Jane Mertz Garcia

Viscosity Measurements of Nectar- and Honey-thick Liquids: Product, Liquid, and Time Comparisons

This study compared the viscosity (thickness) of five different liquids thickened to nectar- or honey-like consistencies with a variety of thickening products. Samples were prepared using manufacturer guidelines and viscosity was measured at the recommended time to thicken (standard) and also after 10 and 30 min. Centipoise (cP) measurements of the samples were compared across products and within product lines for each level of thickness at all three time periods. Statistical analysis showed that the viscosity of a nectar- or honey-like liquid was highly dependent on the type of thickening product and the time it was allowed to thicken. Variability in viscosity measurements also was noted within a product line for thickening various liquids. Results are discussed in relation to the National Dysphagia Diet guidelines for nectar- and honey-like consistencies.

Serving Temperature Viscosity Measurements of Nectar- and Honey-Thick Liquids

This study reports the viscosity (thickness) of nectar- and honey-thick liquids measured at a typical serving temperature. Centipoise (cP) measurements were compared for three products (two starch and one gum-based thickener) mixed with five beverages that set for three time intervals (manufacturer-recommended time to thicken, 10 min, and 30 min). The serving temperature of the cold beverages was 4°C (water, apple juice, orange juice, and milk), and the hot beverage (coffee) was measured at 70°C. Statistical analysis showed that all factors interacted with one another, meaning that the viscosity of a nectar- or honey-like liquid varies greatly depending on the type of thickening agent and beverage combination in relation to the amount of time it thickens. Simply Thick, the gum-based thickener, typically produced samples that were the least viscous but they maintained a more consistent level of thickness over time. Serving temperature results are contrasted with viscosity measurements collected at room temperature, showing variable thickening patterns especially related to the type of thickening agent.

Managing dysphagia through diet modifications.

OVERVIEWDysphagia can lead to malnutrition, dehydration, aspiration pneumonia, and even death. The condition has diverse causes and symptoms vary widely. Nurses are likely to encounter patients with dysphagia in various settings, including acute care medical units, rehabilitation centers, and skilled nursing facilities. Dietary modification—altering the consistency of foods and liquids—is a fundamental aspect of dysphagia management. This article describes normal and impaired swallowing, discusses several types and levels of dietary modification, and offers readers a concise list of nursing considerations. Keywordsdysphagia, impaired swallowing, dietary modification, malnutrition, aspiration pneumonia

Quality of care issues for dysphagia: modifications involving oral fluids.

AIMS AND OBJECTIVES This study examined practices of health care providers who thicken oral fluids for patients with impaired swallowing (dysphagia). It contrasts viscosity (thickness) of nectar-like and honey-thick consistencies prepared and measured in a laboratory setting to actual practices in health care settings and to guidelines of the National Dysphagia Diet. BACKGROUND The care plans for many patients include changes to fluid thickness to maintain safe intake of oral fluids. Serving patients improperly prepared beverages may contribute to medical complications such as dehydration if patients consume less fluid, or aspiration of overly thin or thickened liquids, which may increase the risk of pneumonia. DESIGN Descriptive analysis of group trends for viscosity measurements of liquids prepared by health care providers in four care settings to laboratory measurements and the National Dysphagia Diet. METHODS Forty-two health care providers participated. Each prepared thickened samples in their natural work environment using typical procedures. RESULTS Viscosity measurements of modified liquids prepared by health care providers did not compare favourably to published findings of laboratory viscosity measures or to the ranges of the National Dysphagia Diet. Participants who prepared overly thick or overly thin nectar-like liquids followed a similar pattern with honey-like samples. Many participants failed to use product label information in sample preparation. CONCLUSIONS Results suggest that many patients are served modified liquids that are too thick or too thin in relation to their target level of thickness, possibly increasing risk of further medical complications for those who consume them. Product directions that are too vague or general also may contribute to inaccurate results. RELEVANCE TO CLINICAL PRACTICE The patients nursing staff typically oversees nutritional care plans that may include modifications to oral fluids to enable their patients to safely drink by mouth. Additional consideration should be given to training procedures and possible noncompliance with preparation guidelines.

Perceptual Ratings for Pureed and Molded Peaches for Individuals with and without Impaired Swallowing

Food molds have been created to alter the appearance of pureed foods by making the pureed consistencies look more like typically prepared foods. This study examined the perceptions of 15 adults with impaired swallowing and 15 adults with nonimpaired swallowing for three different types of pureed peach: a typically prepared pureed peach, a pureed peach with a thickening agent added, and a pureed peach with a thickening agent added and molded to look like peach slices. Results are presented for the attribute ratings of overall liking; liking of taste, texture, and appearance; and ease of chewing and swallowing. The results showed that the adults with impaired swallowing rated the attributes of chewing and swallowing significantly lower (i.e., more difficult) for each type of puree. Significant differences within samples also were found for the attributes of overall liking and liking of taste. Overall, the pureed peach molds were not perceived favorably for any of the examined attributes. In addition, the molded peach was rated lower (more difficult) in its ease of chewing. The implications of these findings and ideas for further research are discussed.

Comparison Ratings of Pureed versus Molded Fruits: Preliminary Results

Food molds change the appearance of pureed items to resemble typically prepared food. The present study examined the perceptions of 12 adults with normal swallowing and two adults with impaired swallowing for typical pureed versus molded pureed fruits (peach and pear). Results are presented for ratings of overall liking, taste, texture, appearance, and ease of chewing and swallowing. The present findings indicated that the pureed food molds did not positively influence attribute ratings. For both groups of adults, the typical method of pureed food presentation was rated higher or very similar to the molded pureed fruit. Results are discussed in terms of scaling methods, criteria applied for ratings, and implication of altering the viscosity of pureed foods.

Comparisons of Thickened Beverages Using Line Spread Measurements

Concerns about the preparation of thickened beverages for patients with dysphagia highlight the need for objective measurements with application to clinical settings. This cross-sectional study examined the line spread test (distance a liquid flows) to determine reproducibility of the measurements and whether specific line spread measurements can differentiate nectar- and honey-like thickness levels in the National Dysphagia Diet. Two common thickeners were tested in three different beverages. Replication of preparation procedures allowed comparison of product/beverage line spread results to viscometer-determined viscosity measured at a similar temperature and time to thicken. Analysis of variance showed a significant two-way interaction for both levels of thickness, indicating that line spread measurements differentiated products mixed with different beverages. Standard deviations and confidence intervals confirmed that measurements were highly repeatable. Line spread distance (cm) and viscosity measured in centipoise (cP) for a similar product/beverage statistically correlated with one another, suggesting that line spread and viscometry provided some similar information about thickness across the six product/beverage combinations tested.

Sensory Texture Analysis of Thickened Liquids during Ingestion

Practitioners support the use of thickened liquids for many patients with disordered swallowing. Although physical measures have highlighted differences among products there are questions about the ability of the measures to fully explain the sensory texture effects during swallowing of thickened liquids. This study used a trained sensory panel to describe the textural aspects of liquids during ingestion and swallowing. The lexicon was able to characterize differences in beverages, thickeners, and thickness levels with the most important attribute being viscosity, which loaded heavily in the almost one-dimensional space that resulted from the sensory analysis of these beverages. Other effects, such as slipperiness provided some minimal additional information on the products. PRACTICAL APPLICATIONS Trained sensory panelists were shown to be useful in the measurement of differences in thickened liquid products prescribed for patients with dysphagia. They were able to differentiate products based on perceived differences related to flow speed, viscosity, and other parameters suggesting their use in further studies of swallowing behavior and for development of products for disordered swallowing should be considered. Understanding how these variables might relate to clinical decision making about product selection or modification to best meet the nutritional needs of a person with disordered swallowing could be helpful. This is especially true given the difficulties in measuring texture instrumentally in these products.

Hand Gestures: Perspectives and Preliminary Implications for Adults With Acquired Dysarthria

Most communicators engage in some degree of hand gesturing while speaking. The purposes of the present paper are to review in detail the nature of hand gestures (gesticulations) in normal communica...

Evaluation of a health education programme about traumatic brain injury

Objective: Our aim was to evaluate a health education programme (TBIoptions: Promoting Knowledge) designed to increase public awareness and understanding about traumatic brain injury (TBI) through in-person (classroom) and computer-based (electronic) learning environments. Design: We used a pre-post survey design with randomization of participants to classroom (N = 22) or electronic (N = 22) delivery of the programme, in classroom and computer laboratory settings on the campus of Kansas State University, Manhattan, KS. Method: Forty-four participants rated areas of knowledge about TBI prior to and after the programme experience. They also rated health programme quality and instructional strategies (e.g. video vignettes). Written responses provided information for qualitative analysis. Results: Participants reported significantly higher ratings of knowledge after the programme experience. Qualitative analysis of written responses provided further evidence to support quantitative outcomes. There were no significant differences in comparing the two methods of delivery (classroom versus electronic learning format). Participants rated the quality of the programme and various instructional strategies very highly. Conclusion: TBIoptions: Promoting Knowledge offers a health education programme to increase understanding about TBI. Both modes of delivery, classroom and electronic, appeared equally effective in terms of self-report of change.