[Dysphagia] Logemann results

[krivalcr at email.uc.edu (Kate Krival)]

Irene and list,

Thank you for your additional comments. Of course some people aspirate
thicker consistencies; I believe we are agreeing here. And  some people may
aspirate thicker consistencies and not aspirate thinner ones - I have seen
patients for whom this is true. My earlier objective was only to state my
belief that the  Perlman et al. (2004) investigation did not support your
statement "thickened fluids are aspirated, the thicker more than the
thinner", primarily because the authors did not compare thin and thick
consistencies. I do apologize if my earlier communication was somehow
unclear.

I second the notion that we must never simply read (or cite) abstracts. We
are all already far too much at risk of confirmation bias (the tendency to
evaluate evidence that supports our preconceptions differently from evidence
that challenges them).

Regarding your comment about what we perceive as puree, you bring up an
important point - it can be difficult to know what was actually tested if
the authors do not report viscosity measures, or at least offer a really
good description of what they're using. In the Perlman et al. (2004)
article, the authors did not describe the viscosity (or, for that matter,
the density or food composition) of their pureed stimulus. Because this was
probably part of a series of papers, perhaps they did so in another paper.
Since, as you point out, their puree could have been runny applesauce or
salmon mousse, this further limits our ability to draw conclusions from the
article, though I suspect the authors would happily supply this information
if contacted (I might - now I'm curious!).
**
Best regards,
Kate
-- 
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:
>
> 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 componentis 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
>
>
> <http://www.interactivetherapy.com>
>