[Dysphagia] Logemann results

[eripley at yahoo.com (Irene Campbell-Taylor)]

The definition of pureed food varies widely.  To me, it's baby food, thin and pourable. To others, it's what I would call pate, or mousse.  The point is that some patients, possibly many, aspirate consistencies that are thicker than water and the belief that thick consistencies prevent aspiration is unfounded.  The article, beyond the abstract, makes this point very clear.

Kate Krival <troutbird at gmail.com> wrote:  
Dear Irene and list,

Thanks as always for pointing us to the literature. I was initially surprised that I had missed such an interesting finding (that "thickened fluids are aspirated, the thicker more than the thinner") in a review of the literature I am writing. So...I went back to this article, and re-read it.

I am the first to say I may be wrong (about many things!) and I have no wish to engage in a discussion of the merits of thickener (I am not a fan, particularly), but I do believe that the Perlman, et al. (2004) article does not necessarily fully support your statement. If I am misinterpreting this article, or your statement, I would be glad for gentle guidance -- but here's my go at it :-):

Perlman and colleagues examined the relative likelihood of patients with and without sensory (per FEESST, based on elicitation of the laryngeal adductor reflex to air puff) and motor (defined as reduced pharyngeal squeeze) deficits to aspirate pureed foods. They did not report on any fluid consistencies  - in this study -- for comparison. They did refer to other studies that suggested that sensory deficits are highly correlated with aspiration on thinner fluids.

In their conclusions, they wrote (the italics are mine) : "It appears from these studies that the motor component of the swallow is more important than sensation when administrating a pureed diet and the sensory component is more important for the safe consumption of thin liquids. The clinical implication of these findings is that persons with an intact squeeze should be able to consume pureed food."

My interpretation of these findings is that they remind us primarily that our job is to assess the sensory and motor function of our patients, using whatever methods are appropriate, and that we understand the physiology of the swallow relative to the foods and liquids we provide, the cognitive and emotional state of the patient, and the environmental and cultural issues (e.g. dietary preferences) in each case.

Best regards,

Kate Krival M.S. CCC-SLP
Doctoral Candidate
Communication Sciences and Disorders
University of Cincinnati


  On 5/11/07, Irene Campbell-Taylor <eripley at yahoo.com> wrote:  

Rob Melchionna <robmelch70 at hotmail.com> wrote:      P  {  margin:0px;  padding:0px  }  body  {  FONT-SIZE: 10pt;  FONT-FAMILY:Tahoma  }
  "thickened fluids are aspirated, the thicker more than the thinner (as Perlman proved years ago)" 
Can you clarify that  for us? I've never heard that before.


  Perlman PW; Cohen MA; Setzen M; Belafsky PC; Guss J; Mattucci KF; Ditkoff M The risk of aspiration of pureed food as determined by flexible endoscopic evaluation of swallowing with sensory testing. Otolaryngol Head Neck Surg 2004 ;130:80-3 
  Patients with impaired pharyngeal squeeze at different levels of sensory deficits are at significantly greater risk for aspiration of pureed foods
.. Dysphagic patients who are given a pureed diet to prevent aspiration may still be at risk for aspiration. 
Also,
"the almost universl belief that thickening prevents aspiration"

Where did that come from? Do you mean among SLPs? Nurses? MDs?  I really don't think this is the case anymore...
*** I'm surprised that you are surprised. I have been excoriated repeatedly for suggesting that thickening does not prevent aspiration as the archives of this list will show.  There is a multi-million dollar business now operating on the assumption - transmitted to patients and families - that that thickening is essential to preent aspiration. In fact a recent message on this list clearly implied exactly that. I sincerely wish that it becomes NOT the case any more. 
  Irene





---------------------------------
  > Date: Wed, 9 May 2007 15:45:05 -0700
> From: eripley at yahoo.com
> To: Wilma.Clancy at cdha.nshealth.ca; dysphagia at b9.com
> Subject: [Dysphagia] Logemann results
>
> These are the patients most often found in LTC ? and the Parkinson's with dementia is actually the parkinsonian stage of dementing illness. I don't believe anyone has made general statements about all dysphagic patients ? simply that, contrary to popular belief, thickened fluids are aspirated, the thicker more than the thinner (as Perlman proved years ago), and, as the authors say, it is probable that the lungs' ciliary motion cannot clear the gum-based thickener used. If so, this would apply to all since lung function is not affected by dementing illness. 
> The importance of the findings is mainly to point out that the almost universl belief that thickening prevents aspiration is false and that dehydration is a constant danger.
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
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Dr I Campbell-Taylor 
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com