title: A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia.
abstract: The objective of this study was to compare the outcomes of two tongue resistance training protocols. One protocol ("tongue-pressure profile training") emphasized the pressure-timing patterns that are typically seen in healthy swallows by focusing on gradual pressure release and saliva swallowing tasks. The second protocol ("tongue-pressure strength and accuracy training") emphasized strength and accuracy in tongue-palate pressure generation and did not include swallowing tasks. A prospective, randomized, parallel allocation trial was conducted. Of 26 participants who were screened for eligibility, 14 received up to 24 sessions of treatment. Outcome measures of posterior tongue strength, oral bolus control, penetration-aspiration and vallecular residue were made based on videofluoroscopy analysis by blinded raters. Complete data were available for 11 participants. Significant improvements were seen in tongue strength and post-swallow vallecular residue with thin liquids, regardless of treatment condition. Stage transition duration (a measure of the duration of the bolus presence in the pharynx prior to swallow initiation, which had been chosen to capture impairments in oral bolus control) showed no significant differences. Similarly, significant improvements were not seen in median scores on the penetration-aspiration scale. This trial suggests that tongue strength can be improved with resistance training for individuals with tongue weakness following stroke. We conclude that improved penetration-aspiration does not necessarily accompany improvements in tongue strength; however, tongue-pressure resistance training does appear to be effective for reducing thin liquid vallecular residue.
authors.affiliation: Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada. Catriona.steele@uhn.ca.|University of Toronto, Toronto, ON, M5G 1X5, Canada. Catriona.steele@uhn.ca.
authors.forename: Catriona M
authors.identifier: 0000-0002-4294-6561
authors.initials: CM
authors.lastname: Steele
authors.affiliation: Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada.|University of Toronto, Toronto, ON, M5G 1X5, Canada.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Bayley
authors.affiliation: Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada.
authors.forename: Melanie
authors.initials: M
authors.lastname: Peladeau-Pigeon
authors.affiliation: Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada.|University of Fayoum, Fayoum, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nagy
authors.affiliation: Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada.|University of Toronto, Toronto, ON, M5G 1X5, Canada.
authors.forename: Ashwini M
authors.initials: AM
authors.lastname: Namasivayam
authors.affiliation: Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada.
authors.forename: Shauna L
authors.initials: SL
authors.lastname: Stokely
authors.affiliation: Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada.
authors.forename: Talia
authors.initials: T
authors.lastname: Wolkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D011312:Pressure; D011446:Prospective Studies; D055070:Resistance Training / Q000379:methods*; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D000071939:Stroke Rehabilitation / Q000379:methods*; D014059:Tongue / Q000503:physiopathology*; D016896:Treatment Outcome
keywords: Deglutition; Deglutition disorders; Dysphagia; Rehabilitation; Tongue