Time-Dependent Rheology of Starch Thickeners and the Clinical Implications for Dysphagia Therapy

Dewar, Richard J.; Joyce, Malcolm J.

doi:10.1007/s00455-006-9050-7

Cited by 66 publications

(69 citation statements)

References 25 publications

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“…These include poor sensory characteristics [19,20], the influence of dispersing media [21][22][23], the effect of standing time [24], the effect of temperature [25,26], and lack of training/education of end users [27].…”

Section: Introductionmentioning

confidence: 99%

Consistently Inconsistent: Commercially Available Starch-Based Dysphagia Products

et al. 2009

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Individuals with dysphagia may be prescribed thickened fluids to promote a safer and more successful swallow. Starch-based thickening agents are often employed; however, these exhibit great variation in consistency. The aim of this study was to compare viscosity and the rheological profile parameters complex (G*), viscous (G″), and elastic modulus (G') over a range of physiological shear rates. UK commercially available dysphagia products at "custard" consistency were examined. Commercially available starch-based dysphagia products were prepared according to manufacturers' instructions; the viscosity and rheological parameters were tested on a CVOR Rheometer. At a measured shear rate of 50 s(-1), all products fell within the viscosity limits defined according to the National Dysphagia Diet Task Force guidelines. However, at lower shear rates, large variations in viscosity were observed. Rheological parameters G*, G', and G″ also demonstrated considerable differences in both overall strength and rheological behavior between different batches of the same product and different product types. The large range in consistency and changes in the overall structure of the starch-based products over a range of physiological shear rates show that patients could be receiving fluids with very different characteristics from that advised. This could have detrimental effects on their ability to swallow.

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Section: Introductionmentioning

confidence: 99%

Consistently Inconsistent: Commercially Available Starch-Based Dysphagia Products

et al. 2009

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“…The type of thickener used and the liquid being thickened, along with the thickened liquid temperature and time elapsing after preparation, may impact overall liquid thickness [13,14]. Measurement techniques to quantify viscosity include viscometers, consistometers, and line spread tests (LST), i.e., a simple tool measuring flow distance across a flat surface.…”

Section: Introductionmentioning

confidence: 99%

Use of Thickened Liquids to Manage Feeding Difficulties in Infants: A Pilot Survey of Practice Patterns in Canadian Pediatric Centers

et al. 2015

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Improved survival rates of sick or preterm infants have resulted in an increase of observed feeding difficulties. One common method for managing feeding difficulties in infants is to manipulate liquid viscosity by adding thickening agents to formula or expressed breast milk. Concerns regarding the lack of clinical practice guidelines for the use of this strategy have been raised in the literature and in clinical settings for several years. This study aimed to survey feeding clinicians working in major Canadian pediatric centers to identify current practice patterns for use of thickened liquids in managing feeding difficulties of infants and to justify the need for standardization of this practice. A web-based pilot survey was developed using Fluidsurveys software. The questionnaire contained 37 questions targeting the process of prescribing thickeners, choice of thickener, awareness of issues, and inconsistencies raised in the literature about thickener use and how to address them. A total of 69 questionnaire responses were analyzed using descriptive statistics and inductive thematic analysis methods. Our study results indicate that thickened liquids continue to be broadly used to manage feeding difficulties in Canadian infants, despite numerous areas of concern related to their use raised by our respondents. While clear practice patterns for assessment and management were observed among the respondents, some areas of practice did not reflect recent published research or experts' opinion. Further research to develop a systematic approach for assessment, intervention, and follow-up is warranted to guide clinicians in this complex decision-making process.

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“…As a baseline condition, both middle meatus and sphenoidal ostia were occluded under endoscopic control using maltodextrin food thickener, a jelly-like viscous mass composed of cornstarch powder and water, routinely used in the assessment of swallowing disorders [5]. Under experimental conditions, the occlusion was removed by targeted suction.…”

Section: Methodsmentioning

confidence: 99%

Contribution of Paranasal Sinuses to the Acoustic Properties of the Nasal Tract

Havel¹,

Hofmann²,

Mürbe³

et al. 2014

Folia Phoniatr Logop

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Background: The contribution of the nasal and paranasal cavities to the vocal tract resonator properties is unclear. Here we investigate these resonance phenomena of the sinonasal tract in isolation in a cadaver and compare the results with those gained in a simplified brass tube model. Methods: The resonance characteristics were measured as the response to sine sweep excitation from an earphone. In the brass model the earphone was placed at the closed end and in the cadaver in the epipharynx. The response was picked up by a microphone placed at the open end of the model and at the nostrils, respectively. A shunting cavity with varied volumes was connected to the model and the effects on the response curve were determined. In the cadaver, different conditions with blocked and unblocked middle meatus and sphenoidal ostium were tested. Additionally, infundibulotomy was performed allowing direct access to and selective occlusion of the maxillary ostium. Results: In both the brass model and the cadaver, a baseline condition with no cavities included produced response curves with clear resonance peaks separated by valleys. Marked dips occurred when shunting cavities were attached to the model. The frequencies of these dips decreased with increasing shunting volume. In the cadaver, a marked dip was observed after removing the unilateral occlusion of the middle meatus and the sphenoidal ostium. Another marked dip was detected at low frequency after removal of the occlusion of the maxillary ostium following infundibulotomy. Conclusion: Combining measurements on a simplified nasal model with measurements in a cadaveric sinonasal tract seems a promising method for shedding light on the acoustic properties of the nasal resonator. © 2014 S. Karger AG, Basel

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Time-Dependent Rheology of Starch Thickeners and the Clinical Implications for Dysphagia Therapy

Cited by 66 publications

References 25 publications

Consistently Inconsistent: Commercially Available Starch-Based Dysphagia Products

Consistently Inconsistent: Commercially Available Starch-Based Dysphagia Products

Use of Thickened Liquids to Manage Feeding Difficulties in Infants: A Pilot Survey of Practice Patterns in Canadian Pediatric Centers

Contribution of Paranasal Sinuses to the Acoustic Properties of the Nasal Tract

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