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Optimizing Sensory, Rheologic and Swallowing Parameters in the Development of Biophysically Designed Beverages for Swallowing Impaired Elders K. Banaszynski 1 , J. Hind 2, 5 , H. Mendenhall 3 , H. Damodhar 4 , C. Grummer 3 , A. Joyce 1 , Z. Vickers 4 , J. Robbins 1, 2, 5 , R. Hartel 3 University of Wisconsin, Madison, WI Department of Nutrition 1 , Department of Medicine 2 , Department of Food Science 3 , University of Minnesota, St. Paul, MN Department of Food Science and Nutrition 4 , William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison 5 Nearly 40% of Americans over age 60 experience swallowing problems (dysphagia) 1 Dysphagia can lead to pneumonia, malnutrition and dehydration 2 One common treatment for people with dysphagia is to thicken the beverages they drink 3 Thickened liquids move slower than thin liquids, making them less likely to enter the airway, however little is known regarding the important parameters for designing optimal “biophysically – 4, 5 Background Methods Acknowledgments Conclusions Although further work is necessary, these preliminary results rheological properties so they are refreshing and mouth clearing, with the swallowing characteristics needed for people suffering from dysphagia Future Work Continue data collection Partner with commercial manufacturers to develop to match the standard barium materials used for diagnosing dysphagia, while maintaining appealing sensory and nutrition characteristics Madison VA hospitals to determine the effectiveness of the developed products as a treatment for diagnosed dysphagic patients USDA Grant NRI2007-2234 This material is the result of work supported with resources and use of facilities at the William S. Middleton Memorial Veterans Hospital, Madison, WI The contents do not represent the views of the Department of Veterans Affairs or the United States Government References 1. Ney DM, Weiss JM, Kind AJ, Robbins J. Senescent swallowing: impact, strategies, and interventions. Nutr Clin Pract 2009;24(3):395-413 2. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest 2003;124(1):328-36 3. Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients. Evid Rep Technol Assess (Summ) 1999:1-6 4. Lazarus CL, Logemann JA, Rademaker AW, Kahrilas PJ, Pajak T, Lazar R, Halper A. Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients. Arch Phys Med Rehabil 1993;74:1066-70 Subjects: 15 Healthy males and females, 22-72yr (mean 43yr) 5 Dysphagic males and females, 23-87yr (mean 68yr) Data Collection and Analysis: yield stress) and sensory attributes to best represent a wide range of (Table 1) radiopaque Sensory o questionnaire with labeled affective magnitude and visual analog scales o Outcome Measures coating and thirst quenching Digital Fluoroscopy o and standard barium products (Varibar Nectar ® and Varibar Thin Honey ® , Bracco) o Outcome Measures: direction, duration and completeness of Swallowing Pressures o Lingual pressures generated during swallowing were measured the Digital Swallowing Workstation ® (KayPentax)(Figure 1) o Outcome Measures: maximum pressure (mmHg) and the gradient of the pressure rise (mmHg/sec) were calculated from pressure waveforms produced at each bulb location during each swallow Results Sensory (Table 2) highest in overall liking and thirst quenching Methoxyl Pectin as lowest in liking and thirst quenching and Dysphagic subjects liked the 1500cp Iota Carageenan best, Digital Fluoroscopy associated barium standards Agar (300cp) and Tara Gum (1500cp) varied most from their respective barium standards in terms of faster pharyngeal transit and total swallow duration Swallowing Pressures generated during the swallow Methylcellulose (300cp) had faster time to reach peak pressure compared with the barium standard Table 1. hydrocolloids in two viscosity groups (300cp and 1500cp). 300 cp 1500 cp High Methoxyl Pectin Iota Carrageenan Tara Gum Agar Methycellulose Xanthan Gum Table 1 Measures of central tendency were computed for sensory data. Repeated-measures analysis of variance models were used to on peak pressure, time to peak pressure, swallowing durations, residue and penetration-aspiration scale, adjusting for age, sex, dysphagia and bulb (for pressure only). Analyses were conducted using Proc Mixed in SAS Version 9.1 (SAS Institute Inc, Cary NC). A nominal p-value of 0.05 was regarded as Figure 1 Table 2. Overall Liking was measured using a labeled affective magnitude scale from 0 (greatest possible dislike) to 15.6 (greatest were rated using a visual analog scale (0-15) with 0 being “none/not at all” and 15 being “large amount or very.” Table 2 Statistical Analysis

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Page 1: Document65

Optimizing Sensory, Rheologic and Swallowing Parameters in the Development of Biophysically Designed Beverages

for Swallowing Impaired EldersK. Banaszynski1, J. Hind2, 5, H. Mendenhall3, H. Damodhar4, C. Grummer3, A. Joyce1, Z. Vickers4, J. Robbins1, 2, 5, R. Hartel3

University of Wisconsin, Madison, WI Department of Nutrition1, Department of Medicine2, Department of Food Science3, University of Minnesota, St. Paul, MN Department of Food Science and Nutrition4, William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison5

��Nearly 40% of Americans over age 60 experience swallowing problems (dysphagia)1

��Dysphagia can lead to pneumonia, malnutrition and dehydration2

��One common treatment for people with dysphagia is to thicken the beverages they drink3

��Thickened liquids move slower than thin liquids, making them less likely to enter the airway, however little is known regarding the important parameters for designing optimal “biophysically –�������������4, 5

Background

Methods

Acknowledgments

ConclusionsAlthough further work is necessary, these preliminary results ����� ����������������������������������������������������rheological properties so they are refreshing and mouth clearing, with the swallowing characteristics needed for people

suffering from dysphagia

Future WorkContinue data collectionPartner with commercial manufacturers to develop ������������������������ ������� ������������ �������������to match the standard barium materials used for diagnosing dysphagia, while maintaining appealing sensory and nutrition characteristics ��� ��������������������������� ����������������������� ��Madison VA hospitals to determine the effectiveness of the developed products as a treatment for diagnosed dysphagic patients

��USDA Grant NRI2007-2234��This material is the result of work supported with resources and use

of facilities at the William S. Middleton Memorial Veterans Hospital, Madison, WI

��The contents do not represent the views of the Department of Veterans Affairs or the United States Government

References1. Ney DM, Weiss JM, Kind AJ, Robbins J. Senescent swallowing:

impact, strategies, and interventions. Nutr Clin Pract 2009;24(3):395-413

2. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest 2003;124(1):328-36

3. Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients. Evid Rep Technol Assess (Summ) 1999:1-6

4. Lazarus CL, Logemann JA, Rademaker AW, Kahrilas PJ, Pajak T, Lazar R, Halper A. Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients. Arch Phys Med Rehabil 1993;74:1066-70

Subjects:15 Healthy males and females, 22-72yr (mean 43yr) 5 Dysphagic males and females, 23-87yr (mean 68yr)

Data Collection and Analysis:��������������������������!""��� ��������#$""��&���������������' ����������������� �� �������������*���������*����������� ��yield stress) and sensory attributes to best represent a wide range of ������ � +������(Table 1)

/��������������������+����������!<�' ���+����� ������+ ������+�radiopaqueSensory o ��'=�������+������� ���������� �� ����������������������� �

questionnaire with labeled affective magnitude and visual analog scales

o Outcome Measures>����� ��������*������� ��� ���*������� ��+�����coating and thirst quenching

Digital Fluoroscopyo ��'=������� �����������$+?�'����������� ������������������

and standard barium products (Varibar Nectar® and Varibar Thin Honey®, Bracco)o Outcome Measures: direction, duration and completeness of

'���������Swallowing Pressureso Lingual pressures generated during swallowing were measured

����� �!@'��'� �� ����������������� �Q������������ ���� � ��� ��the Digital Swallowing Workstation® (KayPentax)(Figure 1)

o Outcome Measures: maximum pressure (mmHg) and the gradient of the pressure rise (mmHg/sec) were calculated from pressure waveforms produced at each bulb location during each swallow

ResultsSensory (Table 2)Y�����!""�����������������*��� �������'=������ ����[� ��highest in overall liking and thirst quenching Y�����#$""�����������������*��� �������'=������ ����\����Methoxyl Pectin as lowest in liking and thirst quenching and ������������������� ���� ��+������� ���Dysphagic subjects liked the 1500cp Iota Carageenan best, � ������������������������� ���� ��+������� ���

Digital Fluoroscopy [����������������� �������+������� ����� ������� �������associated barium standardsAgar (300cp) and Tara Gum (1500cp) varied most from their respective barium standards in terms of faster pharyngeal transit and total swallow duration

Swallowing Pressures[���������+ ����������' ���+��� � �������� �����������generated during the swallowMethylcellulose (300cp) had faster time to reach peak pressure compared with the barium standard

Table 1. ��'=������� �������������������������������hydrocolloids in two viscosity groups (300cp and 1500cp).

300 cp 1500 cp

High Methoxyl Pectin

Iota Carrageenan

Tara Gum

Agar

Methycellulose

Xanthan Gum

Table 1

Measures of central tendency were computed for sensory data. Repeated-measures analysis of variance models were used to �����������+� �������������������� ������������' ���+��� � ���on peak pressure, time to peak pressure, swallowing durations, residue and penetration-aspiration scale, adjusting for age, sex, dysphagia and bulb (for pressure only). Analyses were conducted using Proc Mixed in SAS Version 9.1 (SAS Institute Inc, Cary NC). A nominal p-value of 0.05 was regarded as �� ������ ��������Q� �^

Figure 1

Table 2. Overall Liking was measured using a labeled affective magnitude scale from 0 (greatest possible dislike) to 15.6 (greatest �����'�������&^�?�������� ���*�+������� ���� ���������_�������were rated using a visual analog scale (0-15) with 0 being “none/not at all” and 15 being “large amount or very.”

Table 2

Statistical Analysis