Supplementary Material for: Tongue Pressure Resistance Training for Post-Stroke Dysphagia: A Case Study

ABSTRACT
Purpose: The purpose of this study was to explore the effect of a lingual resistance training protocol on the swallowing function of an individual presenting with dysphagia and reduced tongue pressures following a supratentorial ischemic stroke.
Methods: A study involving a lingual resistance training protocol with videofluoroscopy to measure outcomes comparing different parameters to ASPEKT normative reference values at three timepoints: baseline (VFSS A), following a 4-week lead-in period to control for spontaneous recovery (VFSS B), and at the 8-week endpoint of treatment (VFSS C). The study was interrupted due to the COVID-19 pandemic after 1 participant enrollment and is presented as single case study.
Results:
Isometric tongue pressures: Following the 4-week lead-in, a decline in maximum isometric anterior tongue pressure (MAIP) and regular effort saliva swallow pressures (RESS) was noted, however there was no change in maximum posterior isometric tongue pressures (MPIP). Isometric tongue pressures improved post-treatment, with increases in MAIP, MPIP, and to a lesser degree RESS.
Swallowing Function: Impairments in swallowing safety continued between the baseline VFSS A (Penetration-Aspiration Scale score [PAS]=8) and lead-in VFSS B (PAS=5). Swallowing safety improved following the intervention, with PAS scores = 1 at the endpoint VFSS C. Pixel-based measures of swallowing efficiency revealed a reduced frequency of post-swallow total pharyngeal reside following the treatment. Improvements were found in two other swallowing parameters, laryngeal vestibule closure integrity and pharyngeal area at maximum pharyngeal constriction, at the endpoint VFSS.
Conclusion: These pilot data suggest improvements in some swallowing parameters as an outcome of intervention.

摘要
研究目的：本研究旨在探讨舌部阻力训练（lingual resistance training）方案对幕上缺血性脑卒中（supratentorial ischemic stroke）后出现吞咽困难（dysphagia）且舌压力降低的个体吞咽功能的影响。
研究方法：本研究采用舌部阻力训练方案，通过电视透视检查（videofluoroscopy）测量结局指标，并在三个时间点与ASPEKT标准参考值进行对比：基线阶段（VFSS A）、用于控制自发恢复影响的4周导入期后（VFSS B），以及治疗8周的终点阶段（VFSS C）。本研究在纳入1名受试者后因新型冠状病毒肺炎（COVID-19）大流行中断，最终以单病例研究（single case study）形式呈现。
研究结果：
等长舌压力：4周导入期后，受试者的最大等长前舌压力（maximum isometric anterior tongue pressure, MAIP）与常规用力唾液吞咽压力（regular effort saliva swallow pressures, RESS）均出现下降，但最大等长后舌压力（maximum posterior isometric tongue pressure, MPIP）无明显变化。治疗后，等长舌压力得到改善，MAIP、MPIP均升高，RESS亦有小幅提升。
吞咽功能：基线VFSS A阶段（渗透-误吸量表（Penetration-Aspiration Scale, PAS）评分=8）与导入期VFSS B阶段（PAS=5）之间，吞咽安全性缺陷持续存在。干预后吞咽安全性显著改善，终点阶段VFSS C的PAS评分降至1。基于像素的吞咽效率测量指标显示，治疗后吞咽后咽部总残留频率降低。在终点VFSS阶段，另外两项吞咽参数——喉前庭闭合完整性及最大咽缩时的咽腔面积——均得到改善。
研究结论：本初步研究数据表明，干预可使部分吞咽参数得到改善。