Improvements in tongue strength and pressure-generation precision following a tongue-pressure training protocol in older individuals with dysphagia: three case reports

Abstract

Dysphagia, or difficulty swallowing, often occurs secondary to conditions such as stroke, head injury or progressive disease, many of which increase in frequency with advancing age. Sarcopenia, the gradual loss of muscle bulk and strength, can place older individuals at greater risk for dysphagia. Data are reported for three older participants in a pilot trial of a tongue-pressure training therapy. During the experimental therapy protocol, participants performed isometric strength exercises for the tongue as well as tongue pressure accuracy tasks. Biofeedback was provided using the Iowa Oral Performance Instrument (IOPI), an instrument that measures tongue pressure. Treatment outcome measures show increased isometric tongue strength, improved tongue pressure generation accuracy, improved bolus control on videofluoroscopy, and improved functional dietary intake by mouth. These preliminary results indicate that, for these three adults with dysphagia, tongue-pressure training was beneficial for improving both instrumental and functional aspects of swallowing. The experimental treatment protocol holds promise as a rehabilitative tool for various dysphagia populations.

Figures

Figure 1

Means (with standard deviations shown by error bars) for maximum isometric tongue pressure measurements (in kilopascals), collected with the IOPI bulb in the anterior position, are shown across the course of treatment for Case A. The dotted line shows, for reference, the normative values for maximum anterior isometric tongue pressure generation in healthy older males reported by Nicosia and colleagues (2000).

Figure 2

Means (with standard deviations shown by error bars) for maximum isometric tongue pressure measurements (in kilopascals), collected with the IOPI bulb in the posterior position, are shown across the course of treatment for Case A. The dotted line shows, for reference, the normative values for maximum posterior isometric tongue pressure generation in healthy older males reported by Nicosia and colleagues (2000).

Figure 3

Means (with standard deviations shown by error bars) for tongue pressure accuracy (ie, distance from a specified target in kilopascals), collected with the IOPI bulb in the anterior position, are shown across the course of treatment for Case A.

Figure 4

Means (with standard deviations shown by error bars) for tongue pressure accuracy (ie, distance from a specified target in kilopascals), collected with the IOPI bulb in the anterior position, are shown across the course of treatment for Case A.

Figure 5

Mean anterior tongue pressure accuracy (ie, distance from a specified target, measured in kilopascals), is shown as a percentage of the maximum isometric anterior tongue pressure measured (in kilopascals) in the corresponding treatment session for Case A. The linear trend line shows the pattern of change across the course of treatment.

Figure 6

Mean posterior tongue pressure accuracy (ie, distance from a specified target, measured in kilopascals), is shown as a percentage of the maximum isometric posterior tongue pressure measured (in kilopascals) in the corresponding treatment session for Case A. The linear trend line shows the pattern of change across the course of treatment.

Figure 7

Means (with standard deviations shown by error bars) for maximum isometric tongue pressure measurements (in kilopascals), collected with the IOPI bulb in the anterior position, are shown across the course of treatment for Case B. The dotted line shows, for reference, the normative values for maximum anterior isometric tongue pressure generation in healthy older males reported by Nicosia and colleagues (2000).

Figure 8

Means (with standard deviations shown by error bars) for maximum isometric tongue pressure measurements (in kilopascals), collected with the IOPI bulb in the posterior position, are shown across the course of treatment for Case B. The dotted line shows, for reference, the normative values for maximum posterior isometric tongue pressure generation in healthy older males reported by Nicosia and colleauges (2000).

Figure 9

Mean anterior tongue pressure accuracy (ie, distance from a specified target, measured in kilopascals), is shown as a percentage of the maximum isometric anterior tongue pressure measured (in kilopascals) in the corresponding treatment session for Case B. The linear trend line shows the pattern of change across the course of treatment.

Figure 10

Mean posterior tongue pressure accuracy (ie, distance from a specified target, measured in kilopascals), is shown as a percentage of the maximum isometric posterior tongue pressure measured (in kilopascals) in the corresponding treatment session for Case B. The linear trend line shows the pattern of change across the course of treatment.

Figure 11

Means (with standard deviations shown by error bars) for maximum isometric tongue pressure measurements (in kilopascals), collected with the IOPI bulb in the anterior position, are shown across the course of treatment for Case C. The dotted line shows, for reference, the normative values for maximum anterior isometric tongue pressure generation in healthy older males reported by Nicosia and colleagues (2000).

Figure 12

Means (with standard deviations shown by error bars) for maximum isometric tongue pressure measurements (in kilopascals), collected with the IOPI bulb in the posterior position, are shown across the course of treatment for Case B. The dotted line shows, for reference, the normative values for maximum posterior isometric tongue pressure generation in healthy older males reported by Nicosia and colleagues (2000).

Figure 13

Mean anterior tongue pressure accuracy (ie, distance from a specified target, measured in kilopascals), is shown as a percentage of the maximum isometric anterior tongue pressure measured (in kilopascals) in the corresponding treatment session for Case C. The linear trend line shows the pattern of change across the course of treatment.

Figure 14

Mean posterior tongue pressure accuracy (ie, distance from a specified target, measured in kilopascals), is shown as a percentage of the maximum isometric posterior tongue pressure measured (in kilopascals) in the corresponding treatment session for Case C. The linear trend line shows the pattern of change across the course of treatment.