July 2020 Independent Eating and Drinking Newsletter
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Evaluating Swallowing Using a Simulator
In last month’s Newsletter thickeners were discusses in relation to their ability to improve the safety of swallowing for individuals who have problems with aspiration when swallowing. Aspiration while eating or drinking is an ongoing problem that scientists have been studying for several decades. When someone is suspected of aspirating while eating or drinking it is common for a videofluoroscopic swallow study (VFFS) to be conducted. During a VFFS the patient is provided with food/liquid of different thicknesses and, possibly different textures that have barium mixed with them. As they are swallowed, video x-rays capture the swallow process. The barium is visible in the x-ray and its movement can be seen as it passes from the mouth to the esophagus. During a normal swallow the food will pass to the back of the throat and then be swallowed. However, sometimes the food can pass into the airway, rather than the esophagus, causing aspiration. This can be seen during the VFFS. The problem with a VFFS is that it is only a ”concise” picture of what is happening during swallowing. The typical VFFS is short because it is desirable to expose the patient to as little radiation as possible.
Some of the issues that may be identified during a VFFS are:
1. Food or liquid “going down the wrong way” or passing into the airway instead of the stomach – i.e., aspiration.
2. Particles from the bolus remaining in the mouth or throat – i.e., residue.
3. Parts of the mouth or throat that do not function properly when processing food or liquid.
4. A specific texture or viscosity of food or liquid makes it easier or harder to process a swallow.
5. Specific positions allow eating and swallowing to be conducted more safely.
To be able to find the best solutions for any identified problems, experimentation and repetition is useful. Yet because of radiation exposure, only limited experimentation is feasible using VFFS.
To investigate the textures of food and liquid and how they can be modified to improve the safety of swallowing them for individuals who are identified as having dysphagia, scientists have been experimenting with creating various artificial swallowing devices. The different devices do not necessarily perform in the same way or achieve the same goals. However, they are a way of evaluating how different food properties perform when swallowed.
One such mechanism called The In Vitro Swallow Simulator, or the Cambridge Throat, has been used in a research study conducted by Simmi Patel, et al., to evaluate the characteristics of thickening agents, jellies and yogurt. The impact of thickening agents upon foods and liquids is sometimes unpalatable to patients. This study hoped to evaluate the properties of normal table food as compared to thickened foods. Additionally, it compared the performances of different thickness of food, from nectar thick, to spoon thick food. Results found that yogurt and jellies performed similarly to thickened food prepared at spoon thickness. Despite the limits of the Cambridge Throat, the study was able to measure the oral transit times, and bolus length for the various foods being tested. It was found that a longer transit time from entry of the mouth to being swallowed, was provided by a more viscose bolus. In practical terms this will allow the consumer more time to react and adjust their muscles to provide themselves with a safer swallow. Thicker foods, when tested using the Cambridge Throat, were shown to be better controlled with a shorter bolus length than thinner materials. However, very thick substances tended to leave residual particles in the throat which would require a more effortful swallow to clear them from the throat.
With the development of machines that can be used to test the properties of foods, clinicians and scientists will be able to better prescribe the appropriate types of food and liquid for individuals who have dysphagia. This will make designing a safe diet far more of a science than it has been in the past.
| The Mealtime Partner Dining System |
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Serving a Variety of Textures and Volumes
of Food and the Pace of Eating is User Controlled |
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For those individuals who have chewing and
swallowing difficulties, the Mealtime Partner Dining System can
serve foods of a wide-range of textures. The device can serve
regular table food that has been cut up, or it can serve chopped,
minced, or pureed foods. The amount of food present for each bite
can be controlled from a level spoonful to a rounded or heaped
spoonful. Thus small bites can be provided for those who should eat
a small amount at a time. Food volume is controlled by the unique Bowl Covers that are attached to the bowls. |
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| Additionally, because the user controls when they take a bite of food from the spoon, they can pace how quickly or slowly they eat each bite of food. |
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| The Mealtime Partner Dining Device Presenting a Bite of Food |
| Because the Mealtime Partner is such a flexible device, it can meet the dining needs of a diverse group of individuals. For complete information about the Mealtime Partner Dining System, click here. For additional information, or for assistance selecting the best eating or drinking system(s) to serve your needs, email us at info@mealtimepartners.com, or give us a call at 800-996-8607. |
Feeding and Swallowing Assessments
After tests conducted by their physician or a speech pathologist, if someone exhibits ongoing problems with swallowing, medical professionals may recommend that a videofluoroscopic swallowing study (VFSS), or videofluoroscopy, be conducted. This is also frequently called a modified barium swallow, or MBS. This type of test is conducted by having the patient eat or drink items that have barium in them. As they swallow, a video x-ray is recorded of their mouth and throat. The barium shows on the x-ray, thus the path of the material being swallowed can be seen and analyzed to determine if and where difficulties occur. An example of a video swallow study can be found on YouTube.Because x-rays are used in this type of study, the study must be limited to a short time (a few swallows) and cannot be repeated too frequently. A VFSS is felt to be invasive by many parents and family members and for that reason both healthcare professionals and family members need an alternative non-instrumental assessment of swallowing and feeding.
Dysphagia [dis-fa´jah] is the term used to describe difficulty in swallowing. It can also describe problems with chewing, moving a bolus of food around in the mouth, or moving it into the esophagus, and swallowing difficulties in general. Those who suffer from dysphagia are more likely to experience a range of health complications including the possibility of malnutrition, extended times spent in the hospital, a need for more help when they are sent home from the hospital, and the likelihood of medical complications and a higher mortality rate. Malnutrition occurs for both children and adults who have difficulties swallowing. They may eat less because of the difficulties they have chewing and swallowing comfortably and/or safely, Also eating enough calories may take a protracted mealtime.
All of these issues have created a need for non-invasive, (non-instrumental) assessments that can replace or supplement VFSS, mentioned earlier. Individual groups with specific areas of interest, have developed assessments. For example: Brief Autism Mealtime Behavior Inventory; Child Mealtime Feeding Behavior Questionnaire; Dysphagia Evaluation Protocol; Infant Feeding Style Questionnaire; Preterm Infant Breastfeeding Behavior Scale; Swallow Ability and Function Evaluation; etc
Knowing that there is a need for this type of assessment, researchers from Australia and the Netherlands conducted a study titled: Systematic Review: Non-Instrumental Swallowing and Feeding Assessments in Pediatrics. After thorough searches of all applicable data bases, 30 assessments were included in the final review.
The assessments can be categorized by respondent: caregiver (11 of the 30 assessments), clinician (18 of the 30); and 1 assessment could be completed by either caregiver or clinician. The populations that the assessments are geared towards varied considerably, as did the areas of assessment covered, and the methods of scoring the assessments.
The study concluded that although there are many assessments available to evaluate swallowing and eating in the pediatric population, there is a lack of instructions available for how to use, and how to score the assessments. Without instructions, the assessments could easily be misused or the data collected misinterpreted. The study recommended that further research be conducted to validate the psychometric properties of the assessments and to validate the reliability of the data collected. To read the article on the study, click here
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Did you know? Did you know that falls account for the most injuries that happen to people over 65? According to the University of Rochester Medical Center one in three people over 65 will experience a fall during a one year period. Because the numbers of people who are injured every year is so significant, it is important for seniors to take action to prevent them from falling. Exercise to strengthen the body is important, but it is also important to regularly undertake balance training. Additionally, attention should be paid to safe walking. Home modifications can also help prevent seniors from falls. If you are at risk of falling talk to your healthcare provider to make sure you are doing everything to keep yourself safe! |
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