1. Noel McAuliffe Wayne State University Dr. Fleming March 2013

2. Explore the existing literature concerning the implications of the National Dysphagia Diet Research in the literature suggests several variables that complicate the standardization of the National Dysphagia Diet Variables: temperature, time, thickening agents used, and clinician interpretations

3. The goal of dysphagia treatment: ensure safe and adequate nutrition and hydration for the patient Diet modifications American Dietetic Association established a set of standards and terminology to regulate the application of diet modifications used to manage dysphagia This set of standards and terminology is known as the National Dysphagia Diet

4. Inconsistencies in the rheological properties of both instant food thickeners and commercially packaged pre-thickened beverages Temperature influence both of these products Commercially packaged pre-thickened beverages were less viscous than the guidelines set by the National Dysphagia Diet Task Force Instant food thickener was more likely to be within the guidelines than the commercially packaged pre-thickened beverages Adeleye & Rachal, 2007

5. Variation among the starch-based thickening agents All of the viscosity limits were within the guidelines set by the National Dysphagia Diet Task Force However, there was variation of the consistency and structure of the liquids that used the starch-based thickening agents Payne, Methven, Fairfield, & Bell, 2011

6. Subjective Measurements Interpretation of product directions Correctly identify the viscosity of a physical sample of the liquid The study found that physical manipulation of the liquids was a more accurate subjective measurement Steele and Goff, 2003

7. gum-based food thickeners were more likely, than starch-based food thickeners to maintain a consistent level of viscosity over time As the amount of time that the liquid is allowed to thicken increases, the viscosity of the liquid also increases As temperature increased, the viscosity decreased Garcia, Chambers, Matta, & Clark, 2008

8. Increase in viscosity measurements over time with nectar-thick and honey-thick liquids Garcia, Chambers, Matta, and Clark, 2005 Increased viscosity for starch-thickeners when the thickening agent was allowed to thicken for thirty minutes Dewar and Joyce, 2006

9. Inconsistencies regarding the application of the National Dysphagia Diet Clinical Application Patient drink preferences Patients rate of beverage consumption Type of thickening products the facility has available

10. Adeleye, B., & Rachal, C. (2007). Comparison of the rheological properties of ready-to- serve powdered instant food thickeners at different temperatures for dysphagic patients. Journal of the american dietetic association, 10, 1176-1182. Dewar, R., & Joyce, M. (2006). Time- dependent rheology of starch thickener and the clinical implications for dysphagia therapy. Dysphagia, 10, 264-269.

11. Garcia, J., Chambers, E., Matta, Z., & Clark, M. (2005). Viscosity measurements of nectar- and honey-thick liquids: Product liquid and time comparisons. Dysphagia, 20, 325-335. Garcia, J., Chambers, E., Matta, Z., & Clark, M. (2008). Serving temperature viscosity measurements of nectar- and honey-thick liquids. Dysphagia, 23, 65-75.

12. Payne, C., Methven, L., Fairfield, C., & Bell, A. (2011). Consistently inconsistent: Commercially available starch-based dysphagia products. Dysphagia, 26, 27-33. Steele, C., & Goff, H. (2003). The rheology of liquids: A comparison of clinicians subjective impressions and objective measurement. Dysphagia, 18, 182-195.