Flexibility for Intensity Dosing in Lingual Resistance Exercises: A Large Randomized Clinical Trial in Typically Aging Adults as Proof of Principle.

OBJECTIVE: The objective of this study was to determine the effect of intensity dosing during tongue exercise on tongue pressure generation, adherence, and perceived effort. DESIGN: This was a five-site, prospective, randomized clinical trial. Outcome measures were obtained across multiple baselines, biweekly during exercise, and 4-weeks post-intervention. SETTING: The general community at each study site. PARTICIPANTS: Typically aging adults between 55-82 years of age with no history of neurological or swallowing disorders. Eighty-four volunteers completed the study. INTERVENTIONS: Participants were randomly assigned to one of four exercise groups: (a) maximum intensity/no biofeedback, (b) progressive intensity/no biofeedback, (c) maximum intensity/biofeedback, and (d) progressive intensity/biofeedback. Half of the participants completed a maintenance exercise program. OUTCOME MEASURES: Maximum isometric pressure (MIP), regular effort saliva swallow pressure, adherence, and the Borg Rating of Perceived Exertion Scale. RESULTS: All exercise protocols were efficacious for gains in MIP (large effect sizes; Cohen's d). Group 3 made gains in regular effort saliva swallow pressure (medium effect size). There was a significant change in perceived exertion for regular effort saliva swallow pressure at 8 weeks. Tongue pressure gains were maintained at 1 month, regardless of maintenance group status. Mean adherence across groups was high. CONCLUSIONS: All groups improved pressure generation. Intensity dosing differences did not affect strength gains, adherence, or detraining. Regular effort saliva swallow pressure may be most responsive to maximum intensity with biofeedback. The findings suggest flexibility in approach to tongue exercise protocols. Tongue muscles may differ from limb muscles in terms of dose response and neuroplasticity principles.

A Randomized Controlled Trial Comparing Physical and Mental Lingual Exercise for Healthy Older Adults.

Mental practice using motor imagery (MP-MI) has been shown to improve motor outcomes of upper and lower extremities especially when combined with physical exercise. Here, we studied community-dwelling, healthy older adults to determine the effects of including an MP-MI component with lingual strengthening exercise. In this pilot study, twenty-nine typically aging participants were assigned to an intervention group: physical lingual exercise (n = 7), physical and MP-MI lingual exercise (n = 8), MPMI lingual exercise (n = 7), or a control group (placebo exercise) (n = 7). All participants completed the assigned exercise regimen with three sessions per day, three days a week, for 6 consecutive weeks. Maximum isometric pressure (MIP) and regular effort saliva swallowing (RESS) pressure were collected at baseline and weeks 2, 4, and 6. A post hoc Bonferroni corrected treatment effect from baseline to week 6 was shown for only participants in the MP-MI/Physical exercise group for MIP (p = 0.003 MPMI/ Physical group; p = 0.11 Control group; p = 0.32 Physical only group; p = 0.14 MP-MI only group) and RESS (p = 0.009 MP-MI/Physical group; p = 0.14 Control group; p = 0.10 Physical only group; p = 0.04 MP-MI only group). Findings also indicate spontaneous carryover of significantly increased swallowing pressure when mental and physical exercise are combined. In conclusion, the potential effect of including an MPMI lingual exercise component in preventative and rehabilitative frameworks with older persons to possibly enhance functional swallowing improvement is promising and should be investigated.

Mental Practice Using Motor Imagery in Dysphagia Rehabilitation: A Survey of Practicing Speech-Language Pathologists.

Mental practice (MP) using motor imagery is recognized as an effective clinical tool in rehabilitative medicine for improving motor performance. Preliminary data using MP in dysphagia rehabilitation are promising, though nothing is known about the current landscape among speech-language pathologists (SLPs) relating to MP implementation. This nationwide study surveys practicing SLPs about knowledge and practice patterns of using MP to gain a better understanding of the current knowledge, as well as perceived benefits and challenges in using MP. Descriptive data are reported and open-ended questions analyzed for emerging themes using inductive coding. Over half of the participants were familiar or somewhat familiar with motor imagery in the context of dysphagia rehabilitation, though only 16% of those SLPs reported using MP with a patient. Nearly 75% of respondents expressed interest in learning more about MP. Emerging themes include factors SLPs perceive to limit patient engagement, evidence-based practice concerns, and therapeutic environmental factors. More research on MP and access to training for clinicians is needed in the area of dysphagia rehabilitation to address acknowledged interest in MP.

Motor Imagery Practice and Increased Tongue Strength: A Case Series Feasibility Report.

Purpose The aim of the study was to determine the effects of a 6-week progressive resistance tongue exercise protocol in mental practice form on tongue strength. Investigation begins in typically aging adults, a population susceptible to reduced tongue strength and dysphagia secondary to age-related changes in the swallowing mechanism. It was hypothesized that typically aging adults who perform a 6-week progressive resistance tongue exercise protocol in mental practice form would increase tongue strength. Method A prospective, case series intervention study was used. Six healthy women aged 53-78 years completed a 6-week mental practice tongue resistance exercise program utilizing motor imagery to imagine completion of tongue exercises. The main outcome was mean isometric maximum tongue pressures (tongue strength), which were collected at baseline and Weeks 2, 4, and 6 using the Iowa Oral Performance Instrument ( IOPI Medical, 2013 ). Results By Week 6 of the study, all participants had significantly increased their tongue strength compared to baseline. Conclusions The findings indicate that mental practice using motor imagery for tongue exercise may improve tongue strength in healthy individuals at risk for dysphagia and may thus represent a promising direction warranting further investigation in typically aging individuals and patients with dysphagia and decreased tongue strength.