Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double‐blind, randomized controlled trial

Park, Hee-Su; Oh, Dong-Hwan; Yoon, Taehyung; Park, Jisu

doi:10.1111/1460-6984.12453

Cited by 58 publications

(68 citation statements)

References 13 publications

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“…In an RCT in which healthy subjects were treated with either effortful swallowing or a sham exercise, a non-significant increase in tongue strength was found in the treatment group after 4 weeks of intervention [ 192 ]. In a small RCT, in which dysphagic stroke patients either used effortful swallowing or performed a sham exercise (saliva swallowing), the intervention was associated with a significant improvement in tongue strength and oral swallowing function [ 193 ]. In addition, a small cohort study of Parkinson patients showed an increase in manometric pharyngeal pressure levels [ 194 ].…”

Section: Therapymentioning

confidence: 99%

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Dziewas

Allescher

Aroyo

et al. 2021

Neurol. Res. Pract.

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Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).

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Section: Therapymentioning

confidence: 99%

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Dziewas

Allescher

Aroyo

et al. 2021

Neurol. Res. Pract.

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“…First, the current study implemented effortful prolonged swallowing, a combination of effortful swallowing training and the Mendelsohn maneuver training. In previous studies, training outcomes of effortful swallowing alone only revealed significant increases in the maximum isometric pressure of the anterior tongue, lingua-palatal pressures, and swallowing functions [ 41 , 45 ]. However, in this study, effortful prolonged swallowing positively affected swallowing tongue pressure.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study

Kim¹,

Cho²,

Kim³

et al. 2020

JMIR Mhealth Uhealth

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Background Tongue pressure is an effective index of swallowing function, and it decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue-strengthening therapy on tongue function. Tongue exercises delivered through mobile health (mHealth) technologies have the potential to advance health care in the digital age to be more efficient for people with limited resources, especially older adults. Objective The purpose of this study is to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention with biweekly (ie, every 2 weeks) human mediation aimed at improving the swallowing tongue pressure in older adults. Methods We developed an mHealth app intervention that was used for 8 weeks (3 times/day, 5 days/week, for a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age 75.7 years) who complained of swallowing difficulties. The app included a swallowing monitoring and intervention protocol with 3 therapy maneuvers: effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation. The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant’s progress and ability to implement the training sessions according to the given protocol. Preintervention and postintervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument. We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12 weeks postintervention. Results Of the 11 participants, 8 adhered to the home-based 8-week app therapy program with the optimal intervention dosage. At the main trial end point (ie, 8 weeks) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median 17.5 kPa before the intervention and 26.5 kPa after the intervention; P=.046). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12 weeks postintervention were not observed. Conclusions Swallowing tongue pressure is known to be closely related to dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined methods of effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation using mobile app training accompanied by biweekly human mediation in improving swallowing tongue pressure in older adults. The mHealth app is a promising platform that can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size and observe the long-term effects of the intervention program, further studies are warranted. International Registered Report Identifier (IRRID) RR2-10.2196/19585

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“…Four studies reported this outcome [38,[40][41][42], using the Functional Dysphagia Scale (FDS) [67]; Videofluoroscopy Scoring Scale (VFSS) [68] and Videofluoroscopic Dysphagia Scale [69]. Meta-analysis of three studies reporting continuous outcomes found a beneficial effect from swallowing therapy (n = 64, SMD (FDS, VFSS, VDS scores) − 0.78, 95% CI − 1.3 to − 0.26, I 2 = 39%, P = 0.003) (very low certainty).…”

Section: Change In Pharyngeal Residue Severitymentioning

confidence: 96%

“…All studies reported rationale for treatment, materials and procedures used and the number, frequency, timing and intensity of treatment sessions. Thirteen studies reported who delivered the intervention [28, 29, 32-34, 37-39, 41, 42, 45, 47, 48] and seven detailed the training and/or experience of such personnel [27,29,33,39,41,42,45]. Thirteen studies provided information on whether treatments were tailored [27, 28, 30, 31, 33, 35, 37-40, 43, 45, 48], and no studies reported if an intervention was modified or whether intervention adherence assessment was completed.…”

Section: Intervention Reporting and Replicationmentioning

confidence: 99%

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Interventions for oropharyngeal dysphagia in acute and critical care: a systematic review and meta-analysis

et al. 2020

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Purpose: To determine the effectiveness of dysphagia interventions compared to standard care in improving oral intake and reducing aspiration for adults in acute and critical care. Methods: We searched electronic literature for randomised and quasi-randomised trials and bibliography lists of included studies to March 2020. Study screening, data extraction, risk of bias and quality assessments were conducted independently by two reviewers. Meta-analysis used fixed effects modelling. The systematic review protocol is registered and published. Results: We identified 22 studies (19 stroke, 2 intensive care stroke and 1 general intensive care) testing 9 interventions and representing 1700 patients. Swallowing treatment showed no evidence of a difference in the time to return to oral intake (n = 33, MD (days) − 4.5, 95% CI − 10.6 to 1.6, 1 study, P = 0.15) (very low certainty) or in aspiration following treatment (n = 113, RR 0.79, 95% CI 0.44 to 1.45, 4 studies, I 2 = 0%, P = 0.45) (low certainty). Swallowing treatment showed evidence of a reduced risk of pneumonia (n = 719, RR 0.71, 95% CI 0.56 to 0.89, 8 studies, I 2 = 15%, P = 0.004) (low certainty) but no evidence of a difference in swallowing quality of life scores (n = 239, MD − 11.38, 95% CI − 23.83 to 1.08, I 2 = 78%, P = 0.07) (very low certainty). Conclusion: There is limited evidence for the effectiveness of swallowing treatments in the acute and critical care setting. Clinical trials consistently measuring patient-centred outcomes are needed.

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Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double‐blind, randomized controlled trial

Cited by 58 publications

References 13 publications

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study

Interventions for oropharyngeal dysphagia in acute and critical care: a systematic review and meta-analysis

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