Thickened Liquid Challenge-Revisited

The Thickened Liquid Challenge Re-Visited

Thickened Liquid Challenge

I don’t know about everybody else, but I was extremely excited to see the #thickenedliquidchallenge when it popped up on my Twitter feed.  The first thing I thought was, what an amazing way to raise awareness for dysphagia!  I continue to see so many who simply don’t know what dysphagia is.  

I recently had a conversation with a friend and colleague via Twitter who questioned the #thickenedliquidchallenge.  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.  

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.  

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!

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.

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