This means that individuals who are involved in purchasing or preparing thickened liquids for people with dysphagia rely on the information on product labels or on subjective measures, such as the stirring and manipulation of a liquid, observation of the liquid while being poured from a cup or analysis of the liquid by mouthfeel, or oral appraisal. However, neither the equipment nor the skills necessary to perform accurate viscosity measurements at controlled shear rates are accessible to clinicians, caregivers, or patients with dysphagia. Viscosity measurements for these categories were proposed at a shear rate of 50 reciprocal seconds (/s) as follows: thin: 1–50 cP nectar-like: 51–350 cP honey-like: 351–1750 cP and spoon-thick: > 1750 cP. In North America, liquids used in dysphagia management have been known by the labels thin, nectar-like, honey-like, and spoon- or pudding-thick since the publication of the National Dysphagia Diet (NDD) in 2002. A 2013 review of terminology and guidelines around the world clearly illustrated the potential for confusion across countries. ĭespite the widespread use of thickened liquids in dysphagia management, without clear definitions for different degrees of thickening, there is a high likelihood of variability in practice. However, to date, the literature has not identified the degree of thickening that is required to achieve therapeutic benefit. In 2008, a landmark study by Logemann and colleagues showed that individuals with dementia or Parkinson’s disease who aspirated thin barium were less likely to aspirate thicker liquids. Thickened liquids flow more slowly than thin liquids, and this provides extra time for a person with dysphagia to achieve airway protection during swallowing. Texture modification is a widely used intervention for dysphagia.
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