Progress 01/01/09 to 12/31/13
Outputs
Target Audience: The primary target audience are medical practitioners who diagnose and treat dysphagic patients, but researchers in the field will also benefit from this work. Changes/Problems:
Nothing Reported
What opportunities for training and professional development has the project provided? Several graduate students worked on this project, gaining research experience while also learning more about dysphagia. Various undergraduates assisted the investigators, gaining valuable research experience. Results from this work are now used as a lab module in a senior-level Food Functionality course at UW-Madison. The lab describes aspects of dysphagia and through the context of thickened fluid rheology, ties back to the hydrocolloid section of the course. How have the results been disseminated to communities of interest? Due to the patent application, no research articles have yet been published, although at least one manuscript is in preparation. However, numerous oral and poster presentations have been made at various conferences. For one, our research group has presented at the first two international conferences on Food Oral Processing. Presentations at the American Speech Language and Hearing Association (ASLHA) and Dysphagia Research Society (DRS) meetings have also disseminated the results to researchers and practitioners. A list of presentations is provided below. • Robbins, J, Hind, J, Grummer, Carrie, Vickers, Z, Hartel, RW (2010). Identifying the Most Effective Fluids for Diagnosing and Treating Swallowing Problems, Food Oral Processing Conference: Physics, Physiology and Psychology of Eating, Leeds, UK. • Robbins, Hind J Divyak B, Zielinski J, Gangnon R, Hartel R. (2010). Identifying the Most Effective Fluids for Diagnosing and Treating Swallowing Problems. Poster Institute on Aging Colloquium • Robbins, J, Hind, J, Mendenhall, H, Vickers, Z, Hartel, RW (2012). Relationship between Oropharyngeal Swallowing Physiology and Systematically Designed Fluids, 2nd International Food Oral Processing Conference, Beaune, France. • Hind J, Vickers Z, Hartel R, Mendenhall H, Robbin J. (2013) Relationship Among Swallowing Physiology, Sensory Attributes and Rheologic Properties of Fluids Thickened with Various Hydrocolloids. Dysphagia Research Society Annual Conference, Seattle WA March 2013 • Hind J, Pulia J. (2013) Balancing Risk in Diet Selection for Dysphagic Patients. American Speech Language and Hearing Association Invited Webinar, February 2013 In addition, the research team came together to present a short course at an ASLHA meeting in 2012. Details are provided below. • Robbins J, Hind J, Malandraki G, Vickers Z, Hartel R. (2012) Short Course: Sensorimotor Integration: Nexus Between Dietary Modification and Oropharyngeal Exercise, American Speech Language and Hearing Association Convention, November 2012 What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
Impact: People with dysphagia suffer from difficulty in swallowing, with a swallow often accompanied by aspiration of the fluid into the lungs, an event that leads to long-term complications. Dysphagia is diagnosed in clinics by having people swallow diagnostic fluids designed with specific flow properties (viscosity). The patients are then instructed to purchase commercial thickened fluids to reduce swallowing problems. However, many of the commercial products do not match the attributes of the diagnostic fluids and are not as beneficial to the dysphagia sufferer as they might be. Thus, the primary aim of this project was to develop thickened fluids for dysphagia sufferers that match the diagnostic standards to promote optimal health (successful swallowing), provide desired nutrition, and are generally well-received from a sensory perspective. Through a multi-disciplinary approach involving food scientists, sensory scientists, nutritionists, speech pathologists and clinical doctors, we have developed an improved understanding of what attributes of these fluids are important to meet our aims. This has led to a patent application detailing the required flow properties of these thickened fluids. This provisional patent application has been licensed by a company eager to build on this work to produce these scientifically-designed fluids. Once this company has successfully completed final development plans, new scientifically-based products will be available on the market that provide improved options for dysphagia sufferers. Objectives: 1. To evaluate the interrelations among rheological properties of fluids (viscosity, yield stress, etc.) made from different thickeners and both (a) sensory properties (mouth coating, thirst quenching, liking, etc.) and (b) swallowing biomechanics (oropharyngeal and bolus flow kinematics and lingual pressure forces). Fluids were formulated to match the apparent viscosities of diagnostic fluids (Varibar Nectar and Thin Honey). Nectar apparent viscosities were formulated to 300 cP at 30 s-1, and Thin Honeys were formulated to 1500 cP at 30 s-1. Fifteen thickeners were used to formulation fluids to target viscosities, for a total of thirty fluids. Thickeners were primarily selected based on reproducibility (consistent viscosities from sample to sample). Additionally, differences in overall rheological behaviors and perceived sensory characteristics were used to select thickeners in an effort to find a wide range of differences among thickeners. At the University of Minnesota Sensory Lab, the relationships among sensory perceptions of mouth coating, rheological parameters, swallowing dynamics and objective measurements of mouth coating using the 30 thickened beverages. Twenty panelists with no swallowing disorders were asked to distinguish between several sensory texture attributes (mouth coating, thickness, adhesiveness, etc). Swallowing pressures for each panelist and fluid were measured using a 3-bulb array pressure sensor fixed to the hard palate. Good correlations (R2 > 0.80) were found for perceived thickness and consistency (K) as well as perceived flow index (n). A positive correlation was found for consistency (essentially overall thickness of a fluid) and perceived thickness. There was a negative correlation between perceived thickness and flow index (a description of shear thinning behavior). Six thickeners were chosen from the fifteen thickeners initially selected for formulation to move forward to videofluoroscopy studies. Three different thickeners were used to produce fluids at Nectar consistency and three others at Thin Honey consistency. Thickener selection for two of the fluids was based on rheological similarities (apparent viscosity, flow index, and consistency) to the diagnostic fluids (Varibar Nectar and Thin Honey). The remaining four thickeners were selected based on sensory attributes. Those thickeners that were rated at the furthest sensory extremes (i.e. greatest or least thickness, mouth coating, adhesiveness, slipperiness) were chosen for Nectar or Thin Honey consistency. Twenty-three dysphagic (22-72yr, mean 40yr) and 15 healthy adults (23-92yr, mean 67yrs) completed videofluoroscopic swallowing examination consisting of swallowing two 5ml trials of the barium standards and each of the six fluids (total = 16 swallows). Post-swallow residue, bolus flow and maximum pressure during swallowing were collected using the KayPENTAX Digital Swallowing Workstation. Sensory evaluation was completed after tasting non-barium laced fluid. Results are as follows: Dysphagic subjects had the least residue in the oral cavity, posterior pharyngeal wall, pyriform sinuses and cricopharyngeus with agar (Nectar group) and tara gum (Thin Honey group). Dysphagic subjects had quicker bolus clearance with agar (Nectar) and tara gum (Thin Honey). Dysphagic and healthy subjects rated agar highest in “Overall Liking” compared to other nectar fluids. Iota carrageenan (Thin Honey) was preferred by dysphagic subjects and healthy subjects. Based on these results, a provisional patent application was filed through WARF. A summary of the important aspects of the invention follows. Disclosed is an edible composition of matter having an apparent viscosity of from about 150 cP to about 2000 cP at about 30 s-1; a yield stress of from 0 Pa to about 20 Pa at 1 s-1; and a flow index of from about 0.2 to about 0.6. The composition may also have an apparent viscosity from about 200 cP to about 2000 cP, a yield stress 5 of from 0 to about 15 Pa, and a flow index from about 0.3 to about 0.5. The composition may also have an apparent viscosity of from about 250 cP to about 1800 cP, a yield stress of from 5 to about 14 Pa, and a flow index of from about 0.3 to about 0.5. The apparent viscosity of the edible composition may be from about 250 cP to about 1800 cP, the yield stress from 10 0 to about 2 Pa, and the flow index from about 0.3 to about 0.5. 2. To partner with commercial manufacturers to develop fluid drinks with the appropriate rheological properties to match the standard barium materials used for diagnosing dysphagia, while maintaining appealing sensory and nutrition characteristics. After evaluating possibilities for partnering with companies, the investigators chose to form a start-up company, Swallow Solutions, that would utilize these findings. The intent was to commercialize thickened fluids based on the results of this USDA-funded research. To that end, Swallow Solutions has entered an exclusive licensing agreement with WARF to utilize the results of the provisional patent application. Work still underway at Swallow Solutions is aimed towards further development of thickened fluid prototypes, with different targeted nutritional needs from hydration to protein enhancement. Plans for commercial production of these fluids for further testing are under development. Swallow Solutions has applied for a SBIR grant to help with prototype testing and development. 3. To trial prototype fluids in the local University of Wisconsin and Madison VA hospitals to determine the effectiveness of the developed products as a treatment for diagnosed dysphagic patients. This part of the project has yet to be completed due to the delay in getting commercial prototypes prepared. However, as part of the daily responsibilities of Dr. Robbins in her work at the VA Hospital and UW Clinics and Hospital, she will be responsible for evaluating these fluids on a wider basis.
Publications
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Progress 01/01/12 to 12/31/12
Outputs
OUTPUTS: Patent disclosure filed with WARF Platform presentation at 2nd Inter. Food Oral Processing, Beaune, France (July 2012) PARTICIPANTS: Richard Hartel, PD; JoAnne Robbins, co-PD; Zata Vickers, co-PD; Jackie Hind, speech pathologist; Carrie Grummer, graduate student; Heather Mendenhall, graduate student; Hetvi Damodhar, graduate student; Emma Kultgen, undergraduate student; Maddy Levin, undergraduate student TARGET AUDIENCES: The primary target audiences are medical practitioners who diagnose and treat dysphagic patients, but researchers in the field will also benefit from this work. Further, companies that manufacture thickened fluid products for people suffering from dysphagia will also benefit from these results. PROJECT MODIFICATIONS: A no-cost extension was requested and approved in order to complete the trial studies with dysphagia sufferers. This was due to a temporary upset in the availability of these patients to our medical school staff.
Impacts
Six hydrocolloids (thickening agents) (three Nectar 300cp and three Thin Honey 1500cp) were selected systematically based on rheologic, oropharyngeal pressures and sensory measures from the results of Objective 1. Two thickeners were selected based on rheologic similarities to radiographic diagnostic fluids. Hydrocolloids were added to a base liquid containing sugar, citric acid, lemon flavor and 3% barium to make them radiopaque. Twenty-three dysphagic (22-72yr, mean 40yr) and 15 healthy adults (23-92yr, mean 67yrs) completed videofluoroscopic swallowing examination consisting of swallowing two 5ml trials of the barium standards and each of the six fluids (total = 16 swallows). Post-swallow residue, bolus flow and maximum pressure during swallowing were collected using the KayPENTAX Digital Swallowing Workstation. Sensory evaluation was completed after tasting non-barium laced fluid. - Dysphagic subjects had the least residue in the oral cavity, posterior pharyngeal wall, pyriform sinuses and cricopharyngeus with agar (Nectar group) and tara gum (Thin Honey group). - Dysphagic subjects had quicker bolus clearance with agar (Nectar) and tara gum (Thin Honey). - Maximum pressures generated during swallowing were ranked within subject. Dysphagic subjects used the least amount of pressure with agar (Nectar) and tara gum (Thin Honey). - Dysphagic and healthy subjects rated agar highest in "Overall Liking" compared to other nectar fluids. - Iota carrageenan (Thin Honey) was preferred by dysphagic subjects and healthy subjects. - Agar and tara gum were rated most thirst quenching by dysphagic subjects.
Publications
- No publications reported this period
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Progress 01/01/11 to 12/31/11
Outputs
OUTPUTS: To date, twenty-four healthy and fifteen dysphagic males and females have participated in evaluating the six thickened fluids from the first stage of this project. These six thickened fluids (three 300cp and three 1500cp) were selected based on rheologic (apparent viscosity, flow index, consistency and yield stress) and sensory attributes representing a wide range of fluid parameters. Subjects completed a sensory evaluation using a questionnaire with labeled affective magnitude and visual analog scales. During the x-ray swallowing assessment, subjects swallowed two 5mL boluses of each prototype fluid and standard barium products while time linked lingual pressures generated during swallowing were collected. PARTICIPANTS: Richard Hartel, PD; JoAnne Robbins, co-PD; Zata Vickers, co-PD; Jackie Hind, speech pathologist; Carrie Grummer, graduate student; Heather Mendenhall, graduate student; Hetvi Damodhar, graduate student; Emma Kultgen, undergraduate student; Maddy Levin, undergraduate student. TARGET AUDIENCES: The primary target audiences are medical practitioners who diagnose and treat dysphagic patients, but researchers in the field will also benefit from this work. Further, companies that manufacture thickened fluid products for people suffering from dysphagia will also benefit from these results. PROJECT MODIFICATIONS: A no-cost extension was requested in order to complete the trial studies with dysphagia sufferers. This was due to a temporary upset in the availability of these patients to our medical school staff.
Impacts
Preliminary analyses revealed that healthy subjects rated Agar (300cp) highest in overall liking and thirst quenching and High Methoxyl Pectin (1500cp) as lowest in liking and thirst quenching and highest in lingering flavor and mouth coating. Dysphagic subjects liked Iota Carageenan (1500cp) best, rating it lowest on lingering flavor and mouth coating. All fluids cleared from the pharynx faster than their associated barium standards. All fluids matched the barium standards in peak pressure generated during the swallow. Based on the results of this project to date, an Invention Disclosure has been submitted to WARF related to the rheological properties desired in thickened fluids for dysphagia suffers.
Publications
- No publications reported this period
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Progress 01/01/10 to 12/31/10
Outputs
OUTPUTS: Since patent disclosures are being considered based on the results to date, there have been few published outputs for this project this past year. The only presentation of this work was a poster presentation at a conference on Food Oral Processing in June 2010. PARTICIPANTS: RW Hartel, Professor, Food Science, University of Wisconsin - project director; Z Vickers, Professor, Food Science, University of Minnesota - co-PD; J Robbins, Professor, Medical school, University of Wisconsin - co-PD; J Hind, Medical school, University of Wisconsin - staff; C Grummer, Food Science, University of Wisconsin - grad student; H Mendenhall, Food Science, University of Wisconsin - grad student; K Banaszynski, Food Science, University of Wisconsin - undergrad student; E Kultgen, Food Science, University of Wisconsin - undergrad student; A Joyce, Medical school, University of Wisconsin - grad student; A Kaufman, Medical school, University of Wisconsin - grad student; H Damodhar, Food Science, University of Minnesota - grad student TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.
Impacts
(1) Sensory results on thickened fluids have been correlated to rheological properties. (2) Six thickened fluids with the widest range of rheological properties are currently being evaluated in swallowing kinematic trials by both healthy subjects and dysphagic patients. (3) Product development work is still in its infancy pending completion of the swallowing kinematic data.
Publications
- No publications reported this period
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Progress 01/01/09 to 12/31/09
Outputs
OUTPUTS: (1) Sensory profiles (thickness, mouthcoating, slipperiness, etc.), lingual pressure values and physical mouth coating (based on a riboflavin assay) were measured for 30 different thickened fluids, 15 each at nectar (300 cP) and thin honey (1500 cP) viscosities. The sensory results will be presented at the Food Oral Processing conference in July, 2010, Leeds, UK. (2) The 6 fluids to be continued for videofluoroscopy measurements were selected based on the widest range of sensory properties. There fluids were re-designed to contain 3% barium sulfate particles for clear videofluoroscopy. PARTICIPANTS: Richard Hartel, UW-Madison, Food Science (PI); JoAnne Robbins, UW-Madison, Medical School (co-PI); Zata Vickers, UMinnesota, Food Science (co-PI); Carrie Grummer, graduate student, UW-Madison, Food Science; Heather Mendenhall, graduate student, UW-Madison, Food Science; Hetvi Damodar, grad student, U Minnesota, Food Science; Jackie Hind, UW-Madison, Medical School; Amanda Ganser, grad student, UW-Madison, Medical School TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.
Impacts
(1) Sensory thickness of the tested fluids generally decreased with the shear thinning index of power law non-Newtonian fluids, although this was more evident for the nectar fluids than the thin honey fluids. (2) Lingual pressure varied widely from subject to subject and no trends with thickener were observed. (3) The sensory perception of mouth coating in the nectar thick fluids increased with increases in flow index and with decreases in the k-value (consistency coefficient). (4) The sensory perception of mouth coating in the honey thick fluids also increased with both increases in flow index and increases in the k-value (consistency coefficient). (5) Mouth coating in the honey thick fluids decreased with increases in density and with increases in yield stress. (6) Swallowing pressures increased with increases in mouth coating. (7) The residual riboflavin measurement was a good indicator of the sensory perception of mouth coating.
Publications
- No publications reported this period
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