title: Effects of Device-Facilitated Isometric Progressive Resistance Oropharyngeal Therapy on Swallowing and Health-Related Outcomes in Older Adults with Dysphagia.
abstract: Swallowing disorders (dysphagia) are associated with malnutrition, aspiration pneumonia, and mortality in older adults. Strengthening interventions have shown promising results, but the effectiveness of treating dysphagia in older adults remains to be established. The Swallow STRengthening OropharyNGeal (Swallow STRONG) Program is a multidisciplinary program that employs a specific approach to oropharyngeal strengthening-device-facilitated (D-F) isometric progressive resistance oropharyngeal (I-PRO) therapy-with the goal of reducing health-related sequelae in veterans with dysphagia. Participants completed 8 weeks of D-F I-PRO therapy while receiving nutritional counseling and respiratory status monitoring. Assessments were completed at baseline, 4, and 8 weeks. At each visit, videofluoroscopic swallowing studies were performed. Dietary and swallowing-related quality of life questionnaires were administered. Long-term monitoring for 6-17 months after enrollment allowed for comparison of pneumonia incidence and hospitalizations to the 6-17 months before the program. Veterans with dysphagia confirmed with videofluoroscopy (N = 56; 55 male, 1 female; mean age 70) were enrolled. Lingual pressures increased at anterior (effect estimate = 92.5, P < .001) and posterior locations (effect estimate = 85.4, P < .001) over 8 weeks. Statistically significant improvements occurred on eight of 11 subscales of the Quality of Life in Swallowing Disorders (SWAL-QOL) Questionnaire (effect estimates = 6.5-19.5, P < .04) and in self-reported sense of effort (effect estimate = -18.1, P = .001). Higher Functional Oral Intake Scale scores (effect estimate = 0.4, P = .02) indicated that participants were able to eat less-restrictive diets. There was a 67% reduction in pneumonia diagnoses, although the difference was not statistically significant. The number of hospital admissions decreased significantly (effect estimate = 0.96; P = .009) from before to after enrollment. Findings suggest that the Swallow STRONG multidisciplinary oropharyngeal strengthening program may be an effective treatment for older adults with dysphagia.
authors.affiliation: Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.|Divisions of Gastroenterology and Hepatology, University of Wisconsin at Madison, Madison, Wisconsin.|Speech, Swallowing, and Dining Enhancement Program, University of Wisconsin at Madison, Madison, Wisconsin.
authors.forename: Nicole
authors.initials: N
authors.lastname: Rogus-Pulia
authors.affiliation: Swallow STRengthening OropharyNGeal Program, Madison, Wisconsin.
authors.forename: Nicole
authors.initials: N
authors.lastname: Rusche
authors.affiliation: Clinical Affairs, Swallow Solutions LLC, Madison, Wisconsin.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Hind
authors.affiliation: William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
authors.forename: Jill
authors.initials: J
authors.lastname: Zielinski
authors.affiliation: Divisions of Infectious Diseases, University of Wisconsin at Madison, Madison, Wisconsin.|Department of Medicine, University of Wisconsin at Madison, Madison, Wisconsin.|Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin at Madison, Madison, Wisconsin.
authors.forename: Ronald
authors.initials: R
authors.lastname: Gangnon
authors.affiliation: Geriatric Research, Education and Clinical Center, Madison, Wisconsin.
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
authors.affiliation: Divisions of Gastroenterology and Hepatology, University of Wisconsin at Madison, Madison, Wisconsin.|Speech, Swallowing, and Dining Enhancement Program, University of Wisconsin at Madison, Madison, Wisconsin.|Geriatric Research, Education and Clinical Center, Madison, Wisconsin.
authors.forename: JoAnne
authors.initials: J
authors.lastname: Robbins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000209:etiology* / Q000517:prevention & control*; D058996:Quality Improvement; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014922:Wisconsin
keywords: dysphagia; lingual; oropharyngeal; pneumonia; strengthening