The majority of stroke survivors — up to three-quarters, according to some studies — experience some form of trouble swallowing after a stroke. Called dysphagia, it can affect everything from speech to eating, drinking, and even breathing. University of Cincinnati researchers want to know if certain tongue exercises could improve swallowing function.
"When you have a stroke, or another condition that impairs your swallowing, it impacts your life in an incredible way," says Brittany Krekeler, Ph.D., assistant professor and clinician-scientist at the UC College of Medicine's Dysphagia Rehabilitation Laboratory.
"It not only disposes you to potentially developing a life threatening condition — like pneumonia is something we always worry about with swallowing impairments because when you can't swallow things correctly, it can end up in your lungs, causing pneumonia. That's kind of the most extreme case, but it can also really impact your nutrition, hydration, and then it's highly linked to depression, and other kinds of social aspects of life."
RELATED: She was having a stroke and didn't know it. But her son knew the warning signs
Krekeler is leading a five-year study, funded by the National Institutes of Health, investigating if tongue endurance exercises can improve swallowing function.
"We hypothesize that there's a specific way to approach rehab of swallowing disorders, and that if you target these specific impairments in this way, and regain the motor integration to swallow, then you can improve your swallowing and be able to go back to as close to a normal diet as possible."
Researchers will enroll 60-75 patients. They'll meet with clinicians to learn the at-home exercises and how to use a pressurized bulb connected via Bluetooth to a smart device that will measure how hard they're pressing the bulb with their tongue. Participants will complete the exercises three times per day for eight weeks.
Krekeler says the goal isn't strengthening so much as gaining endurance.
"We're trying to target fatigue resistance or endurance of the tongue instead of strength because to swallow, you don't have to push your tongue as hard as you can every single time, you have to generate enough pressure to move whatever is in your mouth through your throat into your esophagus," she explains. "What we're doing in this study is training people to press repeatedly over a longer period of time with the hope that that will carry over to more functional swallowing change."
RELATED: With AI, doctors can now diagnose and plan stroke treatment in 3 minutes or less
The study will focus on participants with primarily ischemic (as opposed to hemorrhagic or subarachnoid) strokes. Ischemic strokes are the most common, and researchers are looking for people who have difficulty with swallowing but don't have some of the different pathological challenges as someone who has had a hemorrhagic stroke, for example.
"It's really anyone that is still having any issues swallowing at three to six months after that ischemic stroke," says Krekeler.
It will take a while to collect and analyze all the data. Krekeler isn't expecting to have that finished until around 2028. After that, the next phase would likely be a larger, multi-site trial that includes other interventions such as lingual exercise, swallowing-specific exercises and various combinations.
"Recovering swallowing function is kind of like recovering walking function in the fact that when when you're rehabilitating the lack of ability to walk, you can strengthen the legs, you can practice lifting weights, but you're not going to learn how to walk again until you actually get up and do some assisted walking. Swallowing is the same way, you can get the tongue stronger, you can condition the tongue, but until you actually swallow something, your swallowing probably won't improve."
Eligibility requirements
- At least 18 years of age
- History of ischemic stroke 3-6 months ago
- Still having difficulty swallowing
- No history of other neurological conditions
Time commitment
- 8 weeks of home exercise
- Participation in 3 on site visits
- 1x per week virtual or in-person visit with a licensed speech-language pathologist.
More information can be found by contacting Anna Hopkins CCC-SLP at hopkiak@ucmail.uc.edu or 513-479-6439.
