1. Innovation in Nutritional Treatment for Dysphagia
Thérèse Dufresne, RD
Introduction:
Welcome…
Objective of session: introduction to an innovation developed and manufac tured in Canada.
An advanced technology, unique in the world
(according to context) ackowledge the leadership and vision of this Centre for the decision to offer this revolutionary treatment

2. Prophagia : a network of strategic alliances
Synergy : together, we go faster & further
Convergence of mission : quality of nutritional care for the Hospital client and LTC Resident
Complementarity of compentencies
Prophagia is a spin off of St.Anne’s Hospital, the Veterans Hospital in Montreal that created Epikura
Prophagia’s mission is to develop technologies dedicated to the treatment of dysphagia
Prophagia’s business model is to network with partners who have complementatry competencies in order to achieve its goals faster and better 2

3. Our client Scientific Partner Research Partners Sainte.Anne’s Hospital
McGill University
Prophagia was created at Ste.Anne.s Hospital in year 2000
It is a firm which sole mission is to develop innovative technologies dedicated to the nutritional treatment of dysphagia, such as controlled texture foods (solids and liquids), and diagnostic tools.
It’s first partner was Ste.Anne’s Hospital, Veterans Affairs Canada where theResearch Program started the early ’90’ies. This Hospital has 460 residents, of which 180 suffer from dysphagia.
Ste.Anne’s has been recognized for the excellence of its dysphagia programme
The School of Human Nutrition and Depatment of Food Science of McGill University contribute to the clinical studies and to the analysis of texture, called rheology. McGill’s food texture lab is probably the best in Cananda
Technology Partner 3

4. Outline Overview of Dysphagia General Overview Prevalence Consequence
Epikura : a Novel Treatment for Dysphagia
Background
History
Results
Introduction to Food Rheology
Texture Parameters
Application to Nutritional Treatment of Dysphagia

5. Dysphagia dys = difficulty phagein = eat
Oral Phase
- Preparatory
- Transport
Pharyngial Phase
Oesophagial Phase
from: ME Groher, Dysphagia: Diagnosis and Management 5

6. Over 50 nerves and arteries

7. Over 45 muscles

8. Etiology of Dysphagia Neurogenic Inadequate dentition Psychiatric
Dementia Multiple Sclerosis
CVA - Strokes Muscular Dystrophy
Parkinson’s Disease Alzheimer’s Disease
Huntington’s Disease
Inadequate dentition
Psychiatric
Depression
Iatrogenic Conditions
Medication Induced Injury Chemotherapy Radiotherapy

9. Sainte.Anne’s Dysphagic Population per Diagnostic
April 2005 – March 2006

10. Prevalence of Dysphagia
from: ME Groher, Dysphagia: Diagnosis and Management
Acute Care Setting:  30 to 35%
Chronic Care:  35 to 75%
In Canada:
400,000 dysphagic persons
98,200 institutionalized dysphagic persons

11. Traditional Modified Texture Diet
Unappealing
Diluted (↓nutrients, ↓taste)
Unrecognizable
No quantification nor standardization of texture
No demonstrated efficiency to treat dysphagia 11

12. Consequences of dysphagia
Slow eating
Choking
Fear to eat or drink
Reduced food intake
Undernutrition, frailness, decreased quality of life, decreased autonomy, increased infections, pneumopathies and cost of care 12

13. A Revolution in the Nutritional Treatment of Dysphagia
The Joy of Eating back on the menu!
40 main entrees
Normal looking
Minced & Pureed
Meats, poultry & fish
Pasta 13

14. Epikura’s Fresh Tasting Veggies
10 Vegetables
Cooked & Raw
Puréed 14

15. Epikura’s Sweetness
9 Cakes
6 Fruits
Puréed 15

16. Tasting Break Awareness of 3 phases of swallowing Dysphagic swallow
Food Descriptors - Compaction vs aeration
Particle size
Cohesiveness
Adhesivene
Syneresis
Taste profile: intensity of flavours

17. Randomized Clinical Study 1999 (n=17)
A Demonstrated Efficacy (Germain et al, JADA, Oct. 2006)
Randomized Clinical Study 1999 (n=17)
The BMI of the Treated Subjects increases from 22 to 24 in 12 weeks while the BMI of Control Subjects remains low 17

18. For the Joy of eating and a taste af life!
Before: 60 kg
After : 82 kg 18

19. A Unique Technology which offers:
Something for every taste, every day
Offers the dysphagic clientèle a balanced and varied diet
Competitive prices
Fresh food, pure ingredient
Handy frozen individual portions 19

20. Implementation Support
Expert Team
Consulting and training 20

21. Objectives and Indicators
consumption of meals served
(or food intake: protein, energy, …)
variety of foods consumed
weights (BMI) and nutritional status of residents
meal appreciation by patients 21

22. Strategy, steps and calendar
Impact analysis
Identification of operational needs
equipements
procedures, recipes, menus, …
Communications
Operation team
Admin and multi team
Nursing team 22

23. Now available for the Canadian Health Centres