Nutritional Aspects of Dysphagia Management

Gallegos, C.; Fuente, Edmundo Brito-de la; Clavé, Père; Costa, Alícia; Assegehegn, Getachew

doi:10.1016/bs.afnr.2016.11.008

Cited by 92 publications

(76 citation statements)

References 113 publications

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“…Thickening agents increase the viscosity of fluids and thin liquids, enhancing the safety of swallow by avoiding aspirations and their associated complications, as stated in a review by the European Society for Swallowing Disorders (ESSD) . Viscosity is a rheological property which measures the resistance of a fluid to flow, expressed in SI units as mPa s —rheology is the study of the flow and deformation of fluids .…”

Section: Introductionmentioning

confidence: 99%

“…The primary objective was to assess the percentage of patients that could swallow safely at each of the three main viscosities (2000, 800 or 250 mPa s) compared with thin liquid. Secondary and exploratory objectives were to assess the effect of all viscosities on penetrations, aspirations, the Penetration‐Aspiration Scale (PAS) developed by Rosenbek, the presence and severity of oral and pharyngeal residue, and the effects on the biomechanics of the swallow response …”

Section: Introductionmentioning

confidence: 99%

“…11 The pathophysiology of PSOD is characterized by several motor impairments in the kinematics of the swallow response including delayed laryngeal vestibule closure (LVC) and decreased bolus propulsion forces 12 ; also, patients affected by unilateral stroke showed a disrupted pattern of sensory cortical activation after pharyngeal stimulation as a distinctive marker of abnormal sensory integration of swallowing pathways in PSOD. 13 Thickening agents increase the viscosity of fluids and thin liquids, enhancing the safety of swallow by avoiding aspirations and their associated complications, 14,15 as stated in a review by the European Society for Swallowing Disorders (ESSD). 16 Viscosity is a rheological property which measures the resistance of a fluid to flow, expressed in SI units as mPa s 15,17 -rheology is the study of the flow and deformation of fluids.…”

Section: Introductionmentioning

confidence: 99%

“…Secondary and exploratory objectives were to assess the effect of all viscosities on penetrations, aspirations, the Penetration-Aspiration Scale (PAS) developed by Rosenbek, 21 the presence and severity of oral and pharyngeal residue, and the effects on the biomechanics of the swallow response. 13,15 2 | PATIENTS AND ME THODS…”

Section: Introductionmentioning

confidence: 99%

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Effect of a gum‐based thickener on the safety of swallowing in patients with poststroke oropharyngeal dysphagia

Bolivar‐Prados

Rofes

Arreola

et al. 2019

Neurogastroenterology Motil

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BackgroundIncreasing viscosity with thickening agents is a valid therapeutic strategy for oropharyngeal dysphagia (OD). To assess the therapeutic effect of a xanthan gum‐based thickener (Nutilis Clear®) at six viscosities compared with thin liquid in poststroke OD (PSOD) patients.MethodsA total of 120 patients with PSOD were studied in this controlled, multiple‐dose, fixed‐order, and single‐blind study using videofluoroscopy (VFSS). A series of boluses of 10 mL thin liquid and 2000, 1400, 800, 450, 250, and 150 mPa s viscosities were given in duplicate, interrupted in case of aspiration. We assessed the safety and efficacy of swallow and the kinematics of the swallow response.Key ResultsA total of 41.2% patients had safe swallow at thin liquid which significantly increased for all viscosities from 71.9% at 150 mPa s to 95.6% at 1400 mPa s (P < .001). PAS score (3.7 ± 2.3) at thin liquid was also reduced by increasing bolus viscosity (P < .001). The prevalence of patients with aspiration at thin liquid was 17.5% and decreased at all viscosities (P < .01), except at 150 mPa s. Increasing viscosity shortened time to laryngeal vestibule closure (LVC) at all viscosities (P < .01) and reduced bolus velocity at ≥450 mPa s (P < .05). The prevalence of patients with pharyngeal residue at each viscosity 37.7%‐44.7% was similar to that at thin liquid (41.2%).Conclusions and InferencesThe prevalence of unsafe swallow with thin liquids is very high in PSOD. Increasing shear bolus viscosity with this xanthan gum‐based thickener significantly increased the safety of swallow in patients with PSOD in a viscosity‐dependent manner without increasing the prevalence of pharyngeal residue.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of a gum‐based thickener on the safety of swallowing in patients with poststroke oropharyngeal dysphagia

Bolivar‐Prados

Rofes

Arreola

et al. 2019

Neurogastroenterology Motil

View full text Add to dashboard Cite

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“…Despite the fact that all guidelines for the preparation of dysphagic meals are only referred to food viscosity before it is introduced into the mouth, it is also important to take into account that the mixing of saliva with foodstuff may change its rheological properties. Although few analyses regarding viscosity and thickening after the mixing with saliva have been performed ( 19 , 21 , 55 ), these findings must be taken into account in dietary prescriptions for dysphagia.…”

Section: Discussionmentioning

confidence: 99%

Optimizing Texture Modified Foods for Oro-pharyngeal Dysphagia: A Difficult but Possible Target?

et al. 2018

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Dysphagia is a swallowing disorder characterized by the difficulty in transferring solid foods and/or liquids from the oral cavity to the stomach, imparing autonomous, and safe oral feeding. The main problems deriving from dysphagia are tracheo-bronchial aspiration, aspiration pneumonia, malnutrition and dehydration. In order to overcome dysphagia-induced problems, over the years water and food thickening has been used, focusing specifically on viscosity increase, but limited results have been obtained. Elastic components and their effects on the cohesiveness on the bolus should be taken into account in the first place. We provide an analysis of dysphagia and suggest possible corrections to the protocols which are being used at present, taking into account rheological properties of food and the effect of saliva on the bolus. We reckon that considering such aspects in the dysphagia management market and healthcare catering would result in significant clinical risk reduction.

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Predictors of severe dysphagia following radiotherapy for head and neck cancer

Petersson

Finizia

Tuomi

2021

Laryngoscope Investig Oto

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Objective To investigate if severe dysphagia following radiotherapy for head and neck cancer (HNC) could be predicted by patient and tumor characteristics, feeding tube use, weight factors, jaw opening function, and saliva secretion. Methods Data was collected from 94 HNC patients 6 to 36 months post radiotherapy. Swallowing function was assessed by videofluroscopy (VFS). Severe dysphagia was defined by Penetration Aspiration Scale (PAS) as PAS≥5 or a total score ≤60 on the M. D. Anderson Dysphagia Inventory (MDADI). Results Thirty‐three patients (35%) had PAS ≥5 and 19 (20%) a MDADI ≤60, that is, presented with severe dysphagia. Univariable logistic regression analysis (UVA) gave that tumor of the tonsil, overweight at time of VFS and each unit increase in Body Mass Index (BMI) predicted less risk of PAS ≥5. Dependency of feeding tube at time of VFS and each month's continued use and weight loss ≥7.5% since treatment to time of VFS predicted increased risk of PAS ≥5. Predictive variables from the UVA of PAS ≥5 (tumor of the tonsil, overweight, and total duration of feeding tube), were analyzed by multivariate logistic regression analysis. All retained power as independent predictors. UVA for MDADI showed that use of feeding tube at time of VFS predicted MDADI ≤60 with the risk increasing each month. Each increasing unit of BMI decreased risk of MDADI ≤60. Conclusion Long time users of feeding tube and higher weight‐loss are at risk of severe dysphagia. This makes collaboration between professionals working with dysphagia an important step in detecting severe dysphagia. Level of Evidence: 3.

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Nutritional Aspects of Dysphagia Management

Cited by 92 publications

References 113 publications

Effect of a gum‐based thickener on the safety of swallowing in patients with poststroke oropharyngeal dysphagia

Effect of a gum‐based thickener on the safety of swallowing in patients with poststroke oropharyngeal dysphagia

Optimizing Texture Modified Foods for Oro-pharyngeal Dysphagia: A Difficult but Possible Target?

Predictors of severe dysphagia following radiotherapy for head and neck cancer

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