Visualizing the Consistency of Thickened Liquids With Simple Tools: Implications for Clinical Practice.

Purpose Accurate texture modifications to thin liquids are a critical aspect of patients' nutritional health and well-being. This study explored the use of 3 tools (2 distance- and 1 time-measuring devices) to characterize texture-modified liquids. The objectives were to use the tools to measure modified liquids, to determine if measurements differentiated nectar and honey levels of modification, and to compare measurements with other published reports. Method We measured the flow distance of 33 prethickened water samples in centimeters (cm) using a line spread apparatus and a Bostwick Consistometer (Christison Particle Technologies). We selected a Zahn viscosity cup to measure the stream time of each prethickened liquid in seconds. Results The 2 distance-measuring devices (line spread and Bostwick Consistometer) showed that thinner (nectar-thick) modifications spread or flowed a farther distance in comparison to thicker (honey-like) modifications. Testing with the line spread indicated that an average spread distance of 4.5 cm differentiated nectar-thick and honey-like consistencies. A flow distance of greater than 15 cm differentiated nectar from honey consistency measured with a Bostwick Consistometer. We were not successful in using the Zahn viscosity cup to determine the stream time of modified liquids. Conclusions Two of the tools provided objective information about levels of liquid modification, which has implications for day-to-day preparation. Measurement tools that are accurate and easy to use have the potential to provide quick and dependable feedback to verify a prescribed level of liquid modification. Further efforts are needed to standardize the application of simple measurement tools in the management of patients who consume thickened liquids.

[1]  Cathy A. Pelletier What Do Certified Nurse Assistants Actually Know About Dysphagia and Feeding Nursing Home Residents , 2004 .

[2]  Jane Mertz Garcia,et al.  Perspectives of Registered Dietitians About Thickened Beverages in Nutrition Management of Dysphagia , 2012 .

[3]  Jane Mertz Garcia,et al.  Line spread as a visual clinical tool for thickened liquids. , 2013, American journal of speech-language pathology.

[4]  J. Seabrook,et al.  Accuracy and reliability of direct observations of home-packed lunches in elementary schools by trained nutrition students. , 2012, Journal of the Academy of Nutrition and Dietetics.

[5]  R. Milczarek,et al.  RELATIONSHIP BETWEEN THE BOSTWICK MEASUREMENT AND FLUID PROPERTIES , 2006 .

[6]  Catriona M. Steele,et al.  Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework , 2016, Dysphagia.

[7]  E. Chambers,et al.  Comparisons of thickened beverages using line spread measurements. , 2008, Journal of the American Dietetic Association.

[8]  Edgar Chambers,et al.  Thickened liquids: practice patterns of speech-language pathologists. , 2005, American journal of speech-language pathology.

[9]  Mark A. Nicosia,et al.  The Usefulness of the Line Spread Test as a Measure of Liquid Consistency , 2007, Dysphagia.

[10]  Jae Hyeon Park,et al.  Comparison of Different Gum-Based Thickeners Using a Viscometer and Line Spread Test: A Preliminary Study , 2014, Annals of rehabilitation medicine.

[11]  V. Castellanos,et al.  Use of thickened liquids in skilled nursing facilities. , 2004, Journal of the American Dietetic Association.

[12]  D. Lilienfeld,et al.  Comparison of 2 Interventions for Liquid Aspiration on Pneumonia Incidence , 2008, Annals of Internal Medicine.

[13]  T. Ghosh,et al.  Viscosity of Liquids: Theory, Estimation, Experiment, and Data , 2006 .

[14]  H. Ramaswamy,et al.  Rheological characterization of thickened beverages used in the treatment of dysphagia , 2006 .

[15]  Devon L. Glassburn,et al.  Thickener Viscosity in Dysphagia Management: Variability among Speech-Language Pathologists , 1998, Dysphagia.

[16]  B. Adeleye,et al.  Comparison of the rheological properties of ready-to-serve and powdered instant food-thickened beverages at different temperatures for dysphagic patients. , 2007, Journal of the American Dietetic Association.

[17]  B. Hanson,et al.  Thickened fluids: investigation of users' experiences and perceptions. , 2014, Clinical nutrition.

[18]  Catriona M. Steele,et al.  The Influence of Food Texture and Liquid Consistency Modification on Swallowing Physiology and Function: A Systematic Review , 2014, Dysphagia.

[20]  M. Arroyo,et al.  A short training program improves the accuracy of portion-size estimates in future dietitians. , 2007, Archivos latinoamericanos de nutricion.

[21]  S. Alavi,et al.  Tolerance Testing for Cooked Porridge made from a Sorghum Based Fortified Blended Food. , 2016, Journal of food science.

[22]  S. Leder,et al.  Promoting Safe Swallowing When Puree is Swallowed Without Aspiration but Thin Liquid is Aspirated: Nectar is Enough , 2013, Dysphagia.

[23]  B. Yoo,et al.  Relationship between Apparent Viscosity and Line-Spread Test Measurement of Thickened Fruit Juices Prepared with a Xanthan Gum-based Thickener , 2014, Preventive nutrition and food science.

[24]  N. Paik,et al.  Categorization of dysphagia diets with the line spread test. , 2004, Archives of physical medicine and rehabilitation.

[25]  E. Chambers,et al.  Quality of care issues for dysphagia: modifications involving oral fluids. , 2010, Journal of clinical nursing.

[26]  L. Mann,et al.  Development of an objective method for assessing viscosity of formulated foods and beverages for the dysphagic diet. , 1996, Journal of the American Dietetic Association.

[27]  J. Wiklund,et al.  Correlation between in-line measurements of tomato ketchup shear viscosity and extensional viscosity , 2016 .

[28]  Feeding beliefs of certified nurse assistants in the nursing home: a factor influencing practice. , 2005, Journal of gerontological nursing.

[29]  Malcolm C. Bourne,et al.  CHAPTER 1 – Texture, Viscosity, and Food , 1982 .

[30]  M. Bourne Food Texture and Viscosity: Concept and Measurement , 2002 .

[31]  Kathryn L. McCarthy,et al.  RELATIONSHIP BETWEEN RHEOLOGICAL BEHAVIOR AND BOSTWICK MEASUREMENT DURING MANUFACTURE OF KETCHUP , 2008 .

[32]  K. Abbas,et al.  Suitability of viscosity measurement methods for liquid food variety and applicability in food industry - A review , 2010 .