*This post is sponsored by SimplyThick. Although SimplyThick has paid for this post, I am a huge fan of SimplyThick when liquids need to be thickened! You can visit the SimplyThick Dysphagia Ramblings page here to request free samples.*
SimplyThick (you know, the gel thickener) was founded back in 2001 by John Holahan. SimplyThick was founded when a prototype was created using a liquid xanthan gum thickener. This was a ground-breaking alternative to the starch thickeners that were widely used at the time. You can read more about SimplyThick in John’s own words!
If you have attended the ASHA convention, you might remember their table (the one with the wine fountain!)
Guest Post By: Jessica Lasky, MS, CCC-SLP and Allison Boyer, MA, CCC-SLP
Who We Are
The Dysphagia Outreach Project is a 100% volunteer-run 501(c)(3) nonprofit organization that was founded in 2019. The mission of the Dysphagia Outreach Project is to provide meaningful assistance to low-income individuals affected by dysphagia via our Dysphagia Food Bank and educational efforts. This organization relies on both product and monetary donations to provide our recipients with the safest and most evidence-based dysphagia products shipped right to their front door at no cost to them. The Dysphagia Outreach Project also provides free education to patients and families, as well as clinicians and physicians. Additionally, the volunteer branch allows clinicians across the country to contribute to this cause and is the backbone of the organization which enables the Dysphagia Outreach Project to operate in all fifty states in the USA.
Dysphagia In Adults
How does dysphagia affect the adult population? Dysphagia affects 1 out of 25 adults annually; moreover, dysphagia is associated with lost workdays, with the average person with dysphagia missing 12-13 days annually. Women are more likely than men to report swallowing problems. Stroke and neurological causes are the number 1 and 2 reported etiologies (Bhattacharyya, 2014). Additionally, 1 in 6 adults reported swallowing difficulties. Of those, half of them never discussed their dysphagia concerns with their physician or medical team. They suspected that a lot of the dysphagia in these cases were treatable (Adkins, C et al., 2020).
Dysphagia After Stroke
In patients who are status post-stroke (cerebrovascular accident, or CVA), they recover swallowing function gradually, and therapeutic interventions for dysphagia generally are successful. In a prospective investigation of 128 patients admitted because of acute stroke, a swallowing abnormality was detected in 51% on clinical examination and in 64% on videofluoroscopy at initial presentation (Masiero S et al., 2008). Additionally, patients who have had a stroke are likely to decrease their dietary intake, which increases their risk of malnutrition or exacerbates existing malnourishment. In an investigation of the nutritional status of patients with stroke who were admitted to a rehabilitation service, 49% had malnutrition, and 65% of those with dysphagia were malnourished. (Odderson IR, et al., 1995).
Dysphagia In Pediatrics
An estimated 116,000 newborn infants are discharged from short-stay hospitals with a diagnosis of feeding problems, according to the National Hospital Discharge Survey from the CDC (National Center for Health Statistics, 2010). Prevalence is estimated to be 30%–80% for children with developmental disorders (Delaney, 2008). According to the Centers for Disease Control and Prevention (CDC), survey interviews indicated that within the past 12 months, 0.9% of children (approximately 569,000) ages 3–17 years are reported to have swallowing problems (Bhattacharyya, 2015; Black, Vahratian, & Hoffman, 2015). Additionally, a study by Kooi-van Es et al found that out of 295 children with neuromuscular disease, dysphagia and dysarthria had a pooled overall prevalence of 47.2% and 31.5%, respectively. The investigators reported that 90.0% of children with dysphagia had chewing problems, while 43.0% had swallowing problems, and 33.3% demonstrated difficulties with both chewing and swallowing (Kooi-Van et al, 2020). Lastly, prevalence rates of oral dysphagia in children with craniofacial disorders are estimated to be 33%–83% (Caron et al., 2015; de Vries et al., 2014; Reid, Kilpatrick, & Reilly, 2006).
Dysphagia Outreach Project Statistics
Here at The Dysphagia Outreach Project, no single person within the organization–from the founders to the occasional volunteer–is paid anything. We are a 100% volunteer-based organization. Any donations that come to us go straight to our recipients or to keep the lights on. As of the year 2020, 81% of our recipients are pediatric. Ninety percent of our pediatric recipients are under five years of age and 60% of our recipients are under 24 months old. We’ve received over 10,000 items and distributed over 8,600 of those items. Our average recipient family size is 3.6 people and the average recipient family income is just over $40,000 per year. Lastly, the Dysphagia Outreach Project boasts 151 registered volunteers, whose combined efforts are one of the primary reasons that we are able to provide the help that we do!
The Giving Event
In order for us to continue to provide this level of assistance to individuals and families in need, we need your help! The Dysphagia Outreach Project will be hosting its annual fundraiser, The Giving Event, which will be held the week of Giving Tuesday [Monday, November 30th to Friday, December 4th]. Following Thanksgiving, Giving Tuesday is a day associated with international charitable giving which marks the beginning of the Christmas and holiday season.
The Giving Event will go live on The Dysphagia Outreach Project’s Facebook page at 8 pm EST, every night for 5 nights, starting on Monday, November 30th. We will be awarding a TON of cool prizes [think exclusive CEU courses, memberships to hugely popular SLP subscription services, a brand new iPad, and MUCH MORE]!
How to Donate
For every $5 dollars you donate, your name will be entered on our virtual prize wheel. The more donations = the more entries! Each night of the Giving Event, a Dysphagia Outreach Project representative will spin the wheel to select a prize winner at random. To enter, please text GIVINGEVENT to 44-321 and follow the prompts to submit your donation. Together, we can make the holidays of those experiencing dysphagia a little bit brighter.
Adkins C, Takakura W, Spiegel BMR, Lu M, Vera-Llonch M, Williams J, Almario CV. Prevalence and Characteristics of Dysphagia Based on a Population-Based Survey. Clin Gastroenterol Hepatol. 2020 Aug;18(9):1970-1979.e2. doi: 10.1016/j.cgh.2019.10.029. Epub 2019 Oct 24. PMID: 31669055; PMCID: PMC7180111.
Bhattacharyya N. The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg. 2014 Nov;151(5):765-9. doi: 10.1177/0194599814549156. Epub 2014 Sep 5. PMID: 25193514.
Caron, C. J. J. M., Pluijmers, B. I., Joosten, K. F. M., Mathijssen, I. M. J., van der Schroeff, M. P., Dunaway, . . . Koudstaal, M. J. (2015). Feeding difficulties in craniofacial microsomia: A systematic review. International Journal of Oral & Maxillofacial Surgery, 44, 732–737.
Delaney AL, Arvedson JC. Development of swallowing and feeding: prenatal through first year of life. Dev Disabil Res Rev 2008;14:105–17.
de Vries, I. A. C, Breugem, C. C., van der Heul, A. M. B., Eijkemans, M. J. C., Kon, M., & Mink van der Molen, A. B. (2014). Prevalence of feeding disorders in children with cleft palate only: A retrospective study. Clinical Oral Investigations, 18, 1507–1515.
Kooi-van Es M, Erasmus CE, de Swart BJM, et al. Dysphagia and Dysarthria in Children with Neuromuscular Diseases, a Prevalence Study. J Neuromuscul Dis. 2020 Mar 11. [Medline].
Masiero S, Pierobon R, Previato C, Gomiero E. Pneumonia in stroke patients with oropharyngeal dysphagia: a six-month follow-up study. Neurol Sci. 2008 Jun. 29(3):139-45. [Medline].
The International Dysphagia Diet Standardisation Initiation is here and being utilized in many facilities.
IDDSI was created to replace the National Dysphagia Diet and to standardize food and liquid consistencies.
I’m sure you have probably been in a number of facilities that interpret Mechanical Soft, Dysphagia Soft, etc a little different than other facilities. Some facilities allow a number of food items on one diet level that another facility adds into a different level.
IDDSI involves 5 food consistency levels and 5 liquid levels.
So what do these levels mean?
Level 0 (Thin) is a liquid that flows like water. (Flow test 1 ml or less in the syringe.)
Level 1 (Slightly Thick) Thicker than water, but is not quite Mildly Thick (formerly Nectar Thick). (Flow test 1-4 ml remains in syringe). This may include formula or commercially available nutrition drinks such as Boost or Ensure.
Level 2 (Mildly Thick formerly Nectar Thick). Flows off a spoon but is thicker than water. Requires increased effort to drink from a straw. (Flow test 4-8 ml left in the syringe.)
Level 3 (Moderately Thick formerly Honey Thick). This level takes a moderate effort to drink through a straw, but can be drunk from a cup. This level can be taken from a spoon, but is too thin for a fork. (Flow test 8-10 ml left in the syringe.)
Level 4 (Pureed/Extremely Thick formerly Pudding Thick). Usually can be administered via spoon, however may also be eaten via fork. Cannot be taken through a straw, usually taken via spoon. There should be no lumps, requires no chewing and the liquid should not separate. (Flow Test 10 ml remains in the syringe.) Spoon tilt test-should fall off the spoon in single spoonful. Should sit in a mound on top of the spoon/fork with minimal dripping through the fork.
Level 5 (Minced and Moist) Small lumps in the bolus (no larger than 4mm width and 15mm length for adults), can be eaten using spoon or fork. Liquid should not separate from food. (Fork test minimal pressure to mash with no blanching of the thumbnail to white while pressing.) (Spoon test should fall off the spoon in a cohesive mound with little to none left on the spoon.)
Level 6 (Soft and Bite Sized) Can be eaten with a fork, spoon or chopsticks. Each piece should be no larger than 15mm. Chewing is required with this consistency, however biting or cutting is not required. (Fork test, when a fork is pressed against the food, the thumbnail should blanch or turn white to squash or break apart the food). (Spoon test pressure from the spoon can cut, squish, mash or break apart the food and it will not return to its shape.)
Level 7 (Easy to Chew) Normal, everyday soft foods. Size of food is not restricted. Requires the ability to bite/chew food. (Fork/Spoon Test food is easily cut with pressure from a fork/spoon, thumbnail blanches or turns white when applying pressure to the food until it smashes, breaks apart or crumbles without resuming its original shape.
Level 7 (Regular) Normal, everyday food.
Transitional Foods (Fork/Spoon test, add 1 ml water, wait 1 minute, when applying pressure on the fork/spoon on the food, thumbnail blanches while applying pressure until the food breaks or smashes.)
Some examples of transitional foods?
Ice cream/Sherbet if assessed as suitable by a Dysphagia specialist
Japanese Dysphagia Training Jelly sliced 1 mm x 15 mm
Wafers (also includes Religious Communion wafer)
Waffle cones used to hold ice cream
Some biscuits/ cookies/ crackers
Some potato crisps – only ones made or formed from mashed potato (e.g. Pringles)
Baby Mum Mums™
Gerber Graduate Puffs™
For everything you need to know regarding IDDSI, visit the website here.
Do you want easily printable information sheets for each level and testing for each level? Find that here.
Want samples and examples for testing liquids/foods? Find that here.
Supplementary Notice: Modification of the diagrams or descriptors within the IDDSI Framework is DISCOURAGED and NOT RECOMMENDED. Alterations to elements of the IDDSI framework may lead to confusion and errors in diet texture or drink selection for patients with dysphagia. Such errors have previously been associated with adverse events including choking and death.
Thickened liquids have had a lot of publicity lately in social media. They’ve been a large part of dysphagia management. Sometimes, it can be argued that the use of thickened liquids occurs more frequently than other compensation or management techniques.
“Texture modification has become one of the most common forms of intervention for dysphagia and is widely considered important for promoting safe and efficient swallowing.” (Steele and Miller 2010)
Often, products or research is aimed at reducing the use or need of thickening liquids. The Provale cup is one such product that only allows the patient 5-10 ml per drink, which may or may not be a safer amount of thin or nectar thick liquids.
There is a lot to look at when looking into thickened liquids. The physical cost is definitely an issue. Thickener is not cheap. My friend Vince Clark calculated the cost of pre-thickened liquids and posted the following on Facebook:
When we look at the cost of Thickened liquids:
Per Day: 9 x .34 = $3.06
These are the costs of a single organization. An individual purchasing thickener may pay double.
We also need to look at how thick we’re recommending for our patients. Many times and research back that maybe nectar thick is enough. Dr. Leder looked at patients that aspirated thin liquids and found that these same patients had 100% successful swallows with both nectar and honey thick liquids indicating that nectar thick may be adequate to promote safe swallowing. (Leder et al 2012)
There has been research leading to the fact that maybe we shouldn’t thicken liquids. Dr. Logemann et al found honey thick liquids were the most effective in eliminating aspiration when compared to nectar thick liquids and a chin tuck.However, when aspirated, honey thick liquids had the most significant impact causing pneumonia, longer hospital stays or death. (Protocol 201).
There are times patients are seen for a Modified Barium Swallow Study (MBSS), they penetrate with both thin and nectar so they are placed on honey thick liquids. Perhaps the debate should not be an all or nothing, thickened liquids or no thickened liquids, but look at the whole patient and make the decision with them. Always consider those patients that aspirate thin liquids during the MBSS, return home, continue to drink thin liquids and never die from aspiration pneumonia like we sometimes teach them will happen when they aspirate.
My interpretation of this research into my very real daily job is that I need to consider the whole patient and that some patients just need those thickened liquids. They’re not going anywhere anytime soon.
In fact, thickened liquids can be great therapeutically. Dr. Bonnie Martin-Harris has done quite a bit of research while developing the Modified Barium Swallow Impairment Profile (MBSImP) and has found that using a nectar consistency during the Modified Barium Swallow Study (MBSS) there is more significant pharyngeal movement during the swallow. There are also studies looking at how adding “weight” to the bolus can be an effective therapeutic strategy.
We need to be careful in interpretation of research. Just because an article came out that says not to use thickened liquids at all, don’t go and throw out all your thickener. (Wallace, this article, 2016).
The cost is not only monetary, but also in our patient’s health, satisfaction and quality of life. We all have or have had that patient that just really doesn’t mind thickened liquids. They drink the liquids, they may not be turning cartwheels with thickened liquids but they tolerate them. Some patients know it’s short-term and once they rehabilitate their swallowing function they may be able to resume thins.
We also have or have had those patients that just outright refuse thickened liquids. They don’t like the texture or the consistency. This may be the patient that says, “I know I need them but they taste like snot.” (A former patient on thickened liquids circa 2011.) This may also be the patient that refuses to follow your recommendations or just stops drinking all-together.
There always has to be a balance and a consideration for hydration, overall health, respiratory health and patient satisfaction. I’m not talking the survey the patient gets and rates you on a scale from 1-whatever. I’m talking about their everyday, I’m happy with my life satisfaction.
Always look at your patient as a whole. Look at their respiratory system, their overall health, history, cognition and if able create a plan with that patient.
I have completed many MBSS’s with many patients over my years. “Remember, the person is here because they have been having difficulty with their swallow. I’m guessing this isn’t the first or last time they have or will aspirate.” (Wallace at every MBSS when the radiologist is ready to quit because the patient aspirated.)
Remember those elders at the SNF that are put on thickened liquids and remain on honey thick liquids for the rest of their days. These may be the same people you say wandering the halls, stealing drinks at the water cooler, stealing drinks from the tables in the dining room or sneaking drinks from the bathroom sink.
Steele, C. M., & Miller, A. J. (2010). Sensory input pathways and mechanisms in swallowing: a review. Dysphagia, 25(4), 323-333.
Robbins, J., Hind, J., & Logemann, J. (2004). An ongoing randomized clinical trial in dysphagia. Journal of communication disorders, 37(5), 425-435.
Leder, S. B., Judson, B. L., Sliwinski, E., & Madson, L. (2013). Promoting safe swallowing when puree is swallowed without aspiration but thin liquid is aspirated: nectar is enough. Dysphagia, 28(1), 58-62.
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?
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.
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.
I was really excited to see Gelmix at the ASHA Convention this year. I’ve heard a lot about Gelmix, but have never had the opportunity to try it until now!
What is Gelmix?
Gelmix is a “healthy thickener” as it is USDA Organic. Gelmix was formulated to thick breast milk, formula and other liquids. Gelmix is also free from common allergens including: gluten, corn, lactose, casein and soy.
Gelmix is made from Carob Bean Gum. Carob Bean Gum is widely used for its gelling and thickening properties. The other two ingredients in Gelmix are Organic Tapioca Maltodextrin and Calcium Carbonate.
Gelmix is activated in warm liquids, so you must warm the liquid prior to thickening it with Gelmix.
Gelmix can be used for term infants and children under 3 to thicken to a “light honey-thick consistency.” For children over 3 and adults, Gelmix can be used to thicken liquids to a “spoon-thick consistency.”
Gelmix is contraindicated for infants under a gestational age of 42 weeks or under 6 pounds. It also cannot be used with infants with suspected allergy to galactomannans.
Gelmix is available in an 8.8 oz jar (250 grams) which will thicken up to 624 fluid ounces for $29.99 or you can buy the “stick pack” which contain 5 stick, individual serving packets for $5.99. Each stick will thicken 4 oz of liquid to nectar consistency.
The instructions for thickening with Gelmix:
Warm desired amount of liquid (between 100-120 degrees F for best results).
Sprinkle in Gelmix per usage instructions.
Mix well until Gelmix is completely dissolved.
Wait 5 minutes for the mixture to thicken and cool to a safe feeding temperature, mix again before serving.
Infants and Children under 3:
Half Nectar: Add 1 scoop for every 3-4 ounces of liquid.
Nectar-Thick: Add 1 scoop for every 2 ounces of liquid.
(For infants and children under 3 years old, do not use more than one scoop Gelmix per 2 ounces of liquid. To avoid gassiness, start with lowest concentration, particularly for infants 6-12 pounds.)
Adults and Children over 3:
Nectar-Thick: Add 2 scoops per 4 ounces of liquid.
Honey-Thick: Add 3-4 scoops per 4 ounces of liquid.
Spoon-Thick: Add 4-5 scoops per 4 ounces of liquid.
Gelmix may gradually thicken over time.
Time for a Trial
Last night, I thought what a great time to try Gelmix and combine it with the #thickenedliquidchallenge. I heated up my water and some milk. I mixed the Gelmix in, per recommendations for honey thickened liquid.
I used a whisk to mix the thickener because when using a spoon, the water was extremely clumpy. The milk actually became more of a pudding thick liquid.
The water was a little discolored, as with almost all thickened water. The Gelmix really didn’t add a flavor to the water.
The milk was not discolored at all and had no added flavor.
The texture was another thing. I am just not a honey-thickened liquid person.
The Gelmix seems to be a good option for a more organic thickener, if you have access to heating your liquids. It seems to be a great option for babies and would love to hear your thoughts on using Gelmix with babies!
I was excited to have recently discovered a new thickener company called Slo Drinks. You may ask how I discovered this company since they’re based out of the UK. I found them on Twitter.
The company has been great to work with and were more than willing to send me samples. Twice.
After some delays, I received both sample packages!
Slo Drinks is a xantham based thickener, which comes in packets specified for specific drinks including soda, tea, wine, coffee, juice and beer. The packets also have a number 1 or 2, indicating the consistency. 1 is syrup consistency (nectar) and 2 is custard consistency (honey).
Slo Drinks come with a sheet of information that says:
“Slo Drinks flow slowly so they are safer to swallow. To make Slo Drinks, we deposit individual sachets with doses of our thickeners which dissolve quickly and are tasteless.
Our thickener works with alcoholic drinks and only requires mixing with the specified amount of fluid to reach the prescribed consistency Stage 1: Syrup, 2: Custard and make it flow slowly enough for the drinker to cope with.
As a result, you simply add the contents of the relevant sachet into a glass, add a favorite drink and change it into Slo Wine, Slo Cider, Slo Lager, Slo Beer, Slo Bubbly or Slo Mixer.
They will taste the same as ordinary glasses of wine, cider etc., but flow slowly.”
I wanted to try these for myself.
The only difficulty I had was the packages are made to add to ml of the fluid. There was no easy conversion to cups (that I found), so I converted as close as possible!
First up was the Lager. I stole one of my husband’s Samual Adams and mixed away. I put the Slo Lager in the glass, then added the Sam Adams and stirred.
The lager fizzed quite a bit, not the volcanic explosion of soda with corn starch based thickener. The fizzy went away after a few minutes. The lager then had to sit for 5 minutes.
It was definitely thick. It was smooth however and maintained most of the flavor and some of the fizz. I’m not a beer or lager fan, so I actually found the taste to be disgusting both before and after thickening!
It was the time for juice. I had orange juice in the house, so that’s what I used. This packet is nectar consistency.
I had to stir a little more vigorously with the juice. It was definitely not as thick as the lager.
I left both drinks sitting out for quite a while and the consistency never changed.
Then it was time for wine and tea.
I mixed both in a mixer bottle this time. I added the liquid and then added the thickener and shook both.
After sitting for 5 minutes per instructions:
Both were thick, honey consistency, but both maintained flavor. The consistency was smooth as most of the xantham gum based thickeners I have used. Both maybe lost a little bite, but not much.
I also tried the soda. I used Sprite and did the same as with the tea and wine. I added Sprite to the shaker bottle, then added the thickener. (There was no volcanic eruption!) I shook the Sprite. Unfortunately, I forgot to take pictures!!
I waited the 5 minutes and tasted the Sprite. It maintained flavor, but really had no fizz. Again, the liquid did maintain it’s consistency over time, even several hours later.
While I’m not a fan of the consistency of thickened liquids, the flavor of Slo Drinks was definitely one of the best that I have tried. They are worth looking into!!
A few months back, my friend and Simply Thick representative Eileen Hahn approached me. She had something new and exciting for me to try and she was going to visit my area in the near future.
You know how when you have a patient that can no longer drink thin liquids, because they aspirate, the two main items they seem to want is jello and water. They have a very difficult time understanding that jello melts to a thin liquid and they can no longer have this.
Eileen brought me samples of jello she made using Simply Thick to thicken the jello so that it remains thick. Much like the concept of the Magic Cups.
Eileen brought me several samples to try. Some nectar consistency and some were honey consistency. I tried the jello at first just for the taste. It actually tasted like jello and was good. A little thicker than I remember jello, but it really didn’t seem much different.
So, in remembering the pragmatic skills that we learn and teach, I waited until Eileen left, shut my door and then came the real taste-test. I held the jello in my mouth as long as possible. I swished the jello, chewed it and at times, just held it. Then, I spit the jello back into the cup for the clinical spoon test. You know, it’s how we poor clinicians test the consistency of liquids. Run it off the spoon to check the consistency. The jello seemed to maintain it’s thickened consistency, at least per the spoon test.
Simply Thick is continuing to test the product and is using the expert input of SLPs that specialize in dysphagia. They had many samples made up for testing at the 2013 ASHA convention.
Here are the directions, straight from Eileen, if you would like to make and trial your own thickened jello!
“I purchased the pre-made Jello in 4oz cups from the grocery and put it into the food processor. For every 4oz container, I added either one Nectar or one Honey packet. Processed it and put it back into container and back into the refrigerator to re-set.”
“When using powdered jello, I followed the recipe, but shorted the cold water portion by the number of ounces of SimplyThick I added. Since SimplyThick is mostly water, I thought reducing the water would keep the flavor from being diluted and improve the thickness.”
Thank you so much Eileen for a fantastic idea!
Do you want *FREE* samples of SimplyThick Slightly Thick packets? You can request them by clicking on the picture below!!
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.
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.
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.
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.
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…..
No added flavor
water with added flavor
tastes like water
Preferred by 4
Thick chalky tasting
left after taste
thicker than #1
had to wait for sip
Preferred by 0
thinner than 2
tastes-not too bad
Preferred by 0
similar to #1
sticking all over
Preferred by 0
no over-powering flavor
no after taste
no flavor at all
went down ok
Preferred by 0
worst thing seen or tasted
Preferred by 0
thick and clumpy
spit back out
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.
#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.