The practice of thickening liquids has become one of the most frequently used interventions for swallowing impairment (dysphagia). However, the terminology used to describe thickened liquids (such as nectar-thick and honey-thick) is subjective and we lack empirical evidence about how alterations in liquid consistency affect swallowing function and physiology. The International Dysphagia Diet Standardisation Initiative is a multidisciplinary task force (www.iddsi.org) that has recently developed a new taxonomy of terms to label different levels of liquid consistency used in dysphagia management; these are paired with operational definitions and practical gravity-flow measurement techniques that can be used by caregivers and clinicians to confirm the category of any liquid at the time of preparation or serving. The goal of the current proposal is to measure the in vitro physiological flow of liquids representative of the IDDSI levels of liquid consistency (thin, slightly-thick, milly-thick, moderately-thick and extremely-thick). Physiological measures of liquid flow require an understanding both of the rheological properties of the liquid (gravity-flow; viscosity) and the forces that are applied to the liquid during swallowing (tongue pressure; swallowing muscle contraction). Additional sensory attributes of the bolus (such as slipperiness, graininess and cohesiveness) are also likely to be relevant. We will measure these properties and study bolus flow in healthy adults to establish a reference perspective of expected flow in the context of healthy tongue pressure generation. We will then collect comparative measures in individuals with dysphagia of different etiologies (stroke, acquired brain injury, oropharyngeal cancer, post cervical spine surgery, and neurodegenerative disease) to determine how alterations in swallowing motor function impact liquid flow. These measurements will provide information to guide clinicians in determining optimal levels of thickening to recommend for patients with dysphagia. This research is highly significant because it will establish a new foundation of understanding with respect to the influence of thickened liquids on swallowing. This is essential for advancing clinical practice and setting the stage for future treatment efficacy research.

Public Health Relevance

Thickened liquids have become the most common intervention for dysphagia (swallowing impairment), yet we lack a clear understanding of how this intervention works to achieve clinical benefit. In this project, we will advance our understanding of how thickening influences swallowing by measuring the physiological flow of 5 incremental degrees of liquid thickening. These measures of physiological flow will take into consideration both the physical flow properties of these liquids and the forces applied during swallowing by healthy adults and individuals with swallowing impairment due to stroke, brain injury, oropharyngeal cancer, post cervical spine surgery and neurodegenerative disease.

Agency
National Institute of Health (NIH)
Institute
National Institute on Deafness and Other Communication Disorders (NIDCD)
Type
Research Project (R01)
Project #
5R01DC011020-06
Application #
9433634
Study Section
Motor Function, Speech and Rehabilitation Study Section (MFSR)
Program Officer
Shekim, Lana O
Project Start
2010-08-01
Project End
2021-02-28
Budget Start
2018-03-01
Budget End
2019-02-28
Support Year
6
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University Health Network
Department
Type
DUNS #
208469486
City
Toronto
State
ON
Country
Canada
Zip Code
M5 2M9
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Namasivayam-MacDonald, Ashwini M; Burnett, Lynsey; Nagy, Ahmed et al. (2017) Effects of Tongue Strength Training on Mealtime Function in Long-Term Care. Am J Speech Lang Pathol 26:1213-1224
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Steele, Catriona M; Grace-Martin, Karen (2017) Reflections on Clinical and Statistical Use of the Penetration-Aspiration Scale. Dysphagia :
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Waito, Ashley A; Valenzano, Teresa J; Peladeau-Pigeon, Melanie et al. (2017) Trends in Research Literature Describing Dysphagia in Motor Neuron Diseases (MND): A Scoping Review. Dysphagia 32:734-747
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Nagy, Ahmed; Peladeau-Pigeon, Melanie; Valenzano, Teresa Josephine et al. (2016) The effectiveness of the head-turn-plus-chin-down maneuver for eliminating vallecular residue. Codas 28:113-7

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