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The Perceived Intensity and Agreeability of Sensory and Chemesthetic Stimuli, and Identification of Taster Type Among a Non-Dysphagic Female Population

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The Perceived Intensity and Agreeability of Sensory and Chemesthetic Stimuli, and Identification of Taster Type Among a Non-Dysphagic Female Population TASTERS, SENSORY AND CHEMESTHETIC STIMULI The perceived intensity and agreeability of sensory and chemesthetic stimuli, and identification of taster type among a non-dysphagic female population. Anya Smyth Supervisor: Dr. Arlene McCurtin Student Number: 12011762 Final Word Count: 8,230 This research paper has been formatted for submission to Dysphagia A research paper submitted in partial fulfillment of the requirements for the Masters of Science Degree in Speech and Language Therapy, May 2014 Abstract Bolus modifications, compensatory strategies, are commonly used in dysphagia therapy, but often limited by accompanying factors to pathologies such as cognitive and communication deficits, poor compliance and fatigue. Previous researchers have hypothesized that swallow functions can be improved through the excitement of neural pathways, yet the role of taste, which is significant in choice and preference of food, remains largely under-researched. Perception of taste is dependent on the tongues density of fungiform papillae (Bartoshuk 1994), and further investigation into how taste is perceived by different tasters has the potential to benefit future dysphagia research, and the development of assessment and therapy tools. This pilot study aimed to collect preliminary data, identifying sensory and chemesthetic stimuli that provoke the strongest reactions in a non-dysphagic population, to be utilized in the development of dysphagia assessment and treatment tools. It also investigates if the identification of taster types can be of use in the domain of dysphagia. 108, non-dysphagic, female volunteers, aged 18-50 were recruited. Fungiform papillae were measured using a blue-dye test and participants rated the perceived intensity and agreeability of 54 taste stimuli. Taster identification does not appear to pertain to dysphagia therapy or research, no differences were found among the tasting groups and tasters had no significant relationship to perceived intensity or agreeability. Individual tastes such as sweet, perfumed and minty, and several prospective groups were identified that have the potential to be beneficial in future dysphagia therapy research that could allow the continuation of typical eating habits. Keywords: Dysphagia, Sensory, Chemesthetic, Taste, Fungiform Papillae, Intensity, Agreeability ii Acknowledgements Through out the writing of this research project lots of knowledge and experience has been acquired which would not have been possible without the support and co-operation of other people. First of all, I would like to express my sincere appreciation to my supervisor Dr. Arlene McCurtin for the guidance, motivation and instrumental role played throughout the research process. I also owe a debt of appreciation to Anita Condron, Maurice Hartnett, and of course Claire Hartery, whose partnership and support made this study a pleasure. Of course a heart felt thank you to my fiancé, Eoghan, whose support and encouragement has kept me motivated (and fed) not only for this project, but also over the last two years. Last but not the least the participants who volunteered their time and tongue’s, without them there would have been no study. iii Table of Contents 1 Introduction 1.1 Dysphagia 1 1.2 Taste 2 1.3 Perception of taste 5 1.4 Influence of intensity and agreeability 6 1.5 Research aims 7 2 Methodology 2.1 Participants 8 2.2 Materials 8 2.3 Procedures 9 2.4 Data analysis 12 2.5 Ethical considerations 13 3 Results 3.1 Tests of normality 14 3.2 Taster types and strongest reactions 14 3.3 Associations between Perceived Intensity and Agreeability 16 3.4 Tasters and tastes 17 3.5 Identification of tastes for future development 19 4 Discussion 4.1 Principle findings 22 4.2 Implications 27 4.3 Limitations 27 4.4 Summary 28 4.5 Conclusions 28 Reference List 29 Appendices 1 Recruitment email 35 2 Advertising poster 36 3 Information leaflet 37 4 Consent form 38 5 Questionnaire 39 6 Taster status information 53 7 Tests of normality – Shapiro Wilk 54 8 Q-Q plots, histograms, boxplots, skewness and kurtosis 55 9 Factor loadings- Perceived Intensity 56 10 Factor loadings – Agreeability 58 iv List of Tables 2.1 Taste stimuli 2.2 Taster category 3.1 Spearman’s correlation coefficient 3.2 Directly related stimuli 3.3 Inversely related stimuli 3.4 Factor analysis loadings of Perceived Intensity 3.5 Reliability of Perceived Intensity 3.6 Factor analysis loadings of Agreeability 3.7 Reliability of Agreeability List of Figures 1.1 Filiform Papillae 2.1 Analysis of blue dye test 2.2 Rating scales –Perceived Intensity 2.3 Rating scales – Agreeability 3.1 Overall Medians – Perceived Intensity 3.2 Overall Medians – Agreeability 3.3 Tasters and fudge 3.4 Mann Whitney 3.5 Mann Whitney - significance 3.6 Scree plot – Perceived Intensity 3.7 Scree plot- Agreeability v Introduction 1. Introduction. 1.1. Dysphagia Swallowing is a life sustaining function, essential for food ingestion and is controlled by a diffuse, bilateral cerebral system (Ertekin and Aydogdu 2003). An inability to swallow, or dysphagia, occurs as a result of anatomical abnormalities or physiologic disturbances to the oral cavity, pharynx, larynx or esophagus. These presentations can be congenital (e.g. cerebral palsy), caused by sudden neurological damage (e.g. stroke, traumatic brain injury), or gradual (e.g. Parkinson’s disease, Multiple sclerosis), (Logemann 1998). The presence of dysphagia places a person at risk of malnutrition, dehydration and/or aspiration pneumonia. A speech and language therapist seeks to implement an intervention that aims to reduce and/or eliminate the risk of aspiration through the use of rehabilitative approaches and compensatory strategies. A recent study by McCurtin (2012) found compensatory strategies texture modification, thickening of fluids and changes of posture to be the most commonly used techniques in dysphagia therapy in Ireland. However, the evidence to support this approach is weak and research has found that people prescribed thickened liquids have a higher incidence of pneumonia and rarely meet their fluid intake requirements (Finestone et al. 2001; Logemann et al. 2008). Accompanying factors such as cognitive and communication deficits, poor levels of compliance and general fatigue limit the potential of these methods to benefit the dysphagic population (Sdravou et al. 2012). The need for compensatory strategies requiring fewer physical and cognitive demands on the dysphagic person has been highlighted through out the literature. Compensatory strategies using the modification of bolus properties taste, temperature, volume, and texture have been found to modulate swallowing behavior through adaptation of biomechanical and temporal measures in both healthy adults and the dysphagic population (Rofes et al. 2012; Ebihara et al. 2006; Pelletier and Steele 2014; Ding 2003; Sdravou et al. 2012; Logemann et al. 1995; Pelletier & Lawless 2003; Cola et al 2010; Sciortino et al. 2003; Ebihara et al. 2005). These studies have suggested increased sensory input can influence the swallow by the neural excitement of the peripheral sensory receptors in the taste buds, approximating the sensory threshold of swallows in the brainstem, leading to a stronger, prompter swallow and a reduction in aspiration. 1 Introduction 1.2 Taste Taste has often been cited as the most significant factor in food choice and preference (Feeney et al. 2011; Schwartz et al. 2009) and food behaviour is guided by our preferences in taste and flavor (Clark 1998). Although the human tongue is able to recognize many different taste compounds, there are five classical perceptual taste qualities: sweet, salty, sour, bitter and umami (the oral sensation stimulated by salts of glutamic or aspartic acids, [Lawless and Heymann 2010]). Our sense of taste is contained in receptors on the tongue, fungiform papillae, which when activated lead to oral sensations. Oral chemesthesis is innervated by the trigeminal nerve, which is the main chemosensory pathway along with the cranial nerves IX (glossopharyngeal) and X (vagus). Tastes such as salty or sweet have been found to heighten the activation of the facial nerve as its braches innervate the taste buds in the more anterior folds of the foliate papillae (Ding et al. 2003). The glossopharyngeal nerve innervates the posterior part of tongue and the upper pharyngeal region which are more sensitive to sour and bitter tastes (Frank and Smith 1991). Figure 1.1 – Filiform papillae Physiological changes in swallowing have been found to result from normal aging. In the healthy older individual, overall tongue movement during the early portion of the swallow is slower, and the triggering of the pharyngeal phase of the swallow is more delayed. Absolute taste thresholds typically rise in advanced age, and older individuals have difficulty detecting and recognizing taste, as well as difficult discriminating between tastes. While taste is such a significant factor in our choice and preference of foods, few studies have investigated its influence on swallow. Correspondingly, a thorough examination of the effects of manipulating food characteristics, taste and chemesthesis, on swallowing has not yet been carried out extensively in humans. Knowledge of how different tastes provoke different reactions anatomically and physiologically will be of great benefit in the development of dysphagia research. 2 Introduction Taste such as sour (Logemann et al. 1995; Pelletier and Lawless 2003; Pelletier and Dhanaraj 2006; Cola et al. 2010), sweet (Pelletier
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