title: The effects of lingual intervention in a patient with inclusion body myositis and Sjögren's syndrome: a longitudinal case study.
abstract: OBJECTIVE
  To report the 5-year course of a patient's swallowing disorder in the context of progressive neuromuscular disease and the effectiveness of a lingual strengthening treatment program.
  
  
  METHODS
  This is a case report that describes a lingual treatment protocol that was repeated 3 times over a 5-year period with and without maintenance periods.
  
  
  METHODS
  The study was completed in 2 settings-an outpatient swallowing clinic at an acute care hospital and the patient's home.
  
  
  METHODS
  The subject was a 77-year-old woman who was diagnosed with inclusion body myositis and Sjögren's syndrome.
  
  
  METHODS
  The patient participated in an intensive 8-week lingual strengthening protocol 3 times (at years 1, 4, and 5) and a subsequent maintenance program twice (at years 4 and 5).
  
  
  METHODS
  Three outcome measures were collected during the study: (1) lingual manometric pressures at the anterior and posterior tongue, measured by using a lingual manometric device, (2) airway invasion measured by using an 8-point Penetration-Aspiration Scale, and (3) clearance of the bolus measured by using a 3-point residue scale.
  
  
  RESULTS
  Isometric lingual strengthening was effective in maintaining posterior tongue lingual pressure and Penetration-Aspiration Scale scores during the treatment periods. Residue scale scores did not significantly change during treatment.
  
  
  CONCLUSIONS
  We conclude that, in this patient, lingual strengthening slowed the progression of disease-related lingual strength loss and extended functional swallowing performance. Thus, this type of intervention may hold promise as an effective swallowing treatment option for patients with neurodegenerative inflammatory diseases such as inclusion body myositis and Sjögren's syndrome.
authors.affiliation: Program of Speech and Language Pathology, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA. malandraki@tc.columbia.edu
authors.forename: Georgia A
authors.initials: GA
authors.lastname: Malandraki
authors.forename: Andrew
authors.initials: A
authors.lastname: Kaufman
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hind
authors.forename: Stephanie
authors.initials: S
authors.lastname: Ennis
authors.forename: Ronald
authors.initials: R
authors.lastname: Gangnon
authors.forename: Andrew
authors.initials: A
authors.lastname: Waclawik
authors.forename: Joanne
authors.initials: J
authors.lastname: Robbins
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D018979:Myositis, Inclusion Body / Q000150:complications*; D026741:Physical Therapy Modalities; D012859:Sjogren's Syndrome / Q000150:complications*