Assessment of Functional Food Dioscorea Japonica Paste As A Thickened Liquid For Elderly With Dysphagia

Background: In the elderly, reduced mastication and swallowing functions result in malnutrition and deterioration in the quality of life. As individuals age in the society, the novel concept of dysphagia diet is essential in order to prevent lifestyle and chronic diseases and maintain nutrition intake. Recently, we reported that Dioscorea japonica, a wild yam, has preventive effects on chronic inflammation via the inhibition of proinflammatory lipid mediator synthesis. The paste of Dioscorea japonica showed conformable physical properties as a thickened liquid for patients with dysphagia in rheological analysis. In the present study, we focused on the unique physical properties of Dioscorea japonica paste and evaluated its stability and usefulness as a thickened liquid compared with commercially available thickened liquids. Methods: The paste prepared using a uniformly freeze-dried Dioscorea japonica powder could suitably modify the viscosity by altering the blending amount. Viscosities of the Dioscorea japonica paste, xanthan gum, and commercially available thickened liquids were measured using a cone and plate viscometer after 1 min by employing the following setting: temperature of 20°C and shear rate of 50 s−1. The effect of changes in temperature and pH, and addition of NaCl and α-amylase, on viscosity was compared among the thickened liquids. Results: Compared with the other commercially available agents, the Dioscorea japonica paste was stable in terms of viscosity on the addition of NaCl, and no change was observed on the addition of α-amylase as similar as the others. Although the Dioscorea japonica paste was relatively stable in terms of viscosity with change in pH, it was slightly unstable with change in temperature. Conclusion: The findings of this study indicate that the Dioscorea japonica paste is useful as a novel type of thickened liquid for patients with dysphagia.

Factors Influencing Oral Bolus Hold Type: Tipper or Dipper

Purpose: This retrospective study investigated the impact of age, sex, and swallow task on bolus hold location during cued liquid swallows in healthy, community-dwelling adults. Furthermore, we investigated the association between bolus hold location and Modified Barium Swallow Impairment Profile (MBSImP) Components 2 (bolus hold) and 4 (lingual transport) scores. Method: Cued swallows of standardized barium liquids (thin, nectar-thickened, honey-thickened) observed during videofluoroscopy in 195 participants were judged as either tipper or dipper bolus hold type. Logistic regression was used to determine relationships between bolus hold location and age, sex, and swallow task. Fisher's exact test was used to determine associations between MBSImP scores and bolus hold type. Results: The majority of swallow tasks (95%) were of tipper bolus hold type. A significant relationship was observed between age and bolus hold type for swallows of 5-ml thin liquid and 5-ml honey-thickened liquid, with older individuals more likely to demonstrate a tipper bolus hold type. Sex was observed to be a significant factor for two swallow tasks (cup sip of thin liquid and 5 ml of nectar-thickened liquid), with males being more likely to be dippers. No significant relationships were observed between bolus hold type and MBSImP Component 2 or 4 scores. Conclusions: A tipper bolus hold type was the most common type observed in healthy adults, although the dipper bolus hold type was also observed (albeit at a lower frequency). These study findings further contribute to defining typical swallowing behaviors.

Analysis of Speech-Language Pathology Graduate Students' Experience with Thickened Liquids

Purpose: Thickened liquids are frequently recommended for patients with dysphagia to minimize aspiration. When discussing the use of thickened liquids with graduate students in Communication Sciences & Disorders (CSD), it is beneficial to discuss the potential effect(s) of this dietary recommendation. Graduate level preparation involving first-hand experience with thickened liquids may help future speech-language pathologists (SLPs) develop a more complete understanding of the effects of diet modification. The purpose of the current study was to examine the reactions of graduate students in CSD to a brief period of thickened liquid use as an experiential learning activity. Methods: Sixty-eight graduate students enrolled in an accredited CSD program completed the study. As part of a class assignment, students were instructed to consume only thickened liquids for 24 hours. No further restrictions on food intake were made. Each student wrote a brief summary detailing his/her experience at the conclusion of the thickened liquid intake session. The narratives were examined for key terms that seemed to define the participants’ experiences. Results: Experiential terms were divided into physical symptoms, emotional responses, and behavioral changes. Common symptoms included persistent thirst, dryness, fatigue, perception of the experience as being unpleasant, irritability, and difficulty concentrating. Conclusion: Many of the symptoms were associated with dehydration secondary to reduced fluid intake, per the students’ reports. Specific symptoms included craving water, fatigue, and headache. All participants reported a greater understanding of thickened liquid use upon completion.

Laryngeal cleft type I in neonate: case report

Laryngeal cleft (LC) is a congenital malformation that leads to the unusual communication between the esophagus and the laryngotracheal complex. It is a rare disease, mostly prevalent among male individuals. The goal of this study was to describe the evaluation and intervention by the speech language pathologist of a female newborn diagnosed with LC type I, admitted on the University Hospital of Universidade de São Paulo, in her second hospitalization due to small weight gain and pneumonia. She was submitted to a bedside clinical evaluation of the swallowing and the most important occurrence was frequent gagging. The videofluoroscopy swallowing study showed laryngotracheal aspiration level 8 for thin liquid and level 1 for thickened liquid, according to the Penetration-Aspiration Scale. The newborn was submitted to a microlaryngoscopy, in which the presence of LC type I was found. After the diagnosis, the speech language pathologist offered thickened liquid at 6% and, in 8 days, the newborn was discharged with exclusive oral diet without gagging. Eight outpatient consultations were carried out for 11 months, with emphasis on reintroduction of thin liquids. The treatment was discontinued and the patient was put on general diet for the age without modifications. Throughout follow-up, the patient remained asymptomatic and showed no respiratory complications.