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SimplyThick Level 1 Thickening Packets

SimplyThick

*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!)

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The Dysphagia Outreach Project Giving Event

The Dysphagia Outreach Project Giving Event 2020

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. 

References

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].
National Center for Health Statistics. (2010). Number of all-listed diagnoses for sick newborn infants by sex and selected diagnostic categories [Data File]. Retrieved from https://www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf
Odderson IR, Keaton JC, McKenna BS. Swallow management in patients on an acute stroke pathway: quality is cost effective. Arch Phys Med Rehabil. 1995 Dec. 76(12):1130-3. [Medline].
Reid, J., Kilpatrick, N., & Reilly, S. (2006). A prospective, longitudinal study of feeding skills in a cohort of babies with cleft conditions. The Cleft Palate–Craniofacial Journal, 43,702–709.

Want More?

Want to find out more about thickened liquids, altered food consistencies and thickeners?   You can read more about them by clicking the links below!

IDDSI

The Great Thickener Challenge

Pre-Made Pureeds…..Not All the Same

The Cost of Thickened Liquids

 Looking to give after this event is over?   You can find their website here.

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Do I Really Not Have Access to Instrumental?

It’s the never-ending soapbox.   I know.  There was probably even an eye-roll at seeing this article.

All.  The.  Time.

Did you get an instrumental?  Well, why not?   You don’t know anything without the instrumental.

Reason Numero Uno

The number one reason, that I’ve seen for not obtaining an instrumental is no access.   The SLP wants an instrumental, but they are either told no by their facility or there is no facility even remotely close enough to send the patient.

There are times that the SLP does not request an instrumental because they already “know” the patient is aspirating.

Learn to Advocate

In the references is a link to a phenomenal guide by Theresa Richard for advocating for an instrumental for your patient.  Please look at that!

Do the Math

Administrators are in the business of business.  They have a facility to maintain and make sure that they stay open so they are always interested in the numbers.

These can be easy enough to obtain with a little hard work.   Look at how many patients are on thickened liquids.   How much does the facility pay for those thickened liquids.   Especially if the facility buys pre-thickened liquids, thickened liquids can cost a facility.

Let’s Look at Rehospitalization

How much is spent on rehospitalization?  This can be a cost also in loss of revenue from the patient not being in your facility.  What is the primary reason for rehospitalization and is it avoidable and something that can be prevented through dysphagia treatment?

Look at the numbers of how many patients  are misdiagnosed.   If you are changing diets at bedside, we may be overdiagnosing up to 70% of the time.   That means a large majority of those assessed at bedside only, may be on thickened liquids for no reason at all!!  This creates unnecessary expense to the facility.

It All Adds Up

When you add the cost of thickened liquids or the cost of rehospitalization vs. the cost of one instrumental assessment, your facility should be able to see the benefit.

Also, if you can show the numbers, that if you are able to obtain a good report and then treat the patient, often these patients can be rehabilitated with more than the usual list of oral motor exercises.

Going Mobile

The other great thing is that instrumental assessments are mobile.  You can often use mobile MBSS or mobile FEES to assess patients at a fraction of the cost of sending the patient to the hospital for the exam.

Do your research, crunch the numbers and be that squeaky wheel to get appropriate care for your patients!

References:

The Step-by-Step Guide to Advocating For Access to Instrumentation for Our Patients

Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clinical Interventions in Aging. 2012;7:287-298. doi:10.2147/CIA.S23404.

Attrill, S., White, S., Murray, J., Hammond, S., & Doeltgen, S. (2018). Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review. BMC health services research18(1), 594.

Ekberg, O., Hamdy, S., Woisard, V., Wuttge–Hannig, A., & Ortega, P. (2002). Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia, 17(2), 139-146.

Patel, D. A., Krishnaswami, S., Steger, E., Conover, E., Vaezi, M. F., Ciucci, M. R., & Francis, D. O. (2017). Economic and survival burden of dysphagia among inpatients in the United States. Diseases of the Esophagus, 31(1), dox131.

Bonilha, H. S., Simpson, A. N., Ellis, C., Mauldin, P., Martin-Harris, B., & Simpson, K. (2014). The one-year attributable cost of post-stroke dysphagia. Dysphagia29(5), 545-552.

Bours, G. J., Speyer, R., Lemmens, J., Limburg, M., & De Wit, R. (2009). Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review. Journal of advanced nursing, 65(3), 477-493.

 

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Variations in Tongue-Palate Pressures with Xanthan Gum Thickened Liquids

Steele, CM, Molfenter, SM, Peladeau-Pigeon, M, Polacco, RC, Yee, C.  Variations in Tongue-Palate Swallowing Pressures When Swallowing Xanthan Gum-Thickened Liquids.  Dysphagia (2014) 29:678-684.

“Thickened liquids are frequently recommended to reduce the risk of aspiration in patients with oropharyngeal dysphagia.”  We know that tongue-palate pressures increase with thicker liquids, however little is known about the differences in swallowing pressures with nectar and honey thick liquids.

“Liquid boluses are initially held in a chamber along the midline groove of the tongue.  The tongue moves upwards and forwards, compressing a bolus against the palate and squeezing it backwards in a conveyer-belt like fashion.  As the bolus reaches the pharynx, the tongue withdraws from the palate, and sweeps downwards and backwards.” 

Participants:  78 healthy adults.  40 (19 men and 21 women) with a mean age of 27 and 38 (22 women and 16 men) with a mean age of 70.  No participants had a history of swallow, motor speech, gastro-esophageal or neurological difficulties.  

Equipment:  Lingual pressures were measured using the lingual manometry module of the KayPentax Swallowing Signals Lab.  Using a soft silicone strip with three pressure bulbs were placed in the palate and measurements were registered at the anterior, mid and posterior hard palate.  Participants took blocks of 4 repeated sips using flavored (lime, raspberry, diet raspberry or cranberry) water, nectar thick and honey thick liquids.  Sip size was not controlled and cups contained 60 ml of liquid.  The cup was instructed to be removed from the lips following each sip.  The xanthan thickener was supplied by Flavour Creations, Inc.  

Results:  Healthy adults do recruit higher tongue-palate pressure amplitudes with nectar and honey thick liquids using xanthan gum as compared to water.  The authors warn that “although thicker liquids elicit higher amplitudes of tongue-palate pressure compared to water, the observed values should still be easily achieved by most adults, falling below 40% of maximum isometric pressure values.”  It is also important to remember that although thickened liquids require higher tongue pressures to propel, caution is needed when selecting thickened liquids for patients with reduced tongue strength and that viscosity may become too thick to be effective for oral processing.

The authors also warn that there are limitations to the findings including:

  1. That the sweetness of the flavoring may have contributed to the observed pressure differences compared to the water.
  2. Sip volume was not controlled and the influence of the sip size on tongue pressures is unknown.
  3. Participants with dentures had to remove their top plates to avoid damage from glue from the sensors.
  4. Different thickening agents may encourage different results.

Tongue

I think this area will take an interesting turn with the amount of people getting their tongues pierced.  What are your thoughts?

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Gelmix Thickener

Gelmix

Finding Gelmix

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.

Usage Instructions:

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.

I miserably failed the #thickenedliquidchallenge and will be donating to the National Foundation of Swallowing Disorders (NFOSD).

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!

Did you enjoy this post?  You can read more about the cost of thickened liquids.

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