May is Stroke Awareness Month. More than 50% of the 665 thousand stroke survivors experience dysphagia acutely, of which approximately 80,000 experience persistent dysphagia at 6 months. Early treatment of dysphagia aims to reduce secondary complications such as dehydration, malnutrition and pneumonia and allows for spontaneous recovery of swallowing function. For those with dysphagia persisting beyond the acute phase, it is crucial to continue treatment that, in addition to reducing secondary complications, targets the physiologic deficits caused by the stroke with the goal of improving swallowing function or compensating for lost function (Vose et al., 2014).
Dysphagia Grand Rounds 5 reviews a recent research study that compares two tongue-pressure resistance training protocols for post-stroke dysphagia. Read the article below before watching the DGR 5 webinar to maximize your learning experience.
A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia
Authors: Catriona M. Steele, Mark T. Bayley, Melanie Peladeau-Pigeon, Ahmed Nagy, Ashwini M. Namasivayam, Shauna L. Stokely, and Talia Wolkin
Journal: Dysphagia. 2016;31(3):452-461
Download DGR 5 article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871779/
Download DGR 5 webinar here: http://dysphagiagrandrounds.yondo.com/playlist/dgr-5-may-2017/305
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 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.