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Effects of Device-Facilitated Lingual Strengthening Therapy on Dysphagia Related Outcomes in Patients Post-Stroke: A Randomized Controlled Trial

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Abstract

Background

Swallowing impairments resulting from stroke have few rehabilitative options. Prior evidence suggests lingual strengthening exercise may provide some benefit, but more randomized controlled trials are required. The purpose of this study was to examine efficacy of progressive lingual resistance training on lingual pressure generative capacity and swallowing outcomes for individuals with dysphagia after stroke.

Methods

Participants with dysphagia within 6 months of acute stroke were randomly assigned to: (1) treatment: progressive resistance tongue exercise using pressure sensors for 12 weeks with usual care; or (2) control: usual care only. Outcomes were measured at baseline, 8 and 12 weeks to assess group differences in lingual pressure generation, swallow safety, efficiency, oral intake, and swallowing quality of life.

Results

Final sample included 19 participants [treatment (N = 9) and control (N = 10)] with 16 males and 3 females (mean age = 69.33). Functional Oral Intake Scale (FOIS) scores improved significantly (p = 0.04) in the treatment group from baseline to 8 weeks compared to usual care (control). No significant differences between treatment groups were identified for other outcomes; large effect sizes were detected for group differences in lingual pressure generative capacity from baseline to 8 weeks at the anterior sensor (d = .95) and posterior sensor (d = 0.96), and vallecular residue of liquids (baseline to 8-week d = 1.2).

Conclusions

Lingual strengthening exercise resulted in significant improvements in functional oral intake for patients with post-stroke dysphagia as compared to usual care after 8 weeks. Future studies should include a larger sample size and address treatment impact on specific aspects of swallow physiology.

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Abbreviations

MBSS:

Modified Barium Swallow Study

NIHSS:

National Institute of Health Stroke Scale

MMSE:

Mini Mental State Examination

FOIS:

Functional Oral Intake Scale Score

PAS:

Penetration-Aspiration Scale

NRRS:

Normalized Residue Ratio Scale

SWAL-QOL:

Swallowing Quality of Life Questionnaire

IDDSI:

International Dysphagia Diet Standardization Initiative

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Author information

Authors and Affiliations

  1. Department of Otolaryngology Head & Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA

    Brittany N. Krekeler

  2. Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA

    Brittany N. Krekeler

  3. Division of Otolaryngology- Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA

    Brittany N. Krekeler, Glen Leverson, Molly Knigge & Susan Thibeault

  4. Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA

    Joanne Yee & Nicole Rogus-Pulia

  5. Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA

    Joanne Yee, Atsuko Kurosu & Nicole Rogus-Pulia

  6. Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA

    Fauzia Osman, Brittany Young, Justin Sattin & Nicole Rogus-Pulia

  7. Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA

    Rodolfo Peña-Chávez, Susan Thibeault & Nicole Rogus-Pulia

  8. Departamento de Ciencias de la Rehabilitación en Salud, Facultad de Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Concepción, Chile

    Rodolfo Peña-Chávez

  9. Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison GRECC (11G), Room D4240, Madison, WI, 53705, USA

    Nicole Rogus-Pulia

Authors
  1. Brittany N. Krekeler
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  2. Joanne Yee
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Correspondence to Nicole Rogus-Pulia.

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Krekeler, B.N., Yee, J., Kurosu, A. et al. Effects of Device-Facilitated Lingual Strengthening Therapy on Dysphagia Related Outcomes in Patients Post-Stroke: A Randomized Controlled Trial. Dysphagia 38, 1551–1567 (2023). https://doi.org/10.1007/s00455-023-10583-0

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