Thickened Liquids, do they still have a place in the dysphagia toolkit?

We had the privilege of having Emily Hanks (Adult Acute SLT, STLinks mentor, former dolphin trainer) and Claudia-Kate Au Yeung (Adult Stroke SLT, STLinks Founder, aspiring surgeon) who co-led the journal club looking at the article by Lazenby-Paterson (2020). 

These are some of my surprising learning points when I read the journal: 

• Common signs of dysphagia that we often share with non-SLT practitioners (e.g. HCAs) are deemed 'unreliable and misleading single markers of aspiration' (Brodsky et al 2016) 

• The importance of ensuring that people are looking out for MULTIPLE clinical markers of aspiration (as paper says that it improves screening accuracy - Brodsky et al 2016)

• "Even instrumental diagnosis of aspiration does not predictably lead to an established set of consequences in individuals with or without oropharyngeal dysphagia" - what did they mean?

• In Butler et al's study, they found that aspiration and penetration increased with age, fluid volume and liquid fat content - really interesting considering that many of our drinks would have some fat content, e.g. lattes, milky teas. 

• That "there is limited understanding about the role of oropharyngeal dysphagia-associated aspiration in the development of pneumonia".

• I found it funny when Ferguson et al proposed that the terms 'aspiration' and 'aspiration pneumonia' should be abandoned, because "given nearly all infectious organisms implicated in pneumonia are aspirated". 

• Use of barium sulphate in radiological swallow assessments is deemed a predictor for pneumonia. - I was surprised to learn that patients are asked to sign liability waivers when they say they don't want thickened liquids. 

Did you attend the journal club or read the journal? 

Are you an SLT who use thickeners often at your practice? 

What are your thoughts about this article? 

Do you routinely monitor for dehydration when you review use of thickened liquids? 

How are you currently supporting patients to make informed decisions about whether they wish to accept thickened liquids treatment or not?

We would love to hear your thoughts - feel free to email us on speechtherapistslinks@gmail.com.