**4. Use of specialized thickeners**

The most crucial point in the treatment of dysphagia is the selection of the food consistency [30–32]. The modern functional food market now offers specialized products for enteral oral nutrition with varying degrees of thickening. Products of the *NUTRI* company are of great scientific and clinical interest in this regard. Nevertheless, in our practice, we used the *Softia S* product to solve swallowing problems (fluids) and facilitate the swallowing of solid food, the *Softia G* product, based on xanthan gum, made it possible to expand thtient's diet1 .

We have conducted a study of the effectiveness of the use of these products. The Federal State Budgetary Scientific Institution "Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology" approved the studies; protocol No. 5/19 dated December 26, 2019.

Comparison of two groups (primary—*Softia S, Softia G*; control—standard diet) numerically was carried out using the nonparametric Mann-Whitney method. We compared three or more groups in terms of quantitative variables using the nonparametric Kruskal-Wallis method. The statistical significance of the differences between groups for paired and nominal indicators was carried out using the Pearson Chi-square (χ<sup>2</sup> ) and McNeimer tests in the case of independent and dependent groups, respectively. Relationship analysis was performed using Spearman's nonparametric rank correlation. The analysis of dependent indicators in the case of comparing two periods was carried out based on the Wilcoxon nonparametric test. In the case of comparing three or more measurements, the Friedman nonparametric

<sup>1</sup> Instructions for use of *Softia S*. http://nutri-us.com/products/softias/index.html and instructions for use of *Softia G*. http://nutri-us.com/products/softiau/index.html [Accessed: September 14, 2021].

test is used. The level of statistical significance was fixed at 0.05. Statistical data processing was performed using Statistica 10 and SAS JMP 11 software packages.

#### **4.1 Product Softia S**

According to the initial speech therapy assessment data, all patients had a mild degree of neurogenic dysphagia. According to the instrumental assessment of swallowing function on the Rosenbek scale (PAS), four patients had an aspiration rating of 3 (food enters the airways, remains above the vocal cords, but is not excreted from the airways), 26 patients had an aspiration rating of 2 (food enters the airways, stays above the vocal cords, and clears his throat from the airways). On the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) scale, all patients had a penetration score of 3 (fluid penetration with an excellent protective reflex).

By the end of the study, eight people of the primary group showed restoration of the swallowing function; residual effects of choking persisted in seven people. In the control group, we observed a slight improvement in two patients. In the remaining 13, changes in the degree of dysphagia were not observed (**Table 1**). Laboratory parameters and the bodyweight of patients during the observation period in both groups did not change significantly. In addition, there were no cases of pyrexia during the observation period.

To test the hypothesis about significant changes that occurred during the periods "Day 1," "Day 3," "Day 5," "Day 7," and "Day 14," a statistical analysis was carried out. In the considered period in the category "Breakfast," four out of 16 indicator changes were statistically significant. The most significant changes were found for the indicators "Food consumption time, thickener" (on average, 3.7 min; p = 0.0033); "The number of chokes after fluid intake, thickener" (on average, 7.0 min; p < 0.0001); "Number of chokes during fluid intake, thickener" (average for 8.8 min; p < 0.0001). On the other hand, the minor changes between periods are observed for the following indicators: "Calorie content, control," "F" (fats), and "C" (carbohydrates) (p > 0.6184) (**Table 1**).

In the considered period in the "Lunch" category, three out of 16 indicators change statistically significantly. The most significant changes were found for the indicators "Number of chokes after hydration, thickener" (on average, 8.1 min; p < 0.0001); "The number of chokes during fluid intake, thickener" (on average, 12.1 min; p < 0.0001); "Food consumption time, thickener" (on average, 6.9 min; p < 0.0001). On the other hand, the smallest changes between periods were observed for the following indicators: "Number of chokes after fluid intake, control," "Food consumption time, control," and "C" (carbohydrates) (p > 0.6015) (**Table 2**).

In the considered period in the category "Dinner," eight out of 16 indicators change statistically significantly. The most significant changes were found for the indicators "Number of chokes after fluid intake, thickener" (on average, 6.8 min; p < 0.0001); "The number of chokes during fluid intake, thickener" (average of 8.7 min; p < 0.0001). On the other hand, the pettiest changes between periods were observed for the following indicators: "P" (protein), "Number of chokes after fluid intake, control," and "Amount of fluid consumed, control" (p > 0.4098) (**Table 3**).

Assessing qualitative indicator dynamics (the presence or absence of dysphonia with sputum), statistically significant differences in the dynamics of dysphonia from the 1st to the 14th day of the study were revealed in the primary group all meals. In contrast, in the control group, there were no significant differences (**Table 4**).

#### **4.2 Product Softia G**

The duration of the study was 28 days. For the first 14 days, patients received a standard hospital diet, then for another 14 days—a diet supplemented with Softia

