Effects of Tongue Pressure Strength and Accuracy Training on Tongue-Pressure Strength, Swallowing Function, and Quality of Life in Subacute Stroke Patients with Dysphagia

다국어 초록 (Multilingual Abstract)

The aim of this study was to investigate the effect of tongue pressure strength and accuracy training (TPSAT) on tongue pressure strength, swallowing function, and quality of life in subacute stroke patients with dysphagia. Sixteen subacute stroke patients were randomly assigned into either the TPSAT group (n = 8) or the control group (n = 8). In the TPSAT group, both TPSAT and traditional dysphagia therapies were performed for 30 min each per day; in the control group, only traditional dysphagia therapy was performed for 30 min twice a day. Both groups performed each daily intervention five times per week for 8-weeks. To assess the tongue pressure strength, anterior and posterior maximum isometric tongue pressures (MIPs) using Iowa Oral Performance Instrument (IOPI) were measured before and after the intervention. Mann assessment of swallowing ability (MASA) and swallowing-quality of life (SWAL-QOL) were also used to assess the swallowing function and quality of life, respectively. TPSAT with traditional dysphagia therapy significantly improved MIPs, MASA, and SWAL-QOL both anteriorly and posteriorly, and traditional dysphagia therapy significantly increased MIPs, MASA, and SWAL-QOL anteriorly compared with the pre-values (p < 0.05). The TPSAT group showed a significant improvement of anterior and posterior MIPs and tongue movement score in MASA compared with the control group (p < 0.05). Our findings suggest that TPSAT may be used for dysphagia management in subacute stroke patients clinically.

목차 (Table of Contents)

• Ⅰ. Introduction ······················································ 8
• 1. Significance of the study ············································ 8
• 2. The purpose of study ················································ 10
• 3. Research hypothesis ··················································· 11
• Ⅱ. Background ····················································· 12
• 1. Mechanism of swallowing ············································ 12
• 2. Dysphagia and stroke ················································· 16
• 3. Tongue strength, accuracy and swallowing function ·············· 17
• 4. Quality of life of patients with dysphagia ·························· 19
• Ⅲ. Method ·························································· 20
• 1. Subjects ···································································· 20
• 2. Iowa Oral Performance Instrument (IOPI) ··························· 21
• 3. Procedures ···························································· 22
• 4. Randomization and blinding ··········································· 24
• 5. Tongue Pressure Strength and Accuracy Training (TPSAT) ···· 25
• 6. Outcome measures ························································ 26
• 7. Statistical analysis ······················································ 27
• Ⅳ. Results ··························································· 28
• 1. General Characteristics of subjects ································· 28
• 2. Comparisons of maximum isometric tongue pressures for both groups before intervention ············································· 29
• 3. Comparisons of swallowing function for both groups before ····· 30
• 4. Comparisons of swallowing quality of life for both groups before intervention ······························································· 31
• 5. Change of maximum isometric tongue pressures for TPSAT group ····································································· 32
• 6. Change of swallowing function for TPSAT group ················· 33
• 7. Change of swallowing quality of life for TPSAT group ·········· 35
• 8. Change of maximum isometric tongue pressures for control group ····································································· 37
• 9. Change of swallowing function for control group ·················· 38
• 10. Change of swallowing quality of life for control group ··········· 40
• 11. Change score of maximum isometric tongue pressures for both groups ···································································· 41
• 12. Change score of swallowing function for both groups ············ 42
• 13. Change score of swallowing quality of life for both groups ······ 44
• Ⅴ. Discussion ·························································· 45
• Ⅵ. Conclusion ·························································· 49
• References ······························································· 50
• <국문요약> ······························································ 60
• Appendix 1 ······························································ 62
• Appendix 2 ······························································ 76