From the Guidelines
The management plan for dysphagia with liquids should focus on thickening liquids to improve swallowing safety, as evidenced by the most recent study in 2022 1.
Key Recommendations
- Patients should use commercially available thickening agents like SimplyThick, Thick-It, or Resource ThickenUp to modify liquid consistency to nectar-thick, honey-thick, or pudding-thick depending on the severity of dysphagia.
- A speech-language pathologist should evaluate the patient to determine the appropriate thickness level needed, as recommended by the 2018 ESPEN guideline on clinical nutrition in neurology 1.
- Patients should implement compensatory strategies such as:
- Tucking the chin while swallowing
- Taking smaller sips
- Avoiding talking while drinking
- Proper positioning during meals, such as sitting upright at 90 degrees, is essential, as highlighted in the 2016 Canadian stroke best practice recommendations 1.
- Medications that cause dry mouth should be reviewed and possibly adjusted.
- Swallowing exercises prescribed by a speech therapist can strengthen relevant muscles over time.
- Adequate hydration must be maintained despite thickened liquids being less appealing.
Rationale
This approach works because thicker liquids move more slowly through the pharynx, giving the patient more time to coordinate the swallowing mechanism and protect the airway, thereby reducing the risk of aspiration pneumonia, as demonstrated in the 2022 study on risk factors for aspiration pneumonia after receiving liquid-thickening recommendations 1. The IDDSI framework is considered an appropriate classification system to standardize liquid thickness levels, as mentioned in the 2022 study 1. Texture modified diets and/or thickened liquids should be prescribed only after a clinical swallow exam and/or instrumental dysphagia assessment has been carried out, as recommended by the 2018 ESPEN guideline 1. Patients, families, and caregivers should receive education on swallowing and feeding recommendations, as emphasized in the 2016 Canadian stroke best practice recommendations 1.
From the Research
Management Plan for Dysphagia with Liquids
The management plan for dysphagia with liquids involves a comprehensive approach to prevent aspiration, malnutrition, and dehydration.
- Identify the underlying cause of dysphagia, such as neurological disorders, traumatic brain injury, or Parkinson's disease 2, 3
- Assess the patient's swallowing ability using instrumental methods like videofluoroscopic swallowing study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) 3, 4
- Develop a personalized treatment plan, which may include:
- Pharmacological interventions to manage underlying conditions 3, 4
- Swallowing exercises and techniques to improve swallowing safety and efficiency 3, 4
- Dietary modifications, such as thickened fluids or pureed foods, to reduce the risk of aspiration 5, 6
- Expiratory muscle strength training to improve swallowing function 3, 4
Considerations for Liquid Consistency
- The use of thickened fluids can help reduce the risk of aspiration, but may also affect quality of life 5, 6
- Studies have shown that patients with good mobility and cognitive function may be able to safely drink thin liquids without increasing the risk of aspiration pneumonia 5
- The Frazier Rehabilitation Centre free water protocol allows for the provision of water to patients with dysphagia, with strict guidelines and monitoring 5
Importance of Individualized Care
- Each patient's dysphagia pattern and needs are unique, and require an individualized approach to management 3, 4
- A multidisciplinary team, including speech-language therapists, occupational therapists, and healthcare professionals, should work together to develop and implement a comprehensive management plan 2, 3