The Importance of Extensional Rheology in Bolus Control during Swallowing

Hadde, Enrico Karsten; Cichero, Julie A. Y.; Chen, Wei; Chen, Jianshe

doi:10.1038/s41598-019-52269-4

Cited by 45 publications

(35 citation statements)

References 33 publications

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“…Similarly, a second study with videofluoroscopic observations in healthy subjects ( n = 8, age range: 22–30 year.) showed significant differences in pharyngeal transport time only between IDDSI Levels 1 and 4 ( p < 0.01) [ 44 ]. The small sample size is an important limitation in this study.…”

Section: Resultsmentioning

confidence: 99%

Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

Côté

Giroux²,

Villeneuve-Rhéaume

et al. 2020

Geriatrics

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To delay impacts of aging, optimal nutritional status is essential. Several factors can reduce food intake, such as isolation, income, and cognitive/physical decline. Additionally, chewing and swallowing difficulties, or dysphagia, often disrupt the ability to consume life-long favorite dishes. Food and liquids could require modification of texture or consistency to ensure a comfortable or safe swallow. The food industry, foodservices facilities, and caregivers need quality control benchmarks to provide adequate nourishment and meet these new feeding challenges. The International Dysphagia Diet Standardisation Initiative (IDDSI) is proposing the IDDSI framework and testing methods to describe food used in nutritional care plans to circumvent dysphagia and improve communication among caregivers. This systematic review assesses the validity and reliability of the IDDSI testing methods using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). Two publications presented content validity whereas 19 publications looked at construct validity or reliability for the IDDSI testing methods. One study was conducted in older adults presenting dysphagia. This review concludes that there is insufficient evidence to recommend the IDDSI testing methods. Further research, conducted with robust methodological design and reporting, is needed to develop and assess nutritious adapted food for frail older populations.

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Section: Resultsmentioning

confidence: 99%

Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

Côté

Giroux²,

Villeneuve-Rhéaume

et al. 2020

Geriatrics

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“…Overall, thin, elastic and cohesive liquids give rise to a moderate expansion upon leaving the in vitro oral cavity (die swell) that partly counteracts the elongation induced by gravity and result in a smooth and compact bolus shape, characterized by a lower bolus elongation. Recent in vivo results 29 provide a first confirmation of the potential benefit on bolus coherence in the pharynx of fluids with some level of extensional viscosity, but further in vivo studies should confirm this effect for fluids with stronger exten- sional properties. Liquids with similar steady shear rheology show a similar dynamics when leaving the in vitro oral cavity, but a more compact bolus is observed when the relaxation time and the filament breakage time in extension are higher.…”

Section: Liquid Samplementioning

confidence: 96%

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

Marconati

Ramaioli

2020

Food Funct.

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Swallowing disorders deteriorate significantly the quality of life and can be lifethreatening. Texture modification using shear thinning food thickeners have proven effective in the management of dysphagia. Some studies have recently considered the positive role of cohesiveness, but there is still an insufficient understanding of the effect of the rheological properties of the liquid bolus on the dynamics of bolus transport, particularly when elasticity and extensional properties are combined with a shear thinning behaviour. This study combines steady shear, SAOS and capillary breakage extensional rheometry with an in vitro method to characterize the oral transport of elastic liquids. Bolus velocity and bolus length were measured from in vitro experiments using image analysis and related to the shear and extensional properties. A theory describing the bolus dynamics shows that the elastic and extensional properties do not influence significantly the oral transit dynamics. Conversely, in vitro results suggest that the extensional properties can affect the transition from the oral to the pharyngeal phase of swallowing, where thin, viscoelastic liquids lead to a fast transit, lower oral post-swallow residues and more compact bolus with a smoother surface, which may suggest a lower risk of fragmentation. This mechanistic explanation suggests that the benefit of the extensional properties of thin viscoelastic liquids in the management of dysphagia should be further evaluated in clinical trials.

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“…In 2019, Hadde and Chen (2019) hypothesized that the extensional viscosity of the fluid affects the bolus flow and is related to cohesiveness of the fluid. In that same year, Hadde, Cichero, Zhao, Chen, and Chen (2019) confirmed the relevance of the extensional viscosity to bolus swallowing. The ratio of length to the width of the bolus during Upper Esophageal Sphincter (UES) opening were measured under lateral view of videofluoroscopy swallow study (VFSS) of eight healthy individuals.…”

Section: Thickened Fluidsmentioning

confidence: 80%

“…It was reported that a fluid of higher extensional viscosity generally has a lower bolus aspect ratio than a fluid of lower extensional viscosity. This shows that extensional viscosity reduces the elongation of the bolus in the pharyngeal phase during swallowing, thus potentially reduced the risk of post‐swallow residue due to bolus breakage (Hadde et al, 2019). On a related topic, Patel et al (2019) showed that fluids thickened with xanthan gum based thickener (i.e., high extensional viscosity) produced a significantly shorter bolus elongation at the pharyngeal stage compared to the starch based thickener.…”

Section: Thickened Fluidsmentioning

confidence: 99%

Texture and texture assessment of thickened fluids and texture‐modified food for dysphagia management

Hadde

Chen

2020

Journal of Texture Studies

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Thickened fluids and texture‐modified foods are commonly used in the medical management of individuals who suffer from swallowing difficulty (known as dysphagia). However, how to reliably assess texture properties of such food systems is still a big challenge both to industry and to academic researchers. This article aims to identify key physical parameters that are important for objective assessment of such properties by reviewing the significance of rheological or textural properties of thickened fluids and texture‐modified foods for swallowing. Literature reviews have identified that dominating textural properties in relation to swallowing could be very different for thickened fluids and for texture‐modified foods. Important parameters of thickened fluids are generally related with the flow of the bolus in the pharyngeal stage, while important parameters of texture‐modified foods are generally related with the bolus preparation in the oral stage as well as the bolus flow in the pharyngeal stage. This review helps to identify key textural parameters of thickened fluids and texture‐modified foods in relation to eating and swallowing and to develop objective measuring techniques for quality control of thickened fluids and texture‐modified foods for dysphagia management.

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The Importance of Extensional Rheology in Bolus Control during Swallowing

Cited by 45 publications

References 33 publications

Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

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

Texture and texture assessment of thickened fluids and texture‐modified food for dysphagia management

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