Relationship between tongue pressure and dysphagia diet in patients with acute stroke

Abstract

A dysphagia diet is important for patients with stroke to help manage their nutritional state and prevent aspiration pneumonia. Tongue pressure measurement is a simple, non-invasive, and objective method for diagnosing dysphagia. We hypothesized that tongue pressure may be useful in making a choice of diet for patients with acute stroke. Using balloon-type equipment, tongue pressure was measured in 80 patients with acute stroke. On admission, a multidisciplinary swallowing team including doctors, nurses, speech therapists, and management dietitians evaluated and decided on the possibility of oral intake and diet form; the tongue pressure was unknown to the team. Diet form was defined and classified as dysphagia diet Codes 0 to 4 and normal form (Code 5 in this study) according to the 2013 Japanese Dysphagia Diet Criteria. In multivariate analysis, only tongue pressure was significantly associated with the dysphagia diet form (p<0.001). Receiver operating characteristic analyses revealed that the optimal cutoff tongue pressure for predicting diet Codes 1, 2, 3, 4, and 5 was 3.6 (p<0.001, area under the curve [AUC] = 0.997), 9.6 (p<0.001, AUC = 0.973), 12.8 (p<0.001, AUC = 0.963), 16.5 (p<0.001, AUC = 0.979), and 17.3 kPa (p<0.001, AUC = 0.982), respectively. Tongue pressure is one of the sensitive indicators for choosing dysphagia diet forms in patients with acute stroke. A combination of simple modalities will increase the accuracy of the swallowing assessment and choice of the diet form.

Stroke: An electromyographic approach to the masseter and temporal muscles, orofacial soft tissue pressure, and occlusal force

“…Speech, suction, and swallowing are performed with the direct participation of the tongue, lips, and buccinator muscles [ 25 ]. The lower pressure of the tongue prevents the control of the food bolus and increases the amount of oral residues, which increases the risk of aspiration [ 26 ]. In addition, changes in the tongue due to the occurrence of neurological diseases can promote dysphagia, sucking, and communication difficulties [ 25 ].…”

Validation of the applicability of the mealtime observation checklist in predicting the risk of aspiration pneumonia in older adults receiving oral intake support: A retrospective cohort study of four long‐term care facilities

“…In this study, participants were provided with texture‐modified diets that fit their levels of dysphagia under the direction of physicians. The diets were classified based on the Japanese Dysphagia Diet 2013 (JDD2013) by the Japanese Society of Dysphagia Rehabilitation (JSDR) dysphagia diet committee (codes 1 to 4 and normal form) 14,15 . The details of the classification are given in Table S2.…”

“…In this study, participants were provided with texture-modified diets that fit their levels of dysphagia under the direction of ). 14,15 The details of the classification are given in Table S2.…”

Effects of tongue right positioner use on tongue pressure: a pilot study

“…Therefore, a reduction in TP should be considered since it may serve as a valuable index for rehabilitation in dysphagia cases. Regarding the relationship between clinical symptoms and TP, prolonged mealtime, decrease in meal amount 9 , the occurrence of aspiration 10 , and pharyngeal residue 11 have been reportedly associated with decreased TP. Consequently, it is necessary to improve TP during rehabilitation using exercises such as balloon tongue resistance 12 , tongue protrusion 13 , and tongue pressure resistance 14 trainings.…”