The Effects of Adding Particles in Texture Modified Food on Tongue Strength and Swallowing Function in Patients with Oropharyngeal Dysphagia: A Proof of Concept Study.

Abstract

The use of texture modified food (TMF) is widely spread in the daily care of patients with oropharyngeal dysphagia (OD). However, TMF have been shown to have a negative impact on the patients' quality of life. Adherence rates are low, increasing the risk of malnutrition and aspiration in an already vulnerable patient population. The aim of this exploratory study was to gain insight in the feasibility of adding particles to pureed food on tongue strength, swallowing safety and efficiency in patients with OD. Ten adult participants with OD swallowed three different boluses. Bolus 1 consisted of no particles (IDDSI level 4), small and bigger particles were added in bolus 2 and 3. Tongue strength during swallowing (Pswal) was measured using the Iowa Oral Performance Instrument (IOPI). Swallow safety (penetration and aspiration) and swallow efficiency (residu) were quantified during fiberoptic endoscopic evaluation of swallowing by means of the PAS scale and Pooling score. RM Anova and Friedman tests were performed for analyzing the impact of bolus on the outcome parameters. No significant effect of bolus type on Pswal was measured. Neither the PAS nor the Pooling score differed significantly between the three different boluses. Aspiration was never observed during swallowing any bolus with particles. This preliminary study shows that the addition of particles to pureed food had no impact on Pswal, swallowing efficiency or safety in patients with OD. This innovative project is the first step in research to explore the characteristics of TMF beyond bolus volume, viscosity and temperature.