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Julie A Y Cichero - One of the best experts on this subject based on the ideXlab platform.
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evaluation of Thickened Fluids used in dysphagia management using extensional rheology
Dysphagia, 2020Co-Authors: Enrico Karsten Hadde, Timothy Nicholson, Julie A Y CicheroAbstract:Recent studies show that understanding the rheological properties of Thickened Fluids, such as viscosity and yield stress, is advantageous in designing optimal Thickened Fluids for the treatment of dysphagia. To date, these studies have focused on the rheological behavior of Thickened Fluids in shear deformation, while limited information is available on the surface tension of Thickened Fluids or their rheological behavior in extensional deformation. Knowledge of the extensional properties of Thickened Fluids (extensional viscosity and cohesiveness) is important to fully understand the behavior of such Fluids while swallowing. Our aim in this work, therefore, was to characterize water and skim milk Thickened with a commercial thickener (xanthan gum based) to determine extensional deformation and surface tension properties. It was observed that the surface tension decreases as the thickener concentration increases due to the accumulation of the biopolymer at the surface of the fluid when it dissolves in water. In addition, the extensional viscosity of the fluid increased over time as the filament thinned (i.e., as the Hencky strain increased) until it reached a plateau. It was observed that the maximum extensional viscosity, which is related to the cohesiveness of the fluid, increases with the higher concentrations of thickener. However, the cohesiveness of Thickened skim milk was lower than that of the Thickened water at a given thickener concentration due to lower surface tension. This study confirms that by increasing the concentration of thickener, it will not only increase the shear viscosity (i.e., bolus thickness) of the fluid, but also the extensional viscosity (i.e., bolus cohesiveness).
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development of international terminology and definitions for texture modified foods and Thickened Fluids used in dysphagia management the iddsi framework
Dysphagia, 2017Co-Authors: Julie A Y Cichero, Jianshe Chen, Ben Hanson, Peter Lam, Catriona M Steele, Roberto Oliveira Dantas, Janice Duivestein, Jun Kayashita, Caroline LeckoAbstract:Dysphagia is estimated to affect ~8% of the world’s population (~590 million people). Texture-modified foods and Thickened drinks are commonly used to reduce the risks of choking and aspiration. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded with the goal of developing globally standardized terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures. A multi-professional volunteer committee developed a dysphagia diet framework through systematic review and stakeholder consultation. First, a survey of existing national terminologies and current practice was conducted, receiving 2050 responses from 33 countries. Respondents included individuals with dysphagia; their caregivers; organizations supporting individuals with dysphagia; healthcare professionals; food service providers; researchers; and industry. The results revealed common use of 3–4 levels of food texture (54 different names) and ≥3 levels of liquid thickness (27 different names). Substantial support was expressed for international standardization. Next, a systematic review regarding the impact of food texture and liquid consistency on swallowing was completed. A meeting was then convened to review data from previous phases, and develop a draft framework. A further international stakeholder survey sought feedback to guide framework refinement; 3190 responses were received from 57 countries. The IDDSI Framework (released in November, 2015) involves a continuum of 8 levels (0–7) identified by numbers, text labels, color codes, definitions, and measurement methods. The IDDSI Framework is recommended for implementation throughout the world.
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viscosity of Thickened Fluids that relate to the australian national standards
International Journal of Speech-Language Pathology, 2016Co-Authors: Enrico Karsten Hadde, Julie A Y Cichero, Timothy NicholsonAbstract:AbstractPurpose: In 2007, Australia published standardized terminology and definitions for three levels of Thickened Fluids used in the management of dysphagia. This study examined the thickness of the current Australian National Fluid Standards rheologically (i.e. viscosity, yield stress) and correlated these results with the “fork test”, as described in the national standards.Method: Clinicians who prescribe or work with Thickened liquids and laypersons were recruited to categorize 15 different Thickened Fluids of known viscosities using the fork test. The mean apparent viscosity and the yield stress for each fluid category were calculated.Result: Clear responses were obtained by both clinicians and laypersons for very thin Fluids ( 1150 mPa.s), but large variations of responses were seen for intermediate viscosities. Measures of viscosity and yield stress were important in allocating liquids to different categories.Conclusion: Three bands of fluid viscosity with dist...
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Crushed Tablets: Does the Administration of Food Vehicles and Thickened Fluids to Aid Medication Swallowing Alter Drug Release?
2015Co-Authors: Yady J Manrique, Julie A Y Cichero, Danielle J Lee, Faiza Islam, Jason R Stokes, Lisa M. Nissen, Kathryn JAbstract:ABSTRACT- Purpose. To evaluate the influence of co-administered vehicles on in vitro dissolution in simulated gastric fluid of crushed immediate release tablets as an indicator for potential drug bioavailability compromise. Methods. Release and dissolution of crushed amlodipine, atenolol, carbamazepine and warfarin tablets were tested with six foods and drinks that are frequently used in the clinical setting as mixers for crushed medications (water, orange juice, honey, yoghurt, strawberry jam and water Thickened with Easythick powder) in comparison to whole tablets. Five commercial thickening agents (Easythick Advanced, Janbak F, Karicare, Nutilis, Viscaid) at three thickness levels were tested for their effect on the dissolution of crushed atenolol tablets. Results. Atenolol dissolution was unaffected by mixing crushed tablets with thin Fluids or food mixers in comparison to whole tablets or crushed tablets in water, but amlodipine was delayed by mixing with jam. Mixing crushed warfarin and carbamazepine tablets with honey, jam or yoghurt caused them to resemble the slow dissolution of whole tablets rather than the faster dissolution of crushed tablets in water or orange juice. Crushing and mixing any of the four medications with Thickened water caused a significant delay in dissolution. When tested with atenolol, all types of thickening agents at the greatest thickness significantly restricted dissolution, and products that are primarily based on xanthan gum also delayed dissolution at the intermediate thickness level. Conclusions. Dissolutio
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rheological characterisation of Thickened Fluids under different temperature ph and fat contents
Nutrition & Food Science, 2015Co-Authors: Enrico Karsten Hadde, Timothy Nicholson, Julie A Y CicheroAbstract:Purpose – The purpose of this paper was to examine the rheological characterisation of Thickened water under different temperature and pH conditions and Thickened milk with different fat contents. Design/methodology/approach – Beverages Thickened with powdered thickeners are used in the medical management of individuals who suffer swallowing difficulties (dysphagia). Each individual requires a specific level of thickness to best meet the needs of their dysphagia. Although the level of thickness is defined, obtaining the correct consistency of Thickened Fluids is difficult. This is due to fluctuations associated with temperature and type of Fluids to be Thickened. Rheological characterisation of commercially available xanthan gum-based thickener was performed under different conditions of temperature, pH and fat contents. Findings – The viscosity and the yield stress of Thickened water was found to be unaffected by pH. Similarly, temperature did not affect the viscosity at a high thickener concentration, a...
Enrico Karsten Hadde - One of the best experts on this subject based on the ideXlab platform.
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texture and texture assessment of Thickened Fluids and texture modified food for dysphagia management
Journal of Texture Studies, 2020Co-Authors: Enrico Karsten Hadde, Jianshe ChenAbstract:Thickened Fluids and texture-modified foods are commonly used in the medical management of individuals who suffer from swallowing difficulty (known as dysphagia). However, how to reliably assess texture properties of such food systems is still a big challenge both to industry and to academic researchers. This article aims to identify key physical parameters that are important for objective assessment of such properties by reviewing the significance of rheological or textural properties of Thickened Fluids and texture-modified foods for swallowing. Literature reviews have identified that dominating textural properties in relation to swallowing could be very different for Thickened Fluids and for texture-modified foods. Important parameters of Thickened Fluids are generally related with the flow of the bolus in the pharyngeal stage, while important parameters of texture-modified foods are generally related with the bolus preparation in the oral stage as well as the bolus flow in the pharyngeal stage. This review helps to identify key textural parameters of Thickened Fluids and texture-modified foods in relation to eating and swallowing and to develop objective measuring techniques for quality control of Thickened Fluids and texture-modified foods for dysphagia management.
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evaluation of Thickened Fluids used in dysphagia management using extensional rheology
Dysphagia, 2020Co-Authors: Enrico Karsten Hadde, Timothy Nicholson, Julie A Y CicheroAbstract:Recent studies show that understanding the rheological properties of Thickened Fluids, such as viscosity and yield stress, is advantageous in designing optimal Thickened Fluids for the treatment of dysphagia. To date, these studies have focused on the rheological behavior of Thickened Fluids in shear deformation, while limited information is available on the surface tension of Thickened Fluids or their rheological behavior in extensional deformation. Knowledge of the extensional properties of Thickened Fluids (extensional viscosity and cohesiveness) is important to fully understand the behavior of such Fluids while swallowing. Our aim in this work, therefore, was to characterize water and skim milk Thickened with a commercial thickener (xanthan gum based) to determine extensional deformation and surface tension properties. It was observed that the surface tension decreases as the thickener concentration increases due to the accumulation of the biopolymer at the surface of the fluid when it dissolves in water. In addition, the extensional viscosity of the fluid increased over time as the filament thinned (i.e., as the Hencky strain increased) until it reached a plateau. It was observed that the maximum extensional viscosity, which is related to the cohesiveness of the fluid, increases with the higher concentrations of thickener. However, the cohesiveness of Thickened skim milk was lower than that of the Thickened water at a given thickener concentration due to lower surface tension. This study confirms that by increasing the concentration of thickener, it will not only increase the shear viscosity (i.e., bolus thickness) of the fluid, but also the extensional viscosity (i.e., bolus cohesiveness).
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cohesiveness visual evaluation of Thickened Fluids
Food Hydrocolloids, 2020Co-Authors: Enrico Karsten Hadde, Wei Chen, Jianshe ChenAbstract:Abstract Cohesiveness is recognized as an important property of food for medical management of individuals who suffer from swallowing difficulty (known as dysphagia). However, while the term cohesiveness is commonly used for description of such products, its sensory nature and instrumental assessment remain a big challenge. Therefore, our aim in this work was to compare and correlate the rheological parameters of Thickened Fluids with the perceived cohesiveness obtained from the sensory analysis by visual perception. Thirty-two participants were recruited for this study to evaluate the cohesiveness of ten samples of Thickened water prepared with different commercial food thickeners. Four rheological parameters (shear viscosity, yield stress, shear modulus, maximum extensional viscosity) of the samples were measured and correlated with the perceived cohesiveness obtained from the visual perception. It was observed that the maximum extensional viscosity is the most-well correlated with the cohesive properties as evaluated by the visual perception and could be used as a feasible indication of fluid cohesiveness. In addition, syringe extrusion flow behavior technique was developed as an alternative methodology to measure the cohesiveness of semi-solid and liquid materials. This technique was highly correlated with the perceived cohesiveness from the visual perception and could be used as a standardized methodology of evaluating cohesiveness of semi-solid and liquid materials for industrial purposes.
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viscosity of Thickened Fluids that relate to the australian national standards
International Journal of Speech-Language Pathology, 2016Co-Authors: Enrico Karsten Hadde, Julie A Y Cichero, Timothy NicholsonAbstract:AbstractPurpose: In 2007, Australia published standardized terminology and definitions for three levels of Thickened Fluids used in the management of dysphagia. This study examined the thickness of the current Australian National Fluid Standards rheologically (i.e. viscosity, yield stress) and correlated these results with the “fork test”, as described in the national standards.Method: Clinicians who prescribe or work with Thickened liquids and laypersons were recruited to categorize 15 different Thickened Fluids of known viscosities using the fork test. The mean apparent viscosity and the yield stress for each fluid category were calculated.Result: Clear responses were obtained by both clinicians and laypersons for very thin Fluids ( 1150 mPa.s), but large variations of responses were seen for intermediate viscosities. Measures of viscosity and yield stress were important in allocating liquids to different categories.Conclusion: Three bands of fluid viscosity with dist...
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rheological characterisation of Thickened Fluids under different temperature ph and fat contents
Nutrition & Food Science, 2015Co-Authors: Enrico Karsten Hadde, Timothy Nicholson, Julie A Y CicheroAbstract:Purpose – The purpose of this paper was to examine the rheological characterisation of Thickened water under different temperature and pH conditions and Thickened milk with different fat contents. Design/methodology/approach – Beverages Thickened with powdered thickeners are used in the medical management of individuals who suffer swallowing difficulties (dysphagia). Each individual requires a specific level of thickness to best meet the needs of their dysphagia. Although the level of thickness is defined, obtaining the correct consistency of Thickened Fluids is difficult. This is due to fluctuations associated with temperature and type of Fluids to be Thickened. Rheological characterisation of commercially available xanthan gum-based thickener was performed under different conditions of temperature, pH and fat contents. Findings – The viscosity and the yield stress of Thickened water was found to be unaffected by pH. Similarly, temperature did not affect the viscosity at a high thickener concentration, a...
Renee Speyer - One of the best experts on this subject based on the ideXlab platform.
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effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia white paper by the european society for swallowing disorders essd
Dysphagia, 2016Co-Authors: Roger D Newman, Natalia Vilardell, Pere Clave, Renee SpeyerAbstract:Fluid thickening is a well-established management strategy for oropharyngeal dysphagia (OD). However, the effects of thickening agents on the physiology of impaired swallow responses are not fully understood, and there is no agreement on the degree of bolus thickening. To review the literature and to produce a white paper of the European Society for Swallowing Disorders (ESSD) describing the evidence in the literature on the effect that bolus modification has upon the physiology, efficacy and safety of swallowing in adults with OD. A systematic search was performed using the electronic Pubmed and Embase databases. Articles in English available up to July 2015 were considered. The inclusion criteria swallowing studies on adults over 18 years of age; healthy people or patients with oropharyngeal dysphagia; bolus modification; effects of bolus modification on swallow safety (penetration/aspiration) and efficacy; and/or physiology and original articles written in English. The exclusion criteria consisted of oesophageal dysphagia and conference abstracts or presentations. The quality of the selected papers and the level of research evidence were assessed by standard quality assessments. At the end of the selection process, 33 articles were considered. The quality of all included studies was assessed using systematic, reproducible, and quantitative tools (Kmet and NHMRC) concluding that all the selected articles reached a valid level of evidence. The literature search gathered data from various sources, ranging from double-blind randomised control trials to systematic reviews focused on changes occurring in swallowing physiology caused by Thickened Fluids. Main results suggest that increasing bolus viscosity (a) results in increased safety of swallowing, (b) also results in increased amounts of oral and/or pharyngeal residue which may result in post-swallow airway invasion, (c) impacts the physiology with increased lingual pressure patterns, no major changes in impaired airway protection mechanisms, and controversial effects on oral and pharyngeal transit time, hyoid displacements, onset of UOS opening and bolus velocity—with several articles suggesting the therapeutic effect of thickeners is also due to intrinsic bolus properties, (d) reduces palatability of Thickened Fluids and (e) correlates with increased risk of dehydration and decreased quality of life although the severity of dysphagia may be an confounding factor. The ESSD concludes that there is evidence for increasing viscosity to reduce the risk of airway invasion and that it is a valid management strategy for OD. However, new thickening agents should be developed to avoid the negative effects of increasing viscosity on residue, palatability, and treatment compliance. New randomised controlled trials should establish the optimal viscosity level for each phenotype of dysphagic patients and descriptors, terminology and viscosity measurements must be standardised. This white paper is the first step towards the development of a clinical guideline on bolus modification for patients with oropharyngeal dysphagia.
Nicholas F. Taylor - One of the best experts on this subject based on the ideXlab platform.
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Implementing the Free Water Protocol does not Result in Aspiration Pneumonia in Carefully Selected Patients with Dysphagia: A Systematic Review
Dysphagia, 2017Co-Authors: Anna Gillman, Renata Winkler, Nicholas F. TaylorAbstract:The Frazier Free Water Protocol was developed with the aim of providing patients with dysphagia an option to consume thin (i.e. unThickened) water in-between mealtimes. A systematic review was conducted of research published in peer-reviewed journals. An electronic search of the EMBASE, CINAHL and MEDLINE databases was completed up to July 2016. A total of 8 studies were identified for inclusion: 5 randomised controlled trials, 2 cohort studies with matched cases and 1 single group pre-post intervention prospective study. A total of 215 rehabilitation inpatients and 30 acute patients with oropharyngeal dysphagia who required Thickened Fluids or were to remain ‘nil by mouth’, as determined by bedside swallow assessment and/or videofluoroscopy/fiberoptic endoscopic evaluation of swallowing, were included. Meta-analyses of the data from the rehabilitation studies revealed (1) low-quality evidence that implementing the protocol did not result in increased odds of having lung complications and (2) low-quality evidence that fluid intake may increase. Patients’ perceptions of swallow-related quality of life appeared to improve. This review has found that when the protocol is closely adhered to and patients are carefully selected using strict exclusion criteria, including an evaluation of their cognition and mobility, adult rehabilitation inpatients with dysphagia to thin Fluids can be offered the choice of implementing the Free Water Protocol. Further research is required to determine if the Free Water Protocol can be implemented in settings other than inpatient rehabilitation.
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Implementing the Free Water Protocol does not Result in Aspiration Pneumonia in Carefully Selected Patients with Dysphagia: A Systematic Review
Dysphagia, 2017Co-Authors: Anna Gillman, Renata Winkler, Nicholas F. TaylorAbstract:The Frazier Free Water Protocol was developed with the aim of providing patients with dysphagia an option to consume thin (i.e. unThickened) water in-between mealtimes. A systematic review was conducted of research published in peer-reviewed journals. An electronic search of the EMBASE, CINAHL and MEDLINE databases was completed up to July 2016. A total of 8 studies were identified for inclusion: 5 randomised controlled trials, 2 cohort studies with matched cases and 1 single group pre-post intervention prospective study. A total of 215 rehabilitation inpatients and 30 acute patients with oropharyngeal dysphagia who required Thickened Fluids or were to remain ‘nil by mouth’, as determined by bedside swallow assessment and/or videofluoroscopy/fiberoptic endoscopic evaluation of swallowing, were included. Meta-analyses of the data from the rehabilitation studies revealed (1) low-quality evidence that implementing the protocol did not result in increased odds of having lung complications and (2) low-quality evidence that fluid intake may increase. Patients’ perceptions of swallow-related quality of life appeared to improve. This review has found that when the protocol is closely adhered to and patients are carefully selected using strict exclusion criteria, including an evaluation of their cognition and mobility, adult rehabilitation inpatients with dysphagia to thin Fluids can be offered the choice of implementing the Free Water Protocol. Further research is required to determine if the Free Water Protocol can be implemented in settings other than inpatient rehabilitation.
Peter Halley - One of the best experts on this subject based on the ideXlab platform.
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Thickened Fluids and Water Absorption in Rats and Humans
Dysphagia, 2007Co-Authors: Kendall Sharpe, Leigh Ward, Julie Cichero, Peter Sopade, Peter HalleyAbstract:Individuals with dysphagia are commonly provided with oral Fluids Thickened to prevent aspiration. Most thickening agents are either gum-based (guar or xanthan) or are derived from modified starches. There is evidence, predominantly anecdotal, that dysphagic individuals are subclinically dehydrated. Dysphagia has a particular impact on elderly individuals and there is justifiable concern for dehydration in this population. It has been speculated that dehydration may, in part, be the result of the water-holding capacity of these thickening agents decreasing water absorption from the gut. The aim of this study was to determine the rate of intestinal absorption of water from Thickened Fluids. The method used was a laboratory tracer study in rats and humans in vivo . We found that there were no significant differences in water absorption rates between Thickened Fluids or pure water irrespective of thickener type (modified maize starch, guar gum, or xanthan gum). These data provide no support for the view that the addition of thickening agents, irrespective of type, to orally ingested Fluids significantly alters the absorption rate of water from the gut.