The Great Thickener Challenge

So maybe it’s not really great, but it was a challenge. So what in the heck am I talking about??

Have you ever looked at all those different brands of thickener? Sometimes you don’t know which will be the best for your patients. Between Thick-It, Simply Thick, Thick n Clear, ThickenUp it’s hard to decide which will be best for your patient. Maybe by best, we also need to think about the look, taste and consistency that will be the most palatable for your patient.

I think we’ve all had those patients that just won’t drink because you put “that stuff” in their drinks. Their family members say if they could just have a drink of something maybe they’ll feel better.

A Cup to Help with Drink Sizes

There is a very nice product out there called the Provale cup. By limiting the amount of liquid a patient receives, either 5cc or 10cc, the patient may then be able to safely drink thin liquids. The Provale cup is for another post.

Thickener Samples

Going to conferences, particularly, the ASHA Convention, there are samples of thickener to go around. Nestle Nutrition also provides samples of ThickenUp free of charge. I decided that one day I would mix these samples with water, using the same container and method to mix, the same water and thicken the water to nectar consistency, just to see the variation.

The Process

I used 4 ounces of water from our cooler, which is purified water. I put the 4 ounces in a shaker and shook the water mixed with the pre-measured packet of thickener for nectar consistency. I shook for 30 seconds and then poured the liquid in a small cup.

The liquids were allowed to sit our for 10 minutes then the taste test began.

Comments

The following are comments by patients, therapists and myself regarding each thickener, marked by number. I could only get 4 to sample the thickened drinks, which is not a significant number, but I’m not publishing this…..

1. Clear-bubbly
Smooth
No added flavor
“look-best”
alright
water with added flavor
no flavor
slightly sweet
smooth
tastes like water
looked good

Preferred by 4

2. Cloudy
Thick chalky tasting
left after taste
“looks thick”
thicker than #1
not bad
no flavor
very thick
pasty
floury
looks terrible
tastes terrible
feels sticky
had to wait for sip

Preferred by 0

3. Cloudy
Flour-taste
grainy
after taste
“no”
not palatable
tastes bad
floury
thinner than 2
little thick
tastes-not too bad
looks bad

Preferred by 0

4. clear
slimy-coating after
flour taste
“ew”
similar to #1
little thicker
looks good
too thick
after taste
sticking all over

Preferred by 0

5. clear
no over-powering flavor
no after taste
smooth
no
no flavor at all
looks ok
went down ok
no taste

Preferred by 0

6. cloudy
thick
starchy taste
No
thick
worst thing seen or tasted

Preferred by 0

7. cloudy
thick and clumpy
starchy taste
no
spit back out
too thick
tastes/looks terrible

Preferred by 0

There were many variations including the yield, the color varied from clear to cloudy. The consistency differed from a honey consistency to a slightly thicker than thin consistency.

The results:

#1 Simply Thick

#2 Thick It

#3 Thick It 2

#4 Thik and Clear

#5 Thicken Up Clear

#6 Thicken Up

#7 Thick and Easy

By a landslide, all 4 people chose Simply Thick as the best during this challenge.

Everyone should challenge themselves to get as many thickener samples as they can.  Try those thickeners and determine the quality of the thickeners so that you can make an educated recommendation for your patients to increase their willingness to comply with the liquids and to provide them with the best quality thickener available.

Concerns with Thickener

A friend and colleague expressed concerns over a social media thickened liquid challenge.  Her concern is that we see so many of the videos where people are making faces and almost making it amusing.  Her main concern is that there are people out there that NEED thickened liquids and perhaps physicians will see these videos and decide to stop ordering thickened liquids.

There are absolutely many concerns we need to think of when we think about and look into thickened liquids.  

Concerns to Consider with Thickened Liquids

Hydration-How many of our patients on thickened liquids simply choose to stop drinking.  They either don’t like the taste or they don’t like the texture.  Most would do anything for a glass of regular water.  We know dehydration leads to so many other issues including xerostomia, urinary tract infection, cognitive deficits, etc.  

Risk of aspiration-Many studies have shown that thickened liquids do in fact slow the bolus.  The thicker substance typically gives the patient more control of the bolus.  Many studies have also found an increase of pharyngeal residue with these thickened liquids with concern for aspiration after the swallow.  Logemann, et al found that patients have a greater mortality rate with aspiration of thickened liquids vs. regular liquids.

As a Speech-Language Pathologist, we must be cognizant of what we recommend for our patients.  Instead of always just jumping to thickened liquids, what else can we try?  What are all the factors with this patient?  

Rehabilitation

Thickened liquids can have value in rehabilitation of the swallow.  There is evidence to support the use of a heavier or thicker bolus to increase muscle function during the swallow.  Thickening liquids can be a great way to add a little weight to the bolus.

I would encourage everyone to use this #thickenedliquidchallenge as a means of educating others regarding dysphagia.  Don’t just try the liquid, say it is gross and swear off thickened liquids.  We need to educate everyone on why we use thickened liquids.  Not just because that’s what we were told to do.  

Donate

I would also use this as an opportunity whether or not you complete the challenge (I couldn’t do it!) to donate to the National Foundation of Swallowing Disorders (NFOSD).  They provide great services and education.  These happen because of donations!

Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation?   Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care?  You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes.   You can get your copy here.  

References:

http://www.geripal.org/2015/01/do-thickened-liquids-help-people-with-dysphagia.html?m=1

Logemann, Jeri A., et al. “A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease.”Journal of Speech, Language, and Hearing Research 51.1 (2008): 173-183.

Steele CM, Miller AJ. Sensory Input Pathways and Mechanisms in Swallowing:  A Review. Dysphagia (2010) 25: 323-333.

Steele CM, et al. The Influence of Food Texture and Liquid ConsistencyModification on Swallowing Physiology and Function: A Systematic Review.  Dysphagia DOI: 10.1007/s00455-014-9578-x.

Steele CM, Lieshad P. Influence of Bolus Consistency on Lingual Behaviors inSequential Swallow. Dysphagia 19: 192-206 (2004).

Garcia JM, Chambers E. Insights Into Practice Patterns for Thickened Liquids.  Perspectives in Swallowing and Swallowing Disorders. 15 (1) 14-18.