Purpose: Texture modification is a widespread practice as a strategy for the management of dysphagia and can be very effective in individual cases. However, it is often performed in a qualitative, subjective manner and practices vary internationally according to multiple sets of national guidelines. This paper aims to identify best practice by reviewing the theory and practice of texture modification, focussing on recent advances.
Recent findings:Instrumental assessment of texture modification in-vivo is challenging, but studies including rheology and perception have indicated that fluid viscosity is only one of many factors affecting texture modification in practice. Systematic reviews have identified a historical lack of high-quality clinical evidence, but recent controlled studies are beginning to identify positive and negative aspects of thickened fluids. Research and practice to date have been limited by the lack of control and standardisation of foods and drinks. However in 2015 a notfor-profit organisation, the International Dysphagia Diet Standardisation Initiative, has published a framework for texture modification from thin liquids to solid foods based on all the existing documentation and guidance, and the -limited-available clinical evidence.
Summary:Rheology exists in the lab, however normal practice is often subjective or lacking control and standardisation. In the near future, cohesion of practice and the availability of practical standardisation tools may increase awareness and use of rheology.
KeywordsDysphagia, Swallowing, Rheology, Viscosity, Texture modification
Key points •The relationships between rheology and swallowing are beginning to be characterised using oral pressure sensing and videofluoroscopy, together with careful control of bolus rheology.• It is becoming clearer that viscosity alone is not sufficient to categorise texture modification.• Literature to date shows a trend for reduced aspiration with increased thickness of liquids, and increased residue with some thicker consistencies, however evidence is scarce.• An inconsistent approach to definition of texture modification techniques has been limiting the collation of a coherent evidence base.• A new international standard (IDDSI) has been created, drawing on available evidence and including practical objective measures.