Abstract
The purpose of this study was to investigate comparability of viscosity of liquids used in assessment and treatment of infants with dysphagia. Goals of this study were as follows: (1) Establish baseline viscosity values for (a) the commercial barium assessment liquids of varying thicknesses and (b) clinically typical infant formula thickened with varied thickeners. (2) Compare the baseline viscosities of the various liquids for correlation of values. We attempted to mimic real-world situations and recreate clinical assessment and treatment conditions. We also identified and made every effort to control typical clinical variables, e.g., mixer and mixing procedure, brand of product, and temperature of liquid. The method of measurement was based on rheologic principles and used a Brookfield Engineering LVDV II + Pro Cone/Plate Viscometer at spindle and speed combinations to maximize shear rates consistent with swallowing. Statistically, there was no comparability between barium and formula mixtures, regardless of thickener utilized. The implications of these findings and the need to develop a standardized means of thickening formula to a viscosity comparable to the assessment materials are discussed.
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References
Lefton-Greif MA, Carroll JL, Loughlin GM. Long-term follow-up of oropharyngeal dysphagia. Pediatr Pulmonol. 2006;41:1040–8. doi:10.1002/ppul.20488.
Arvedson J, Brodsky L. Management of feeding and swallowing problems. In: Pediatric swallowing and feeding assessment and management. Albany, NY: Singular Publishing; 2002. p. 389–468.
Coster ST, Schwarz WH. Rheology and swallow-safe bolus. Dysphagia. 1987;1:113–8. doi:10.1007/BF02412327.
Hall KD. Medical disorders and other etiologies of pediatric dysphagia. In: Hall KD, editor. Pediatric dysphagia resource guide. San Diego, CA: Singular Publishing; 1983. p. 47–76.
Kron RE, Stein M, Goddard KE, Phoenix MD. Effect of nutrient upon the sucking behavior of newborn infants. Psychosom Med. 1967;XXIV(1):24–32.
Wolf LS, Glass RP. Feeding and swallowing disorders in infancy: assessment and management. San Antonio, TX: Therapy Skill Builders; 1992.
Dantas RO, Kern MK, Massey BT, Dodds WJ, Kahrilas PJ, Brasseur JG, et al. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol. 1990;258(5 Pt 1):G675–81.
Logemann J, Rademaker A, Kahrilas P, Lazarus C. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Hear Res. 1994;37:1041–9.
Glassburn DL, Deem JF. Thickener viscosity in dysphagia management: variability among speech-language pathologists. Dysphagia. 1998;13(4):218–22. doi:10.1007/PL00009575.
Cichero J, Jackson O, Halley P, Murdoch B. Which one of these is not like the others? An inter-hospital study of the viscosity of thickened fluids. J Speech Lang Hear Res. 2000;43:537–47.
Stuart S, Waldron A, Tanner J. Baby cereal: the other thickener. Poster presentation at the American speech-language-hearing association convention, San Diego, CA; November 21, 2005.
Dieticians Association of Australia. The speech pathology association of Australia limited: texture-modified foods and thickened fluids as used for individuals with dysphagia: Australian standardized labels and definitions. Nutr Diet. 2007;64(2):53–76. doi:10.1111/j.1747-0080.2007.00153.x10.1111/j.1747-0080.2007.00153.x.
Chaney L, Bradshaw J, Pillsbury DC, Rubin BK. The viscosity of dysphagia diet foods and barium test solutions is highly variable and often inconsistent with published guidelines. Chest. 2007;132:666S.
Nicosia MA, Robbins J. The usefulness of the line spread test as a measure of liquid consistency. Dysphagia. 2007;22(4):306–11. doi:10.1007/s00455-007-9086-3.
Cichero J, Jackson O, Halley P, Murdoch B. How thick is thick? Multicenter study of the rheological and material property characteristics of mealtime fluids and videofluoroscopy fluids. Dysphagia. 2000;15:188–200. doi:10.1007/s004550000027.
Garcia JM, Chambers E, Matta Z, Clark M. Serving temperature viscosity measurements of nectar- and honey-thick liquids. Dysphagia. 2008;23:65–75. doi:10.1007/s00455-007-9098-z.
Smith CH, Logemann JA, Burghardt WR, Zecker SG, Rademaker AW. Oral and oropharyngeal perceptions of fluid viscosity across the age span. Dysphagia. 2006;21(4):209–17. doi:10.1007/s00455-006-9045-4.
Brookfield Engineering Labs, Inc. More solutions to sticky problems. Middleboro, MA: Brookfield Engineering Labs, No. 1056-1014 10 M; December 2005.
Steele CM, Van Lieshout P, Goff HD. The rheology of liquids: a comparison of clinicians’ subjective impressions and objective measurement. Dysphagia. 2003;18:182–95. doi:10.1007/s00455-002-0104-1.
McCullough G, Pelletier C, Steele C. National dysphagia diet: What to swallow? ASHA Lead. 2003;16:27–9.
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Stuart, S., Motz, J.M. Viscosity in Infant Dysphagia Management: Comparison of Viscosity of Thickened Liquids Used in Assessment and Thickened Liquids Used in Treatment. Dysphagia 24, 412–422 (2009). https://doi.org/10.1007/s00455-009-9219-y
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DOI: https://doi.org/10.1007/s00455-009-9219-y