A Randomized Study of Three Interventions for Aspiration of Thin Liquids in Patients With Dementia or Parkinson's Disease

• Published in: Journal of speech, language, and hearing research language, and hearing research, 2008-02, Vol.51 (1), p.173-183
• Main Authors: Logemann, Jeri A, Gensler, Gary, Robbins, JoAnne, Lindblad, Anne S, Brandt, Diane, Hind, Jacqueline A, Kosek, Steven, Dikeman, Karen, Kazandjian, Marta, Gramigna, Gary D, Lundy, Donna, McGarvey-Toler, Susan, Miller Gardner, Patricia J
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aspiration; Care and treatment; Changes; Clinical trials; Deglutition; Deglutition Disorders - diagnostic imaging; Deglutition Disorders - etiology; Deglutition Disorders - therapy; Dementia; Dementia - complications; Diseases; Eating Habits; Effectiveness; Evaluation Methods; Evidence Based Practice; Exhibits; Female; Fluoroscopy; Food; Head Injuries; Human Posture; Humans; Influence; Intervention; Liquids; Male; Middle Aged; Multivariate Analysis; Parkinson Disease - complications; Parkinson's disease; Patients; Physiology; Pneumonia, Aspiration - prevention & control; Posture; Psychological aspects; Solutions; Studies; Viscosity
• ISSN: 1092-4388; 1558-9102
• DOI: 10.1044/1092-4388(2008/013)

Gary Gensler The EMMES Corporation, Rockville, MD JoAnne Robbins University of Wisconsin, Madison, WI Anne S. Lindblad Diane Brandt The EMMES Corporation, Rockville, MD Jacqueline A. Hind William S. Middleton VA Medical Center, Madison, WI Steven Kosek Minneapolis VA Medical Center, Minneapolis, MN Karen Dikeman Marta Kazandjian New York Hospital Medical Center – Queens, Flushing, NY Gary D. Gramigna VA Boston Healthcare System, Roxbury, MA Donna Lundy University of Miami Medical Center, Miami, FL Susan McGarvey-Toler Richard L. Roudebush VA Medical Center, Indianapolis, IN Patricia J. Miller Gardner Communication Sciences and Disorders Clinical Trials Research Group, American Speech-Language-Hearing Association, Rockville, MD Contact author: Jeri A. Logemann, Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, #3-358, Evanston, IL 60208. E-mail: j-logemann{at}northwestern.edu . Purpose: This study was designed to identify which of 3 treatments for aspiration on thin liquids—chin-down posture, nectar-thickened liquids, or honey-thickened liquids—results in the most successful immediate elimination of aspiration on thin liquids during the videofluorographic swallow study in patients with dementia and/or Parkinson's disease. Method: This randomized clinical trial included 711 patients ages 50 to 95 years who aspirated on thin liquids as assessed videofluorographically. All patients received all 3 interventions in a randomly assigned order during the videofluorographic swallow study. Results: Immediate elimination of aspiration on thin liquids occurred most often with honey-thickened liquids for patients in each diagnostic category, followed by nectar-thickened liquids and chin-down posture. Patients with most severe dementia exhibited least effectiveness on all interventions. Patient preference was best for chin-down posture followed closely by nectar-thickened liquids. Conclusion: To identify best short-term intervention to prevent aspiration of thin liquid in patients with dementia and/or Parkinson's disease, a videofluorographic swallow assessment is needed. Evidence-based practice requires taking patient preference into account when designing a dysphagic patient's management plan. The longer-term impact of short-term prevention of aspiration requires further study. KEY WORDS: dementia, Parkinson's disease, aspiration, thickened liquids, posture CiteULike     Connotea     Del.icio.us     Digg     Facebook     Re