Tongue Pressure Resistance Training for Post-Stroke Dysphagia: A Case Study

Abstract

Introduction: Swallowing outcomes regarding lingual resistance training have been mixed due to variability in methods, leading to ambiguity concerning the utility of this intervention. The purpose of this study was to explore the effect of a lingual resistance training protocol on the swallowing function of an individual presenting with dysphagia and reduced tongue pressure following a supratentorial ischemic stroke. Methods: A study involving a lingual resistance training protocol with videofluoroscopy to measure outcomes comparing different parameters to ASPEKT normative reference values at three timepoints: baseline (videofluoroscopic swallowing study [VFSS] A), following a 4-week lead-in period to control for spontaneous recovery (VFSS B), and at the 8-week endpoint of treatment (VFSS C). The study was interrupted due to the COVID-19 pandemic after 1 participant enrollment and is presented as a single case study. Results: Isometric tongue pressures: Following the 4-week lead-in, a decline in maximum isometric anterior tongue pressure (MAIP) and regular effort saliva swallow pressures (RESS) was noted; however, there was no change in maximum posterior isometric tongue pressures (MPIP). Isometric tongue pressures improved post-treatment, with increases in MAIP, MPIP, and to a lesser degree RESS. Swallowing function: Impairments in swallowing safety continued between the baseline VFSS A (Penetration-Aspiration Scale score [PAS] = 8) and lead-in VFSS B (PAS = 5). Swallowing safety improved following the intervention, with PAS scores = 1 at the endpoint VFSS C. Pixel-based measures of swallowing efficiency revealed a reduced frequency of post-swallow total pharyngeal residue following the treatment. Improvements were found in two other swallowing parameters, laryngeal vestibule closure integrity and pharyngeal area at maximum pharyngeal constriction, at the endpoint VFSS. Conclusion: These pilot data suggest improvements in some swallowing parameters as an outcome of intervention.