title: Tongue pressure profile training for dysphagia post stroke (TPPT): study protocol for an exploratory randomized controlled trial.
abstract: BACKGROUND
  It is estimated that approximately 50% of stroke survivors will experience swallowing difficulty, or dysphagia. The associated sequelae of dysphagia include dehydration, malnutrition, and aspiration pneumonia, all of which have can have serious medical consequences. To improve swallowing safety and efficiency, alternative nutritional intake methods (for example, a feeding tube) or a modified diet texture (such as pureed foods or thickened liquids) may be recommended but these modifications may negatively affect quality of life. An alternative approach to treating dysphagia has emerged over the past few years, targeting stronger lingual muscles through maximal isometric pressure tasks. Although these studies have shown promising results, thin-liquid bolus control continues to be challenging for patients with dysphagia. Previous work investigating lingual pressures when healthy participants swallow has suggested that greater task specificity in lingual exercises may yield improved results with thin liquids.
  
  
  METHODS
  This is a small, exploratory randomized clinical trial being conducted with post-stroke patients 4 to 20 weeks after onset of dysphagia secondary to impaired lingual control. At enrollment, participants are randomly assigned to one of two treatment protocols, either tongue pressure profile training (TPPT) or the control treatment, tongue pressure strength-and-accuracy training (TPSAT). Each treatment protocol consists of 24 sessions of treatment over 8 to 12 weeks with monitoring of tongue pressure as well as a baseline and outcome videofluoroscopic swallowing study. Tongue pressure measures, videofluoroscopic measures, and functional outcome measures will be obtained following training of 60 participants (30 in each condition), to determine whether TPPT yields better outcomes.
  
  
  CONCLUSIONS
  This study will continue to explore options beyond tube feeding and modified diets for people with neurogenic dysphagia following stroke. Should the novel protocol, TPPT, prove to be more effective than the TPSAT protocol, this may influence standards of care and best practices for patients with dysphagia involving impaired thin-liquid control as a result of stroke.
  
  
  BACKGROUND
  Clinicaltrials.gov http://NCT01370083.
authors.affiliation: Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue #12-125, Toronto, ON M5G 2A2, Canada. Catriona.Steele@uhn.ca
authors.forename: Catriona M
authors.initials: CM
authors.lastname: Steele
authors.forename: Mark A
authors.initials: MA
authors.lastname: Bayley
authors.forename: Melanie
authors.initials: M
authors.lastname: Péladeau-Pigeon
authors.forename: Shauna L
authors.initials: SL
authors.lastname: Stokely
mesh_terms: D001696:Biomechanical Phenomena; D002985:Clinical Protocols; D019781:Corneal Topography; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D005081:Exercise Therapy; D005471:Fluoroscopy; D006801:Humans; D053580:Muscle Strength; D009864:Ontario; D011237:Predictive Value of Tests; D011312:Pressure; D020127:Recovery of Function; D012107:Research Design; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013997:Time Factors; D014059:Tongue / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016896:Treatment Outcome; D014741:Video Recording