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Item Thermoreversible Hydrocolloid Blends for Structurally Stable Reheated Carrot Purée in Dysphagia Management(MDPI (Basel, Switzerland), 2025-07-01) Maran N; Dharmawan J; Goh KKT; Zhan F; Zhu XOropharyngeal dysphagia is a common condition among older adults and individuals with neurological disorders, necessitating the use of texture-modified foods (TMFs) to ensure safe swallowing; however, reheating often leads to syneresis and structural breakdown, compromising both functionality and patient acceptability. This study aimed to evaluate the efficacy of single and binary hydrocolloid systems for improving the thermal and structural stability of moulded carrot purée formulated to meet International Dysphagia Diet Standardisation Initiative (IDDSI) Level 4 standards. The main methods involved preparing purées with various hydrocolloid combinations, assessing gel strength, shape retention, and syneresis following steaming, and validating results using commercial moulds. Thermoreversible methylcellulose (Benecel™ A4M) was the most effective single-component system, while binary blends of A4M with locust bean gum (LBG)—specifically B2 (1.5% A4M + 0.5% LBG) and B3 (1.5% A4M + 1% LBG)—demonstrated superior structural integrity, with height retention of 80 ± 2% (B2) and 85 ± 2% (B3), and reduced syneresis (~22 ± 1% and ~19 ± 3%, respectively; p < 0.05), both meeting IDDSI requirements. In contrast, formulations containing agar, xanthan, or carboxymethylcellulose exhibited poorer shape fidelity, likely due to matrix-disrupting interactions. These findings indicate that A4M-LBG blends offer a practical solution for producing reheatable, visually recognisable meals for individuals with moderate-to-severe dysphagia.Item Dysphagia management in community/home settings: A scoping review investigating practices in Africa.(Taylor & Francis Group, 2024-02-21) Jayes M; Madima V; Marshall J; Pillay MPURPOSE: Little is known about how people living with dysphagia in rural, socioeconomically impoverished contexts in Africa are supported and manage their disability. This scoping review sought to map and synthesise evidence relating to the management of dysphagia in adults in community/home settings in Africa as a starting point for a broader study on this topic. METHOD: A multifaceted search strategy involved searches of electronic databases and grey literature, hand searches, ancestry searches, and consultation with expert advisors. Records were screened by two blinded researchers. Characteristics of included studies were summarised, and their findings synthesised using the Framework approach. RESULT: Six studies were included, relating to services for people with dysphagia secondary to various aetiologies. No grey literature was identified that provided service delivery descriptions or practice guidance. This limited evidence suggests little professional support is available to people living with dysphagia in the community. Individuals and carers use a range of strategies, including choosing different food and drink items and modifying how food is chewed and swallowed. CONCLUSION: Further research is required to understand current practice in managing dysphagia in the community in Africa, and the needs and priorities of community members who experience dysphagia and their carers.Item Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation(AOSIS, 2021-07-29) Pillay T; Pillay MBackground: This study explored the available literature on the phenomenon of clinical reasoning and described its influence on the clinical swallow evaluation. By exploring the relationship between clinical reasoning and the clinical swallow evaluation, it is possible to modernise the approach to dysphagia assessment. Objectives: This study aimed to contextualise the available literature on clinical reasoning and the CSE to low-middle income contexts through the use of a scoping review and expert consultation. Method: A scoping review was performed based on the PRISMA-ScR framework. The data was analysed using thematic analysis. Articles were considered if they discussed the clinical swallow evaluation and clinical reasoning, and were published in the last 49 years. Results: Through rigorous electronic and manual searching, 12 articles were identified. This review made an argument for the value of clinical reasoning within the clinical swallow evaluation. The results of the study revealed three core themes related to the acquisition, variability and positive impact of clinical reasoning in the clinical swallow evaluation. Conclusion: The results of this review showed that the clinical swallow evaluation is a complex process with significant levels of variability usually linked to the impact of context. This demonstrates that in order to deliver effective and relevant services, despite challenging conditions, healthcare practitioners must depend on clinical reasoning to make appropriate modifications to the assessment process that considers these salient factors.Item It’s crunch time: Exploring the sensibility of food textural acoustics for individuals with dysphagia(AOSIS, 2021-06-30) Karani TF; Pillay MBackground: Various fields of study have alluded to food textural, and its associated acoustic, properties (i.e. food textural acoustics). However, because of the challenging nature of the inclusion of acoustic properties in diet textural modifications in dysphagia (swallowing disorders), this construct has not been sufficiently considered in the field. Objective: To investigate the sensibility of food textural acoustics as a construct to understand eating for individuals with dysphagia. Method: The study design was based on qualitative evidence synthesis methodologies. This involved revised scoping review methods (peer-reviewed published articles from 1980 to 2020 over seven databases), with an adapted consultation phase through online focus group discussions with six world experts. The data was analysed using frequency and thematic analysis, and ideology critique. Results: A total of 11 articles were included in the revised scoping review analysis (seven research studies and four review articles). The analysis of these articles revealed a lack of diversity in geography, discipline and perspective exploring the construct of food textural acoustics. A total of three themes with three associated core arguments emerged from the revised scoping review and the consultation phase. These arguments highlighted (1) the need to study food textural acoustics because of its salience and pleasure responses, (2) possible methodological dilemmas in studying food textural acoustics due to the complexity of eating, and (3) considerations with regard to the approach and positioning adopted when studying the construct. Conclusion: Food textural acoustics may be a sensible construct to understand eating for individuals with dysphagia. As eating is a complex process, there is a need to challenge the methods we use when studying this construct of food textural acoustics. We hope that this article inspires researchers and practitioners to think differently by using textural, and its associated acoustic, properties as a way to reimagine dysphagia practice, especially for those from low- to middle-income contexts such as South Africa and Brazil.Item Decision making and the bedside assessment: The Speech Language Therapists’ thinking when making a diagnosis at the bed(AOSIS, 2021-06-30) Coutts K; Pillay MBackground: The bedside assessment is often seen as a screener because of its high variability in sensitivity and specificity, whilst the instrumental measures are viewed as gold standards because of the ability of speech-language therapist (SLT) to visualise the swallow more objectively. Objectives: This research article explores how the value needs to be placed on the decision-making abilities of the SLT rather than on the assessment measure itself. Method: A mixed methodology concurrent triangulation design was employed to collect data in two phases: the first phase included observing seven SLTs conducting assessments using a standardised bedside measure together with pulse oximetry and cervical auscultation. The second phase was a focus group discussion based on the findings from the first phase. Data were analysed thematically using a bottom-up approach. Results: The following factors were found to influence the decision-making process at the bedside: bedside assessment data sets, patient, multidisciplinary team, context and then SLT. The availability of more data from the assessment from different data sets improved the confidence of the SLT at the bedside when needing to make clinical decisions. Clinical instincts are developed through experience and observation of those more experienced. These skills need to be developed from junior years. Conclusion: This research study showed that a bedside assessment can provide valuable information that will allow for diagnostic decisions to be made at the bedside. This study also highlighted the importance of critical thinking using clinical instincts, and that these are the factors that need to be valued and emphasised rather than the assessment measures themselves.Item Pathogenic oral bacteria in hospitalised patients with dysphagia: The silent epidem(AOSIS, 2021-07-30) Weimers MJ; Pillay MBackground: Aspiration pneumonia is a serious and fatal complication of dysphagia, secondary to the ingestion of bacteria-laden secretions. However, no studies have documented the oral hygiene features present in patients who present with dysphagia. Objectives: The purpose of this study was to describe the oral hygiene problems of adults admitted to a sub-acute rehabilitation hospital and who presented with dysphagia. Methods: A descriptive, cross-sectional survey was conducted, during which 40 participants – 57.5% (n = 23) male and 42.5% (n = 17) female – underwent a clinical swallow evaluation using the Mann Assessment of Swallowing Ability (MASA) augmented with cervical auscultation (CA) and pulse oximetry (PO), an oral hygiene assessment using an adapted version of the Oral Health Assessment Tool (OHAT), followed by microbiology laboratory analysis of buccal swab samples to detect bacteria not considered part of the normal oral flora. Results: Results indicated that poor oral hygiene status was a common feature amongst all participants who presented with dysphagia. The most prevalent oral hygiene issues were related to abnormalities concerning saliva (60%), oral cleanliness (82.5%), the tongue (80%) and the use of dentures (71.4%). A high prevalence, 62.5% (n = 25), of opportunistic bacteria was found. The most commonly occurring bacteria groups were: (1) Candida albicans (47.5%) and (2) respiratory pathogens (37.5%) such as Klebsiella pneumoniae and Staphylococcus aureus. Conclusion: Persons with dysphagia have poor oral hygiene which creates favourable environments for bacteria to flourish and increases the prevalence of pathogenic oral bacteria associated with the development of aspiration pneumonia. The management of oral health issues for persons with dysphagia should receive greater attention during hospitalisation.