Characterizing the Flow of Thickened Barium and Non-barium Liquid Recipes Using the IDDSI Flow Test

Abstract

The use of thickened liquids for dysphagia management has become wide-spread. Videofluoroscopy is commonly used to determine dysphagia severity and to evaluate the effectiveness of interventions, including texture modification, but this requires the use of radio-opaque contrast media. In order for the results of a videofluoroscopy to have validity with respect to confirming swallowing safety and efficiency on different liquid consistencies, it is important to understand the flow characteristics of the contrast media used and how the flow of these stimuli compares to the flow of liquids that are provided outside the assessment context. In this study, we explored the flow characteristics of 20% w/v barium and non-barium stimuli prepared using starch and gum thickeners to reach the slightly, mildly and moderately thick liquid categories defined by the International Dysphagia Diet Standardisation Initiative (IDDSI). Our goal was to identify recipes that would produce stimuli with stable flow properties over a 3 h time frame post mixing. Thickener concentration was titrated to achieve matching flow (i.e., IDDSI Flow Test results within a 1 ml range) across the four stimulus types (non-barium starch, non-barium gum, barium starch, barium gum) within each IDDSI level. The combination of barium and thickeners resulted in further thickening, particularly with starch-based thickening agents. A probe of the influence of refrigeration showed no difference in flow measures between chilled and room temperature stimuli over a 3-h time frame. Overall, recipes with stable flow over three hours were identified for all barium and non-barium liquids tested.

The role of extensional rheology in the oral phase of swallowing: an in vitro study

“…Moreover, hardly any outflow was measured in the 10 s test-time for concentrations of PEO above 4% w/w. The 2% w/w PEO solution, the 1% w/w cereal extract solution and the TUC solution (1.19 % w/w) were classified as IDDSI Level 2, the latter in agreement with the level indicated on the package and with the results of other studies 15,16 . Finally, the 0.3% w/w cereal extract was characterized as IDDSI Level 1.…”

“…Under the IDDSI framework, thickened beverages are classified via a simple gravity discharge test 13 . This flow test has already been considered by several authors [14][15][16][17] , but a relationship between the liquid rheology and the IDDSI scale has not yet been comprehensively investigated. While there is general agreement that texture modified liquids reduce aspiration, but the mechanistic reasons why this occurs are still debated.…”

A Cross-Sectional, Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Amyotrophic Lateral Sclerosis

“…Each cup was weighed before and after the participant took a sip to obtain measures of bolus weight, which were converted to bolus volume using published conversions ( Steele, Peladeau-Pigeon, Barbon, Guida, Tapson, et al, 2019 ). All liquids were mixed following standardized recipes ( Barbon & Steele, 2018 ) to a 20% weight-to-volume concentration of barium contrast (Bracco Diagnostics E-Z-PAQUE barium sulfate) and thickened with a xanthan gum thickener (Nestlé Resource ThickenUp Clear). Boluses were presented from thinnest (IDDSI Level 0) to thickest (IDDSI Level 4), and each participant was given three trials of each consistency, yielding up to 15 boluses, as tolerated.…”

Are Medication Swallowing Lubricants Suitable for Use in Dysphagia? Consistency, Viscosity, Texture, and Application of the International Dysphagia Diet Standardization Initiative (IDDSI) Framework

“…They do not drip through a syringe, hold their form on a fork, and slide off a spoon without leaving a sticky residue. IDDSI Level 4 products are appropriate for patients with dysphagia that cannot safely drink liquids through a straw and require them to be thickened enough to consume from a spoon [ 17 ]. This consistency can improve safety by reducing the potential for liquid aspiration and reducing bolus velocity in patients with dysphagia [ 9 , 33 , 34 ].…”

“…Evaluation of the effectiveness of the IDDSI framework concludes that it can be an efficient tool for clinical application [ 15 ]. This guideline has been broadly welcomed by food manufacturers, stakeholders and aged care facilities, and it is being applied in many countries [ 16 , 17 ].…”