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In the February 2010 Newsletter Topic "Thickening Food and Liquid", products that are used to thicken liquids and some foods were discussed. However, how individuals who are prescribed thickened liquids drink them, was not discussed.
There are two basic methods for consuming liquids: drinking from some type of container (i.e., a cup or glass, etc.) that is held to your lips and tipped to have the contents flow into your mouth; or, by sucking the liquid out of a container, using a straw. For drinking thickened liquid, the use of a straw becomes difficult, or impossible, depending upon the actual thickness of the liquid. A familiar example of this is trying to drink a very thick milk shake through a straw, even if the diameter of the straw is larger than that of a standard straw. If the shake is extremely thick, the straw will collapse before the shake will pull up through it.
However, serving thickened liquids from a regular cup, glass or other container, presents another set of complications. The container is tilted to cause the flow of liquid into the mouth. However, the slow moving liquid encourages the user to tilt the container upward at a greater angle than is normal when drinking thin liquids. The high angle of the container encourages raising the chin and tipping the head backward. This head position exposes the airway to an unnecessary risk of aspiration. A secondary problem experienced when drinking from a cup is that the user may consume the liquid too rapidly (several swallows in rapid succession), and, again, be at a greater risk of choking. The desired speed of consumption should be a single small swallow of around 5 cc’s per sip.
Mealtime Partners, Inc. sells the Provale Cup that dispenses 5 cc’s of thin liquid per tip of the cup. This cup is a good way of controlling the rate at which someone drinks thin liquid, but it is unable to serve thickened liquids. (For more information about the Provale Cup, click here.)
Mealtime Partners, Inc. is now pleased to make available the Thickened Liquids Cup, a unique product that expands our line of hydration systems. The Thickened Liquids Cup has been designed for individuals who require thickened liquids. It has two features that make it unique. First, it has a fully adjustable flow control that regulates the continuous output of liquids. It can be adjusted from a normal flow to a greatly reduced flow (as little as a drip at a time). Once the flow rate is selected, the regulator can be locked so that the user cannot adjust the flow rate (and thus inadvertently increase their risk of choking or aspiration). Secondly, the cup is specifically designed to provide liquids to the user without the need for the cup to be tipped at an angle greater than 60 degrees. A user will be able to completely empty the cup without increasing the angle of tilt beyond 60 degrees! To purchase the Thickened Liquids Cup, click here.
Feedback: Our thanks
to Nancy Turman for providing comments regarding
our earlier Newsletter article:
Promoting a Chin Tuck for Safer Eating.
Her comments drew our attention to the omission of any
qualifying statements that explained that the information in the
article was directed towards individuals who are dependent upon
another person for their nutritional and hydration needs but who
have normal oral motor, and swallow abilities.
According to Nancy: "The chin tuck posture is not supported for all individuals with dysphagia. Those with medial and/or distal pharyngeal weakness can actually be at increased risk of aspiration when using a chin tuck posture. Placing the chin in the tucked position may actually divert material, especially liquids, into the airway. Generally, a modified barium swallow study would be recommended prior to suggesting any postural change such as a chin tuck or head turn. Another point you make in your article is that the use of a head turn to either side when swallowing is beneficial for those with reduced sensitivity. Posturing to one side or the other is actually beneficial for those with reduced motor function, not sensitivity. It is the reduction of movement unilaterally that may require the patient to use a head turn and divert away from the side of weakness or decreased function. There may be a loss of sensation in conjunction with loss of motor function, but it is the movement issue that is of more importance. Again, this should be evaluated during a modified barium swallow study, preferably with the patient in the A-P position to assess medial/distal pharyngeal movement on both sides of the pharynx."
Nancy Turman, MS CCC-SLP, BRS-S Speech Language Pathologist, Board Recognized Specialist in Swallowing and Swallowing Disorders.
Thanks again to Nancy for providing this valuable clarification.
We want your feedback! If you have comments or suggestions to expand and/or clarify the information in our Newsletter articles, please feel free to email us at: firstname.lastname@example.org. Comments like these help us provide better, more complete information to the community that we serve.
When providing food for individuals who lack the ability to self-feed, it is important to be sure that the texture of the food being offered is appropriate for their oral motor skills and that it will not increase their risk of choking. This article will discuss how foods, depending upon their texture, breakdown when being eaten and how the body, especially the teeth and mouth, react to different textures and flavors of food.
First, it is helpful to understand a little bit about how our body works when it comes to food and eating and discussing the significance of food textures. Our digestive system is a series of organs that both mechanically and chemically break down the food we eat, and extracts nutrition and energy from it. The beginning of the digestive system is the mouth. Food is put into the mouth and our teeth tear and grind it into small particles. As the food is being chewed, saliva, that contains enzymes that break down the food chemically, are released by the salivary glands in the mouth. The saliva mixes with the food to moisten it and allows it to be formed into a bolus (a ball of soft chewed food) that will be swallowed. Most people produce saliva freely. It can be stimulated by smell as well as food being placed in our mouth. When we smell something good, like cookies baking, we salivate. However, it should be noted that some medications reduce the amount of saliva produced resulting in a dry mouth which makes swallowing more difficult, so it is necessary to be cognizant of the medications being used.
Certain foods break down more easily than others. For example, meat will not break down in your mouth without our teeth tearing and grinding it into particles, however long you hold it there. Other foods, like some kinds of crackers, will dissolve without chewing, if they are held in the mouth. After a few minutes they will become liquidized as they mix with saliva.
Some people lack the ability to move their jaw laterally and only use an up and down jaw movement to break up food. This is inefficient and without the back teeth grinding food the particles are irregular in size and large lumps can be left. Additionally, if the tongue does not move from side to side in a controlled manner, food is not pushed onto the back teeth to be chewed. (If teeth are missing then chewing ability is reduced. Some people are able to "gum" normal food to a consistence that is appropriate for them to swallow while others who have missing teeth, cannot.)
As mentioned earlier, when providing food for individuals who lack the ability to self-feed, it is important to be sure that the texture of the food being offered is appropriate for their oral motor skills and that it will not increase their risk of choking. Jonathan Rosenfeld, a lawyer who represents people injured in nursing homes, draws attention to the importance of food texture to everyone who is at risk of aspiration or choking. In an article on his blog, he relates the story of a nursing home resident who choked to death on a tuna fish sandwich. This is a dramatic example, but nevertheless, important because it profoundly illustrates how important food texture is for safe eating.
Various foods can be misleading as to how safe they are. This is more significant if the person is not seated correctly and does not have a chin-tuck. A good exercise to go through to understand this concept is to eat pudding. Sit in a chair and take a spoonful of pudding into your mouth. Hold the pudding in your mouth and lean back in your chair into a relaxed position. The pudding will move to the back of your mouth in this position. Note how it moves freely in your mouth rather than being easily formed into a bolus. Clear your mouth and take another bite, this time while the pudding is in your mouth raise your chin. The pudding will trickle to the back of your mouth and then to your throat. It will create the feeling of gagging. This exercise illustrates that even with soft food that appears to be easy to eat, it isn’t necessarily easy to control once it is in your mouth. Think about how runny the second bite of pudding became in your mouth. Sweet food will produce more and more saliva and therefore the second, and following bites, will become runnier as more saliva is produced. Also, the addition of saliva reduces the strength of the flavor and thus the taste buds are less able to track where it is in the mouth. To reduce excessive saliva production it is helpful to eat something more savory alternately with sweet food.
Many people are able to eat a normal variety of foods if they are prepared appropriately for them. Meat and other solid foods should always be cut into small pieces rather than lumps. It is safer to offer three or four small pieces of meat than one big piece, even if it is easier and quicker to offer a big bite. On the other hand, many people are fed texture-controlled foods that have been chopped or blended instead of cut into small pieces. There is a significant change in the taste of foods when they are minced or blended. Meats, in particular, lose much of the flavor when they are broken into particles, they also lose much of their moisture and liquids must be added to blend them. (Of course, if a texture-controlled diet has been prescribed, pieces of food should not be offered!) If blended or chopped food is being offered, improving the flavor should be addressed so that the consumer still enjoys the flavor of the meal. The importance of food flavor is addressed in our January 2010 Newsletter Topic: Food Flavor.
|Safety in Eating:
Regardless of the textures of food that is being eaten, the
individual who cannot self-feed is still at risk because they
are being fed. The Mealtime Partner Dining System is able to
serve foods from puree texture to normal bite sized pieces of
meat, etc. Additionally, it is able, through the use of
specially shaped bowl covers, to provide different volumes of
food for each spoonful served. For those who depend upon another
person for their nutritional needs, the Mealtime Partner Dining
System provides the best option to safe and independent eating.
For information about the Mealtime Partner Dining System, you can visit the Mealtime Partners' website, or view our 4 minute video. There is no other assistive dining system that meets the needs of the users, like the Mealtime Partner.
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