1
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Sasegbon A, Cheng I, Hamdy S. The neurorehabilitation of post-stroke dysphagia: Physiology and pathophysiology. J Physiol 2024. [PMID: 38517302 DOI: 10.1113/jp285564] [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: 12/02/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
Swallowing is a complex process involving the precise contractions of numerous muscles of the head and neck, which act to process and shepherd ingested material from the oral cavity to its eventual destination, the stomach. Over the past five decades, information from animal and human studies has laid bare the complex network of neurones in the brainstem, cortex and cerebellum that are responsible for orchestrating each normal swallow. Amidst this complexity, problems can and often do occur that result in dysphagia, defined as impaired or disordered swallowing. Dysphagia is common, arising from multiple varied disease processes that can affect any of the neuromuscular structures involved in swallowing. Post-stroke dysphagia (PSD) remains the most prevalent and most commonly studied form of dysphagia and, as such, provides an important disease model to assess dysphagia physiology and pathophysiology. In this review, we explore the complex neuroanatomical processes that occur during normal swallowing and PSD. This includes how strokes cause dysphagia, the mechanisms through which natural neuroplastic recovery occurs, current treatments for patients with persistent dysphagia and emerging neuromodulatory treatments.
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Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
- Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
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2
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Schluterman HM, Linardos CG, Drulia T, Marshall JD, Kearns GL. Evaluating palatability in young children: a mini-review of relevant physiology and assessment techniques. Front Pediatr 2024; 12:1350662. [PMID: 38390280 PMCID: PMC10881860 DOI: 10.3389/fped.2024.1350662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
The palatability of pediatric pharmaceutical products plays a crucial role of influencing medication compliance. Rejection of unpalatable medications can potentially lead to treatment failure which can have immediate and delayed consequences. With advances in both the food and pharmaceutical industries, the systematic assessment of palatability has gained importance. Various methods such as visual analogue scales, facial hedonic scales, and facial recognition software, have been employed to assess palatability. While proven to be useful, these methods have significant limitations and may not be workable for young children. Despite these advancements, a universally accepted "gold standard" for assessing pediatric mediation palatability, recognized by drug regulatory agencies, is yet to be established.
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Affiliation(s)
- Haley M Schluterman
- Departments of Medical Education, The Anne Marion Burnett School of Medicine, Texas Christian University, Fort Worth, TX, United States
| | - Constance G Linardos
- Departments of Medical Education, The Anne Marion Burnett School of Medicine, Texas Christian University, Fort Worth, TX, United States
| | - Teresa Drulia
- Davies School of Communication Sciences and Disorders, The Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, TX, United States
| | - James D Marshall
- Departments of Pediatrics, The Anne Marion Burnett School of Medicine, Texas Christian University, Fort Worth, TX, United States
- The Divisions of Intensive Care Medicine, Cook Children's Medical Center, Fort Worth, TX, United States
- The Divisions of Palliative Care, Cook Children's Medical Center, Fort Worth, TX, United States
| | - Gregory L Kearns
- Departments of Pediatrics, The Anne Marion Burnett School of Medicine, Texas Christian University, Fort Worth, TX, United States
- The Divisions of Intensive Care Medicine, Cook Children's Medical Center, Fort Worth, TX, United States
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3
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Hummler H, Stillhart C, Meilicke L, Grimm M, Krause E, Mannaa M, Gollasch M, Weitschies W, Page S. Impact of Tablet Size and Shape on the Swallowability in Older Adults. Pharmaceutics 2023; 15:pharmaceutics15041042. [PMID: 37111528 PMCID: PMC10145850 DOI: 10.3390/pharmaceutics15041042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Older adults represent the major target population for oral medications, due to the high prevalence of multimorbidity. To allow for successful pharmacological treatments, patients need to adhere to their medication and, thus, patient-centric drug products with a high level of acceptability by the end users are needed. However, knowledge on the appropriate size and shape of solid oral dosage forms, as the most commonly used dosage forms in older adults, is still scarce. A randomized intervention study was performed including 52 older adults (65 to 94 years) and 52 young adults (19 to 36 years). Each participant swallowed four coated placebo tablets differing in weight (250 to 1000 mg) and shape (oval, round, oblong) in a blinded manner on three study days. The choice of tablet dimensions allowed for a systematic comparison between different tablet sizes of the same shape, as well as between different tablet shapes. Swallowability was assessed using a questionnaire-based method. All tested tablets were swallowed by ≥80% of adults, independent of age. However, only the 250 mg oval tablet was classified as well swallowable by ≥80% of old participants. The same was true for young participants; however, they also considered the 250 mg round and the 500 mg oval tablet as well swallowable. Furthermore, swallowability was seen to influence the willingness to take a tablet on a daily basis, especially for an intake over longer time periods.
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Affiliation(s)
- Henriette Hummler
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacherstr. 124, CH-4070 Basel, Switzerland
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Cordula Stillhart
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacherstr. 124, CH-4070 Basel, Switzerland
| | - Lisa Meilicke
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Michael Grimm
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Elischa Krause
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstr. 1/2, 17489 Greifswald, Germany
| | - Marwan Mannaa
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17489 Greifswald, Germany
| | - Maik Gollasch
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17489 Greifswald, Germany
| | - Werner Weitschies
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Susanne Page
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacherstr. 124, CH-4070 Basel, Switzerland
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4
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Benli ET, Avci Ş, Öğün MN. Feel it or deal with it: Oral perception and aspiration risk in early stroke. J Oral Rehabil 2023; 50:217-222. [PMID: 36533879 DOI: 10.1111/joor.13402] [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: 03/21/2022] [Revised: 08/26/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sensation and perception impairments are significant problems faced by individuals with early-stage stroke. Sensory inputs needed in swallowing guide the perceptual process with the involvement of cognitive functions. In the absence of sensory input, bolus perception may be altered, and swallowing safety may be compromised. OBJECTIVES This study aims to evaluate the oral perception of volume change and the aspiration risk of individuals with stroke and determine the relationship between oral perception and aspiration risk. METHODS Total participants were 35. The Gugging Swallowing Screening Test (GUSS) was used to determine individuals' risk of aspiration and divide them into groups 'aspiration risk' and 'non-aspiration risk'. The Oral Perception of Liquid Volume Changes Test (OPLVCT) was used to determine the level of oral perception. RESULTS The groups were statistically similar in terms of age and other descriptives. When the OPLVC test was examined, the scores of the aspiration risk group were significantly lower (p < .001). In addition, a moderate negative correlation was found between aspiration risk and the OPLVC scores (r: -0.502; p < .001). CONCLUSION In this study, a relationship was found between aspiration risk and oral perception. It also revealed that individuals with stroke who are at risk of aspiration have low oral perception abilities. Based on these results, it was concluded that these individuals cannot reliably determine the maximum volume of liquid to be consumed without assistance. We suggest that evaluations and training of oral perception should be added to the rehabilitation of individuals with stroke.
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Affiliation(s)
- Enes Tayyip Benli
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Şebnem Avci
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Muhammed Nur Öğün
- Faculty of Medicine, Department of Neurology, Bolu Abant İzzet Baysal University, Bolu, Turkey
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5
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Norton V, Lignou S, Faka M, Methven L. Individual variation in mouthfeel sensitivity: investigating influences of whey protein content, consumer age, food format and fat addition. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2022.104638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mulheren R, Westemeyer RM, Dietsch AM. The effect of taste on swallowing: A scoping and systematic review. Crit Rev Food Sci Nutr 2022; 64:1256-1282. [PMID: 36036968 DOI: 10.1080/10408398.2022.2115003] [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] [Indexed: 11/03/2022]
Abstract
Consuming foods and liquids for nutrition requires the coordination of several muscles. Swallowing is triggered and modified by sensory inputs from the aerodigestive tract. Taste has recently received attention as a potential modulator of swallowing physiology, function, and neural activation; additionally, taste impairment is a sequela of COVID-19. This review presents factors impacting taste and swallowing, systematically summarizes the existing literature, and assesses the quality of included studies. A search was conducted for original research including taste stimulation, deglutition-related measure(s), and human participants. Study design, independent and dependent variables, and participant characteristics were coded; included studies were assessed for quality and risk of bias. Forty-eight articles were included after abstract and full-text review. Synthesis was complicated by variable sensory components of stimuli (taste category and intensity, pure taste vs. flavor, chemesthesis, volume/amount, consistency, temperature), participant characteristics, confounding variables such as genetic taster status, and methods of measurement. Most studies had a high risk of at least one type of bias and were of fair or poor quality. Interpretation is limited by wide variability in methods, taste stimulation, confounding factors, and lower-quality evidence. Existing studies suggest that taste can modulate swallowing, but more rigorous and standardized research is needed.
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Affiliation(s)
- Rachel Mulheren
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ross M Westemeyer
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Angela M Dietsch
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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Yang Y, Xu J, Sang TT, Wang HY. A review and evidence based recommendations on starch- and gum-based thickeners for dysphagic patients. JOURNAL OF FOOD MEASUREMENT AND CHARACTERIZATION 2022. [DOI: 10.1007/s11694-022-01418-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Inamoto Y, Kaneoka A. Swallowing Disorders in the Elderly. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-021-00339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Miles BL, Wu Z, Kennedy KS, Zhao K, Simons CT. Elucidation of a lingual detection mechanism for high-viscosity solutions in humans. Food Funct 2022; 13:64-75. [PMID: 34874045 PMCID: PMC8727634 DOI: 10.1039/d1fo02460d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
While perception of high-viscosity solutions (η > 1000 cP) is speculated to be linked to filiform papillae deformation, this has not been demonstrated psychophysically. Presently, just-noticeable-viscosity-difference thresholds were determined using the forced-choice staircase method and high-viscosity solutions (η = 4798-12260 cP) with the hypotheses that the tongue would be chiefly responsible for viscosity perception in the oral cavity, and that individuals with more, longer, narrower filiform papillae would show a greater acuity for viscosity perception. Subjects (n = 59) evaluated solutions in a normal, "unblocked" condition as well as in a "palate blocked" condition which isolated the tongue so that only perceptual mechanisms on the lingual tissue were engaged. Optical profiling was used to characterize papillary length, diameter, and density in tongue biopsies of a subset (n = 45) of participants. Finally, psychophysical and anatomical data were used to generate a novel model of the tongue surface as porous media to predict papillary deformation as a strain-detector for viscosity perception. Results suggest that viscosity thresholds are governed by filiform papillae features. Indeed, anatomical characterization of filiform papillae suggests sensitivity to high-viscosity solutions is associated with filiform papillae length and density (r = 0.68, p < 0.00001), but not with diameter. Modelling indicated this is likely due to a reciprocal interaction between papillae diameter and fluid shear stress. Papillae with larger diameters would result in higher viscous shear stress due to a narrower gap and stronger fluid-structure interaction, but a larger-diameter papilla would also deform less easily.
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Affiliation(s)
- Brittany L Miles
- Department of Food Science & Technology, The Ohio State University, 2015 Fyffe Rd., Columbus, OH 43210-1007, USA.
| | - Zhenxing Wu
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, 915 Olentangy River Rd., Columbus, OH 43212-3153, USA
| | - Kelly S Kennedy
- Division of Oral & Maxillofacial Surgery and Dental Anesthesiology, The Ohio State University, 305 W. 12th Avenue, Columbus, OH 43210-1267, USA
| | - Kai Zhao
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, 915 Olentangy River Rd., Columbus, OH 43212-3153, USA
| | - Christopher T Simons
- Department of Food Science & Technology, The Ohio State University, 2015 Fyffe Rd., Columbus, OH 43210-1007, USA.
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Garand KL, Beall J, Hill EG, Davidson K, Blair J, Pearson W, Martin-Harris B. Effects of Presbyphagia on Oropharyngeal Swallowing Observed during Modified Barium Swallow Studies. J Nutr Health Aging 2022; 26:973-980. [PMID: 36437764 PMCID: PMC10324474 DOI: 10.1007/s12603-022-1854-0] [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] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Understanding how aging impacts swallowing can help differentiate typical from atypical behaviors. This study aimed to quantify age-related swallowing alterations observed during a modified barium swallow study. DESIGN Cross-sectional study. SETTING Adult fluoroscopy suite in a metropolitan hospital at an academic center. PARTICIPANTS 195 healthy adults distributed across 3 age categories: 21-39; 40-59; 60+ years. MEASUREMENTS 17 physiologic components of swallowing across three functional domains (oral, pharyngeal, esophageal), including summed composite scores (Oral Total [OT] and Pharyngeal Total [PT]), from the validated and standardized Modified Barium Swallow Impairment Profile. RESULTS Most components (65%) demonstrated no impairment (scores of "0"). The odds of a worse (higher) score increased significantly with age for: Tongue Control during Bolus Hold, Hyolaryngeal Movement, Laryngeal Closure, Pharyngeal Contraction, and Pharyngoesophageal Segment Opening. OT and PT scores for 40-59-year-olds were worse than the youngest group (p=.01 and p <.001, respectively). Adults 60+ years had significantly worse PT scores among all groups (p-values <.01). CONCLUSION Oropharyngeal swallowing physiology evolves as healthy adults age and should be considered during clinical decision-making.
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Affiliation(s)
- K L Garand
- Kendrea Garand, University of South Alabama, Mobile, AL, USA,
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11
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KAVAKCI M, TANRİVERDİ M, BARMAK E, KAPAN N. Turkish normative data for the Test of Masticating and Swallowing Solids (TOMASS). CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.840796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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12
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Oral Sensitivity to Flowability and Food Neophobia Drive Food Preferences and Choice. FOODS (BASEL, SWITZERLAND) 2021; 10:foods10051024. [PMID: 34066774 PMCID: PMC8150315 DOI: 10.3390/foods10051024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/13/2021] [Accepted: 05/05/2021] [Indexed: 12/02/2022]
Abstract
The study aimed to investigate the role of sensitivity to flowability on food liking and choice, the relationship between sensitivity to flowability and food neophobia, and its role in food liking. Five chocolate creams were prepared with different levels of flowability, and rheological measurements were performed to characterise them. One hundred seventy-six subjects filled in the Food Neophobia Scale and a food choice questionnaire (FCq). The FCq was developed to evaluate preferences within a pair of food items similar in flavour but different in texture. Secondly, the subjects evaluated their liking for creams (labelled affective magnitude (LAM) scale) and the flowability intensity (generalised labelled magnitude (gLM) scale). The subjects were clustered into three groups of sensitivity and two groups of choice preference. The effect of individual flowability sensitivity on food choice was investigated. Finally, the subjects were clustered into two groups according to their food neophobia level. The sensitivity to flowability significantly affected the liking of chocolate creams and the solid food choice. The liking of chocolate creams was also affected by the individual level of neophobia (p = 0.01), which, in turn, was not correlated to flowability sensitivity. These results confirm that texture sensitivity and food neophobia affect what a person likes and drives what a person chooses to eat.
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Abstract
The global population of 80 years and older is predicted to reach 437
million by 2050. As overall brain structure and function progressively degrades,
older and younger adults show differences in sensorimotor performance and brain
activity in the sensorimotor regions. Oral sensorimotor functions are an
important area of focus in natural aging and Alzheimer’s Disease (AD)
because oral health issues are commonly found in both elderly and AD
populations. While human behavioral studies on changes in oral sensorimotor
functions abound, very little is known about their neuronal correlates in normal
and pathological aging.
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14
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Nakatomi C, Yoshino K, Shono Y, Miyamura Y, Hitomi S, Ujihara I, Ono K. The effect of flavor on the oral perception and palatability of viscosity in healthy human subjects. J Oral Biosci 2021; 63:91-96. [PMID: 33524608 DOI: 10.1016/j.job.2021.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Thickeners are frequently used in various foods, including ice cream and sauces, to impart viscosity. Generally, viscous foods have some flavor (smell and taste). In this study, we examined the effects of flavor on the oral perception and palatability of viscosity in humans. METHODS Viscous fluids were prepared by adding the commercial thickener Tsururinko® (0.5 and 3.0%) to water and apple juice, which were used as the control and flavor fluids, respectively. The viscosity and palatability perception of the test fluids were evaluated in nine healthy volunteers using a visual analog scale. In the other seven volunteers, fluid viscosities were measured before and after spitting following retention in the mouth for 5 s to investigate the dilution of viscous fluids by flavor-stimulated saliva. RESULTS With 1.5% Tsururinko®, there was no difference between the physical viscosity of water and apple juice, but the perceived viscosity of apple juice was significantly lower than that of water. With 3.0% Tsururinko®, the viscosity of apple juice was significantly higher than that of water, but the perceived viscosities did not differ significantly. The addition of Tsururinko® reduced palatability in water in a dose-dependent manner. Apple juice suppressed this Tsururinko®-induced reduction. The reduction in viscosity after spitting was significantly larger in apple juice than in water. CONCLUSION Our results suggest that a favorable flavor reduces the perception of oral viscosity, which is due to mixing with stimulated saliva, and suppresses the unpalatability of thickeners.
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Affiliation(s)
- Chihiro Nakatomi
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Kenichi Yoshino
- Section of Primary Dental Education, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Yukine Shono
- Section of Primary Dental Education, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Yuichi Miyamura
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Suzuro Hitomi
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Izumi Ujihara
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Kentaro Ono
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan.
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15
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Groher ME. Normal Swallowing in Adults. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Norton V, Lignou S, Bull SP, Gosney MA, Methven L. An Investigation of the Influence of Age and Saliva Flow on the Oral Retention of Whey Protein and Its Potential Effect on the Perception and Acceptance of Whey Protein Beverages. Nutrients 2020; 12:E2506. [PMID: 32825104 PMCID: PMC7551043 DOI: 10.3390/nu12092506] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022] Open
Abstract
Protein fortified products are regularly recommended to older adults to improve nutritional status and limit sarcopenia. However protein fortification can elicit negative sensory attributes such as mouthdrying. Sensitivity to mouthdrying can increase with age, yet the influence of saliva flow and mucoadhesion remain uncertain. Here, two studies tested different whey protein beverages (WPB); 22 healthy younger volunteers completed a pilot and 84 healthy volunteers from two age groups (18-30; 65+) completed the main study. In both studies salivary flow rates (mL/min) were measured and saliva samples were collected at time intervals post beverage consumption to measure mucoadhesion to the oral cavity, where protein concentration was analysed by Bradford Assay. Volunteers rated perception and acceptability of WPBs in the main study. WPB consumption resulted in significantly increased protein concentration (p < 0.0001) in saliva samples compared with a control whey permeate beverage. Older adults had significantly lower unstimulated saliva flow (p = 0.003) and significantly increased protein concentration (p = 0.02) in saliva samples, compared with younger adults. Heating of WPB significantly (p < 0.05) increased mouthdrying and thickness perception and reduced sweetness compared with unheated WPB. Mucoadhesion is concluded to be a true phenomenon in WPBs and increases with age.
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Affiliation(s)
- Victoria Norton
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, Berkshire RG6 6AD, UK; (V.N.); (S.L.); (S.P.B.)
| | - Stella Lignou
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, Berkshire RG6 6AD, UK; (V.N.); (S.L.); (S.P.B.)
| | - Stephanie P. Bull
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, Berkshire RG6 6AD, UK; (V.N.); (S.L.); (S.P.B.)
| | - Margot A. Gosney
- Royal Berkshire NHS Foundation Trust, London Road, Reading RG1 5AN, UK;
| | - Lisa Methven
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, Berkshire RG6 6AD, UK; (V.N.); (S.L.); (S.P.B.)
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Bourdiol P, Hennequin M, Peyron MA, Woda A. Masticatory Adaptation to Occlusal Changes. Front Physiol 2020; 11:263. [PMID: 32317982 PMCID: PMC7147355 DOI: 10.3389/fphys.2020.00263] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/09/2020] [Indexed: 12/17/2022] Open
Abstract
This review deals with the frequent wide variability of masticatory capacity/incapacity. Neither researchers nor clinicians have taken sufficient account of this variability despite its implications for nutrition. Mastication in normal healthy oral conditions is first described, followed by a short presentation of the mechanisms of masticatory adaptation in the nervous system. Capacity, incapacity, and successful compensatory adaptation of mastication are then defined, along with the different methods used for their evaluation. Examples of adaptation needs are given, such as those concomitant with dental wear or occlusal changes. Finally, given its vital importance for deeply impaired mastication/deglutition function, the impact of masticatory adaptation processes on nutrition is examined.
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Affiliation(s)
- Pierre Bourdiol
- CROC EA 4847, Faculty of Dentistry, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Martine Hennequin
- CROC EA 4847, Faculty of Dentistry, Université Clermont Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Agnes Peyron
- Human Nutrition Unit, Institut National de la Recherche Agronomique, Paris, France
| | - Alain Woda
- CROC EA 4847, Faculty of Dentistry, Université Clermont Auvergne, Clermont-Ferrand, France
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Regan E, O'Neill GJ, Hutchings SC, O'Riordan D. Exploring how age influences sensory perception, thirst and hunger during the consumption of oral nutritional supplements using the check-all-that-apply methodology. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2019.103736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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19
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Martínez O, Vicente M, De Vega M, Salmerón J. Sensory perception and flow properties of dysphagia thickening formulas with different composition. Food Hydrocoll 2019. [DOI: 10.1016/j.foodhyd.2018.12.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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20
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Affiliation(s)
- Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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21
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Humbert IA, Sunday KL, Karagiorgos E, Vose AK, Gould F, Greene L, Azola A, Tolar A, Rivet A. Swallowing Kinematic Differences Across Frozen, Mixed, and Ultrathin Liquid Boluses in Healthy Adults: Age, Sex, and Normal Variability. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:1544-1559. [PMID: 29800050 PMCID: PMC6195055 DOI: 10.1044/2018_jslhr-s-17-0417] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/09/2018] [Indexed: 05/04/2023]
Abstract
PURPOSE The aim of this study was to examine the effects of frozen and mixed-consistency boluses on the swallowing physiology of younger and older adults. We also aimed to quantify factors that lead to increased variability in swallowing outcomes (i.e., age, sex, bolus type). METHOD Forty-one healthy adults (18-85 years old) swallowed 5 blocks of 5 different boluses: 10-ml ultrathin liquid, a teaspoon of iced barium, a teaspoon of room-temperature pudding, a teaspoon of frozen pudding, and ultrathin barium with chocolate chips. All data were recorded with videofluoroscopy and underwent detailed timing kinematic measurements. RESULTS Neither barium ice nor frozen pudding sped up swallow responses. Many healthy adults initiated swallowing with the bolus as deep as the pyriform sinuses. Swallowing temporal kinematics for ultrathin liquid consistencies are most different from all others tested, requiring the best possible physiological swallowing performance in younger and older healthy individuals (i.e., faster reaction times, longer durations) compared with other bolus types tested. In each measure, older adults had significantly longer durations compared with the younger adults. More variability in swallowing kinematics were seen with age and laryngeal vestibule kinematics. CONCLUSION This study provides important contributions to the literature by clarifying normal variability within a wide range of swallowing behaviors and by providing normative data from which to compare disordered populations.
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Affiliation(s)
- Ianessa A. Humbert
- Swallowing Systems Core, Department of Speech, Language, Hearing Sciences, University of Florida, Gainesville
- Department of Neurology, University of Florida, Gainesville
- Rehabilitation Sciences, College of Health and Health Professions, University of Florida, Gainesville
| | - Kirstyn L. Sunday
- Swallowing Systems Core, Department of Speech, Language, Hearing Sciences, University of Florida, Gainesville
| | - Eleni Karagiorgos
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Alicia K. Vose
- Department of Neurology, University of Florida, Gainesville
- Rehabilitation Sciences, College of Health and Health Professions, University of Florida, Gainesville
| | - Francois Gould
- Department of Anatomy and Neurobiology, North East Ohio Medical University, Akron
| | - Lindsey Greene
- Swallowing Systems Core, Department of Speech, Language, Hearing Sciences, University of Florida, Gainesville
| | - Alba Azola
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
| | - Ara Tolar
- Swallowing Systems Core, Department of Speech, Language, Hearing Sciences, University of Florida, Gainesville
| | - Alycia Rivet
- Swallowing Systems Core, Department of Speech, Language, Hearing Sciences, University of Florida, Gainesville
- Rehabilitation Sciences, College of Health and Health Professions, University of Florida, Gainesville
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22
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Ong JJX, Steele CM, Duizer LM. Challenges to assumptions regarding oral shear rate during oral processing and swallowing based on sensory testing with thickened liquids. Food Hydrocoll 2018; 84:173-180. [PMID: 30745713 DOI: 10.1016/j.foodhyd.2018.05.043] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
For people with dysphagia, or difficulty swallowing, thickened liquids are used to slow bolus flow to make them easier to control. For these liquids, the oral shear rate of 50 s-1 has been adopted as the standard at which viscosity measurements are taken. However, there is evidence to suggest that other shear rates may be more appropriate to model the processes in the mouth and throat. This research compared the sensory and rheological properties of xanthan gum, guar gum, and carboxymethyl cellulose thickened liquids that had been matched for apparent viscosity at 50 s-1 to assess the validity of the current shear rate standard. Properties of gums were observed at various viscosity levels based on the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. Textural sensory characteristics of samples were quantified using magnitude estimation scaling and a trained descriptive panel, while rheological measurements were taken at shear rates of 1 to 1000 s-1. Perceived slipperiness of the gums was found to be driven by thickness level at low viscosity levels, but affected by the shear thinning behavior of the gums at higher viscosity levels. Although the liquids had been matched for apparent viscosity at 50 s-1, panelists could distinguish both the perceived viscosities of the gums and their ease of swallowing, suggesting that 50 s-1 is neither appropriate to model the oral nor pharyngeal shear rates. A single oral shear rate could not be predicted from the data, and it is proposed that panelists evaluated oral viscosity using different methods at different viscosity levels. Based on the sensory data, the pharyngeal shear rate during swallowing appears to lie above 50 s-1.
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Affiliation(s)
- Jane Jun-Xin Ong
- Department of Food Science, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada. ;
| | - Catriona M Steele
- Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Lisa M Duizer
- Department of Food Science, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada. ;
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23
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McCoy YM, Varindani Desai R. Presbyphagia Versus Dysphagia: Identifying Age-Related Changes in Swallow Function. ACTA ACUST UNITED AC 2018. [DOI: 10.1044/persp3.sig15.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yvette M. McCoy
- Speak Well Solutions, LLC, Speech Pathology
Leonardtown, MD
- MedStar NRH Rehabilitation Network
Brandywine, MD
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24
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Peyron MA, Woda A, Bourdiol P, Hennequin M. Age-related changes in mastication. J Oral Rehabil 2017; 44:299-312. [DOI: 10.1111/joor.12478] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/26/2022]
Affiliation(s)
- M. A. Peyron
- Human Nutrition Unit; Institut National de la Recherche Agronomique; Saint Genès-Champanelle France
| | - A. Woda
- Université Clermont Auvergne, CROC; Clermont-Ferrand France
| | - P. Bourdiol
- Université Clermont Auvergne, CROC; Clermont-Ferrand France
| | - M. Hennequin
- Université Clermont Auvergne, CROC; Clermont-Ferrand France
- CHU Clermont-Ferrand; Clermont-Ferrand France
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25
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Gallegos C, Brito-de la Fuente E, Clavé P, Costa A, Assegehegn G. Nutritional Aspects of Dysphagia Management. ADVANCES IN FOOD AND NUTRITION RESEARCH 2016; 81:271-318. [PMID: 28317607 DOI: 10.1016/bs.afnr.2016.11.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This chapter describes the nutritional aspects of dysphagia management by starting with the definition of these two conditions (dysphagia and malnutrition) that share three main clinical characteristics: (a) their prevalence is very high, (b) they can lead to severe complications, and (c) they are frequently underrecognized and neglected conditions. From an anatomical standpoint, dysphagia can result from oropharyngeal and/or esophageal causes; from a pathophysiological perspective, dysphagia can be caused by organic or structural diseases (either benign or malignant) or diseases causing impaired physiology (mainly motility and/or perception disorders). This chapter gathers up-to-date information on the screening and diagnosis of oropharyngeal dysphagia, the consequences of dysphagia (aspiration pneumonia, malnutrition, and dehydration), and on the nutritional management of dysphagic patients. Concerning this last topic, this chapter reviews the rheological aspects of swallowing and dysphagia (including shear and elongational flows) and its influence on the characteristics of the enteral nutrition for dysphagia management (solid/semisolid foods and thickened liquids; ready-to-use oral nutritional supplements and thickening powders), with special focus on the real characteristics of the bolus after mixing with human saliva.
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Affiliation(s)
- C Gallegos
- I&D Centre Complex Formulations and Processing Technologies, Fresenius Kabi Deutschland GmbH, Bad Homburg, Germany.
| | - E Brito-de la Fuente
- I&D Centre Complex Formulations and Processing Technologies, Fresenius Kabi Deutschland GmbH, Bad Homburg, Germany
| | - P Clavé
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Barcelona, Spain
| | - A Costa
- Dysphagia Unit, Universitat de Barcelona, Hospital de Mataró, Mataró, Barcelona, Spain
| | - G Assegehegn
- I&D Centre Complex Formulations and Processing Technologies, Fresenius Kabi Deutschland GmbH, Bad Homburg, Germany
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26
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Groher ME. Normal Swallowing in Adults. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Abstract
The effect of food consistency on swallowing function has been widely studied, and it is well recognized that by delaying the flow of the food bolus, thickened liquids can help in the management of swallowing dysfunction. However, fewer studies have been carried out on the impact of food sensory properties and related liking on swallowing function. This paper reviews the role of taste, olfaction, and trigeminal perceptions on swallowing function and highlights the need for a deeper investigation of this aspect of patient diet modification.
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Affiliation(s)
- C Loret
- a Nestlé Research Center , P.O. Box 44, Vers-Chez-Les-Blancs, CH-1000 Lausanne 26, Switzerland
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28
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Swallowing Tablets and Capsules Increases the Risk of Penetration and Aspiration in Patients with Stroke-Induced Dysphagia. Dysphagia 2015. [DOI: 10.1007/s00455-015-9639-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Harding C, Cockerill H. Managing eating and drinking difficulties (dysphagia) with children who have learning disabilities: What is effective? Clin Child Psychol Psychiatry 2015; 20:395-405. [PMID: 24414040 DOI: 10.1177/1359104513516650] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People who work with children who have neurological and learning disabilities frequently need to manage the health and emotional risks associated with eating, drinking and swallowing (dysphagia). Some approaches can support children to develop oral feeding competence or to maximise their ability to maintain some oral intake supplemented with tube feeding. However, some clinicians feel that oral-motor exercises can support eating and drinking skills as well as speech and language development, whereas there is little evidence to support this.The implied "beneficial" association between oral-motor exercises, speech and swallowing skills gives a false impression in terms of future outcomes for parents and carers of children with learning disabilities. This paper considers oral-motor approaches in the remediation of dysphagia and the need for a cultural shift away from this view. Realistic and useful outcomes for people with learning disabilities need to be an essential part of therapeutic intervention.
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Affiliation(s)
- Celia Harding
- City University, London and the Royal Free Hospital, London
| | - Helen Cockerill
- Evelina Children's Hospital, London, Guy's and St. Thomas's NHS Foundation Trust, London
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30
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Rémond D, Shahar DR, Gille D, Pinto P, Kachal J, Peyron MA, Dos Santos CN, Walther B, Bordoni A, Dupont D, Tomás-Cobos L, Vergères G. Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition. Oncotarget 2015; 6:13858-98. [PMID: 26091351 PMCID: PMC4546438 DOI: 10.18632/oncotarget.4030] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/13/2015] [Indexed: 12/11/2022] Open
Abstract
Although the prevalence of malnutrition in the old age is increasing worldwide a synthetic understanding of the impact of aging on the intake, digestion, and absorption of nutrients is still lacking. This review article aims at filling the gap in knowledge between the functional decline of the aging gastrointestinal tract (GIT) and the consequences of malnutrition on the health status of elderly. Changes in the aging GIT include the mechanical disintegration of food, gastrointestinal motor function, food transit, chemical food digestion, and functionality of the intestinal wall. These alterations progressively decrease the ability of the GIT to provide the aging organism with adequate levels of nutrients, what contributes to the development of malnutrition. Malnutrition, in turn, increases the risks for the development of a range of pathologies associated with most organ systems, in particular the nervous-, muscoskeletal-, cardiovascular-, immune-, and skin systems. In addition to psychological, economics, and societal factors, dietary solutions preventing malnutrition should thus propose dietary guidelines and food products that integrate knowledge on the functionality of the aging GIT and the nutritional status of the elderly. Achieving this goal will request the identification, validation, and correlative analysis of biomarkers of food intake, nutrient bioavailability, and malnutrition.
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Affiliation(s)
- Didier Rémond
- UMR 1019, UNH, CRNH Auvergne, INRA, 63000 Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, 63000 Clermont-Ferrand, France
| | - Danit R. Shahar
- Department of Public Health, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel
| | - Doreen Gille
- Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland
| | - Paula Pinto
- Escola Superior Agrária, Insituto Politécnico de Santarém, 2001-904 Santarem, Portugal
- Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal
| | | | - Marie-Agnès Peyron
- UMR 1019, UNH, CRNH Auvergne, INRA, 63000 Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, 63000 Clermont-Ferrand, France
| | - Claudia Nunes Dos Santos
- Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal
- Instituto de Biologia Experimental e Tecnológica, 2780-157 Oeiras, Portugal
| | - Barbara Walther
- Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland
| | - Alessandra Bordoni
- Department of Agri-Food Sciences and Technologies, University of Bologna, 47521 Cesena, Italy
| | - Didier Dupont
- UMR 1253, Science et Technologie du Lait & de l'Œuf, INRA, 35000 Rennes, France
| | | | - Guy Vergères
- Institute for Food Sciences IFS, Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Berne, Switzerland
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31
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Kamarunas E, McCullough GH, Mennemeier M, Munn T. Oral perception of liquid volume changes with age. J Oral Rehabil 2015; 42:657-62. [PMID: 25966827 DOI: 10.1111/joor.12305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2015] [Indexed: 11/29/2022]
Abstract
Bolus volume has been widely studied, and research has demonstrated a variety of physiological impacts on swallowing and swallowing disorders. Oral perception of bolus volume has not, to our knowledge, been investigated in association with normal ageing processes. Research suggests many sensory changes with age, some within the oral cavity, and changes in swallowing function with age have been defined. The role of perception in oropharyngeal deglutition with age requires further investigation. The purpose of this study was to establish the psychophysical relationship between liquid volume and oral perception and examine changes with age. Healthy young and older adults were prospectively assessed using a magnitude estimation task differentiating five volumes of water delivered randomly to the oral cavity. Results suggest a fourfold increase in liquid volume is required by older participants to perceive an approximate twofold increase in the perception of volume compared with younger healthy adults. Sensory receptors in the oral cavity provide a feedback loop that modulates the swallowing motor response so that it is optimal for the size and consistency of the bolus. Changes in perception of bolus volume with age are consistent with other perceptual changes and may provide valuable information regarding sensorineural rehabilitation strategies in the future.
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Affiliation(s)
- E Kamarunas
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA
| | - G H McCullough
- College of Health Sciences, Appalachian State University, Boone, NC, USA
| | - M Mennemeier
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - T Munn
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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32
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Steele CM. The Blind Scientists and the Elephant of Swallowing: A Review of Instrumental Perspectives on Swallowing Physiology. J Texture Stud 2014. [DOI: 10.1111/jtxs.12101] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory; Toronto Rehabilitation Institute; University Health Network; 550 University Avenue Toronto Ontario M5G 2A2
- Department of Speech-Language Pathology; University of Toronto; Toronto Canada
- Graduate Department of Rehabilitation Sciences; University of Toronto; Toronto Canada
- Institute of Biomaterials and Biomedical Engineering; University of Toronto; Toronto Canada
- Bloorview Research Institute; Toronto Canada. International Dysphagia Diet Standardisation Initiative Foundation Committee; Brisbane Australia
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33
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The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia 2014; 30:2-26. [PMID: 25343878 PMCID: PMC4342510 DOI: 10.1007/s00455-014-9578-x] [Citation(s) in RCA: 310] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/10/2014] [Indexed: 10/28/2022]
Abstract
Texture modification has become one of the most common forms of intervention for dysphagia, and is widely considered important for promoting safe and efficient swallowing. However, to date, there is no single convention with respect to the terminology used to describe levels of liquid thickening or food texture modification for clinical use. As a first step toward building a common taxonomy, a systematic review was undertaken to identify empirical evidence describing the impact of liquid consistency and food texture on swallowing behavior. A multi-engine search yielded 10,147 non-duplicate articles, which were screened for relevance. A team of ten international researchers collaborated to conduct full-text reviews for 488 of these articles, which met the study inclusion criteria. Of these, 36 articles were found to contain specific information comparing oral processing or swallowing behaviors for at least two liquid consistencies or food textures. Qualitative synthesis revealed two key trends with respect to the impact of thickening liquids on swallowing: thicker liquids reduce the risk of penetration-aspiration, but also increase the risk of post-swallow residue in the pharynx. The literature was insufficient to support the delineation of specific viscosity boundaries or other quantifiable material properties related to these clinical outcomes. With respect to food texture, the literature pointed to properties of hardness, cohesiveness, and slipperiness as being relevant both for physiological behaviors and bolus flow patterns. The literature suggests a need to classify food and fluid behavior in the context of the physiological processes involved in oral transport and flow initiation.
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34
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Bergmann Tiest WM. Tactual perception of liquid material properties. Vision Res 2014; 109:178-84. [PMID: 25128819 DOI: 10.1016/j.visres.2014.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 12/22/2022]
Abstract
In this paper, studies into the tactual perception of two liquid material properties, viscosity and wetness, are reviewed. These properties are very relevant in the context of interaction with liquids, both real, such as cosmetics or food products, and simulated, as in virtual reality or teleoperation. Both properties have been the subject of psychophysical characterisation in terms of magnitude estimation experiments and discrimination experiments, which are discussed. For viscosity, both oral and manual perception is discussed, as well as the perception of the viscosity of a mechanical system. For wetness, the relevant cues are identified and factors affecting perception are discussed. Finally, some conclusions are drawn pertaining to both properties.
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Affiliation(s)
- Wouter M Bergmann Tiest
- MOVE Research Institute, VU University Amsterdam, The Netherlands; Institut des Systèmes Intelligents et de Robotique, Université Pierre et Marie Curie, Paris, France.
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35
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Variations in tongue-palate swallowing pressures when swallowing xanthan gum-thickened liquids. Dysphagia 2014; 29:678-84. [PMID: 25087111 PMCID: PMC4247849 DOI: 10.1007/s00455-014-9561-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/11/2014] [Indexed: 11/06/2022]
Abstract
Thickened liquids are frequently recommended to reduce the risk of aspiration in patients with oropharyngeal dysphagia. Although it has previously been reported that tongue-palate pressures increase when swallowing spoon-thick and semi-solid consistencies compared to thin liquids, relatively little is known about how swallowing behaviors differ when swallowing liquids of nectar- or honey-thick consistency. Furthermore, previous studies have primarily used starch-based thickeners, and little is known about swallowing behaviors with xanthan gum-thickened liquids, which have recently been introduced for dysphagia management. In this study, we measured variations in tongue-palate pressures during the swallowing of liquids thickened to apparent viscosities of 190, 250, and 380 mPa s at 50/s using increasing concentrations of xanthan gum (0.5, 0.63 and 0.87 w/w%). The viscosity differences between these nectar- and honey-thick stimuli were confirmed to exceed sensory perceptual discrimination thresholds. Data were collected from 78 healthy adults in two sex-balanced age-groups (young; mature) and compared to reference values obtained during water swallowing. The results confirm that increased amplitudes of tongue-palate pressure were used when swallowing the thickened liquid stimuli, compared to swallows of water, and for the honey-thick liquid compared to the two nectar-thick liquids. Age-related reductions were seen in tongue strength but not in swallowing pressures, which fell below 40 % of maximum isometric pressure values. Thus, the use of xanthan gum-thickened liquids is unlikely to tax the swallowing system in terms of tongue pressure generation requirements, even in seniors with reduced maximum isometric tongue pressure measures.
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36
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Steele CM, Hill L, Stokely S, Peladeau-Pigeon M. Age and strength influences on lingual tactile acuity. J Texture Stud 2014; 45:317-323. [PMID: 25663715 DOI: 10.1111/jtxs.12076] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sensory function during the oral processing of liquids is thought to play a key role in informing the tailoring of swallowing motor behaviours to the flow characteristics of the bolus. In addition to taste receptors, the mouth and tongue house trigeminal nerve receptors that support the sensory detection of bolus size, shape (stereognosis), mass, temperature and movement. Recent studies suggest that healthy adults lose tongue strength with advancing age. However, little is known about changes in the sensory function of the tongue attributable to age, or associated with reductions in strength. In this study, we explored lingual tactile acuity in healthy young and older adults, and measured the relationship between tactile acuity and measures of tongue strength. The results showed an age-related reduction in lingual tactile acuity that was not explained by variations in tongue strength. PRACTICAL APPLICATIONS Sensory motor interactions are a topic of interest in understanding the processing activities that take place in the mouth during eating and swallowing. In this paper, we explore a test of sensory acuity in the mouth, in which the tongue is used to "read" embossed letters on Teflon strips. Our questions were to determine whether sensory acuity for this task declines with age, or with age-related reductions in tongue strength. We determined that older people perform this task with less accuracy, suggesting some changes in oral sensory function with age. However, these changes were not related to tongue strength. The findings suggest that strength does not play a major role in the kind of sensory discrimination task tested in this study.
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Affiliation(s)
- Catriona M Steele
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada ; University of Toronto, Toronto, Canada ; Bloorview Research Institute - Holland Bloorview Kids Rehab Hospital, Toronto, Canada
| | - Lisa Hill
- University of Kentucky, Lexington, KY
| | - Shauna Stokely
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
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37
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Abstract
Normal oropharyngeal swallowing is a complex set of neuromotor behaviors containing three phases: 1) Oral preparation to break food down to a swallowable consistency; 2) Oral phase which propels food from the mouth; 3) Pharyngeal phase creates pressure to push food into the esophagus, and includes valve functions which prevent food from entering the nose or airway and allow food into the esophagus. Systematic changes in normal oropharyngeal swallow are based on volume, viscosity, and taste of the food swallowed as well as age. Patients with oropharyngeal swallowing difficulties (dysphagia) react differently to these systematic variables in food characteristics. This review manuscript presents the results of a series of studies that examine the role of each of the stages of the nonoral orpharyngeal swallow. The importance of the definition of food viscosity in the care of dysphagic patients and the role of food production companies in this effort are emphasized.
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Affiliation(s)
- Jerilyn A. Logemann
- Ralph and Jean Sundin Professor, Communication Sciences and Disorders, Northwestern University, 2240 Campus Dr, Evanston Illinois 60208-3570, U.S.A., Phone: (847) 491-2490, Fax: (847) 491-5692
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38
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Steele CM, James DF, Hori S, Polacco RC, Yee C. Oral perceptual discrimination of viscosity differences for non-newtonian liquids in the nectar- and honey-thick ranges. Dysphagia 2014; 29:355-64. [PMID: 24682333 PMCID: PMC4062812 DOI: 10.1007/s00455-014-9518-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 02/07/2014] [Indexed: 12/01/2022]
Abstract
Thickened liquids are frequently used in the management of oropharyngeal dysphagia. Previous studies suggest that compression of a liquid bolus between the tongue and the palate in the oral phase of swallowing serves a sensory function, enabling the tuning of motor behavior to match the viscosity of the bolus. However, the field lacks information regarding healthy oral sensory discrimination ability for small differences in liquid viscosity. We undertook to measure oral viscosity discrimination ability for five non-Newtonian xanthan gum-thickened liquids in the nectar- and honey-thick range. Xanthan gum concentration ranged from 0.5 to 0.87 % and increased by an average of 0.1 % between stimuli in the array. This translated to an average apparent viscosity increase of 0.2-fold between adjacent stimuli at 50 reciprocal seconds (/s). A triangle test paradigm was used to study stimulus discrimination in 78 healthy adults in two, sex-balanced age cohorts. Participants were provided 5-ml samples of liquids in sets of three; one liquid differed in xanthan gum concentration from the other two. Participants were required to sample the liquid orally and indicate which sample was perceived to have a different viscosity. A protocol of 20 sets (60 samples) allowed calculation of the minimum difference in xanthan gum concentration detected accurately. On average, participants were able to accurately detect a 0.38-fold increase in xanthan-gum concentration, translating to a 0.67-fold increase in apparent viscosity at 50/s. The data did not suggest the existence of a nonlinear point boundary in apparent viscosity within the range tested. No differences in viscosity discrimination were found between age cohorts or as a function of sex. The data suggest that for xanthan gum-thickened liquids, there may be several increments of detectably different viscosity within the ranges currently proposed for nectar- and honey-thick liquids. If physiological or functional differences in swallowing can be demonstrated for these smaller increments of detectably different viscosity, more narrowly defined categories of thickened liquids for dysphagia management will be warranted.
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Affiliation(s)
- Catriona M Steele
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, #12-101, Toronto, ON, M5G 2A2, Canada,
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Withers CA, Lewis MJ, Gosney MA, Methven L. Potential sources of mouth drying in beverages fortified with dairy proteins: A comparison of casein- and whey-rich ingredients. J Dairy Sci 2014; 97:1233-47. [PMID: 24440265 DOI: 10.3168/jds.2013-7273] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 11/15/2013] [Indexed: 11/19/2022]
Abstract
Oral nutritional supplement drinks (ONS) are beverages high in dairy proteins that are prescribed to individuals at risk of malnutrition. Consumption of ONS is poor in elderly care facilities, with patients commenting that the sensory attributes of these drinks reduce their enjoyment and willingness to consume. Mouth drying is an attribute of ONS found to build with repeated consumption, which may further limit liking of these products. This study investigated the sources of drying sensations by sequential profiling, with a trained sensory panel rating a range of model milk systems and ONS over repeated sips and during after-effects. Sequential profiling found that fortification of milk with both caseinate and whey protein concentrate significantly increased the perception of mouth drying over repeated consumption, increasing by between 35 and 85% over consumption of 40mL. Enrichment of ONS with either whey protein concentrate or milk protein concentrate to a total protein content of 8.7% (wt/wt) resulted in whey and casein levels of 4.3:4.4% and 1.7:7.0% respectively. The product higher in whey protein was substantially more mouth drying, implying that whey proteins may be the most important contributor to mouth drying in ONS. However, efforts to mask mouth drying of protein-fortified milk by increasing sweetness or fat level were unsuccessful at the levels tested. Increasing the viscosity of protein-fortified milk led to a small but significant reduction in mouth drying. However, this approach was not successful when tested within complete ONS. Further analysis is required into the mechanism of protein-derived mouth drying to mask negative sensations and improve the enjoyment and consumption of protein-rich ONS.
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Affiliation(s)
- C A Withers
- Department of Food and Nutritional Sciences, University of Reading, Reading, RG6 6AP, United Kingdom
| | - M J Lewis
- Department of Food and Nutritional Sciences, University of Reading, Reading, RG6 6AP, United Kingdom
| | - M A Gosney
- Clinical Health Sciences, University of Reading, Reading, RG1 5AQ, United Kingdom; The Royal Berkshire NHS Trust, Reading, RG1 5AN, United Kingdom
| | - L Methven
- Department of Food and Nutritional Sciences, University of Reading, Reading, RG6 6AP, United Kingdom.
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Macrae P, Humbert I. Exploiting Experience-Dependent Plasticity in Dysphagia Rehabilitation: Current Evidence and Future Directions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Morishita M, Mori S, Yamagami S, Mizutani M. Effect of Carbonated Beverages on Pharyngeal Swallowing in Young Individuals and Elderly Inpatients. Dysphagia 2013; 29:213-22. [DOI: 10.1007/s00455-013-9493-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 09/25/2013] [Indexed: 11/25/2022]
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Smith CH, Boland B, Daureeawoo Y, Donaldson E, Small K, Tuomainen J. Effect of aging on stimulated salivary flow in adults. J Am Geriatr Soc 2013; 61:805-8. [PMID: 23617733 DOI: 10.1111/jgs.12219] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The literature on the effect of age on saliva production, which has implications for health, quality of life, differential diagnosis, and case management, remains inconclusive. Physiological changes, motor and sensory, are frequently reported with increasing age. It was hypothesized that there would be a change in saliva production with older age. Whole stimulated saliva was collected by asking participants to chew gauze for 1 minute and then comparing the weight of saliva produced according to age and sex. Data were collected in activity centers for older adults, workplaces, universities, and participants' homes. Five hundred forty healthy individuals (aged 20-97) in three age groups (young = 20-30; middle-aged = 40-50; older ≥ 70) participated (90 men and 90 women in each group). A decrement in saliva production was identified for age in that the young and older participants and the middle-aged and older participants differed significantly from each other, but no difference was found between the young and middle-aged participants. The main effect of sex was not significant, nor was the interaction of age and sex. The results have implications for research and clinical work, including the differential diagnosis and subsequent management of salivary flow impairment due to age or underlying medical diagnosis or treatment. The assessment tool is easily administered and inexpensive and lends itself to use in many different clinical and research settings by different professionals.
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Affiliation(s)
- Christina H Smith
- Division of Psychology and Language Sciences, University College London, London, UK.
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Withers C, Gosney MA, Methven L. Perception of Thickness, Mouth Coating and Mouth Drying of Dairy Beverages by Younger and Older Volunteers. J SENS STUD 2013. [DOI: 10.1111/joss.12039] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Caroline Withers
- Department of Food and Nutritional Sciences; University of Reading; Reading RG6 6AP UK
| | - Margot A. Gosney
- Clinical Health Sciences; University of Reading; Reading UK
- The Royal Berkshire NHS Foundation Trust; Reading UK
| | - Lisa Methven
- Department of Food and Nutritional Sciences; University of Reading; Reading RG6 6AP UK
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Matching the rheological properties of videofluoroscopic contrast agents and thickened liquid prescriptions. Dysphagia 2013; 28:245-52. [PMID: 23407897 PMCID: PMC3669507 DOI: 10.1007/s00455-012-9441-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 12/10/2012] [Indexed: 11/01/2022]
Abstract
In the treatment of oropharyngeal dysphagia, the link between diagnosis and prescription of thickened liquids that are safe to swallow is not always straightforward. Frequently, the capacity to objectively assess and quantify the rheological properties of diagnostic test fluids and to select "rheologically equivalent" dietary products is missing. Perhaps sometimes the importance of an objective comparison is not fully appreciated because two liquids seem reasonably similar in a subjective comparison (e.g., flow from a spoon). The present study deals with some of these issues. Shear viscosity measurements were used to characterize the flow behavior of videofluoroscopic contrast agents and of thickened fluids prepared with commercial thickening agents. Effects of time and composition of the different fluids were analyzed regarding shear-rate-dependent viscosity. Nearly all materials tested showed a pronounced dependence of viscosity with shear rate ("shear thinning"). Results confirm that it is feasible (but not always straightforward) to "match" the viscosities of diagnostic fluids and thickened beverages if certain precautions are taken. For example, the time required to reach final viscosity levels can be significant for some thickeners, particularly when used with liquids containing contrast agents. It is recommend to use only diagnostic materials and thickening agents for which reliable viscosity data are available.
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Schiele JT, Quinzler R, Klimm HD, Pruszydlo MG, Haefeli WE. Difficulties swallowing solid oral dosage forms in a general practice population: prevalence, causes, and relationship to dosage forms. Eur J Clin Pharmacol 2012; 69:937-48. [DOI: 10.1007/s00228-012-1417-0] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 09/19/2012] [Indexed: 11/28/2022]
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Van Lieshout PHHM, Steele CM, Lang AE. Tongue control for swallowing in Parkinson's disease: effects of age, rate, and stimulus consistency. Mov Disord 2011; 26:1725-9. [PMID: 21542018 DOI: 10.1002/mds.23690] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 01/14/2011] [Accepted: 01/31/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patients with Parkinson's disease often suffer from swallowing problems, especially at more advanced stages of the disease. Efficient swallows require well-coordinated tongue movements during bolus flow, but little is known about such movements in Parkinson's disease. METHODS The current study presents data on tongue movements for patients with mild to moderate Parkinson's disease (n=10), age-matched adults (n=13), and younger healthy adults (n=15). RESULTS Participants with Parkinson's disease showed smaller and more variable movements in the horizontal movement plane, indicating that tongue movements are affected in early stages of Parkinson's disease. CONCLUSIONS The small and more variable movements in the horizontal plane of Patients with Parkinson's disease may pose challenges for swallowing liquids efficiently and safely.
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Affiliation(s)
- Pascal H H M Van Lieshout
- Department of Speech-Language Pathology, University of Toronto, and Toronto Western Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
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The Effect of Saliva on the Viscosity of Thickened Drinks. Dysphagia 2011; 27:10-9. [DOI: 10.1007/s00455-011-9330-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 01/12/2011] [Indexed: 10/18/2022]
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Stuart S, Motz JM. Viscosity in infant dysphagia management: comparison of viscosity of thickened liquids used in assessment and thickened liquids used in treatment. Dysphagia 2009; 24:412-22. [PMID: 19472005 DOI: 10.1007/s00455-009-9219-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 03/17/2009] [Indexed: 11/26/2022]
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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Affiliation(s)
- Sheela Stuart
- Department of Hearing and Speech, Children's National Medical Center, Washington, DC 20010, USA
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Abstract
The capacity to swallow or eat is a basic human need and can be a great pleasure. Older adults look forward to sharing mealtimes and participating in social interactions. The loss of capacity to swallow and dine can have far-reaching implications. With age, the ability to swallow undergoes changes that increase the risk for disordered swallowing, with devastating health implications for older adults. With the growth in the aging population, dysphagia is becoming a national health care burden and concern. Upward of 40% of people in institutionalized settings are dysphagic. There is a need to address dysphagia in ambulatory, acute care, and long-term care settings.
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Affiliation(s)
- Ianessa A Humbert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 98 North Broadway, Suite 413, Baltimore, MD 21231, USA
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Alves LMT, Cassiani RDA, Santos CMD, Dantas RO. Gender effect on the clinical measurement of swallowing. ARQUIVOS DE GASTROENTEROLOGIA 2007; 44:227-9. [DOI: 10.1590/s0004-28032007000300009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Accepted: 07/10/2007] [Indexed: 12/23/2022]
Abstract
BACKGROUND: Swallowing coordination is affected by cortical and subcortical inputs from the central nervous system. Our hypothesis is that the swallowing dynamics may be influenced by gender. AIM: To evaluate the influence of gender on water swallowing dynamics. METHODS: We studied 111 health subjects, 36 men, aged 24-77 years (mean: 46.3 ± 16.1 years) and 75 women, aged 22-75 years (mean: 39.6 ± 13.3 years). All volunteers swallowed in triplicate 50 mL of water at 4ºC while precisely timed, when we measured the time to swallow all the volume and counted the number of swallows. We calculated the inter-swallow interval: the time to complete the task, in seconds, divided by the number of swallows; swallowing velocity: volume drunk (mL) by the time taken (s); swallowing volume capacity: volume drunk (mL) divided by the number of swallows. RESULTS: Women had a shorter inter-swallow interval, slower swallowing velocity and lower volume capacity than men. CONCLUSION: Gender has an effect on water swallowing dynamics, with women having a lower swallowing velocity and a lower volume capacity in each swallow than men.
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