401
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Garcia JM, Chambers E, Noll KS. Gravity flow test comparisons for mildly thick consistency. J Texture Stud 2019; 51:308-313. [DOI: 10.1111/jtxs.12491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/26/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jane Mertz Garcia
- Communication Sciences & Disorders, School of Family Studies & Human Services Kansas State University Manhattan Kansas
| | - Edgar Chambers
- Center for Sensory Analysis and Consumer Behavior, Department of Food, Nutrition, Dietetics & Health Kansas State University Manhattan Kansas
| | - Krista S. Noll
- Communication Sciences & Disorders, School of Family Studies & Human Services Kansas State University Manhattan Kansas
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402
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Home Enteral Nutrition in Singapore's Long-Term Care Homes-Incidence, Prevalence, Cost, and Staffing. Nutrients 2019; 11:nu11102492. [PMID: 31627289 PMCID: PMC6835490 DOI: 10.3390/nu11102492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction: Data on home enteral nutrition (HEN) in long-term care facilities (LTCF) in Singapore is scarce. This study aims to determine the prevalence and incidence of chewing/swallowing impairment and HEN, and the manpower and costs related. Methods: A validated cross-sectional survey was sent to all 69 LTCFs in Singapore in May 2019. Local costs (S$) for manpower and feeds were used to tabulate the cost of HEN. Results: Nine LTCFs (13.0%) responded, with a combined 1879 beds and 240 residents on HEN. An incidence rate (IR) of 15.7 per 1000 people-years (PY) and a point prevalence (PP) of 136.6 per 1000 residents were determined for HEN, and an IR of 433.0 per 1000 PY, with PP of 385.6 per 1000 residents for chewing/swallowing impairment. Only 2.5% of residents had a percutaneous endoscopic gastrostomy (PEG). The mean length of residence in LTCF was 45.9 ± 12.3 months. More than half of the residents received nasogastric tube feeding (NGT) for ≥36 months. Median monthly HEN cost per resident was S$799.47 (interquartile range (IQR): 692.11, 940.30). Nursing costs for feeding contributed to 63% of total HEN costs. Conclusions: The high usage and length of time on NGT feeding warrants exploration and education of PEG usage. A national HEN database may improve the care of LTCF residents.
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403
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Ruiz Brunner MDLM, Cieri ME, Rodríguez Marco MP, Cuestas E. The photographic atlas of Spanish food consistency: a new tool for the treatment of dysphagia. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:858-861. [PMID: 31595755 DOI: 10.17235/reed.2019.6305/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION dysphagia requires texture-modified foods and thickened liquids, which is difficult to explain to patients and caregivers. METHODS an atlas has been developed and validated to explain the consistencies using the Likert scale questionnaire and the Delphi survey. The agreement and reliability of the tool were evaluated, with a minimum of 80%. The atlas was developed in Spanish. RESULTS an agreement of 93.3% (95% CI: 63.7-100%) was obtained during the evaluation and a value of 97.5% and a Kappa index of 0.96 (95% CI: 0.93-0.99; p = 0.016] were obtained during the validation processes. CONCLUSION the atlas is a new valid tool that can be used by health professionals.
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Affiliation(s)
| | - María Elisabeth Cieri
- Instituto de investigaciones en Ciencias de la Sal, Universidad Nacional de Córdoba, Argentinien
| | | | - Eduardo Cuestas
- Instituto de investigaciones en Ciencias de la Sal, Universidad Nacional de Córdoba, Argentinien
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404
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Cichero JAY, Lam PTL, Chen J, Dantas RO, Duivestein J, Hanson B, Kayashita J, Pillay M, Riquelme LF, Steele CM, Vanderwegen J. Release of updated International Dysphagia Diet Standardisation Initiative Framework (IDDSI 2.0). J Texture Stud 2019; 51:195-196. [PMID: 31498896 DOI: 10.1111/jtxs.12481] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Julie A Y Cichero
- Board of Directors, International Dysphagia Diet Standardisation Initiative, Brisbane, Queensland, Australia.,School of Pharmacy, Pharmacy Australia Centre of Excellence (PACE), The University of Queensland, Brisbane, Queensland, Australia
| | - Peter T L Lam
- Board of Directors, International Dysphagia Diet Standardisation Initiative, Brisbane, Queensland, Australia.,Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada.,Peter Lam Consulting, Vancouver, Canada
| | - Jianshe Chen
- Board of Directors, International Dysphagia Diet Standardisation Initiative, Brisbane, Queensland, Australia.,School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Roberto O Dantas
- Board of Directors, International Dysphagia Diet Standardisation Initiative, Brisbane, Queensland, Australia.,Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Janice Duivestein
- Board of Directors, International Dysphagia Diet Standardisation Initiative, Brisbane, Queensland, Australia.,Access Community Therapists, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ben Hanson
- Board of Directors, International Dysphagia Diet Standardisation Initiative, Brisbane, Queensland, Australia.,UCL Mechanical Engineering, University College London, London, UK
| | - Jun Kayashita
- Board of Directors, International Dysphagia Diet Standardisation Initiative, Brisbane, Queensland, Australia.,Department of Health Sciences, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Mershen Pillay
- Board of Directors, International Dysphagia Diet Standardisation Initiative, Brisbane, Queensland, Australia.,University of KwaZulu-Natal, Durban, South Africa.,Manchester Metropolitan University, Manchester, UK
| | - Luis F Riquelme
- Board of Directors, International Dysphagia Diet Standardisation Initiative, Brisbane, Queensland, Australia.,New York Medical College, Valhalla, New York.,New York - Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Catriona M Steele
- Board of Directors, International Dysphagia Diet Standardisation Initiative, Brisbane, Queensland, Australia.,KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jan Vanderwegen
- Board of Directors, International Dysphagia Diet Standardisation Initiative, Brisbane, Queensland, Australia.,Department of Speech, Language, and Audiology, Thomas More University College of Applied Sciences, Antwerp, Belgium
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405
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Impact of Multiple Texture-Modified Diets on Oral Intake and Nutritional Status in Older Patients with Pneumonia: A Retrospective Cohort Study. Dysphagia 2019; 35:574-582. [DOI: 10.1007/s00455-019-10063-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/27/2019] [Indexed: 11/26/2022]
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406
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Miranda D, Breda J, Cardoso R, Gonçalves N, Caldas AC, Ferreira JJ. Should the Energy Contribution of Commercial Thickeners Be Considered in the Nutrition Plan of Patients With Dysphagia? Nutr Clin Pract 2019; 35:649-654. [PMID: 31489690 DOI: 10.1002/ncp.10408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Clinical management options for dysphagia include the use of thickeners to increase the consistency of liquids. Health professionals may not be aware of the nutrition value of these products, since there are no such recommendation in clinical guidelines. Our aim was to estimate the added nutrition value of the 2 types of commercial thickeners (starch and xanthan gum) to daily nutrition intake and compare their nutrition value for nectar, honey, and pudding consistencies. Additionally, we compared the nutrition value of both thickeners with a high-energy powder, since they share the same main ingredients. METHODS We collected recommended dosages for obtaining the 3 different consistencies and nutrition content from the technical food labels. Daily intake of fluids was estimated from the Portuguese National Food, Nutrition and Physical Activity Survey. Total daily amount of thickener needed was estimated, as well as their correspondent nutrition contributions. RESULTS Estimated daily fluid intake was 2439 mL. Starch thickeners provide significantly more energy at all consistencies than xanthan gum provides (423-846 kcal, P < 0.05, and 103-308 kcal, P < 0.05, respectively). Significantly more fiber is provided by xanthan gum thickeners (9 g in nectar and 27 g in pudding consistencies, P < 0.05). Median energy and carbohydrate values per 100 g of high-energy powder modules and starch thickeners are similar. CONCLUSION The nutrition value of thickeners should be routinely considered in the nutrition assessment and planning of patients with dysphagia for liquids, since they contribute significantly with energy, carbohydrate, and fiber.
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Affiliation(s)
- Diana Miranda
- CNS- Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Joana Breda
- CNS- Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Rita Cardoso
- CNS- Campus Neurológico Sénior, Torres Vedras, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Nilza Gonçalves
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Castro Caldas
- CNS- Campus Neurológico Sénior, Torres Vedras, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joaquim J Ferreira
- CNS- Campus Neurológico Sénior, Torres Vedras, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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407
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Sungsinchai S, Niamnuy C, Wattanapan P, Charoenchaitrakool M, Devahastin S. Texture Modification Technologies and Their Opportunities for the Production of Dysphagia Foods: A Review. Compr Rev Food Sci Food Saf 2019; 18:1898-1912. [PMID: 33336963 DOI: 10.1111/1541-4337.12495] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/16/2019] [Accepted: 07/28/2019] [Indexed: 12/27/2022]
Abstract
Dysphagia or swallowing difficulty is a common morbidity experienced by those who have suffered a stroke or those undergone such treatments as head and neck surgeries. Dysphagic patients require special foods that are easier to swallow. Various technologies, including high-pressure processing, high-hydrodynamic pressure processing, pulsed electric field treatment, plasma processing, ultrasound-assisted processing, and irradiation have been applied to modify food texture to make it more suitable for such patients. This review surveys the applications of these technologies for food texture modification of products made of meat, rice, starch, and carbohydrates, as well as fruits and vegetables. The review also attempts to categorize, via the use of such key characteristics as hardness and viscosity, texture-modified foods into various dysphagia diet levels. Current and future trends of dysphagia food production, including the use of three-dimensional food printing to reduce the design and fabrication time, to enhance the sensory characteristics, as well as to create visually attractive foods, are also mentioned.
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Affiliation(s)
- Sirada Sungsinchai
- Dept. of Chemical Engineering, Faculty of Engineering, Kasetsart Univ., Bangkok, 10900, Thailand
| | - Chalida Niamnuy
- Dept. of Chemical Engineering, Faculty of Engineering, Kasetsart Univ., Bangkok, 10900, Thailand.,Research Network of NANOTEC-KU on NanoCatalysts and NanoMaterials for Sustainable Energy and Environment, Kasetsart Univ., Bangkok, 10900, Thailand
| | - Pattra Wattanapan
- Dept. of Rehabilitation Medicine, Faculty of Medicine, and Dysphagia Research Group, Khon Kaen Univ., Khon Kaen, 40002, Thailand
| | - Manop Charoenchaitrakool
- Dept. of Chemical Engineering, Faculty of Engineering, Kasetsart Univ., Bangkok, 10900, Thailand
| | - Sakamon Devahastin
- Advanced Food Processing Research Laboratory, Dept. of Food Engineering, Faculty of Engineering, King Mongkut's Univ. of Technology Thonburi, Bangkok, 10140, Thailand.,The Academy of Science, The Royal Society of Thailand, Dusit, Bangkok, 10300, Thailand
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408
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Vucea V, Keller HH, Morrison JM, Duizer LM, Duncan AM, Steele CM. Prevalence and Characteristics Associated with Modified Texture Food Use in Long Term Care: An Analysis of Making the Most of Mealtimes (M3) Project. CAN J DIET PRACT RES 2019; 80:104-110. [DOI: 10.3148/cjdpr-2018-045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: To describe the prevalence and characteristics of modified-texture food (MTF) consumers when applying standard diet terminology. Methods: Making the Most of Mealtimes (M3) is a cross-sectional multi-site study including 32 long-term care (LTC) homes located in 4 Canadian provinces. Resident characteristics were collected from health records using a defined protocol and extraction form. Since homes used 67 different terms to describe MTFs, diets were recategorized using the International Dysphagia Diet Standardization Initiative Framework as a basis for classification. Results: MTFs were prescribed to 47% (n = 298) of participants (n = 639) and prevalence significantly differed among provinces (P < 0.0001). Various resident characteristics were significantly associated with use of MTFs: dysphagia and malnutrition risk, dementia diagnosis, prescription of oral nutritional supplements; lower body weight and calf circumference; greater need for physical assistance with eating; poor oral health status; and dependence in all activities of daily living. Conclusions: This is the first study that used a diverse sample of LTC residents to determine prevalence of MTF use and described consumers. The prevalence of prescribed MTFs was high and diverse across provinces in Canada. Residents prescribed MTFs were more vulnerable than residents on regular texture diets. These findings add value to our understanding of MTF consumers.
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Affiliation(s)
- Vanessa Vucea
- Department of Kinesiology, University of Waterloo, Waterloo, ON
| | - Heather H. Keller
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON
| | | | - Lisa M. Duizer
- Department of Food Science, University of Guelph, Guelph, ON
| | - Alison M. Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON
| | - Catriona M. Steele
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON
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409
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Namasivayam-Macdonald AM, Steele CM, Carrier N, Lengyel C, Keller HH. The Relationship between Texture-Modified Diets, Mealtime Duration, and Dysphagia Risk in Long-Term Care. CAN J DIET PRACT RES 2019; 80:122-126. [PMID: 30907128 DOI: 10.3148/cjdpr-2019-004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Many long-term care (LTC) residents have an increased risk for dysphagia and receive texture-modified diets. Dysphagia has been shown to be associated with longer mealtime duration, and the use of texture-modified diets has been associated with reduced nutritional intake. The current study aimed to determine if the degree of diet modification affected mealtime duration and to examine the correlation between texture-modified diets and dysphagia risk. Data were collected from 639 LTC residents, aged 62-102 years. Nine meal observations per resident provided measures of meal duration, consistencies consumed, coughing and choking, and assistance provided. Dysphagia risk was determined by identifying residents who coughed/choked at meals, were prescribed thickened fluids, and/or failed a formal screening protocol. Degree of texture modification was derived using the International Dysphagia Diet Standardization Initiative Functional Diet Scale. There was a significant association between degree of diet modification and dysphagia risk (P < 0.001). However, there was no association between diet modifications and mealtime duration, even when the provision of physical assistance was considered. Some residents who presented with signs of swallowing difficulties were not prescribed a texture-modified diet. Swallowing screening should be performed routinely in LTC to monitor swallowing status and appropriateness of diet prescription. Physical assistance during meals should be increased.
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Affiliation(s)
| | - Catriona M Steele
- b Toronto Rehabilitation Institute, Toronto, ON.,c University of Toronto, Toronto, ON
| | | | | | - Heather H Keller
- f University of Manitoba, Winnipeg, MB.,g Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON
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410
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Montaldi MR, Dantas RO. Swallowing evaluation in patients without restriction of oral food three months after ischemic stroke. NeuroRehabilitation 2019; 45:37-43. [PMID: 31450522 DOI: 10.3233/nre-192775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Our hypothesis was that even patients without complaints and without evident clinical signs of dysphagia three months after ischemic stroke, may have swallowing alterations. OBJECTIVE To evaluate, by videofluoroscopy, swallowing pattern of ischemic stroke patients without symptomatic dysphagia or restriction of food intake. METHOD Videofluoroscopic examinations were performed in 33 ischemic stroke patients three to five months after the accident, and 19 healthy volunteers. Oral and pharyngeal phases of swallowing were evaluated after swallowing of 5 mL and 10 mL of liquid and paste boluses, and after swallowing of a solid bolus, in duplicate and in a random sequence. RESULTS Stroke patients had higher frequency of head movement, multiple swallows, premature spilage and vallecular residue than volunteers, after swallowing of 5 mL liquid bolus. There was no difference between patients and volunteers in oral and pharyngeal transit, except for a longer oral preparation for a 5 mL liquid bolus in patients. Changes in swallowing caused by increases in bolus volume and consistency were not different between patients and volunteers. CONCLUSION No significant changes in swallowing dynamics were found in patients with no dysphagia symptoms and no restriction of food intake three months after isquemic stroke.
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Affiliation(s)
- Marina Rodrigues Montaldi
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto SP, Brazil
| | - Roberto Oliveira Dantas
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto SP, Brazil.,Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto SP, Brazil
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411
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Effects of Verbal Cueing on Respiratory-Swallow Patterning, Lung Volume Initiation, and Swallow Apnea Duration in Parkinson’s Disease. Dysphagia 2019; 35:460-470. [DOI: 10.1007/s00455-019-10050-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/10/2019] [Indexed: 11/27/2022]
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412
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Christmas C, Rogus-Pulia N. Swallowing Disorders in the Older Population. J Am Geriatr Soc 2019; 67:2643-2649. [PMID: 31430395 DOI: 10.1111/jgs.16137] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/12/2019] [Accepted: 07/20/2019] [Indexed: 12/12/2022]
Abstract
Swallowing problems, or dysphagia, are common as people age, and are associated with significant negative outcomes, including weight loss, pneumonia, dehydration, shortened life expectancy, reduced quality of life, and increased caregiver burden. In this article, we will discuss the complex process of swallowing in normal circumstances and with healthy aging, then review etiologies that contribute to dysphagia. We will discuss approaches to evaluating and treating dysphagia, providing relevant data where they are available. We highlight the desperate need for high-quality research to guide best practices in treating dysphagia in older adults. J Am Geriatr Soc 67:2643-2649, 2019.
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Affiliation(s)
- Colleen Christmas
- Divisions of Geriatric Medicine and General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nicole Rogus-Pulia
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
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413
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Aspiration Pneumonia as a Cause of Death in Critically Ill Patients with Dysphagia After Extubation. Crit Care Med 2019. [PMID: 29538126 DOI: 10.1097/ccm.0000000000002933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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414
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Cichero JAY. Evaluating chewing function: Expanding the dysphagia field using food oral processing and the IDDSI framework. J Texture Stud 2019; 51:56-66. [PMID: 31269230 DOI: 10.1111/jtxs.12462] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/07/2019] [Accepted: 06/16/2019] [Indexed: 01/21/2023]
Abstract
The dysphagia field is still in relative infancy with a sophisticated knowledge base amassed since the early 1980's. The desire to identify aspiration and prevent life threatening pneumonia has resulted in a focus on the complexities of swallowing liquids. However, humans also ingest saliva, food, and oral medications, with the potential for these substances to incompletely clear the pharynx, be aspirated or block the airway. Safe swallowing of solid food in particular requires adequate chewing function, good oral control, and sufficient higher cortical function. Although screening and assessment for liquid swallowing safety is well established, the same cannot be said for the evaluation of safety to chew and swallow different food textures. While research into liquid swallowing physiology and its clinical application has largely come from the medical and allied health fields, our knowledge of chewing function for food textures comes from food texture research and food sensory science arenas. There is an exciting opportunity to bring the medical and food texture science fields together to expand our knowledge base on human chewing function, with clinical application to people with dysphagia. The development of the IDDSI Framework as an international standardized way of describing and labelling food texture and drink thickness allows the field to move toward management of texture modified food and thick liquids in a coordinated fashion, speaking the same language. This commentary will describe what we know of chewing function and how it is assessed clinically, proposing methods of assessment that utilize the IDDSI Framework.
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Affiliation(s)
- Julie A Y Cichero
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
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415
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Azzolino D, Damanti S, Bertagnoli L, Lucchi T, Cesari M. Sarcopenia and swallowing disorders in older people. Aging Clin Exp Res 2019; 31:799-805. [PMID: 30671866 DOI: 10.1007/s40520-019-01128-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/11/2019] [Indexed: 01/06/2023]
Abstract
Aging is accompanied by several changes which may affect swallowing function. The beginning of these changes, termed presbyphagia, still captures a preserved swallowing function, although burdened by the consequences of the physiological aging process. Several stressors (including diseases and medications) can easily trigger the disruption of this (increasingly weak) equilibrium and lead to overt dysphagia. It is noteworthy that the swallowing dysfunction may be aggravated by the sarcopenic process, characterizing the so-called "sarcopenic dysphagia", potentially responsible for several health-related negative outcomes. The assessment and management of sarcopenic dysphagia largely rely on the evaluation and integrated treatment of both constituting conditions (i.e., sarcopenia and dysphagia). The management of dysphagia requires a multidimensional approach and can be designed as either compensatory (aimed at producing immediate benefit for the patient through postural adjustments, swallowing maneuvers, and diet modifications) or rehabilitative. Interestingly, some evidence suggests that resistance training traditionally applied to tackle the lower extremity in sarcopenia may be simultaneously beneficial for sarcopenic dysphagia. If these preliminary results (discussed in the present review article) will be confirmed, the systemic beneficial effects of physical exercise will be indirectly demonstrated. This will also support the need of promoting healthy lifestyle in all sarcopenic individuals (thus potentially at risk of dysphagia).
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Affiliation(s)
- Domenico Azzolino
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Sarah Damanti
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Laura Bertagnoli
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Tiziano Lucchi
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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416
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Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person? Eur Geriatr Med 2019; 10:609-617. [DOI: 10.1007/s41999-019-00206-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/15/2019] [Indexed: 12/17/2022]
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417
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Steele CM, Peladeau-Pigeon M, Barbon CAE, Guida BT, Namasivayam-MacDonald AM, Nascimento WV, Smaoui S, Tapson MS, Valenzano TJ, Waito AA, Wolkin TS. Reference Values for Healthy Swallowing Across the Range From Thin to Extremely Thick Liquids. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1338-1363. [PMID: 31021676 PMCID: PMC6808317 DOI: 10.1044/2019_jslhr-s-18-0448] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 05/03/2023]
Abstract
Purpose Thickened liquids are frequently used as an intervention for dysphagia, but gaps persist in our understanding of variations in swallowing behavior based on incremental thickening of liquids. The goal of this study was to establish reference values for measures of bolus flow and swallowing physiology in healthy adults across the continuum from thin to extremely thick liquids. Method A sex-balanced sample of 38 healthy adults underwent videofluoroscopy and swallowed 20% weight-to-volume concentration barium prepared in thin and slightly, mildly, moderately, and extremely thick consistencies using a xanthan gum thickener. Participants took comfortable sips and swallowed without a cue; sip volume was measured based on presip and postsip cup weights. A standard operating procedure (the ASPEKT method: Analysis of Swallowing Physiology: Events, Kinematics and Timing) was used to analyze videofluoroscopy recordings. Results The results clarify that, for thin liquid sips (10-14 ml), a single swallow without clearing swallows is typical and is characterized by complete laryngeal vestibule closure, complete pharyngeal constriction, and minimal postswallow residue. Aspiration was not seen, and penetration was extremely rare. Bolus position at swallow onset was variable, extending as low as the pyriform sinuses in 37% of cases. With thicker liquids, no changes in event sequencing, laryngeal vestibule closure, pharyngeal constriction, or postswallow residue were seen. The odds of penetration were significantly reduced. A longer timing interval until onset of the hyoid burst movement was seen, with an associated higher bolus position at swallow onset. Other timing measures remained unaffected by changes in bolus consistency. Conclusion The results include new reference data for swallowing in healthy adults across the range from thin to extremely thick liquids.
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Affiliation(s)
- Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Melanie Peladeau-Pigeon
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Carly A. E. Barbon
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Brittany T. Guida
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Ashwini M. Namasivayam-MacDonald
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Department of Communication Sciences and Disorders, Adelphi University, New York, NY
| | - Weslania V. Nascimento
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Faculdade de Medicina, University of São Paulo, Ribeirão Preto, Brazil
| | - Sana Smaoui
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Melanie S. Tapson
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Teresa J. Valenzano
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Ashley A. Waito
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Talia S. Wolkin
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
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418
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Wang ZY, Chen JM, Ni GX. Effect of an indwelling nasogastric tube on swallowing function in elderly post-stroke dysphagia patients with long-term nasal feeding. BMC Neurol 2019; 19:83. [PMID: 31043159 PMCID: PMC6495564 DOI: 10.1186/s12883-019-1314-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 04/22/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In clinical practice, a large number of post-stroke survivors require nasogastric tube (NGT) placement and nasal feeding for a relatively long period. However, its impact on the swallowing function remains largely unknown. This study examines the impact of prolonged placement of an NGT on the swallowing function of elderly post-stroke patients. METHODS The participants of this study were 30 elderly post-stroke patients who had been using an NGT for more than 2 months. A videofluoroscopic swallowing study (VFSS) was performed before and 5 h after removal of the NGT. The following parameters were analyzed and compared, the functional dysphagia scale (FDS), residue in the valleculae, residue in the pyriform sinuses, and the penetration-aspiration scale (PAS). In addition, prior to the VFSS, the pharynx and larynx were examined using a fiberoptic laryngoscope. RESULTS Significant differences were observed between the total scores of the FDS, pharyngeal transit times (PTTs), the residue in the valleculae, and the residue in the pyriform sinuses before and after the NGT removal, suggesting an improved swallowing function following the removal of the NGT. A significantly lower penetration-aspiration degree was found after removing the NGT compared with that before its removal. In addition, examinations using the fiberoptic laryngoscope showed that laryngopharyngeal edema was present in three quarters of the patients. CONCLUSIONS Our results demonstrate that prolonged placement of the NGT had a negative impact on the swallowing function of elderly post-stroke dysphagia patients, mainly on the pharyngeal phase.
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Affiliation(s)
- Zhi-Yong Wang
- 0000 0004 1758 0400grid.412683.aDepartment of Rehabilitation Medicine, First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005 China
| | - Jian-Min Chen
- 0000 0004 1758 0400grid.412683.aDepartment of Rehabilitation Medicine, First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005 China
| | - Guo-Xin Ni
- 0000 0004 1758 0400grid.412683.aDepartment of Rehabilitation Medicine, First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005 China
- 0000 0001 2223 5394grid.411614.7School of Sports Medicine and Rehabilitation, Beijing Sport University, No. 48 Shangdi Information Road, Beijing, 100084 China
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419
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Pill swallowing in Parkinson's disease: A prospective study based on flexible endoscopic evaluation of swallowing. Parkinsonism Relat Disord 2019; 62:51-56. [DOI: 10.1016/j.parkreldis.2019.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 01/29/2019] [Accepted: 02/02/2019] [Indexed: 11/21/2022]
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420
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Prevalence and Associated Impacts of Cervical Esophageal Clearance Issues Post Chemoradiotherapy for Nasopharyngeal Carcinoma (NPC). Dysphagia 2019; 35:99-109. [PMID: 30989394 DOI: 10.1007/s00455-019-10007-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 03/28/2019] [Indexed: 01/27/2023]
Abstract
At present, the nature and extent of upper esophageal stage clearance issues following nonsurgical management of nasopharyngeal cancer (NPC) is not well elucidated. The aim of this study was to conduct an initial retrospective study of the prevalence and severity of upper esophageal clearance impairments in a cohort of patients post-NPC management. A secondary aim was to explore any observed relationship between severity of impairment with both (a) aspiration and (b) temporal oropharyngeal swallowing measures. A cohort of 134 NPC patients who received curative intent (chemo)radiotherapy (C/RT) and completed a videofluoroscopic swallowing study (VFSS) between 2012 and 2015 were reviewed. An Esophageal Clearance parameter, based on the scale used in MBSImP was used to classify the presence and severity of esophageal impairment on thin liquid and semisolids. Data on oral and pharyngeal temporal measures, pharyngeal constriction, and penetration/aspiration were also collected. The prevalence of cervical esophageal clearance impairment was high with ratings > 0 observed among 83% and 97% of patients on thin liquid and semisolids, respectively. With the increasing impairment, significantly (p < 0.05) increased oral transit times were observed for liquid swallows, and increased pharyngeal transit times for semisolids. Significantly higher proportions of patients presented with penetration/aspiration in the group with more severe esophageal clearance impairment. Results confirm that cervical esophageal clearance impairment is highly prevalent post-C/RT treatment for NPC. Causality cannot be determined from this study; however, this initial evidence supports that esophageal impairment may coexist in patients post NPC, presenting with more severe oral/pharyngeal deficits, and the impact of this on swallow function needs to be considered. Further systematic research is required.
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421
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A review of the approaches to predict the ease of swallowing and post-swallow residues. Trends Food Sci Technol 2019. [DOI: 10.1016/j.tifs.2019.02.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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422
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Nordio S, Di Stadio A, Koch I, Stritoni P, Meneghello F, Palmer K. The correlation between pharyngeal residue, penetration/aspiration and nutritional modality: a cross-sectional study in patients with neurogenic dysphagia. ACTA ACUST UNITED AC 2019; 40:38-43. [PMID: 30933178 PMCID: PMC7147538 DOI: 10.14639/0392-100x-2136] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/04/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Sara Nordio
- Fondazione Ospedale San Camillo IRCCS, Venice, Italy
| | | | - Isabella Koch
- Fondazione Ospedale San Camillo IRCCS, Venice, Italy
| | | | | | - Katie Palmer
- Fondazione Ospedale San Camillo IRCCS, Venice, Italy
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423
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Re GL, Vernuccio F, Di Vittorio ML, Scopelliti L, Di Piazza A, Terranova MC, Picone D, Tudisca C, Salerno S. Swallowing evaluation with videofluoroscopy in the paediatric population. ACTA ACUST UNITED AC 2019; 39:279-288. [PMID: 30933173 PMCID: PMC6843585 DOI: 10.14639/0392-100x-1942] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/15/2018] [Indexed: 11/23/2022]
Affiliation(s)
- G Lo Re
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - F Vernuccio
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - M L Di Vittorio
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - L Scopelliti
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - A Di Piazza
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - M C Terranova
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - D Picone
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - C Tudisca
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - S Salerno
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
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424
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Quirós S, Serrano F, Mata S. Design and Validation of the Oropharyngeal Dysphagia Screening Test for Patients and Professionals: A Preliminary Study. Dysphagia 2019; 35:52-65. [PMID: 30887116 DOI: 10.1007/s00455-019-09999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
Abstract
Dysphagia is a very common symptom in people of advanced age and with neurological diseases, although it often remains undiagnosed. At present, there are few assessment tools adapted for the Spanish-speaking population; of the few existing, most of them follow a self-reporting format, which requires a well-preserved cognitive state in the patient in order to be tested. Therefore, the main aim of this study was to design and validate an instrument for screening dysphagia without food, which could have a quick application and did not compromise the patient's safety. A secondary aim was to study the test's ability to examine this symptom in people with cognitive disorders. The study was carried out with 206 participants divided into three groups: people with dysphagia and with preserved cognitive abilities, people with dysphagia and with altered cognitive abilities, and people without dysphagia and with preserved cognitive skills (control group). Participants were assessed with the designed Oropharyngeal Dysphagia Screening Test for Patients and Professionals and other dysphagia tests. The results revealed appropriate psychometric features: reliability and validity both for screening dysphagia directly with the patients or if the tester is the professional caregiver responsible for feeding (in cases of altered cognitive abilities). As conclusion, the Oropharyngeal Dysphagia Screening Test for Patients and Professionals is an instrument of easy use and of short duration that has shown adequate results of reliability and validity, thus being useful for the screening of dysphagia in Spanish-speaking populations.
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Affiliation(s)
- Sandra Quirós
- The Mind, Brain and Behavior Research Center (CIMCYC-UGR), Faculty of Psychology, University of Granada, Campus Cartuja S/N, 18071, Granada, Spain
| | - Francisca Serrano
- The Mind, Brain and Behavior Research Center (CIMCYC-UGR), Faculty of Psychology, University of Granada, Campus Cartuja S/N, 18071, Granada, Spain.
| | - Sara Mata
- The Mind, Brain and Behavior Research Center (CIMCYC-UGR), Faculty of Psychology, University of Granada, Campus Cartuja S/N, 18071, Granada, Spain
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425
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426
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Costa A, Carrión S, Puig-Pey M, Juárez F, Clavé P. Triple Adaptation of the Mediterranean Diet: Design of A Meal Plan for Older People with Oropharyngeal Dysphagia Based on Home Cooking. Nutrients 2019; 11:E425. [PMID: 30781630 PMCID: PMC6412386 DOI: 10.3390/nu11020425] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) and malnutrition are highly prevalent in older patients that are discharged from general hospitals (47% and 30%, respectively). AIMS To develop a nutritional plan for these patients involving a triple adaptation of their traditional diet: (a) rheological adaptation (texture and viscosity) for safe deglutition, (b) nutritional adaptation (water, calories, and proteins), and (c) organoleptic adaptation to improve compliance. METHODS Two fluid viscosities (250 and 800 mPa·s) were selected according to previous studies on optimal viscosities in older patients. The British Dietetic Association food texture classification based on common clinical practice selected two food textures (thick purée and fork-mashable. Two levels of calorie protein enrichment were selected according to previous studies using the Mini Nutritional Assessment (MNA®). RESULTS The daily caloric-protein and hydric needs were established at 1750 kcal, 70 g protein, and 1750 mL water in patients with MNA® ≥ 17; and, 2037 kcal, 90 g protein, and 2000 mL water/day in malnourished patients. Sixteen weekly menus (296 recipes) were developed while using two textures, two levels of viscosity, two nutritional phenotypes (normal/at-risk vs. malnourished), and two seasons of the year (spring/summer-autumn/winter) based on Mediterranean cuisine. CONCLUSION This concept paper demonstrates that traditional Mediterranean cooking can be adapted to meet the rheological, nutritional, and hydration needs of older patients with OD. The recipes that we have developed meet the needs of patients with varying degrees of OD and malnutrition are reproducible in patient's homes and they could have a major impact on the clinical outcomes of these patients.
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Affiliation(s)
- Alicia Costa
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08304 Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 08304 Barcelona, Spain.
- Department of Dietetics and Nutrition, Hospital de Mataró, 08304 Barcelona, Spain.
| | - Silvia Carrión
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08304 Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 08304 Barcelona, Spain.
| | - Marc Puig-Pey
- Fundació Alicia, San Fruitós del Bages, 08272 Barcelona, Spain.
| | - Fabiola Juárez
- Fundació Alicia, San Fruitós del Bages, 08272 Barcelona, Spain.
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08304 Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 08304 Barcelona, Spain.
- Fundació de Recerca en Gastroenterologia, 08304 Barcelona, Spain.
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427
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Garcia JM, Chambers E. Incremental Adjustments to Amount of Thickening Agent in Beverages: Implications for Clinical Practitioners Who Oversee Nutrition Care Involving Thickened Liquids. Foods 2019; 8:foods8020074. [PMID: 30769896 PMCID: PMC6406407 DOI: 10.3390/foods8020074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 12/04/2022] Open
Abstract
This study examined the changes in viscosity in response to small alterations in the amount of a thickening agent mixed with three commonly thickened beverages. A total of 11 incremental adjustments in the amount of a starch-based thickening agent (5.0 g to 7.0 g) were made. The results showed that the incremental increases resulted in systematic changes to the liquid thickness, reflecting modifications that ranged from a nectar (mildly thick) to a honey-like (moderately thick) level of consistency. The findings emphasize the importance of the proper preparation of thickened beverages, highlighting the need for standards in training practices and the use of simple measurement tools for assuring the prescribed levels of consistency.
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Affiliation(s)
- Jane Mertz Garcia
- Communication Sciences & Disorders, School of Family Studies & Human Services, Kansas State University, 1405 Campus Creek Road, Manhattan, KS 66506, USA.
| | - Edgar Chambers
- Center for Sensory Analysis and Consumer Behavior, 1310 Research Park Dr., Manhattan, KS 66502, USA.
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428
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Steele CM, Peladeau-Pigeon M, Barbon CAE, Guida BT, Tapson MS, Valenzano TJ, Waito AA, Wolkin TS, Hanson B, Ong JJX, Duizer LM. Modulation of Tongue Pressure According to Liquid Flow Properties in Healthy Swallowing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:22-33. [PMID: 30950761 PMCID: PMC6437699 DOI: 10.1044/2018_jslhr-s-18-0229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/03/2018] [Accepted: 08/13/2018] [Indexed: 05/11/2023]
Abstract
Purpose During swallowing, the tongue generates the primary propulsive forces that transport material through the oral cavity toward the pharynx. Previous literature suggests that higher tongue pressure amplitudes are generated for extremely thick liquids compared with thin liquids. The purpose of this study was to collect detailed information about the modulation of tongue pressure amplitude and timing across the range from thin to moderately thick liquids. Method Tongue pressure patterns were measured in 38 healthy adults (aged under 60 years) during swallowing with 4 levels of progressively thicker liquid consistency (International Dysphagia Diet Standardisation Initiative, Levels 0 = thin, 1 = slightly thick, 2 = mildly thick, and 3 = moderately thick). Stimuli with matching gravity flow (measured using the International Dysphagia Diet Standardisation Initiative Flow Test; Cichero et al., 2017 ; Hanson, 2016 ) were prepared both with/without barium (20% weight per volume concentration) and thickened with starch and xanthan gum thickeners. Results After controlling for variations in sip volume, thicker liquids were found to elicit significantly higher amplitudes of peak tongue pressure and a pattern of higher (i.e., steeper) pressure rise and decay slopes (change in pressure per unit time). Explorations across stimuli with similar flow but prepared with different thickeners and with/without barium revealed very few differences in tongue pressure, with the exception of significantly higher pressure amplitudes and rise slopes for nonbarium, starch-thickened slightly and mildly thick liquids. Conclusions There was no evidence that the addition of barium led to systematic differences in tongue pressure parameters across liquids with closely matched gravity flow. Additionally, no significant differences in tongue pressure parameters were found across thickening agents. Supplemental Material https://doi.org/10.23641/asha.7616537.
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Affiliation(s)
- Catriona M. Steele
- Toronto Rehabilitation Institute—University Health Network, Swallowing Rehabilitation Research Laboratory, Ontario, Canada
- Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Melanie Peladeau-Pigeon
- Toronto Rehabilitation Institute—University Health Network, Swallowing Rehabilitation Research Laboratory, Ontario, Canada
| | - Carly A. E. Barbon
- Toronto Rehabilitation Institute—University Health Network, Swallowing Rehabilitation Research Laboratory, Ontario, Canada
- Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Brittany T. Guida
- Toronto Rehabilitation Institute—University Health Network, Swallowing Rehabilitation Research Laboratory, Ontario, Canada
| | - Melanie S. Tapson
- Toronto Rehabilitation Institute—University Health Network, Swallowing Rehabilitation Research Laboratory, Ontario, Canada
- Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Teresa J. Valenzano
- Toronto Rehabilitation Institute—University Health Network, Swallowing Rehabilitation Research Laboratory, Ontario, Canada
- Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Ashley A. Waito
- Toronto Rehabilitation Institute—University Health Network, Swallowing Rehabilitation Research Laboratory, Ontario, Canada
- Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Talia S. Wolkin
- Toronto Rehabilitation Institute—University Health Network, Swallowing Rehabilitation Research Laboratory, Ontario, Canada
| | - Ben Hanson
- University College London Mechanical Engineering, United Kingdom
| | - Jane Jun-Xin Ong
- Department of Food Science, University of Guelph, Ontario, Canada
| | - Lisa M. Duizer
- Department of Food Science, University of Guelph, Ontario, Canada
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429
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Marcason W. What Is the International Dysphagia Diet Standardisation Initiative? J Acad Nutr Diet 2019; 117:652. [PMID: 28343526 DOI: 10.1016/j.jand.2017.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Indexed: 10/19/2022]
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430
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Maeda K, Ishida Y, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, Kato R, Mori N. Burden of Premorbid Consumption of Texture Modified Diets in Daily Life on Nutritional Status and Outcomes of Hospitalization. J Nutr Health Aging 2019; 23:973-978. [PMID: 31781727 DOI: 10.1007/s12603-019-1237-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Due to the water-rich cooking process required to soften texture modified diets (TMDs), TMDs may have poorer nutrition. The aim of this study was to investigate the associations between daily premorbid TMD consumption and nutritional status at the time of hospitalization, and its burden on hospitalization outcomes. DESIGN Retrospective observational study. SETTING An academic hospital. PARTICIPANTS The cohort comprised 3,594 older adult patients aged ≥65 years admitted to the hospital. MEASUREMENTS Patients were interviewed on admission using a premorbid daily consumption meal form to determine whether the patient ate a TMD. Nutritional status was examined using nutritional screening tools (Mini-Nutritional Assessment Short Form [MNA-SF], Malnutrition Universal Screening Tool [MUST], Geriatric Nutritional Risk Index [GNRI]) and the European Society of Clinical Nutrition and Metabolism (ESPEN)-defined criteria of malnutrition at admission. Length of hospital stay (LOS) and in-hospital mortality were considered outcomes of hospitalization. Multivariate analyses were performed to detect associations between premorbid TMD consumption and nutritional status and outcomes. RESULTS The mean age of the subjects was 75.9±7.0 years, including 58% males. Overall, 110 (3.1%) patients consuming a premorbid TMD were identified. They were older (p<0.001), had poor nutritional status (lower MNA-SF score [p<0.001] and GNRI value [p<0.001], higher MUST score [p<0.001], and more prevalent ESPEN-defined malnutrition [61.8% vs. 14.0%, p<0.001] than did patients without a TMD. The mortality rate and LOS of patients with TMD was higher (7.3% vs. 2.9%, p=0.017) and longer (19 days vs. 8 days, p<0.001) than those without TMD. Multivariate analyses showed that TMD consumption was independently associated with poor nutritional status and prolonged LOS after adjusting confounders. CONCLUSION Daily consumption of a TMD during the premorbid period affects nutritional status at the time of hospitalization and outcomes. Further studies are necessary to investigate whether nutritional intervention can improve outcomes for people on a TMD.
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Affiliation(s)
- K Maeda
- Keisuke Maeda, M.D., Ph.D., Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan, Phone: +81-561-62-3311; Fax: +81-561-78-6364, E-mail:
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431
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McGinnis CM, Homan K, Solomon M, Taylor J, Staebell K, Erger D, Raut N. Dysphagia: Interprofessional Management, Impact, and Patient-Centered Care. Nutr Clin Pract 2018; 34:80-95. [DOI: 10.1002/ncp.10239] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Kimberly Homan
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | - Meghan Solomon
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | - Julia Taylor
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | | | - Denise Erger
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | - Namrata Raut
- Sanford USD Medical Center; Sioux Falls South Dakota USA
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432
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Fujiso Y, Perrin N, van der Giessen J, Vrana NE, Neveu F, Woisard V. Swall-E: A robotic in-vitro simulation of human swallowing. PLoS One 2018; 13:e0208193. [PMID: 30566460 PMCID: PMC6300196 DOI: 10.1371/journal.pone.0208193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/13/2018] [Indexed: 11/19/2022] Open
Abstract
Swallowing is a complex physiological function that can be studied through medical imagery techniques such as videofluoroscopy (VFS), dynamic magnetic resonance imagery (MRI) and fiberoptic endoscopic evaluation of swallowing (FEES). VFS is the gold standard although it exposes the subjects to radiations. In-vitro modeling of human swallowing has been conducted with limited results so far. Some experiments were reported on robotic reproduction of oral and esophageal phases of swallowing, but high fidelity reproduction of pharyngeal phase of swallowing has not been reported yet. To that end, we designed and developed a robotic simulator of the pharyngeal phase of human swallowing named Swall-E. 17 actuators integrated in the robot enable the mimicking of important physiological mechanisms occurring during the pharyngeal swallowing, such as the vocal fold closure, laryngeal elevation or epiglottis tilt. Moreover, the associated computer interface allows a control of the actuation of these mechanisms at a spatio-temporal accuracy of 0.025 mm and 20 ms. In this study preliminary experiments of normal pharyngeal swallowing simulated on Swall-E are presented. These experiments show that a 10 ml thick bolus can be swallowed by the robot in less than 1 s without any aspiration of bolus material into the synthetic anatomical laryngo-tracheal conduit.
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Affiliation(s)
- Yo Fujiso
- PROTiP Medical SAS, Strasbourg, France
| | | | | | | | | | - Virginie Woisard
- Voice and Deglutition Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Larrey Hospital, Toulouse, France
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433
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Regueiro MRB, Parreira LC, Nascimento WV, Dantas RO. Influence of Body Height on Oral and Pharyngeal Transit Time of a Liquid Bolus in Healthy Volunteers. Gastroenterology Res 2018; 11:411-415. [PMID: 30627264 PMCID: PMC6306106 DOI: 10.14740/gr1063w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Swallowing duration may be influenced by several factors. The effect of body height on oral-pharyngeal bolus transit has not been clearly elucidated. The hypothesis of this investigation was that height has influence on oral-pharyngeal transit time of a liquid bolus. METHODS Videofluoroscopic assessment of swallowing was performed on 40 healthy volunteers: 20 "tall" (171 cm to 207 cm) and 20 "short" (152 cm to 170 cm) subjects, 10 men and 10 women in each group. Each subject performed three swallows of 10 mL of liquid barium bolus. The following parameters were measured: oral transit time (OTT): time from the beginning of tongue tip movement at incisors to arrival of the bolus tail at the fauces; pharyngeal transit time (PTT): time between the arrival of the bolus tail at fauces and complete passage of the bolus tail through the upper esophageal sphincter (UES); pharyngeal clearance (PC): time between the arrival of the bolus head at fauces to complete passage of the bolus tail through the UES; UES opening (UESO): time between the arrival of the bolus head at the UES to complete passage of the bolus tail through the UES; duration of hyoid movement (HM): time interval between the onset and the end of hyoid movement; oral-pharyngeal transit time (OPTT): time from the beginning of tongue tip movement at incisors until complete passage of the bolus tail through the UES. The statistical analysis was done by a linear model with mixed effects. Correlation between height and swallowing events duration was assessed by Spearman's correlation coefficient (r). RESULTS In women OTT, PC, HM and OPTT were longer in tall than in short subjects, what was not seen in men. In women there was a positive correlation between OTT, PTT and OPTT and height. Men (mean height: 177 cm) had longer PTT and PC than women (mean height: 166 cm). CONCLUSIONS In women, oral and pharyngeal transit time of a 10 mL liquid bolus were influenced by height and was longer in taller subjects.
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Affiliation(s)
- Marcia R.K. Bernardi Regueiro
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto SP, Brazil
| | - Luana Casari Parreira
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto SP, Brazil
| | - Weslania Viviane Nascimento
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataro, Universitat Autonoma de Barcelona, Spain
| | - Roberto Oliveira Dantas
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto SP, Brazil
- Department of Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto SP, Brazil
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434
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Barbon CEA, Steele CM. Thickened Liquids for Dysphagia Management: a Current Review of the Measurement of Liquid Flow. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018; 6:220-226. [PMID: 32149018 PMCID: PMC7059648 DOI: 10.1007/s40141-018-0197-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW The use of thickened liquids has become one of the most common management strategies for individuals with dysphagia. The purpose of this paper is to review methods that can be used to measure the flow characteristics of liquids used in dysphagia management. We describe the measurement of apparent viscosity, measures of extensional flow, slump tests (specifically the line-spread test and Bostwick consistometry), gravity flow tests, and subjective methods. RECENT FINDINGS We discuss the relationship between different approaches to measuring flow, the 2002 American National Dysphagia Diet and the 2017 International Dysphagia Diet Standardisation Initiative (IDDSI) framework. A comparison of test results across four methods is provided. SUMMARY A consistent approach is needed for the measurement of flow for thickened liquids used in dysphagia management. This review highlights differences that can be expected across different flow testing methodologies. Adherence to a common method and measurement definitions will promote patient safety and facilitate future research regarding the effectiveness of texture modification as an intervention for dysphagia.
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Affiliation(s)
- Carly E. A. Barbon
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th floor, Toronto, ON M5G 2A2, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th floor, Toronto, ON M5G 2A2, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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435
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Glass TJ, Twadell SL, Valmadrid LC, Connor NP. Early impacts of modified food consistency on oromotor outcomes in mouse models of Down syndrome. Physiol Behav 2018; 199:273-281. [PMID: 30496741 DOI: 10.1016/j.physbeh.2018.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/16/2018] [Accepted: 11/25/2018] [Indexed: 12/12/2022]
Abstract
Down syndrome (DS) in humans is associated with differences of the central nervous system and oromotor development. DS also increases risks for pediatric feeding challenges, which sometimes involve the use of altered food consistencies. Therefore, experimental food consistency paradigms are of interest to oromotor investigations in mouse models of Down syndrome (DS). The present work reports impacts of an altered food consistency paradigm on the Ts65Dn and Dp(16)1Yey mouse models of DS, and sibling control mice. At weaning, Ts65Dn, Dp(16)1Yey and respective controls were assigned to receive either a hard food or a soft food (eight experimental groups, n = 8-10 per group). Two weeks later, mice were assessed for mastication speeds and then euthanized for muscle analysis. Soft food conditions were associated with significantly smaller weight gain (p = .003), significantly less volitional water intake through licking (p = .0001), and significant reductions in size of anterior digastric myofibers positive for myosin heavy chain isoform (MyHC) 2b (p = .049). Genotype was associated with significant differences in weight gain (p = .004), significant differences in mastication rate (p = .001), significant differences in a measure of anterior digastric muscle size (p = .03), and significant reductions in size of anterior digastric myofibers positive for MyHC 2a (p = .04). In multiple measures, the Ts65Dn model of DS was more affected than other genotype groups. Findings indicate a soft food consistency condition in mice is associated with significant reductions in weight gain and oromotor activity, and may impact digastric muscle. This suggests extended periods of food consistency modifications may have impacts that extend beyond their immediate roles in facilitating deglutition.
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Affiliation(s)
- Tiffany J Glass
- Department of Surgery, University of Wisconsin, Madison, WI, USA.
| | - Sara L Twadell
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Luke C Valmadrid
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Nadine P Connor
- Department of Surgery, University of Wisconsin, Madison, WI, USA; Department of Communication Sciences and Disorders, University of Wisconsin, Madison, WI, USA
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436
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Garcia JM, Chambers E, Russell EG, Katt A. Modifying Food Textures: Practices and Beliefs of Staff Involved in Nutrition Care. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1458-1473. [PMID: 30267081 DOI: 10.1044/2018_ajslp-18-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/01/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Modifying food texture is an important part of dysphagia management, yet less is known about the day-to-day practices that might impact the nutritional well-being of patients. This study surveyed staff involved in the service delivery of texture-modified foods with the objectives to gain information about roles and responsibilities, instruction and knowledge about modifying foods, and beliefs about the use of texture-modified foods in nutrition care. METHOD We created a 21-item survey about texture-modified foods. Recruitment efforts focused on both professional and frontline staff involved in service delivery. Practice groups and organizations provided the means of recruiting professionals from different disciplines. Because frontline staff (e.g., certified nursing assistants, cooks) do not have similar membership groups, we recruited them through direct contacts with health care agencies. RESULTS A total of 175 individuals completed the survey. Respondents included 107 professionals (primarily certified dietary managers, registered dietitians, speech-language pathologists) and 68 frontline staff (mostly certified nursing assistants/home health aides). Although the frontline and professional staff showed generally similar patterns of opinions and beliefs about modified food textures, differences emerged in reported experiences, roles, and responsibilities in service delivery. CONCLUSIONS Survey respondents conveyed generally positive attitudes and opinions about the use of texture-modified foods, and respondents perceived them to be easy to execute and beneficial to the nutritional well-being of patients. Survey findings clearly highlight the contributions of frontline staff in the service delivery of modified food textures. Consideration must be given to continued reliance on informal, limited instruction about texture-modified foods and possible implications for safe nutrition care. Both professional and frontline staff convey a willingness to customize or alter food textures and the belief that patients should be able to choose the level of texture modification that they want to eat.
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Affiliation(s)
- Jane Mertz Garcia
- Communication Sciences & Disorders, School of Family Studies & Human Services, Kansas State University, Manhattan
| | - Edgar Chambers
- Center for Sensory Analysis and Consumer Behavior, Food, Nutrition, Dietetics & Health, Kansas State University, Manhattan
| | - Emily Groves Russell
- Communication Sciences & Disorders, School of Family Studies & Human Services, Kansas State University, Manhattan
| | - Abilene Katt
- Communication Sciences & Disorders, School of Family Studies & Human Services, Kansas State University, Manhattan
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437
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Yamada Y, Shamoto H, Maeda K, Wakabayashi H. Home-based Combined Therapy with Rehabilitation and Aggressive Nutrition Management for a Parkinson's Disease Patient with Sarcopenic Dysphagia: A Case Report. Prog Rehabil Med 2018; 3:20180019. [PMID: 32789244 DOI: 10.2490/prm.20180019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/30/2018] [Indexed: 11/09/2022] Open
Abstract
Background Sarcopenic dysphagia is caused by decreased muscle mass and muscle weakness in the swallowing muscles that occurs because of sarcopenia. The key to treating sarcopenic dysphagia is combined therapy with rehabilitation and aggressive nutrition management. However, to our knowledge, no studies based in a home medical care setting have yet been published. Case A 72-year-old man with Parkinson's disease developed sarcopenia and possible sarcopenic dysphagia during hospitalization for drug adjustment. At discharge, the patient's body weight was 39.0 kg (-33.8%/4 months, body mass index: 15.3 kg/m2), the Barthel Index was 45, Functional Oral Intake Scale was level 4, and Dysphagia Severity Scale was 4. Sarcopenia was confirmed by a calf circumference of 23.8 cm, a handgrip strength of 22 kg, and a gait speed of 0.5 m/s. The patient was diagnosed with sarcopenic dysphagia, according to the consensus diagnostic criteria for sarcopenic dysphagia. After the patient was discharged, he underwent a combination of dysphagia rehabilitation, daily activity training, and aggressive nutrition management, which started from 1200 kcal/day and reached a maximum of 2800 kcal/day. Four months after discharge, the patient's swallowing function returned to normal (Functional Oral Intake Scale: 7, Dysphagia Severity Scale: 6) and his weight increased by 31% (body mass index: 20.1 kg/m2). Increases in muscle mass (calf circumference: 32 cm), muscle strength (handgrip strength: 34 kg), physical function (gait speed: 1 m/s), and activities of daily living (Barthel Index: 90) indicated recovery from sarcopenia. Discussion Sarcopenic dysphagia may be a complication of Parkinson's disease, and home-based combined therapy with rehabilitation and aggressive nutrition management may be effective for treating this condition.
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Affiliation(s)
- Yumi Yamada
- Rehabilitation Visiting Nursing Station TRY, Seto City, Aichi, Japan
| | - Hiroshi Shamoto
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan
| | - Keisuke Maeda
- Palliative Care Center, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Yokohama City University Medical Center, Yokohama City, Kanagawa, Japan
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438
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Côté C, Germain I, Dufresne T, Gagnon C. Comparison of two methods to categorize thickened liquids for dysphagia management in a clinical care setting context: The Bostwick consistometer and the IDDSI Flow Test. Are we talking about the same concept? J Texture Stud 2018; 50:95-103. [PMID: 30370530 DOI: 10.1111/jtxs.12377] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/09/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
The Bostwick consistometer and the International Dysphagia Diet Standardization Initiative (IDDSI) Flow Test are both proposed methods to measure and categorize thickened liquids for dysphagia management. The objectives were to: (a) compare the Bostwick consistometer reference values used in clinical settings and the IDDSI reference values of thickened liquids suggested for nutrition care plans in the management of dysphagia when measuring commercially available preprepared thickened liquids; (b) explore the relationship between the two methods; (c) assess the interchangeability; (d) document the intra-rater reliability. Preprepared thickened liquids (n = 32) were measured twice with the Bostwick consistometer and 3 times with the IDDSI Flow Test, using a rigorous methodology. A registered dietitian nutritionist and a registered nutrition and dietetic technician performed the measurements. The Pearson's correlation coefficient was calculated to explore the relationship between the two methods. Using a linear regression equation, back-calculations of the IDDSI Flow Test values were done, based on the experimental Bostwick results. Interchangeability was assessed by documenting the level of agreement between the results with a Bland and Altman graphical analysis. Intraclass correlation coefficients calculation and a Bland and Altman graphical analysis were performed to assess reliability. The strong correlation (r = -.93, p < .001) between the IDDSI Flow Test and the Bostwick consistometer measurements suggests that they measure flow rate in a similar manner, but not exactly the same, as confirmed with the Bland and Altman graphical analysis. Thus, they produced results that are not interchangeable. However, both tests show excellent intra-rater reliability (ICC ≥ 0.99) when using a rigorous methodology. PRACTICAL APPLICATIONS: Thickened liquids are used to manage oropharyngeal dysphagia. Clinicians need to provide quality assurance/quality control (QA/QC) support in the selection or production of thickened liquids as well as staff training or patient education regarding these products. Methods and classification have been proposed to measure and categorize thickened liquids for dysphagia management, such as the line spread test, the Bostwick consistometer method, and the IDDSI Flow Test. Although empirical, these methods are more accessible to clinicians than viscometer or rheometer assessments. Clinicians need to understand the limitations of these techniques as neither appear to capture the full extent of consistency for potential beverages available on the market or produced in-house. In this article, we compare the Bostwick consistometer and the IDDSI Flow Test methods and classifications and propose a standard operating procedure in order to maximize the quality of results. We point out the large variations in consistency levels of commercial preprepared thickened liquids in light of the absence of evidence of clinical outcomes associated with either proposed methods or consistency classifications.
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Affiliation(s)
- Claudia Côté
- Centre de recherche Charles-Le-Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean/Neuromuscular Clinic, Jonquière, Québec, Canada
| | - Isabelle Germain
- Association des nutritionnistes experts en dysphagie, Montréal, Québec, Canada
| | | | - Cynthia Gagnon
- Centre de recherche Charles-Le-Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean/Neuromuscular Clinic, Jonquière, Québec, Canada
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439
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Abstract
The speech language pathologist has a vital management role in patients with voice and swallow concerns, as well as stroke patients and patients with fluency problems. This article summarizes the variety of speech and swallow rehabilitation that adult patients may require or seek. The case examples allow the reader to base the clinical decision-making process within the context of a patient presentation and elucidate the role of speech and language pathology services for the primary care provider in order to refer patients with symptoms and concerns to the right provider early in their medical care.
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Affiliation(s)
- Kristine Pietsch
- Department of Otolaryngology, Johns Hopkins University, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA
| | - Tiffany Lyon
- Department of Speech and Language Pathology, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA
| | - Vaninder K Dhillon
- Department of Otolaryngology, Johns Hopkins University, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA; Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, National Capital Region, 6420 Rockledge Drive, Suite 4920, Bethesda, MD 20817, USA.
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440
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Hanson B, Steele CM, Lam P, Cichero JAY. Fluid Testing Methods Recommended by IDDSI. Dysphagia 2018; 34:716-717. [PMID: 30382382 DOI: 10.1007/s00455-018-9957-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Ben Hanson
- International Dysphagia Diet Standardisation Initiative (IDDSI), Brisbane, Australia. .,Department of Mechanical Engineering, University College London, London, WC1E 7JE, UK.
| | - Catriona M Steele
- International Dysphagia Diet Standardisation Initiative (IDDSI), Brisbane, Australia.,Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Peter Lam
- International Dysphagia Diet Standardisation Initiative (IDDSI), Brisbane, Australia.,Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada.,Peter Lam Consulting, Vancouver, Canada
| | - Julie A Y Cichero
- International Dysphagia Diet Standardisation Initiative (IDDSI), Brisbane, Australia.,School of Pharmacy, Pharmacy Australia Centre of Excellence (PACE), The University of Queensland, 20 Cornwall St, Brisbane, QLD, 4102, Australia
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441
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Scarborough DR, Bailey-Van Kuren M, Creech TN. Letter to the Editor. Dysphagia 2018; 34:415. [PMID: 30334094 DOI: 10.1007/s00455-018-9952-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Donna R Scarborough
- Department of Speech Pathology and Audiology, Miami University, Oxford, OH, USA. .,Miami University, 301 S. Patterson Dr, 26 Bachelor Hall, Oxford, OH, 45056, USA.
| | | | - Taylor N Creech
- Department of Speech Pathology and Audiology, Miami University, Oxford, OH, USA
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442
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Age-Related Changes to Eating and Swallowing Impact Frailty: Aspiration, Choking Risk, Modified Food Texture and Autonomy of Choice. Geriatrics (Basel) 2018; 3:geriatrics3040069. [PMID: 31011104 PMCID: PMC6371116 DOI: 10.3390/geriatrics3040069] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 12/02/2022] Open
Abstract
Reductions in muscle mass and strength are well known complications of advancing age. All muscles of the body are affected, including those critical to chewing and swallowing. A diagnosis of frailty and its features of weakness and unintentional weight loss are particularly relevant to the aging swallowing system. Age related changes to eating and swallowing function means that there is a natural tendency for elders to self-select ‘soft’ foods due to loss of dentition and fatigue on chewing. However, it is not well known that tooth loss and poor dental status is associated with increased choking risk, especially as people age. In fact, people over 65 years of age have seven times higher risk for choking on food than children aged 1–4 years of age. Texture modified foods are provided clinically to reduce choking risk and manage dysphagia. Although certain food textures offer greater swallowing safety, they significantly restrict food choice. This commentary paper will highlight age-related changes to the eating and swallowing system, noting especially those that are relevant for frail elders. Swallowing impairments also affect the ability to manage liquids, and aspiration risk in healthy and frail elders is also discussed. Modified food textures that are most often recommended by clinicians to maintain sufficient oral intake and reduce choking risk will be described, while also highlighting the nutritional challenges associated with these foods and offering some solutions. The ethical challenges associated with balancing the autonomy of choice of food textures with swallowing safety will be addressed.
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443
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Lau ETL, Steadman KJ, Cichero JAY, Nissen LM. Dosage form modification and oral drug delivery in older people. Adv Drug Deliv Rev 2018; 135:75-84. [PMID: 29660383 DOI: 10.1016/j.addr.2018.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 02/15/2018] [Accepted: 04/12/2018] [Indexed: 11/29/2022]
Abstract
Many people cannot swallow whole tablets and capsules. The cause ranges from difficulties overriding the natural instinct to chew solids/foodstuff before swallowing, to a complex disorder of swallowing function affecting the ability to manage all food and fluid intake. Older people can experience swallowing difficulties because of co-morbidities, age-related physiological changes, and polypharmacy. To make medicines easier to swallow, many people will modify the medication dosage form e.g. split or crush tablets, and open capsules. Some of the challenges associated with administering medicines to older people, and issues with dosage form modification will be reviewed. Novel dosage forms in development are promising and may help overcome some of the issues. However, until these are more readily available, effective interdisciplinary teams, and improving patient health literacy will help reduce the risk of medication misadventures in older people.
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Affiliation(s)
- Esther T L Lau
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Julie A Y Cichero
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Lisa M Nissen
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
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444
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Kim YH, Jeong GY, Yoo B. Comparative study of IDDSI flow test and line-spread test of thickened water prepared with different dysphagia thickeners. J Texture Stud 2018; 49:653-658. [PMID: 30187484 DOI: 10.1111/jtxs.12360] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/01/2018] [Accepted: 08/23/2018] [Indexed: 11/28/2022]
Abstract
The flow behaviors of thickened water samples prepared with six commercial instant thickeners (A-F) were investigated at different thickness levels using the inexpensive, simple, and visual clinical tools, such as a line-spread test (LST) and a syringe flow test developed by the International Dysphagia Diet Standardization Initiative (IDDSI). Both the flow distance value measured by the LST and the volume remaining in syringe by IDDSI flow test were compared with the apparent viscosity (ηa,50 ) values measured with a sophisticated computer-controlled rheometer. The ηa,50 values of thickened water samples increased as thickener concentration increased, whereas the flow distance (cm; LST) or remaining volume (ml; IDDSI flow test) were decreased. Plots comparing ηa,50 values to LST flow distances and IDDSI volumes revealed exponential relationships (R2 = 0.926 for the LST and R2 = 0.898 for IDDSI test) between the two measurements. Such lower determination coefficient (R2 ) values (0.898) by IDDSI flow test seems to be due to the stickiness characteristics of starch component in starch-based thickeners (E and F), indicating that the syringe flow test is not suitable for starch-based thickeners. However, the thickened water samples prepared only with xanthan gum (XG)-based thickeners (A-D) showed strong relationships (R2 = 0.972 for the LST and R2 = 0.939 for IDDSI test). These results suggest that the LST is a more reliable method than the IDDSI test for evaluating the correct and desirable viscosity for the dysphagia diet, and that the IDDSI test provides a means to predict the rheometer-measured viscosity of water thickened with only XG-based thickeners. PRACTICAL APPLICATIONS: The effective management of dysphagia requires the thickened fluids prepared with the correct and desirable viscosity. In terms of clinical practice, it is very important to observe the comparison of LST with IDDSI flow test to determine a suitable method for estimating the correct viscosity of thickened fluids. Our results showed good relationships between the rheometer-measured viscosity and flow values measured by the LST and IDDSI test methods for the thickened water samples prepared with different foods thickeners. The IDDSI flow test may be useful as a clinical training tool for preparing thickened fluids with only XG-based thickeners to a target level of viscosity. These results presented in this study will provide clinicians, caregivers, and patients with valuable information for IDDSI flow test as an inexpensive and simple method for measuring the correct viscosity.
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Affiliation(s)
- Yong-Hwan Kim
- Department of Food Science and Biotechnology, Dongguk University - Seoul, Goyang, Gyeonggi, South Korea
| | - Geon Young Jeong
- Department of Food Science and Biotechnology, Dongguk University - Seoul, Goyang, Gyeonggi, South Korea
| | - Byoungseung Yoo
- Department of Food Science and Biotechnology, Dongguk University - Seoul, Goyang, Gyeonggi, South Korea
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445
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Brook S. Nutritional considerations in older adults. Br J Community Nurs 2018; 23:449-452. [PMID: 30156897 DOI: 10.12968/bjcn.2018.23.9.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Sarah Brook
- Specialist Community Dietitian, Community Rehabilitation Team, Calderdale and Huddersfield Foundation Trust
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446
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Lopez FL, Ernest TB, Orlu M, Tuleu C. The effect of administration media on palatability and ease of swallowing of multiparticulate formulations. Int J Pharm 2018; 551:67-75. [PMID: 30170024 DOI: 10.1016/j.ijpharm.2018.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/19/2018] [Accepted: 08/13/2018] [Indexed: 02/02/2023]
Abstract
Multiparticulate formulations based on pellets, granules or beads, could be advantageous for paediatrics, geriatrics and patients with swallowing difficulties. However, these formulations may require suitable administration media to facilitate administration. The aim of this work was to investigate the effect of administration media properties on palatability and ease of swallowing of multiparticulates. A range of vehicles were developed using xanthan gum (XG) and carboxymethyl cellulose (CMC) as model hydrocolloids. Such vehicles were prepared at three consistency levels (Level 1 - 'syrup', Level 2 - 'custard' and Level 3 - 'pudding') to investigate the effect of viscosity on their performance as administration media. A randomised, single-blind sensory evaluation study was carried out in thirty healthy adult volunteers using microcrystalline cellulose pellets as model multiparticulates, dispersed in the hydrogels (and water as control) at a concentration of 250 mg in 5 ml. Samples were evaluated using 5-point scales. The use of hydrogels as administration media improved a range of sample attributes compared to water formulations, including appearance, taste, mouthfeel, ease of swallowing and residue in the mouth (all improved by ca. 0,5 points) and oral grittiness perception (improved by ca. 1 point). Polymeric hydrogels thickened to medium consistency (Level 2, XG 0.5% and CMC 1.0% w/v) demonstrated the best performance.
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Affiliation(s)
- Felipe L Lopez
- School of Pharmacy, University College London, London WC1N 1AX, United Kingdom
| | - Terry B Ernest
- GlaxoSmithKline R&D, Park Road, Ware, Herts SG12 0DP, United Kingdom
| | - Mine Orlu
- School of Pharmacy, University College London, London WC1N 1AX, United Kingdom
| | - Catherine Tuleu
- School of Pharmacy, University College London, London WC1N 1AX, United Kingdom.
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447
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Zhong L, Hadde EK, Zhou Z, Xia Y, Chen J. Sensory discrimination of the viscosity of thickened liquids for dysphagia management. J SENS STUD 2018. [DOI: 10.1111/joss.12464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lei Zhong
- Department of Chemical Engineering, Guangxi Key Laboratory Cultivation Base for Polysaccharide Materials and Modifications, Guangxi University for Nationalities; Nanning Guangxi China
| | - Enrico K. Hadde
- School of Food Science and Biotechnology, Zhejiang Gongshang University; Hangzhou Zhejiang China
| | - Zeguang Zhou
- Department of Chemical Engineering, Guangxi Key Laboratory Cultivation Base for Polysaccharide Materials and Modifications, Guangxi University for Nationalities; Nanning Guangxi China
| | - Yao Xia
- Department of Chemical Engineering, Guangxi Key Laboratory Cultivation Base for Polysaccharide Materials and Modifications, Guangxi University for Nationalities; Nanning Guangxi China
| | - Jianshe Chen
- School of Food Science and Biotechnology, Zhejiang Gongshang University; Hangzhou Zhejiang China
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448
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Aguilera JM, Kim BK, Park DJ. Particular Alimentations for Nutrition, Health and Pleasure. ADVANCES IN FOOD AND NUTRITION RESEARCH 2018; 87:371-408. [PMID: 30678818 DOI: 10.1016/bs.afnr.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
People around the world select their foods and meals according to particular choices based on physiological disorders and diseases, traditions, lifestyles, beliefs, etc. In this chapter, two of these particular alimentations are reviewed: those of the gourmet and the frail elderly. They take place in an environment where food is usually synonymous of body health disregarding its effects on social, cultural and psychological aspects, including emotions. Based on an extensive literature review, it is proposed that the paradigm changes from food equals health to food means well-being, the latter encompassing physical and physiological aspects as well as psychological, emotional and social aspects at the individual and societal levels. The growing food and nutrition requirements of an aging population are reviewed and special nutritious and enjoyable products available for this group are discussed.
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Affiliation(s)
- José Miguel Aguilera
- Department of Chemical and Bioprocess Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Bum-Keun Kim
- Division of Strategic Food Research, Korea Food Research Institute, Seoul, South Korea
| | - Dong June Park
- Division of Strategic Food Research, Korea Food Research Institute, Seoul, South Korea
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449
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Sukkar SG, Maggi N, Travalca Cupillo B, Ruggiero C. Optimizing Texture Modified Foods for Oro-pharyngeal Dysphagia: A Difficult but Possible Target? Front Nutr 2018; 5:68. [PMID: 30131962 PMCID: PMC6090051 DOI: 10.3389/fnut.2018.00068] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/17/2018] [Indexed: 11/21/2022] Open
Abstract
Dysphagia is a swallowing disorder characterized by the difficulty in transferring solid foods and/or liquids from the oral cavity to the stomach, imparing autonomous, and safe oral feeding. The main problems deriving from dysphagia are tracheo-bronchial aspiration, aspiration pneumonia, malnutrition and dehydration. In order to overcome dysphagia-induced problems, over the years water and food thickening has been used, focusing specifically on viscosity increase, but limited results have been obtained. Elastic components and their effects on the cohesiveness on the bolus should be taken into account in the first place. We provide an analysis of dysphagia and suggest possible corrections to the protocols which are being used at present, taking into account rheological properties of food and the effect of saliva on the bolus. We reckon that considering such aspects in the dysphagia management market and healthcare catering would result in significant clinical risk reduction.
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Affiliation(s)
- Samir G Sukkar
- Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino di Genova, Genova, Italy
| | - Norbert Maggi
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genova, Genova, Italy
| | | | - Carmelina Ruggiero
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genova, Genova, Italy
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450
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Creech TN, Bailey-Van Kuren M, Sparks J, Becker SB, Kou RSN, Wnek OC, Scarborough DR. A Comparison of Measurements of a Pediatric Supplement. Dysphagia 2018; 34:257-268. [PMID: 30074060 DOI: 10.1007/s00455-018-9931-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 07/26/2018] [Indexed: 11/29/2022]
Abstract
This study evaluated the flow properties of viscosity and flow rate for water and two common pediatric liquids. The flow properties of the test liquids are of interest to create a cup simulation model and "smart" prototype training cup. Two objective methods of determining flow properties were utilized: a rheometer to assess viscosity and a modified version of the International Dysphagia Diet Standardization Initiative (IDDSI) to assess flow rate. Rheometer results concluded that the pediatric supplements were less than 50 cP at all shear rates evaluated and exhibited shear-thinning properties, placing both liquids into the "thin" category. The IDDSI, which was performed according to standardized protocol and also with experimental modifications of varying syringe volumes, determined that all three test liquids had greater than 1 mL/s flow rate across all syringe types/sizes. The experimental modification of the IDDSI with 60 mL syringe volume was found to be the most consistent and applicable with discrete values obtained across all liquids tested. A flow rate factor equation can be determined with the use of a 60 mL syringe, with our laboratory setup, to create the cup simulation model. This computer-generated cup simulation model also aims to integrate engineering with clinical practice to develop a "smart" prototype training cup equipped with software to control flow rate.
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Affiliation(s)
- Taylor N Creech
- Department of Speech Pathology and Audiology, Miami University, 301 S. Patterson Dr, 26 Bachelor Hall, Oxford, OH, 45056, USA
| | | | - Jessica Sparks
- Department of Chemical, Paper, and Biomedical Engineering, Miami University, Oxford, OH, USA
| | - Samantha B Becker
- Department of Speech Pathology and Audiology, Miami University, 301 S. Patterson Dr, 26 Bachelor Hall, Oxford, OH, 45056, USA
| | - Rita S N Kou
- Department of Speech Pathology and Audiology, Miami University, 301 S. Patterson Dr, 26 Bachelor Hall, Oxford, OH, 45056, USA
| | - Olivia C Wnek
- Department of Speech Pathology and Audiology, Miami University, 301 S. Patterson Dr, 26 Bachelor Hall, Oxford, OH, 45056, USA
| | - Donna R Scarborough
- Department of Speech Pathology and Audiology, Miami University, 301 S. Patterson Dr, 26 Bachelor Hall, Oxford, OH, 45056, USA.
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