The long-term goal of this research program is to advance the treatment of swallowing
disorders in elderly adults. This study will identify the impact of an 8-week progressive
resistance exercise program for oral muscles on swallowing physiology, anatomy, dietary
intake, and Quality of Life (QOL) in frail dysphagic adults. Findings from the exercise
program may indicate new directions for treatments and techniques designed to influence the
biological underpinnings of dysphagia in elderly persons. Translation of these findings
into clinical practice will have far-reaching significance in the fields of gerontology,
speech language pathology, and long-term care.
The overall goal of the proposed research is to evaluate the effects of lingual resistance
exercise on swallowing and related outcomes in frail elderly patients with dysphagia. In
addition, we will determine if there are prognostic factors that will allow us to predict
for whom the intervention is most effective. For all objectives, frail, dysphagic patients
will be randomized into 2 treatment groups: a) standard swallowing treatment and an 8-week
tongue exercise program, or b) standard swallowing treatment and an 8-week hand exercise
program, which serves as a "sham" intervention.
Objective 1: To quantify the effects of the exercise program on bolus flow which are: a)
direction as measured by the Penetration Aspiration Scale; b) completeness (residual rating
scale 7) and; c) duration in msec.
Objective 2: To quantify the effects of the exercise program on oropharyngeal physiology
including lingual pressure (a surrogate for strength) and kinematics of the hyolaryngeal
complex and opening of the upper esophageal sphincter (UES) and to determine the
contributions of these measures to bolus flow and functional outcomes including
swallowing-specific quality of life and dietary intake.
Objective 3: To quantify the underlying changes in lingual volume and tissue composition
resulting from participation in the exercise program.
Objective 4: To determine the effect of an 8-week lingual resistance exercise program on
swallowing function, as quantified by a valid, reliable measure of swallowing-related
quality of life (QOL) and dietary intake.
Objective 5: To explore the time course of the response by examining outcomes after 4 and
after 8 weeks of exercise.
All objectives will be pursued in parallel across the 3 years of research. Milestones for
accomplishing these objectives include: (1) Year 1: implementing procedures, manuals, and
instrumentation for strength testing and training by Month 4; enrolling 24 subjects by Month
12; (2) Year 2: enrolling 40 subjects by Month 24 and writing a preliminary manuscript; (3)
Year 3: completing subject enrollment by Month 30, which requires 16 additional subjects,
completing statistical analyses regarding intervention effects by Month 34, and completing 2
comprehensive reports on results by Month 36.
Age of 65 or older, MD determined medical stability, referred by MD for swallowing
evaluation because of suspected dysphagia, confirmed dysphagia by x-ray evaluation,
geographic access to return for clinic appointments, telephone in home, ability to perform
exercises, capacity to provide informed consent, frailty defined by Winograd et al
Admitted from a nursing home after a longer than 3 month stay, previously enrolled in this
study, not able or willing to return for outpatient visits, unable to complete telephone
interviews, cerebrovascular accident within 90 days, medically unstable as determined by
MD, claustrophobia, known contraindications to MR imaging (e.g., pacemaker, aneurysm
clip), more than 2 dental crowns, poorly controlled psychosis, refractory alcoholism,
other severe disabling diseases resistant to medical management (e.g., class IV congestive
heart failure, end stage renal disease), allergy to barium, terminally ill (predicted
survival less than 6 months)