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Duanmu Z, Ali SJV, Allen J, Cheng LK, Stommel M, Xu W. A Review of In Vitro and In Silico Swallowing Simulators: Design and Applications. IEEE Trans Biomed Eng 2024; 71:2042-2057. [PMID: 38294923 DOI: 10.1109/tbme.2024.3360893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Swallowing is a primary and complex behaviour that transports food and drink from the oral cavity, through the pharynx and oesophagus, into the stomach at an appropriate rate and speed. To understand this sophisticated behaviour, a tremendous amount of research has been carried out by utilising the in vivo approach, which is often challenging to perform, poses a risk to the subjects if interventions are undertaken and are seldom able to control for confounding factors. In contrast, in silico (computational) and in vitro (instrumental) methods offer an alternate insight into the process of the human swallowing system. However, the appropriateness of the design and application of these methods have not been formally evaluated. The purpose of this review is to investigate and evaluate the state of the art of in vitro and in silico swallowing simulators, focusing on the evaluation of their mechanical or computational designs in comparison to the corresponding swallowing mechanisms during various phases of swallowing (oral phase, pharyngeal phase and esophageal phase). Additionally, the potential of the simulators is also discussed in various areas of applications, including the study of swallowing impairments, swallowing medications, food process design and dysphagia management. We also address current limitations and recommendations for the future development of existing simulators.
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Wang K, Cheng Z, Qiao D, Xie F, Zhao S, Zhang B. Polysaccharide-dextrin thickened fluids for individuals with dysphagia: recent advances in flow behaviors and swallowing assessment methods. Crit Rev Food Sci Nutr 2024:1-25. [PMID: 38556920 DOI: 10.1080/10408398.2024.2330711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The global aging population has brought about a pressing health concern: dysphagia. To effectively address this issue, we must develop specialized diets, such as thickened fluids made with polysaccharide-dextrin (e.g., water, milk, juices, and soups), which are crucial for managing swallowing-related problems like aspiration and choking for people with dysphagia. Understanding the flow behaviors of these thickened fluids is paramount, and it enables us to establish methods for evaluating their suitability for individuals with dysphagia. This review focuses on the shear and extensional flow properties (e.g., viscosity, yield stress, and viscoelasticity) and tribology (e.g., coefficient of friction) of polysaccharide-dextrin-based thickened fluids and highlights how dextrin inclusion influences fluid flow behaviors considering molecular interactions and chain dynamics. The flow behaviors can be integrated into the development of diverse evaluation methods that assess aspects such as flow velocity, risk of aspiration, and remaining fluid volume. In this context, the key in-vivo (e.g., clinical examination and animal model), in-vitro (e.g., the Cambridge Throat), and in-silico (e.g., Hamiltonian moving particles semi-implicit) evaluation methods are summarized. In addition, we explore the potential for establishing realistic assessment methods to evaluate the swallowing performance of thickened fluids, offering promising prospects for the future.
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Affiliation(s)
- Kedu Wang
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Zihang Cheng
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Dongling Qiao
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Fengwei Xie
- Department of Chemical Engineering, University of Bath, Bath, UK
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Siming Zhao
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Binjia Zhang
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
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O'Brien E, Johnston S, Douglas C. Implementing a medication lubricant for pill dysphagia on an acute care ward using Plan-Do-Study-Act cycles. BMJ Open Qual 2023; 12:e002505. [PMID: 38114248 DOI: 10.1136/bmjoq-2023-002505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/03/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Pill dysphagia, the difficulty in swallowing solid oral medications, is a common problem that can affect medication adherence and increase pill modifications. Current practices of crushing medications or using food vehicles have limitations and potential risks. This report describes the implementation of a medication lubricant, Gloup, for pill dysphagia on an acute care ward using Plan-Do-Study-Act cycles. OBJECTIVE The objective of this project was to evaluate the implementation of Gloup in the acute care ward setting and assess its acceptability and uptake by patients and ward nurses during medication administration. METHODS The project involved chart audits of medication administration records, collection of patient feedback, and staff feedback through meetings. Patient characteristics and medication administration practices were documented. The implementation process included education and training sessions for staff, development of a medication chart sticker for evaluation data collection and small-scale testing of Gloup with patients before ward-level implementation. RESULTS The implementation of Gloup on the acute care ward showed high uptake and acceptability. The majority of patients using Gloup had crushed medications, and the use of Gloup varied based on patient needs. CONCLUSION The implementation of Gloup as a medication lubricant for pill dysphagia on an acute care ward was successful and well received by patients and staff. The use of Gloup appeared to improve medication administration practices and reduce the need for crushing medications or using food vehicles. This project highlights the importance of addressing pill dysphagia in acute care settings and provides insights for other wards considering similar interventions.
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Affiliation(s)
- Emma O'Brien
- Orthogeriatrics (Ward 2D), The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Sandra Johnston
- School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
| | - Clint Douglas
- School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
- Office of Nursing and Midwifery Services, Metro North Hospital and Health Service, Herston, Queensland, Australia
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Howe S, Steer K, Johnson M, Adjerid K, Edmonds C, German R, Mayerl C. Exploring the interaction of viscosity and nipple design on feeding performance in an infant pig model. J Texture Stud 2023; 54:936-946. [PMID: 37673688 PMCID: PMC10872838 DOI: 10.1111/jtxs.12797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Abstract
Infant feeding behaviors are modulated via sensorimotor feedback, such that sensory perturbations can significantly impact performance. Properties of the nipple and milk (e.g., nipple hole size and viscosity) are critical sources of sensory information. However, the direct effects of varying milk and nipple properties on infant motor output and the subsequent changes in feeding performance are poorly understood. In this study, we use an infant pig model to explore the interaction between nipple hole size and milk viscosity. Using high-speed videofluoroscopy and electromyography, we measured key performance metrics including sucks per swallow and suck duration, then synchronized these data with the onset and offset of activity of jaw opening and closing muscles. The combination of a small nipple hole and thick milk resulted in negative effects on both suck and swallow performance, with reduced feeding efficiency compared to the other treatments. It also appears that this combination of viscosity and hole size disrupts the coordination between correlates of tongue and jaw movements. We did not see a difference in feeding efficiency between viscosities when infants fed on the large-hole nipple, which may be the result of non-Newtonian fluid mechanics. Our results emphasize the importance of considering both fluid and nipple properties when considering alterations to an infant's feeding system.
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Affiliation(s)
- Stephen Howe
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Kendall Steer
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- University of Akron, Akron, Ohio, USA
| | | | | | - Chloe Edmonds
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Kent State University, Kent, Ohio, USA
| | - Rebecca German
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Kent State University, Kent, Ohio, USA
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Pabois O, Avila-Sierra A, Ramaioli M, Mu M, Message Y, You KM, Liamas E, Kew B, Durga K, Doherty L, Sarkar A. Benchmarking of a microgel-reinforced hydrogel-based aqueous lubricant against commercial saliva substitutes. Sci Rep 2023; 13:19833. [PMID: 37985688 PMCID: PMC10662424 DOI: 10.1038/s41598-023-46108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
Xerostomia, the subjective sensation of 'dry mouth' affecting at least 1 in 10 adults, predominantly elders, increases life-threatening infections, adversely impacting nutritional status and quality of life. A patented, microgel-reinforced hydrogel-based aqueous lubricant, prepared using either dairy or plant-based proteins, has been demonstrated to offer substantially enhanced lubricity comparable to real human saliva in in vitro experiments. Herein, we present the benchmarking of in vitro lubrication performance of this aqueous lubricant, both in its dairy and vegan formulation against a range of widely available and employed commercial saliva substitutes, latter classified based on their shear rheology into "liquids", "viscous liquids" and "gels", and also had varying extensional properties. Strikingly, the fabricated dairy-based aqueous lubricant offers up to 41-99% more effective boundary lubrication against liquids and viscous liquids, irrespective of topography of the tested dry mouth-mimicking tribological surfaces. Such high lubricity of the fabricated lubricants might be attributed to their limited real-time desorption (7%) from a dry-mouth mimicking hydrophobic surface unlike the tested commercial products including gels (23-58% desorption). This comprehensive benchmarking study therefore paves the way for employing these microgel-based aqueous lubricant formulations as a novel topical platform for dry mouth therapy.
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Affiliation(s)
- Olivia Pabois
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Marco Ramaioli
- INRAE, AgroParisTech, UMR SayFood, Université Paris-Saclay, 91120, Palaiseau, France
| | - Mingduo Mu
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Yasmin Message
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Kwan-Mo You
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Evangelos Liamas
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
- Unilever Research & Development Port Sunlight Laboratory, Bebington, CH63 3JW, UK
| | - Ben Kew
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Kalpana Durga
- Vitrition UK Ltd, Liversedge, WF15 6RA, UK
- ADM Protexin Ltd, Lopen Head, TA13 5JH, UK
| | | | - Anwesha Sarkar
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK.
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Boehm MW, Nicholson RA, Baier SK. Designing plant-based analogues of animal-derived foods: a review of research ranging from manufacturing to oral processing. Curr Opin Food Sci 2022. [DOI: 10.1016/j.cofs.2022.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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A novel soft robotic pediatric in vitro swallowing device to gain insights into the swallowability of mini-tablets. Int J Pharm 2022; 629:122369. [DOI: 10.1016/j.ijpharm.2022.122369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022]
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Hadde EK, Chen J. Food texture and texture modification for dysphagia management. J Texture Stud 2021; 52:538-539. [PMID: 34927259 DOI: 10.1111/jtxs.12650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Enrico Karsten Hadde
- Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jianshe Chen
- Institute of Food Oral Processing and Sensory Science, Zhejiang Gongshang University, Hangzhou, China
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