IMMERSIVE LEARNING ANALYSIS OF FLUID VISCOSITIES TO TREAT

IMMERSIVE LEARNING: ANALYSIS OF FLUID VISCOSITIES TO TREAT HUMAN DYSPHAGIA BALL STATE UNIVERSITY (SPRING 2019)

What is Physics 469? Immersive Learning Course ● ● Carries academic credit Team of students working on a project that is interdisciplinary Forms a connection to professional in the community Creation of a project that impacts the community Purpose: ● The thickness levels of varibar barium used in swallow studies is inconsistent to the commercial thickeners being sent home with patients ● Finding recipes to achieve the appropriate thickness level according to the IDDSI classification and barium viscosity levels

Community Partners St. Vincent Health Systems ● Molly Jones M. A. , CCC-SLP, BCS-S Meridian Pediatric Rehabilitation ● Catherine Seitz, M. A. , CCC-SLP ● Marissa Barnett, M. A. , CCC-SLP

Dysphagia Definition: Disorder of or difficulty swallowing An impairment of emotion, cognitive, sensory, and/or motor acts involved with transferring a substance from the mouth to stomach, resulting in failure to maintain hydration and nutrition, and posing a risk of choking and aspiration. (Tanner DC: Case studies in communicative sciences and disorders, Columbus, OH 2006, Pearson Prentice Hall. ) Common Signs: Coughing, increased meal time (more than 30 minutes), weight loss or dehydration, recurring pneumonia, wet or gurgly vocal quality after eating or drinking

National Dysphagia Diet Levels Thin ● 0 -50 c. P Nectar Thick ● 51 -350 c. P Honey Thick ● 351 -1750 c. P Spoon Thick ● >1750 c. P

IDDSI: International Dysphagia Diet Standardization Initiative

Testing Viscosity with IDDSI Flow Test Pediatric Recipes Based on WIC Criterion Presented by: Abby Pranger, Lydia Oberley, Julia Waters, and Lexi Harmacinski

WIC is Special Supplemental Nutrition Program for Women, Infants, and Children ● This program helps to provide nutritional referrals and education for women and their children under 5 years of age to prevent the risk of malnutrition. ● Meridian cares for many families who utilize WIC in the local area. Image courtesy of www. in. gov

Thik & Clear ● ● ● A commercialized instant food thickener that is intended to thicken hot and cold foods A gum based thickener which means it should reach maximum thickness within five minutes and should not continue to thicken over time They advertise that it should mix with all types of liquids and pureed foods and that you simply need to follow the recipe on the container for the desired thickness Image courtesy of www. msdonline. com

International Dysphagia Diet Standardisation Initiative ● ● What is IDDSI? ○ According to the IDDSI website, “The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global standard with terminology and definitions to describe texture modified foods and thickened liquids used for individuals with dysphagia of all ages, in all care settings, and for all cultures. ” What is the purpose? ○ IDDSI provides an international standard for medical professionals and families to determine a thickened liquid IDDSI Flow Test Image courtesy of www. iddsi. org

IDDSI Flow Test

How to read data: ● ● ● Red line = Milliliters left on syringe Blue line = Corresponding thickness of Barium Boxes = Corresponding IDDSI number for intended thickness (this matches the color of the IDDSI number) ○ Yellow = IDDSI #3 (Honey thick) ○ Pink = IDDSI #2 (Nectar thick) ○ Light blue = IDDSI #1 -2 (Half-nectar thick)

Gerber Gentle www. amazon. com

Gerber Gentle Notes: ● ● Clumping due to stirring method as instructed on Thik & Clear packet Above intended IDDSI #

Gerber Gentle Notes: ● Trial 1 and 2 were tested at 22 degrees celsius ● Trial 3 was tested at 19 degrees celsius

Gerber Gentle Notes: ● Trial 1 tested at 14 degrees celsius ● Trials 2 -4 tested at 1516 degrees celsius ● Trial 5 tested at 19 degrees celsius

Gerber Gentle Notes: ● Half-nectar recipe was the most reliable

Gerber Soothe www. parenting. com

Gerber Soothe

Gerber Soothe

Gerber Soothe

Gerber Soothe

Juicy Juice 100% Apple Juice www. amazon. com

Apple Juice ● ● Trials 1 -2 are from Batch 1 Trials 3 -5 are from batch 2

Apple Juice ● ● Trial 1 is from batch 1 Trials 2 -4 are from batch 2

Apple Juice

Apple Juice ● ● Trials 1 -2 were tested immediately after mixing Trials 3 -4 were tested from the same batch after letting it sit for 5 minutes

Apple Juice ● ● Trials 1 -2 were tested immediately after mixing Trials 3 -4 were tested from the same batch after letting it sit for 5 minutes

Great Value Vitamin D Milk www. walmart. com

Vitamin D Milk Notes : ● ● Trials 1 and 2 came from batch 1 Trials 3 and 4 came from batch 2

Vitamin D Milk Notes : ● ● Trials 1 and 2 came from batch 1 Trials 3 and 4 came from batch 2

Vitamin D Milk Notes : ● ● Trials 1 and 2 came from batch 1 Trials 3 and 4 came from batch 2

Vitamin D Milk Notes : ● ● ● Trials 1 and 2 came from batch 1 Trials 3, 4 and 5 came from batch 2 Trials 6 and 7 came from batch 3

Vitamin D Milk Notes : ● ● Trials 1 and 2 came from batch 1 Trials 3 and 4 came from batch 2

Vitamin D Milk Notes : ● ● Trials 1 and 2 came from batch 1 Trials 3 and 4 came from batch 2

Vitamin D Milk ● ● Trial 1 was tested from batch 1 Trials 2 -3 were tested from batch 2

Vitamin D Milk

Vitamin D Milk ● ● Trials 1 -2 were tested from batch 1 Trials 3 -4 were tested from batch 2

Recommendations When using Thik and Clear… ● Slowly stir the powder into the liquid instead of pouring the powder into the cup first. ● We found that this method resulted in less clumping of the product. Because of the inconsistency of results that we obtained through our testing we recommend that, if possible, foods are used as thickeners instead of the commercialized products.

For Further Research… ● More trials dealing with the clumping of baby formula and Thik and Clear ○ Other brands/types ● Analyze if there is an existing correlation between temperature and thickness when using Thik and Clear ● More research into using applesauce as an effective thickener

Conclusion ● Success with modified mixing method for Thik & Clear in effectiveness of thickening liquids. ● Food thickeners mixed much more effectively and provided the best results

Pediatric Cereal BEECHNUT VS. GERBER Mallory Polter, Sarah Riedford, Sydney Lange, Alexis Goglia, and James Barnes

Purpose of our Testing The goal of our research was to find recipes of infant cereals and Gerber Soothe formula to match the viscosity levels of Varibar Barium. We chose rice and oatmeal because they are common thickeners for pediatric patients. Not only did we compare rice and oatmeal, but we also compared Beechnut and Gerber.

What did we test? Formula: Gerber Soothe Thickeners: ● ● Gerber Rice Gerber Oats Beech. Nut Rice Beech. Nut Oats

Gerber Rice with Gerber Soothe [Meridian’s Half. Nectar Recipe] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 1 tbsp Gerber Rice IDDSI volume: 0 m. L at 7. 63 secs. IDDSI: 0 Range of c. P: 25 -200 c. P

Gerber Rice with Gerber Soothe [Meridian’s Nectar Recipe] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 2 tbsp Gerber Rice IDDSI volume: 5. 53 IDDSI: 2 Range of c. P: 51 -350 c. P

Gerber Rice with Gerber Soothe [Target: Nectar] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 3 tbsp Gerber Rice IDDSI volume: 7. 18 IDDSI: 2 Range of c. P: 51 -350 c. P

Summary of Gerber Rice

Gerber Oats with Gerber Soothe [Meridian’s Half. Nectar Recipe] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 1 tbsp Gerber Oats IDDSI volume: 0 m. L at 7. 71 secs. IDDSI: 0 Range of c. P: 25 -200 c. P

Gerber Oats with Gerber Soothe [Meridian’s Nectar Recipe] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 2 tbsp Gerber Oats IDDSI volume: 0. 4 m. L IDDSI: 0 Range of c. P: 51 -350 c. P

Gerber Oats with Gerber Soothe [Target: Nectar] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 3 tbsp Gerber Oats IDDSI volume: 3. 86 IDDSI: 1 Range of c. P: 51 -350 c. P

Gerber Oats with Gerber Soothe [Target: Nectar] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 4 tbsp Gerber Oats IDDSI volume: 7. 67 IDDSI: 2 Range of c. P: 51 -350 c. P

Gerber Oats with Gerber Soothe [Target: Nectar] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 5 tbsp Gerber Oats IDDSI volume: 9. 83 IDDSI: 3 Range of c. P: 51 -350 c. P

Summary of Gerber Oats

Beech. Nut Rice with Gerber Soothe [Meridian’s Half. Nectar Recipe] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 1 tbsp Beech. Nut Rice IDDSI volume: 0 m. L at 7. 12 secs. IDDSI: 0 Range of c. P: 25 -200 c. P

Beech. Nut Rice with Gerber Soothe [Meridian’s Nectar Recipe] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 2 tbsp Beech. Nut Rice IDDSI volume: 0 IDDSI: 0 Range of c. P: 51 -350

Beech. Nut Rice with Gerber Soothe [Target: Nectar] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 2. 5 tbsp Beech. Nut Rice IDDSI volume: 4. 4 m. L IDDSI: 2 Range of c. P: 51 -350

Beech. Nut Rice with Gerber Soothe [Target: Nectar] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 3 tbsp Beech. Nut Rice IDDSI volume: 8. 4 m. L IDDSI: 2 Range of c. P: 51 -350

Summary of Beech. Nut Rice

Summary of Beech. Nut Rice

Beech. Nut Oats with Gerber Soothe [Meridian’s Half. Nectar Recipe] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 1 tbsp Beech. Nut Oats IDDSI volume: 0 m. L at 7. 9 secs. IDDSI: 0 Range of c. P: 25 -200 c. P

Beech. Nut Oats with Gerber Soothe [Meridian’s Nectar Recipe] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 2 tbsp Beech. Nut Oats IDDSI volume: 1. 86 m. L IDDSI: 1 Range of c. P: 51 -350 c. P

Beech. Nut Oats with Gerber Soothe [Target: Nectar] Recipe: 4 oz. water, 2 scoops of Gerber Soothe, 3 tbsp Beech. Nut Oats IDDSI volume: 5. 9 m. L IDDSI: 2 Range of c. P: 51 -350 c. P

Summary of Beech. Nut Oats

Summary of Beech. Nut Oats

Comparison: Thin Barium vs. Cereal (1 tbsp. )

Comparison: ½ Nectar Barium vs. Cereal (4 tbsp. )

Recommended Caloric Intake for Infants birth-three months: ● 360 -640 calories per day ● 18 -32 ounces of breast milk or formula per day Infants 4 -6 months: ● 505 -800 calories per day ● 28 -40 ounces of breastmilk or formula per day (cereal starts to be incorporated) Infants 7 -12 months: ● 795 -920 calories per day ● Ounces of breastmilk and formula decreased to 18 -30 ounces around 10 months of age and soft foods, fruits and veggies are incorporated into diet

Scenario A five month old infant is recommended to consume 500 -800 calories per day. To prevent aspiration, the infant was placed on mildly thickened liquids (nectar) using Gerber Oats. The child should consume 7 -10 4 oz. Bottles per day (or 28 -40 oz. ) Each ounce is contains 18 -20 calories (not including cereal thickeners). On average one tablespoon of Gerber Oats adds 15 calories to the formula. According to our research, 4 tablespoon of Gerber Oats must be added to each 4 oz bottle in order to reach the intended thickness level. This adds between 420 -600 calories per day. This infant will consume 9241400 calories per day.

How Do Thickeners Affect Infant Caloric Intake? Cereal Thickeners can add calories that exceed the recommended amount for typical growth and development which can lead to weight gain. Why is this important? ● While infants need a high fat diet to support growth, providing excess calories can cause the infant to gain too much weight, delaying mental and physical development, including crawling and walking.

Challenges ● In order to achieve certain thickness levels, it was necessary to add significant amounts of cereal, which then increases the infant’s caloric intake ● When testing the liquids with IDDSI, rice and oat particles often clogged the syringe, which skewed our IDDSI numbers. ● Our group members mixed the formulas for different amount of times ● Inconsistencies in IDDSI numbers and viscosity numbers ● No set c. P range for half nectar ● Having a barrier between science and functionality

Recommendations for Future Research ● Testing Neosure 22 and other formulas with rice and oat cereals ● Finding consistency in timing the mixing and speed of the stir ● Finding the amount of rice or oat cereal that it takes to reach the same thickness level as Varibar nectar ○ May not be practical due to the caloric intake ● Measure the temperature of each mixture to record if this impacts the viscosity thickness

Pediatric Formula Testing Mixing Techniques By: Amy Boesen, Avery Brown, Kassidy Mc. Donald, Carly Link & Cecilia Collins

Focus Our goal this semester was to find different mixing methods that helped reduce the amount of clumpage created when mixing formula and thickener together. The mixing methods we focused on were stirring with spoons and forks, and shaking the formula and thickener in baby bottles. For most trials, we had the formula premade before mixing in the thickener, and for our last few trials we mixed the thickener and formula simultaneously. Our hopes in all of this testing was to find the best method that resulted in the least amount of clumping in the formula for the baby to successfully and safely drink.

Stirring Methods Spoon Fork Bottle- Formula mixed first and then thickener Bottle- Formula and thickener added simultaneously **Each 4 ounce solution was stirred for one minute and set for 5 minutes, followed by an IDDSI test and then a viscometer**

Reasons for Testing Similac Advance and Thik & Clear - Mostly used in Hospital settings - A popular choice for families to use at home - Similac Advance and Thik and Clear were not tested together in previous semesters.

IDDSI Testing Vs. Viscosity Testing We tested Moderately thick (honey), Mildly thick (nectar), and Slightly thick IDDSI ranges for all liquids. All tests were also completed on the Viscometer. This allowed for the identification of c. P ranges for the National Dysphagia Diet levels. We took the average of 4 IDDSI tests and how many m. L they had remaining to get the most accurate result. Conclusions from IDDSI and Viscosity testing: ● ● ● IDDSI levels and c. P levels from viscometer do not align when clumps were present the IDDSI results ran thinner than when no clumps were present When clumps were presented the levels on the viscometer varied

Graph Results Similac Advance with no thickening agent Thin liquids requirements: IDDSI: 0 Viscosity: 0 -50 c. P

Label Recipe for Nectar-like liquid Usage per 4 fluid ounces serving: Equal to ½ cup 2 teaspoons : 4 oz fluid

Nectar-like liquid requirements: IDDSI: 2 Viscosity: 51 -350 c. P Conclusions: -spoon stir was clumpy but closest to barium -fork stir was thicker but there were no clumps Recommendations: -fork stirring method with less thickener

Nectar-like liquid requirements: IDDSI: 2 Viscosity: 51 -350 c. P Conclusions: -spoon stir was too thin -IDDSI-0 -viscosity-less than 50 c. P Recommendations: -would not recommend this recipe for nectar-like

Nectar-like liquid requirements: IDDSI: 2 Viscosity: 51 -350 c. P Conclusions: -spoon stir/shook-IDDSI 1 -spoon/shook were super clumpy -fork stir-IDDSI 2 -fork stir was closest to barium Recommendations: -fork stir -4 oz formula : 1. 5 teaspoons thickener

Label Recipe for Honey-Like Liquid Usage per 4 fluid ounces serving: Equal to ½ cup 3 teaspoons : 4 oz fluid

Honey-like requirements: IDDSI: 3 Viscosity: 351 -1750 c. P Conclusions: -fork stir is closest to barium -fork/spoon/shook-IDDSI 3 -shook/spoon were super clumpy Recommendations: -fork stir -4 oz formula : 2. 5 teaspoons thickener

Honey-like requirements: IDDSI: 3 Viscosity: 351 -1750 c. P Conclusions: -¼ less teaspoon drastically changed the thickness -not even close to barium -spoon/fork IDDSI-3 Recommendations: -this recipe could be used to wean off of honey-thick

Honey-like requirements: IDDSI: 3 Viscosity: 351 -1750 c. P Conclusions: -very clumpy -shook in bottle-IDDSI 2 -shook in bottle-c. P less than/equal to 350 Recommendations -would not recommend this recipe or mixing method because there were too many clumps in the bottle *thickener and formula were added to the bottle at the same time-swirled the bottle while they were added*

Label Recipe for Slightly Thick/Thin Liquid There was no recommended recipe for a thin liquid on the back of the Thik & Clear canister.

Slightly Thick/Thin liquid requirements: IDDSI: 1 Viscosity: 0 -50 c. P Conclusions: -shook-IDDSI 0 -shook in bottle-c. P within the thin liquid range but was super clumpy -spoon/fork-IDDSI 1 -spoon/fork-c. P is above thin liquid range Recommendations: -fork or spoon (although it is thicker, there are less clumps) *further testing will be needed - evaluate the difference between IDDSI and c. P*

Slightly Thick/Thin liquid requirements: IDDSI: 1 Viscosity: 0 -50 c. P Conclusions: -¼ teaspoon more of thickener drastically changed the thickness -spoon/fork/shook-IDDSI 1 -spoon/fork/shook-c. P within the nectar range Recommendations: -would not recommend this recipe for a thin liquid because IDDSI levels align, but viscosity levels do not align (too much variance in the results)

Conclusion National Dysphagia Diet Levels Thin (0 -50 c. P) Nectar-like (51 -350 c. P) Honey-like (351 -1750 c. P) ● ● ● International Dysphagia Diet Standardisation Initiative Thin - 0 Slightly thick - 1 Mildly thick - 2 (nectar like) Moderately thick - 3 (honey like) Extremely thick - 4 Slightly thick was added to the IDDSI levels (changes the current levels). ○ harder to truly say what each liquid is (thin nectar, half nectar, thin honey, etc. ) ○ the m. L on the syringe has such a wide range for identification of the type of liquid When comparing the viscometer results to the syringe test, we gathered different thickness levels. ○ c. P from our data trials do not match up with the IDDSI levels on all of our tests It is going to be harder to implement this because not all the results align. More testing will need done for IDDSI to have a better understanding of the thickness level. There is always going to be human error: stirring methods, amount of thickener, etc. Best stirring method would be stirring with a fork, worst is shaking the formula and thickener at the same time

Further Research ● Continue testing different stirring methods ○ Dr. Brown’s Formula Mixing Pitcher ● Trying different stirring methods with food based thickeners ● Find closer recipes to barium ● Testing to find which c. P range best fits the slightly thick level of IDDSI

Thickened Liquids for the Adult Population Immersive Learning PHYC 469: Viscosity & Measurements of Human Dysphagia Gabriella Hernandez Megan Matzen Noelle Robinson Taylor Scher

Dysphagia Who is at Risk? ➢ ➢ ➢ CVA/Stroke patients Parkinson’s Disease Cerebral Palsy Head/Neck cancer patients TBI patients Premature infants ➢ Natural aging adults

Why is Dysphagia a Concern to the Geriatric Population? ❖ Impacts patient and family dynamics → eating is considered a “social” event ❖ Aspirationis a major cause of morbidity and mortality in the elderly ➢ Aspirationoccurs when food or liquids enter the airway and travel below the vocal folds by accident

International Dysphagia Diet Standardization Initiative (IDDSI) & Viscosity ❖ Created to determine different textures and consistencies of various foods and beverages. ❖ Viscositycorresponds to informal concepts of “thickness” ❖ It’s important to realize that the viscosity of any fluid depends strongly on temperature ❖ Measured in centipoise (c. P)

Consistency Categories ❖ Thin (0 - 50 c. P) ❖ Sometimes, too thick or thin liquids can be of danger to patients suffering ❖ Nectar thick (51 - 350 c. P) with dysphagia. ❖ Honey thick (351 - 1750 c. P) ❖ “Nectar thick” serves as a nice ❖ Spoon thick (> 1750 c. P) middle ground between too thin liquids and too thick liquids.

Our Goals for Targeted Population ❖ Wanted to create a sense of variety in class data gatherings ❖ More options when it comes to testing liquids ❖ Dysphagia is not only common in pediatric community ❖ Focus to improve the overall quality of life for patients

Thik & Clear vs. Simply Thick Thik & Clear (Gum based) ❖ Pros ➢ Mixes with both hot and cold beverages and foods ➢ Remains stable over time ❖ Cons ➢ Clumps significantly which makes it difficult to create the right recipe ➢ Time consuming Simply Thick (Gum based) ❖ Pros ➢ Mixes easily ➢ Less time to prepare ❖ Cons ➢ Can cause issues within the digestive system (gas)

How We Mixed *Used sample-size measurements for all our liquids so we poured 4 oz of liquid into our cups to mix with the thickeners Thik & Clear 1. Pour 4 m. L of liquid into cup Simply Thick 1. Pour 4 m. L of liquid into cup 2. If the liquid is too hot, let sit for at least a 1: 30 2. Selected package intended for 4 oz of liquid 3. Gradually shake thickener into the liquid (to 3. Stir immediately for 20 seconds avoid clumping) while stirring. 4. Stir continuously for 20 seconds 5. Let sit for 5 minutes. 4. Ready to serve after 20 seconds of stirring.

Varibar Barium - Bracco Diagnostics What is it? An steady oral contrast agent for modified barium swallow (MBS) studies It’s Job? Fill up or coat region of interest ❖ Premixed and premeasured MBS allows for studies to: ➢ Reduce preparation time ➢ Support high quality imaging ➢ Avoid undesirable coating How to read a Barium label: ❖ GI tract diagram given ➢ Black filled in or black outline = region of interest ❖ Viscosity listed ❖ Density (w/v, w/w) ❖ Flavor

Community Partner: St. Vincent ❖ In contact with St. Vincent Health Systems (Molly Jones M. A. , CCC-SLP BCS-S) throughout the semester to determine what liquids were being tested in the St. Vincent Facility and what thickeners they were using. ❖ Suggestions from Molly concerning what liquids to test included: ➢ Coffee ➢ Tea ➢ Lemonade ➢ V 8

Liquids Tested ❖ Chicken Broth: ➢ Regular ➢ Low sodium ❖ Beef Broth: ➢ Regular ➢ Low sodium ❖ Vegetable Broth ❖ Chocolate Ensure Plus ❖ Lipton Tea (Iced) ❖ Root Beer

Chicken Broth Goal: Nectar thick | Result: Level 1 (Slightly Thick) under both thickeners.

Chicken Broth - 50% Less Sodium Goal: Nectar thick | Result: Level 1 (Slightly Thick) under each thickener

Beef Broth Goal: Nectar thick | Results: Simply Thick- Level 1 (Slightly Thick) | Thik & Clear- Level 2 (Mildly Thick)

Beef Broth - 50% Less Sodium Goal: Nectar thick | Result: Level 1 (Slightly Thick) under both thickeners.

Vegetable Broth Goal: Nectar thick | Result: Level 1 (Slightly Thick) under both thickeners

Ensure Plus Baseline. Ensure Plus 2 nd Batch: Goal: Nectar thick (Level 2) Result: Honey thick (Level 3) 3 rd Batch: Goal: Nectar thick (Level 2) Result: Honey thick (Level 3)

Iced Tea Goal: Nectar thick | Result: Mildly thick (Level 2)

Root Beer Goal: Honey Thick | Result: Level 4 (Extremely Thick)

Recommendations ❖ When mixing with Thik & Clear, instead of dumping the entire teaspoon into liquid, gradually shake powder into the liquid while stirring to avoid excess clumping. ❖ Try using powder based thickeners with carbonated beverages. ❖ When mixing hot foods/drinks with Thik & Clear, allow time for a slight cool down. Extremely hot foods clump much more.

Conclusion Simply Thick Thik & Clear ❖ If the liquid is already thick, ❖ Less clumping with cooler using simply thick will make liquids than hotter liquids. it much thicker. (Ensure Plus, Iced Tea. ) ❖ Thinner liquids (broths) were much more consistent with the targeted consistency. ❖ Thin liquids were more consistent with target consistency.

IMMERSIVE LEARNING: ANALYSIS OF FLUID VISCOSITIES TO TREAT HUMAN DYSPHAGIA BALL STATE UNIVERSITY (SPRING 2019)