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Functional Lingual Pressure Thresholds for Swallowing Safety and Efficiency Impairments in Amyotrophic Lateral Sclerosis

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Abstract

Although reductions in lingual strength are reported in individuals with amyotrophic lateral sclerosis (ALS) that are associated with dysphagia; determination of a functional lingual pressure threshold (FLPT) has not yet been established. The present study therefore sought to identify an FLPT for impaired swallowing safety and efficiency in individuals with ALS.Thirty individuals with ALS completed a standardized videofluoroscopic swallowing examination and maximum anterior isometric lingual pressure testing using the Iowa Oral Performance Instrument. Duplicate, blinded ratings of the validated Penetration-Aspiration Scale (PAS) scores and Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) were performed. Binary classifications of safety (unsafe: PAS: ≥ 3) and efficiency (inefficient: ≥ 3% worst total pharyngeal residue) were derived. Descriptives and receiver operating characteristic curve analyses (AUC, sensitivity, specificity) were performed.Unsafe and inefficient swallowing were instrumentally confirmed in 57% and 70% of ALS patients, respectively. Across the entire cohort, the mean maximum lingual physiologic capacity was 32.1 kilopascals (‘kPa’; SD: 18.1 kPa). The identified FLPT for radiographically confirmed unsafe swallowing was 43 kPa (sensitivity: 94%, specificity: 62%, AUC 0.82, p = 0.003). FLPT for inefficient swallowing was 46 kPa (sensitivity: 86%, specificity: 56%, AUC = 0.77, p = 0.02).These data provide preliminary FLPT data in a small cohort of individuals with ALS that need to be further investigated in larger cohorts to inform clinical screening practices.

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Acknowledgements

We are grateful for the support of the Dr. Jon and Nancy McEwans Wilkins Research Fellowship and the individuals with ALS who participated. We would like to thank Amy Ashley, Kasey McElheny, and Kelly Leonard for their assistance with data analysis. This investigation was based on dissertation work submitted by the first author to the University of Florida in partial fulfillment of requirements for the degree of Doctor of Philosophy.

Funding

This work was supported by National Institute of Neurological Disorders and Stroke (NINDS) Grant Numbers: 1R01 NS100859-01, 5R01NS10859-02S1, and 1F99 NS115339-01.

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Authors and Affiliations

  1. Aerodigestive Research Core, University of Florida, Gainesville, FL, USA

    Raele Robison, Lauren DiBiase & Emily K. Plowman

  2. Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA

    Raele Robison

  3. Department of Neurology, University of Florida, Gainesville, FL, USA

    James P. Wymer & Emily K. Plowman

  4. Speech, Language and Hearing Science Department, University of Florida, Gainesville, FL, USA

    Emily K. Plowman

  5. Department of Surgery, University of Florida, Gainesville, FL, USA

    Emily K. Plowman

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Robison, R., DiBiase, L., Wymer, J.P. et al. Functional Lingual Pressure Thresholds for Swallowing Safety and Efficiency Impairments in Amyotrophic Lateral Sclerosis. Dysphagia 38, 676–685 (2023). https://doi.org/10.1007/s00455-022-10499-1

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