A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia

Abstract

The objective of this study was to compare the outcomes of two tongue resistance training protocols. One protocol (“Tongue-Pressure Profile Training”) emphasized the pressure-timing patterns that are typically seen in healthy swallows by focusing on gradual pressure release and saliva swallowing tasks. The second protocol (“Tongue-Pressure Strength and Accuracy Training”) emphasized strength and accuracy in tongue-palate pressure generation and did not include swallowing tasks. A prospective, randomized, parallel allocation trial was conducted. Of 26 participants who were screened for eligibility, 14 received up to 24 sessions of treatment. Outcome measures of posterior tongue strength, oral bolus control, penetration-aspiration and vallecular residue were made based on videofluoroscopy analysis by blinded raters. Complete data were available for 11 participants. Significant improvements were seen in tongue strength and post-swallow vallecular residue with thin liquids, regardless of treatment condition. Stage Transition Duration (a measure of the duration of bolus presence in the pharynx prior to swallow initiation, which had been chosen to capture impairments in oral bolus control) showed no significant differences. Similarly, significant improvements were not seen in median scores on the Penetration-Aspiration Scale. This trial suggests that tongue strength can be improved with resistance training for individuals with tongue weakness following stroke. We conclude that improved penetration-aspiration does not necessarily accompany improvements in tongue strength, however tongue-pressure resistance training does appear to be effective for reducing thin liquid vallecular residue.

Fatores associados à pressão de língua em pacientes pós-acidente vascular cerebral

“…The results of anterior tongue pressure obtained in this study were similar to those found in studies using the IOPI in the Korean (26) and American (14) populations. Those with the posterior pressure were similar to a survey of Canadian subjects (27) , however, lower than those previously mentioned, which shows that this data can vary according to the characteristics of each population.…”

“…In 2013, the Toronto Rehabilitation Institute's Swallowing Rehabilitation Research Laboratory presented a tongue pressure profile training protocol developed specifically for the treatment of dysphagia affecting post-stroke patients (30) and, in 2016, this group published an article comparing the results of this training protocol, which involves muscular training and swallowing, along with another type of training, only muscular, without function training. After an average of 16 sessions, both post-stroke patients with dysphagia and those without dysphagia achieved significant strength gain, accompanied by an improvement in swallowing in some cases, but without a significant difference between the groups (27) . Some limitations could be verified in the development of this study, such as the size of some strata and, especially, the degree of dysphagia (absence of a patient with severe dysphagia).…”

The influence of tongue strength on oral viscosity discrimination acuity

“…Tongue‐strength was reduced into a categorical measure (weak versus within normal range), with a boundary of one standard deviation below the sample mean for maximum isometric tongue pressure (i.e., 40.51 kPa) used to delineate these two categories. This value corresponds to the clinical cut‐off of 40 kPa that has been used in previous clinical trials research for determining whether or not a patient exhibits tongue weakness (Steele et al, ). Age‐group was similarly reduced to a categorical measure (under 70 versus 70 or older).…”

The influence of training variables on lingual strength and swallowing in adults with and without dysphagia

“…Eighteen studies 4,9,12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] were included in our analysis, totalling 374 adults ( Table 1). Ten of the 18 studies targeted healthy adults, 4,9,12,[14][15][16][17][18][19][20] while the other eight studies [21][22][23][24][25][26][27][28] targeted patients with dysphagia. In studies involving healthy individuals, two studies compared tongue strength training vs. a non-exercise control group, 12,14 six studies were composed of only a tongue strength training group, 4,15,16,[18][19][20] one study had two different tongue strength training interventions, 17 and one study compared three different tongue strength interventions and an exercise control group (lip compression).…”

“…9 Seven studies involving patients with dysphagia compared therapy interventions vs. tongue strength training plus therapy interventions. [22][23][24][25][26][27][28] Participants of six of the eight studies involving dysphagia were stroke survivors. 21,23,[25][26][27][28] All studies 4,9,12,14-28 involved men and women; however, it was not possible to identify the number of men and women in each intervention group in three studies 12,17,22 (Table 1).…”