIII  
      BLUEBERRY CRUSH  
     
         
          The following ingredients were measured:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups water to a boil  
          Poured gelatine into 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water, mixing well.  
          Poured in bread crumb mixture stirring until mixed  
          2 pounds pureed blueberries  
          Modified corn starch  
          ½ cup sugar  
          Blueberry sauce  
          Thickened the blueberry puree with the cornstarch until it is of pudding consistency  
          Lined muffin tins with paper baking cups  
          Prepared bread mixture, adding the sugar and stirring well  
          Filled muffin tins with ¼ cup of mixture. Let set  
          Removed paper from muffin and set in center of plate  
          Poured ¼ cup pudding over muffin  
          Placed a second muffin on top of the first  
          Garnished with 1 tablespoon of blueberry, whipped cream and blueberry sauce.  
       
    
      The mixture, once set, appeared as a solid crushable structure of sufficient character to be consumed by level 1 dysphagic patients. This recipe has been tested on people with dysphagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing.  
     EXAMPLE IX  
      BUTTERSCOTCH CRUSH  
     
         
          The following ingredients were measured:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups water to a boil  
          Poured gelatine into 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water, mixing well.  
          Poured in bread crumb mixture stirring until mixed  
          2 pounds butterscotch pudding  
          ½ cup modified cornstarch  
          ½ cup sugar  
          Added the cornstarch to the pudding mixture, stirring well  
          Lined muffin tins with paper baking cups  
          Prepared bread mixture, adding the sugar and stirring well  
          Filled muffin tins with ¼ cup of mixture. Let set  
          Removed paper from muffin and place in center of plate  
          Poured ¼ cup pudding mixture on top  
          Placed a second muffin on top of the first  
          Garnished with 1 tablespoon of pudding and whipped cream.  
       
    
      The mixture, once set, appeared as a solid crushable structure of sufficient character to be consumed by level 1 dysphagic patients. This recipe has been tested on people with dysphagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing.  
     EXAMPLE X  
      MINT CHOCOLATE MUFFIN  
     
         
          The following ingredients were measured:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups water to a boil  
          Poured gelatine into 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water, mixing well.  
          Poured in bread crumb mixture stirring until mixed  
          2 teaspoons mint extract  
          ½ cup chocolate syrup  
          Prepared above bread mixture, adding the mint extract.  
          Lined muffin tins with paper baking cup  
          Filled muffin tins with ¼ cup mixture. Let set.  
          Garnished with chocolate syrup and whipped cream.  
       
    
      The mixture, once set, appeared as a solid crushable structure of sufficient character to be consumed by level 1 dysphagic patients. This recipe has been tested on people with dysphagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing.  
     EXAMPLE XI  
      STRAWBERRY CRUSH  
     
         
          The following ingredients were measured:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups water to a boil  
          Poured gelatine into 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water, mixing well.  
          Poured in bread crumb mixture stirring until mixed  
          2 pounds pureed strawberries  
          Modified cornstarch  
          ½ cup sugar  
          Strawberry sauce  
          Thickened the pureed strawberries with the cornstarch until a pudding consistency  
          Lined muffin tins with paper baking cups  
          Prepared bread mix, adding sugar and stirring well  
          Filled muffin tins with ¼ cup of mixture. Let set  
          Removed paper from muffin and place in center of plate  
          Poured ¼ cups pudding mixture over muffin  
          Placed a second muffin on top of the first muffin  
          Garnished with 1 tablespoon of strawberry pudding, whipped cream and strawberry sauce.  
       
    
      The mixture, once set, appeared as a solid crushable structure of sufficient character to be consumed by level 1 dysphagic patients. This recipe has been tested on people with dysphagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing.  
     EXAMPLE XII  
      BANANA MUFFIN  
     
         
          The following ingredients were measured:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups water to a boil  
          Poured gelatine into 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water, mixing well.  
          Poured in bread crumb mixture stirring until mixed  
          Banana extract  
          ⅔ cup sugar  
          Lined muffins tins with paper baking cups  
          Prepared bread mixture adding the sugar and banana extract.  
          Filled muffin tins with ¼ cup mixture. Let set.  
          Garnished with whipped cream.  
          The mixture, once set, appeared as a solid crushable structure of sufficient character to be consumed by level 1 dysphagic patients. This recipe has been tested on people with dysphagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing.  
       
    
     EXAMPLE XIII  
      BLUEBERRY MUFFINS  
     
         
          The following ingredients were measured:  
          2½ cups bread crumbs  
          4 tablespoons corn starch  
          2 tablespoons powder milk  
          ¼ cup sugar  
          5 cups water  
          2 oz gelatine  
          Mixed bread crumbs, corn starch, powder milk, sugar. Set aside.  
          Brought 4 cups water to a boil  
          Added gelatine to 1 cup cold water stirring until dissolved.  
          Added the dissolved gelatine to the boiling water, mixing well.  
          Poured in bread crumb mixture stirring until mixed  
          ½ cup sugar  
          ½ cup pureed blueberries  
          Lined muffin tins with paper baking cups  
          Prepared bread mixture, adding sugar and blueberries, stirring well  
          Filled muffin tins with ¼ cup mixture. Let set  
          Garnished with whipped cream.  
          The mixture, once set, appeared as a solid crushable structure of sufficient character to be consumed by level 1 dysphagic patients. This recipe has been tested on people with dysphagia and found to be palatable, appetizing and pleasing to the eye as well as nourishing.