Tongue stroke test
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Tongue Stroke Test: Insights from Recent Research
Introduction to Tongue Strength and Stroke
Tongue strength is a critical factor in assessing and managing dysphagia (swallowing difficulties) in stroke patients. Various studies have explored the relationship between tongue strength and swallowing function, aiming to develop reliable screening and diagnostic tools to predict complications such as penetration, aspiration, and pneumonia.
Predicting Penetration and Aspiration with Tongue Strength
Research has shown that tongue strength can be a valuable predictor of penetration and aspiration in stroke patients with dysphagia. A study involving 79 subjects used the Iowa Oral Performance Instrument (IOPI) and videofluoroscopic swallowing study (VFSS) to establish cut-off values for tongue strength during the swallowing of different food consistencies. These values demonstrated positive and negative predictive values ranging from 54.6% to 96.9%, suggesting that tongue strength assessments can effectively screen for penetration and aspiration risks.
Tongue Pressure and Oral Dysphagia
The relationship between tongue pressure and various aspects of oral-phase swallowing function has been extensively studied. Measurements of anterior and posterior tongue pressure have shown significant correlations with bolus formation, mastication, premature bolus loss, tongue-to-palate contact, and oral transit time. These findings indicate that tongue pressure is closely related to the efficiency of the oral phase of swallowing in post-stroke patients.
Tongue Pressure and Dysphagia Diet
Tongue pressure measurements can also guide dietary decisions for stroke patients. A study involving 80 acute stroke patients found that tongue pressure was significantly associated with the form of the dysphagia diet prescribed. Specific cut-off values for tongue pressure were identified for different diet codes, highlighting its utility in tailoring dietary interventions to individual patient needs.
Effortful Swallowing Training (EST) and Tongue Strength
Effortful swallowing training (EST) has been shown to improve tongue strength and oropharyngeal swallowing function in stroke patients. In a randomized controlled trial, patients undergoing EST demonstrated greater improvements in tongue strength and the oral phase of swallowing compared to a control group. This suggests that EST can be an effective rehabilitation strategy for enhancing swallowing function in dysphagia patients.
Predicting Pneumonia with Tongue Pressure
Low tongue pressure has been identified as a predictor of pneumonia in acute stroke patients. A study measuring tongue pressure in 220 patients found that a cut-off value of 21.6 kPa was highly predictive of swallowing dysfunction and subsequent pneumonia risk. Patients with low tongue pressure who did not show improvement within two weeks were more likely to develop pneumonia, underscoring the importance of regular tongue pressure monitoring.
Tongue-to-Palate Resistance Training (TPRT)
Tongue-to-palate resistance training (TPRT) has been demonstrated to improve both tongue strength and swallowing function in subacute stroke survivors. Participants who underwent TPRT showed significant improvements in tongue strength and scores on the videofluoroscopic dysphagia scale (VDS) compared to those receiving traditional dysphagia therapy alone. This highlights TPRT as a beneficial intervention for post-stroke dysphagia rehabilitation.
Conclusion
Tongue strength and pressure measurements are valuable tools in the assessment and management of dysphagia in stroke patients. They can predict risks of penetration, aspiration, and pneumonia, guide dietary decisions, and inform effective rehabilitation strategies such as EST and TPRT. These findings support the integration of tongue strength assessments into clinical practice to enhance the care and outcomes of stroke patients with swallowing disorders.
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