Facilitating Tongue Length and Mobility Using a Novel Loop Device for Dysphagia in Stroke Survivors: Efficacy in a Quasi-Randomized Study
Main Article Content
Keywords
Oral rehabilitation, swallowing function, Tongue mobility, Tongue strength
Abstract
Background: Dysphagia in stroke patients is primarily attributed to motor weakness and decreased voluntary motor control, leading to delayed swallowing reflexes and pharyngeal contractions. There are limited technical aids available for the rehabilitation of the tongue. This study presents an option in the form of a loop device. Objective: To investigate the use of a loop device for dysphagia in stroke survivors using a quasi-randomized study. Methods: This quasi-randomized study was conducted at a hospital on post-stroke dysphagia for 1 year. The sample was divided into either Group A (n = 6) or Group B (n = 6). Group A received tongue stretching and strengthening using the loop device. Group B received tongue stretching (manually) and strengthening intervention (tongue depressor) without using a loop device. Eating Assessment Tool (EAT10), M.D. Anderson Dysphagia Inventory (MDADI), and tongue length change measure or tongue protrusion change (TLCM) were used to check the outcome using the significant difference of means at a p-value of 0.05, considering a normal distribution and SD. Paired and independent t-tests were used for analysis. Results: Group A: the mean TLCM score increased from 1.56 (SD = 0.91) to 2.0 (SD = 0.82) from the pretest to the posttest (p = 0.007). The mean EAT10 score decreased from 24 (SD = 5.21) to 19.33 (SD = 6.80), (p = 0.011). In addition, the mean MDADI score increased from 53.80 (SD = 7.71) to 62.97 (SD = 12.37), (p = 0.021). The p-value was found to be significant at < 0.05. Group B: In Group B, the mean TLCM score increased from 2.23 (SD = 0.34) to 2.50 (SD = 0.41), (p = 0.014). However, the mean EAT10 score decreased notably from 19.16 (SD = 2.48) to 13.5 (SD = 3.27), (p = 0.001). Similarly, the mean MDADI score increased from 51.7383 (SD = 6.16) to 58.3967 (SD = 6.16), (p = 0.001). The p-value was found to be significant at < 0.05. In intergroup comparison, no significant difference is seen. Conclusions: Improvements have been observed in dysphagia using TLCM, EAT-10 scores, and MDADI after the interventions. No significant improvement of the novel device use over the traditional methods is seen in the studied measures, and both are comparable to each other. The loop device provided the intervention in an effective, hygienic, and clinically appropriate manner. The manual stretching of the tongue was not preferred by patients.
Downloads
Abstract 20 | PDF Downloads 5
References
2. Arnold, M., Liesirova, K., Broeg-Morvay, A., et al. Dysphagia in Acute stroke: Incidence, burden and impact on clinical outcome. PLoS One. 2016;11(2):e0148424. https://doi.org/10.1371/journal.pone.0148424.
3. Nagashima, K., Kikutani, T., Miyashita T., et al. Tongue muscle strength affects posterior pharyngeal wall advancement during swallowing: A cross-sectional study of outpatients with dysphagia. J Oral Rehabil. 2021;48(2):169–175. https://doi.org/10.1111/joor.13120.
4. Lee, J.H., Kim. H.S., Yun D.H., et al. The relationship between tongue pressure and oral dysphagia in stroke patients. Ann Rehabil Med. 2016;40(4):620–628. https://doi.org/10.5535/arm.2016.40.4.620.
5. Hwang, N.K., Kim, H.H., Shim, J.M., et al. Tongue stretching exercises improve tongue motility and oromotor function in patients with dysphagia after stroke: A preliminary randomized controlled trial. Arch Oral Biol. 2019;108:104521. https://doi.org/10.1016/j.archoralbio.2019.104521.
6. Aoki, Y., Kabuto, S., Ozeki, Y., et al. The effect of tongue pressure strengthening exercise for dysphagic patients. JJCRS. 2015;6,129–136. https://doi.org/10.11336/jjcrs.6.129.
7. Mulheren, R.W., and González-Fernández, M. Swallow screen associated with airway protection and dysphagia after acute stroke. Arch Phys Med Rehabil. 2019;100(7):1289–1293. https://doi.org/10.1016/j.apmr.2018.12.032.
8. Arnold, M., Liesirova, K., Broeg-Morvay, A., et al. Dysphagia in acute stroke: Incidence, burden and impact on clinical outcome. PLoS One. 2016;11(2):e0148424. https://doi.org/10.1371/journal.pone.0148424.
9. Nakazawa, Y., Kikutani, T., Igarashi, K., et al. Associations between tongue strength and skeletal muscle mass under dysphagia rehabilitation for geriatric out patients. J Prosthodont Res. 2020;64(2):188–192. https://doi.org/10.1016/j.jpor.2019.07.004.
10. Jamil, A., Imtiaz, M., Muhammad, A., et al. Evidence based therapeutic and assessment techniques to rehabilitate post stroke dysphagia patients—A systematic review. Eur Arch Otorhinolaryngol. 2025;282(1):1–10. https://doi.org/10.1007/s00405-024-08874-9.
11. Kim, H.D., Choi, J.B., Yoo, S.J., et al. Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. J Oral Rehabil. 2017;44(1):59–64. https://doi.org/10.1111/joor.12461.
12. Rogus-Pulia, N., and Connor, N.P. Muscle strengthening approaches to dysphagia rehabilitation. Curr Phys Med Rehabil Rep. 2016;4:277–286. https://doi.org/10.1007/s40141-016-0136-3.
13. Jayaprakash, J., Jasobanta, S., Sahil, K., et al. Effect of electrical stimulation of tongue in rehabilitation—A systematic review. Univers J Public Health. 2021;9(5):253–262. https://doi.org/10.13189/ujph.2021.090507.
14. Milazzo, M., Panepinto, A., Sabatini, A.M., et al. Tongue rehabilitation device for dysphagic patients. Sensors. 2019;19(21):4657. https://doi.org/10.3390/s19214657.
15. Khan, M.M., Smart, S., Bogaardt, H., et al. Design of a portable device: Toward assisting in tongue-Strengthening exercises and dysphagia management. IEEE Access. 2024;12:84893–84906. https://doi.org/10.1109/ACCESS.2024.3399199.
16. Hwang, N.K., Yoon, T.H., Chang, M.Y., et al. Dysphagia rehabilitation using digital technology: A scoping review. J Evid Based Med. 2025;18(1):e70009. https://doi.org/10.1111/jebm.70009.
17. Teklemariam, A., Karimian, N., Manga, A., et al. Enhancing dysphagia management: Non-invasive tongue force measurement device for improved diagnosis and treatment. In Proceedings of the Annual British Conference on Non-Destructive Testing, Telford, UK, 2024 Jan 1; The British Institute of Non-Destructive Testing: Northampton, UK. https://doi.org/10.1784/ndt2024.1c2.
18. Maia, A.V., Furlan, R.M.M.M., Moraes, K.O., et al. Tongue strength rehabilitation using biofeedback: A case report. Reabilitação da força da língua utilizando biofeedback: relato de caso. Codas. 2019;31(5):e20180163. https://doi.org/10.1590/2317-1782/20182018163.
19. Matos, K.C., Oliveira, V.F., Oliveira, P.L.C., et al. An overview of dysphagia rehabilitation for stroke patients. Arq Neuropsiquiatr. 2022;80(1):84–96. https://doi.org/10.1590/0004-282x-anp-2021-0073.
20. Silva, R.G. The effectiveness of rehabilitation in oropharyngeal dysphagia. (A eficácia da reabilitação em disfagia orofaríngea). Pro Fono. 2007;19(1):123–130. (in Portuguese). https://doi.org/10.1590/S0104-56872007000100014.
21. Shukla, M., Vishwakarma, D., Goyal, S. Oral rehabilitation frame: A device for oro-motor functions. Sharda University, Greater Noida, India. 2025, (to be submitted).
22. Candy Tongue Depressor. Available online: https://patents.google.com/patent/US5897492A/en.
23. CN206080478U Shaoxing Second Hospital, China available online: https://patents.google.com/patent/CN206080478U/zh.
24. Buscemi, A., Coco, M., Rapisarda, A., et al. Tongue stretching: technique and clinical proposal. J Complement Integr Med. 2021;19(2):487–491. https://doi.org/10.1515/jcim-2020-0101.
25. Belafsky, P.C., Mouadeb, D.A., Rees, C.J., et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919–924. https://doi.org/10.1177/000348940811701210.
26. Alsubaie, H.M., Sayed, S.I., Alsini, A.Y., et al. Validity and reliability of an Arabic version of MD Anderson Dysphagia Inventory (MDADI). Dysphagia. 2022;37(4):946–953. https://doi.org/10.1007/s00455-021-10356-7.
27. Cho, H., Noh, J.S., Park. J., et al. Decreased maximal tongue protrusion length may predict the presence of dysphagia in stroke patients. Ann Rehabil Med. 2021;45(6):440–449. https://doi.org/10.5535/arm.21126.
28. Shimizu, A., Fujishima, I., Maeda, K., et al. Effect of low tongue pressure on nutritional status and improvement of swallowing function in sarcopenic dysphagia. Nutrition. 2021;90:111295. https://doi.org/10.1016/j.nut.2021.111295.
29. Hwang, N.K., Kim, H.H., Shim, J.M., Tongue stretching exercises improve tongue motility and oromotor function in patients with dysphagia after stroke: A preliminary randomized controlled trial. Arch Oral Biol. 2019;108:104521. https://doi.org/10.1016/j.archoralbio.2019.104521.
30. Van den Steen, L., Baudelet, M., Tomassen, P., et al. Effect of tongue-strengthening exercises on tongue strength and swallowing-related parameters in chronic radiation-associated dysphagia. Head Neck. 2020;42(9):2298–2307. https://doi.org/10.1002/hed.26179.
31. Syahrul, S. and Kadar, K. The effectiveness of tongue strengthening exercise in increasing tongue strength among older people with dysphagia: A systematic review. Health Syst Rev. 2022;4:100047. https://doi.org/10.1016/j.hsr.2022.100047.
32. Lin, C.J., Lee, Y.S., Hsu, C.F., et al. Effects of tongue strengthening exercises on tongue muscle strength: A systematic review and meta-analysis of randomized controlled trials. Sci Rep. 2022;12(1):10438. https://doi.org/10.1038/s41598-022-14335-2.
33. Sakai, K., Nakayama, E., Tohara, H., et al. Diagnostic accuracy of lip force and tongue strength for sarcopenic dysphagia in older inpatients: A cross-sectional observational study. Clin Nutr. 2019;38(1):303–309. https://doi.org/10.1016/j.clnu.2018.01.016.
34. Steele, C.M., Bayley, M.T., Peladeau-Pigeon, M., et al. A randomized trial comparing two tongue-pressure resistance training protocols for post-stroke dysphagia. Dysphagia. 2016;31(3):452–461. https://doi.org/10.1007/s00455-016-9699-5.
35. Kang, J.H., Park, R.Y., Lee, S.J., et al. The effect of bedside exercise program on stroke patients with dysphagia. Ann Rehabil Med. 2012;36(4):512–520. https://doi.org/10.5535/arm.2012.36.4.512.
36. Abe, T., Viana, R.B, Wong, V., et al. The influence of training variables on lingual strength and swallowing in adults with and without dysphagia. JCSM Clin Rep. 2020;5(2):29–41. https://doi.org/10.1002/crt2.11.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Author(s) must obtain all parties consent [co-author(s), others if applicable] and submit the acceptance of Copyright Agreement with their paper. Written permission must be obtained by the author for material that has been published in copyrighted material; this includes tables, figures, and quoted text that exceeds 150 words. A copy of all permissions must accompany the manuscript when published in copyrighted material. The author(s) hereby represents and warrants that the paper is original and that he/she is the author of the paper, except for material that is clearly identified as to its original source, with permission notices from the copyright owners where required. Author(s) must clearly indicate that approval for publication has been received in cases of institutional ownership.
In all submitted material authors retain all copyrights; however, the GlobalCE Journal reserve the right to reprint all or portions of the article and to post all or part of the article online. GlobalCE Journal reserves the right to edit manuscripts as required to publish in the journal. Authors are responsible for obtaining any and all clearances as appropriate. Unless stated otherwise, all articles are open-access and distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and original work (e.g. first published in the Global Clinical Engineering Journal) is properly cited with the original URL and bibliographic citation information. The complete bibliographic information, a link to the original publication on www.Globalce.org well as the copyright and license information must be included. No use, distribution or reproduction is permitted which does not comply with these terms.
