Swallowing Problem

Swallowing Therapy Tip: How to Speed Up the Thickening of Nutritional Supplement

Thickening of Resource 2.0 to honey consistency with Nestle Resource ® ThickenUp® Clear

Speech therapists / pathologists in Singapore and around the world assess swallowing with different fluids or diet consistencies. Once the swallowing assessment is carried out, speech therapists will usually prescribe diet and fluids consistencies that are suitable / safer based on the assessment findings. When thickened fluids are recommended, caregiver training on thickening of fluids to the recommended consistency will usually be performed.

One of the common challenges faced by many speech therapists, nurses and caregivers is thickening of nutritional supplement with thickener. I did a search online and found out from the Resource ® ThickenUp® Clear official website (https://www.thickenupclear.com/products/resource-thickenup-clear) that it takes milk and oral nutrition supplements up to 15 minutes to reach desired consistency. It is just too time consuming to prepare thickened supplement.

I might have a way to speed up the thickening of nutritional supplements!

Many years ago, I did a project for a nutritional company in Singapore on thickening of nutritional supplement using Xanthan gum thickener (the brand that I was using in the project was Nestle Resource ® ThickenUp® Clear). I came out with the following “Manual Shake” method to thicken up the nutritional supplement (** However, this method does not work on fruit juice-based supplement). I did a quick search on google but could not find any and not sure if any speech therapists / any institutions in the world are using this method.

We have used this method to thicken up supplement in some hospitals and it has successfully reduced the timing of thickened supplement preparation time. With this method, thickening of supplement process can be achieved within 2 minutes. The thickened supplement remains stable even after 10 minutes. In the following videos (taken in 2015), I show the process of thickening of Nestle Resource 2.0 and Nestle Isocal to honey consistency (moderately thick consistency) and the consistency remains stable after 5 minutes or longer. For Nestle Resource 2.0 and Nestle Isocal, I followed the thickener dosage as listed on Nestle Resource ® ThickenUp® Clear can or dosage chart: https://www.thickenupclear.com/products/resource-thickenup-clear

You can try to use this ‘Manual Shake’ method to thicken up other nutritional supplement but the thickness might vary. I would suggest to trial and error to find out the amount of thickener required for the nutritional supplement(s) that you are using in your hospital. For patient(s) who intend to use this method to thicken up your supplement, please consult your speech therapist/pathologist for advice on the consistency and the amount of thickener powder that might be required.

As the video was done in 2015, I did not do an IDDSI (International Dysphagia Diet Standardization Initiative) flow test on the texture. We just started following IDDSI standard in Singapore and we are planning to conduct another research on this soon. For speech therapists, or dietitian or healthcare professionals who would like to ensure that the texture meet the IDDSI standard, I would suggest that you perform your own IDDSI flow test and I would be grateful if you could share with me or others. You may email me at speechtherapyworks@gmail.com and I would be most happy to post it on my blog.

I collaborated with the nurses in St Luke’s Hospital, Singapore to run a project on thickening of nutritional supplement and the project won 2 quality improvement award and the research poster was presented the International Forum on Quality and Safety in Healthcare, Taipei in 2019.

Jose, R., Rendom, J., Yoon, W.L., Abillar, L., Low, P.S., Su, A.Q., (2019 September). New Practices in Thickener Mixing for Effective Care. Poster session presented at c

Awarded:

  • Agency for Intergrated Care (AIC) Quality Improvement Award (2018)
    • St Luke’s Hospital Clinical Quality Improvement Merit Award (2017)

Here are the steps to thicken up nutritional supplement (non-juice based supplement):

  1. Measure the amount of supplement in a measuring bottle (I would recommend to use a measuring bottle or cup with cover that allows you to shake and serve / drink from)
  2. Mix the amount of thickening powder (Xanthan Gum) required as your stir the supplement.
    • For Nestle Resource 2.0 and Nestle Isocal, I follow the thickener dosage as listed on Nestle Resource ® ThickenUp® Clear can or dosage chart: https://www.thickenupclear.com/products/resource-thickenup-clear
    • Yes, the way I mix it is different as compared to the method recommended by Nestle Resource ® ThickenUp® Clear. Either way of mixing is fine. The reason I mix it the way I did was because it is not easy to ensure that the cup is always dry and pouring in thickener powder into wet cup might cause clump formation.
  3. Cover the bottle / cup and shake it for approximately 2 minutes. *You will feel the gradual thickening up and the slowing of flow of the supplement as your shake the mixture.
  4. Open up the cover and serve / drink. Please ensure safety in drinking the thickened supplement by following the strategies that have been recommended by your speech therapist/pathologist.

I hope you will find this ‘manual shake’ supplement thickening method useful. Please like and share with your friends and others so that the information will reach to those who might needs it.

I will post more useful information on dysphagia from time to time. Please follow my blog and like my Facebook at https://www.facebook.com/SGSwallowingSpecialists/

Please feel free to email me at speechtherapyworks@gmail.com if you have any questions.

Thickening of Resource 2.0 to honey consistency with Nestle Resource ® ThickenUp® Clear
Thickened Isocal and Resource 2.0 remain stable after more than 5 minutes

Disclaimer: When choosing food thickeners or nutritional supplements/beverages, please consult with your speech therapist/pathologist or dietitian or health care professional as to what product is appropriate for your individual needs, as consistencies vary between nutritional supplements and manufacturers. As this method is not tested using IDDSI method, health care professionals who would like to adopt this method are encouraged to perform IDDSI flow test to ensure that the thickened supplement(s) of different brands meet the standard.

Public awareness

Covid 19: Tip to reduce or prevent ear pain from prolonged masks wearing

Pain or itching on ear caused by mask straps

Pain or itching on the ear caused by mask straps from prolonged mask wearing has been a common complaint.
There are many custom made “ear saver” ideas that you can find from Google. Some people are selling these ideas, you may be familiar with the term “mask strap extender”.

‘Ear saver ‘ ideas from Google

Personally, I have tried using a paper clip and it was not very comfortable.
After some experimenting, I have found a design that I would like to share with you to help you make a comfortable “ear saver”.

Here in Singapore, I have taught some of the healthcare professionals and food sellers to make this “ear saver” and the feedback has been good.

The materials required are simple. Just use an elastic band or string!

Tie both mask straps together with the elastic band/string and customise it to a length you are comfortable with.

Just found out another great ‘ear saver’ idea by my Japanese friend Ms Kotomi Sakai.

DIY Ear Saver by Ms Kotomi Sakai using spiral hair tie

speech therapy singapore

Our Online Speech Therapy or Telepractice Experience in Singapore during Covid-19

According to ASHA definition: https://www.asha.org/Evidence-Maps/
‘Telepractice is the application of telecommunications technology to the delivery of speech language pathology and audiology professional services at a distance by linking clinician to client or clinician to clinician for assessment, intervention, and/or consultation.’

Telepractice for Speech Therapy has been proven to be effective and has been practiced in countries like the United States, Canada and Australia.

Our experience:
Since Covid-19 outbreak started, the acceptance of telepractice for speech therapy in Singapore has increased significantly especially during the circuit breaker period.

Our experience shows that it benefits most of our clients who require speech and language therapy, and to some of our clients who require swallowing therapy. We prefer to use Zoom Meetings for our telepractice. We find it easy to be used for 1-to-1 session as well as for group therapy sessions. Therapy tasks can to be shared and be viewed easily by our client(s). Clients are able to respond easily by indicating their answers on the screen by using the writing/drawing function. The Zoom file sharing function has allowed us to still customize and personalize each therapy sessions for our clients.

However, we need to take into consideration client’s proficiency level in technology. For clients who are less tech proficient, our experience shows that simple apps such as Facetime and Whatapp video call can work as well.

LATEST: On 24/4/2020, Facebook has just announced their videoconferencing function that allows video meeting up to 50 people without downloading any apps. That will open up another platform for telepractice.

For Speech-Language Therapists who would like to adopt Telepractice, you may refer to the following links for resources: