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.

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.

Sensory characteristics of beverages prepared with commercial thickeners used for dysphagia diets.

OBJECTIVE: To describe and compare sensory characteristics of six beverages prepared with four commercial thickeners used in dysphagia diets. DESIGN: The study used a completely randomized design within a test of each beverage. SUBJECTS/SETTING: Five highly trained descriptive sensory analysis panelists conducted the testing in a laboratory environment. INTERVENTION: Coffee, milk, apple juice, orange juice, Ensure (Abbott Laboratories, Abbott Park, IL), and water were thickened using two starch-based and two gum-based commercial thickeners according to manufacturers' instructions to achieve nectar-like and honey-like consistencies. MAIN OUTCOME MEASURES: Sensory attributes of the original beverages and the thickened samples were defined and scored. STATISTICAL ANALYSES PERFORMED: Sensory scores were analyzed by analysis of variance using general linear models and Fisher's least significant difference test to determine specific differences. RESULTS: All thickeners suppressed the main flavors of the base beverages and imparted slight off-flavors (bitter, sour, metallic, or astringent) in some beverages. Starch-based thickeners imparted a starchy flavor and grainy texture, whereas gum-based thickeners gave added slickness to the beverages. Although thickeners mixed well with some beverages, they were difficult to disperse in others, making some thickened beverages lumpy. CONCLUSIONS: All thickeners added either a starchy, grainy, or slick flavor or texture and tended to suppress the base flavor of beverages, especially at honey-like consistencies. Thus, individual decisions about which characteristics are more negative (eg, slick vs grainy texture) for specific patients must be made. Additional development of thickening agents seems necessary for improved sensory properties. Information from this article should help professionals and their patients with dysphagia better understand the sensory issues associated with the use of commercial thickening agents in various beverages.