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Clinical evidence supports oropharyngeal strengthening as an effective

standard of care to improve swallowing in patients with dysphagia.

SwallowSTRONG makes strengthening simple, engaging, and quantifiable.

Dysphagia is a swallowing disorder that is growing more common with our aging population. It is estimated that

22% of adults above the age of 50 and 55% of those within institutional settings suffer from dysphagia.1

Dysphagia is commonly caused by weak lingual musculature—often as the result of stroke,

neurodegenerative disorders or head and neck cancer.2, 3

Dysphagia leads to aspiration pneumonia and the need for invasive treatments such as feeding tubes

and dietary modifications.4-6

Dysphagia causes and effects

Independent Variables Odds Ratio (95% CI)

Suctioning 2.55 (2.06, 3.15)

COPD 2.49 (2.27, 2.72)

CHF 1.75 (1.61, 1.90)

Case Mix Index 1.67 (1.55, 1.79)

Indicators of Delirium/ Less Alert 1.63 (1.38, 1.92)

Weight Loss 1.60 (1.47, 1.74)

Swallowing Problem/ Dysphagia

1.46 (1.31, 1.62)

Logistic regression model with backward elimination procedure

identifying 18 statistically significant predictors of aspiration pneumonia

(n=102,755)

Incidence Rate: Readmissions/

100 Person-Years (95% CI)

Attributable Risk: Readmissions/

100 Person-Years (95% CI)

All Readmissions

No Dysphagia 90.7 (87.3, 94.2) 4.75 (–0.87, 10.36)

Dysphagia 95.5 (91.1, 99.9)

Readmissions for Aspiration Pneumonia

No Dysphagia 0.45 (0.21, 0.69)1.83 (1.11, 2.56)

Dysphagia 2.3 (1.6, 3.0)

on incidence rates of hospital readmission, according to oropharyngeal dysphagia status (n=2,359)

Dysphagia is a leading predictor of aspiration pneumonia6

Dysphagia following stroke leads to aspiration4

Dysphagia leads to aspiration pneumonia, which is a major cause of hospital readmissions1

Accounts for 13% to 48% of all infections in

nursing home residents.5

Second most common type of nosocomial

infection in hospitalized patients.5

Overall mortality rate ranges from 20% to 50%

with rates as high as 80% reported.5

S = supraglottic

Assessment I

Assessment I

Aspiration

S. Penetration

Neither

No VF

Totals

Assessment II

Aspiration

4

4

2

2

12

21

44

30

8

103

S Penetration

8

24

6

2

40

Neither

3

10

12

4

29

No VF

6

6

10

0

22

VF = videofluoroscopy

Assessment I

Aspiration

S. Penetration

Neither

No VF

Totals

Assessment II

Aspiration

4

4

2

2

12

21

44

30

8

103

S Penetration

8

24

6

2

40

Neither

3

10

12

4

29

No VF

6

6

10

0

22

VF = videofluoroscopyS = supraglottic

Assessment I

S. Penetration

Assessment II

Aspiration

4

4

2

2

12

21

44

30

8

103

S Penetration

8

24

6

2

40

Neither

3

10

12

4

29

No VF

6

6

10

0

22

S. Penetration

Penetration

Aspiration

Aspiration

21

30

44

8

No VF

No VF

Neither

No Pen/Asp

VF = videofluoroscopy (n=103)

Lingual strengthening improves outcomes for head and neck cancer patients8-10

Diet maintenance improves over the long term8

Lingual strengthening before chemoradiation improves

swallowing function9

Patients who complete swallowing therapy are less

likely to worsen their diet or receive a feeding tube10

Improved quality of life7

Greater happiness and social engagement

Decreased swallowing burden

Elevated energy level

Baseline

Change in Penetration and Aspiration11

Week 4 Week 8

Pene

tratio

n-As

pira

tion

Scal

e Sc

ore 8

7

6

5

4

3

2

1

0

Aspiration

PenetrationP=0.08

P=0.003*

• = Mean score on the Penetration-Aspiration Scale for the

10-mL liquid bolus condition (n=10)

Lingual strengthening for improved health and quality of life

Long

-Ter

m R

egul

ar D

iet,

%

100

90

80

70

60

50NPO,

No TherapyNPO,

TherapyPart PO,

No Therapy

NPO = no oral intake; PO = oral intake (n=497)

Part PO,Therapy

Full PO,No Therapy

Full PO,Therapy

P=0.04*

P=0.02*

Long-Term Diet by Swallowing Groups

Lingual strengthening reduces penetration-aspiration scale scores in stroke patients with dysphagia and improves swallowing safety7

Increased isometric pressure

Increased maximum swallowing pressure

Increased swallowing safety

SWAL-QOL Baseline Week 8

Fatigue 40 58

Burden 49 79

Communication 53 72

Mental

Fatigue

Burden

Communication

Mental

49 80

NOTE: Maximum score per subscale is 100.

Maximum score per subscale is 100 (n=10)

Mean SWAL-QOL Subscale Scores11

*

*

*

0 10 20 30 40 50 60 70 80

Week EightBaseline

*Denotes statistically significant data (P<0.05)

Take dysphagia therapy to the next level with SwallowSTRONG

SwallowSTRONG is designed to make rehab more efficient and effective

for both the speech language pathologist and the patient. A custom-

molded mouthpiece, a tablet and easy-to-use software work together

to implement the evidence-based isometric progressive resistance

oropharyngeal therapy regimen—which improves lingual strength.

Sensors in the mouthpiece measure pressure at four

distinct locations of the tongue. This allows the clinician

to tailor therapy to the patient’s specific needs, including

placing focus on weak back of tongue and/or unilateral

lingual paresis.

Custom-molded mouthpiece ensures sensor placement

is the same in each therapy session, making for repeatable,

reliable results.

Easy-to-use electronic interface indicates performance

levels and automatically calculates therapy targets.

“”

The interface is very user-friendly... the fact that the

mouthpiece is custom-fitted in just minutes and

does not easily dislodge during usage helps

to ensure ease and accuracy of placement, so

that objective results obtained are reliable.

Kathy Groves Wright, PhD, CCC-SLP, BCS-S Cincinnati, VA Medical Center

Sensor

Teeth Guides

Easy-Grip Handle

SwallowSTRONG software provides easy-to-understand

knowledge of performance and results for both the

patient and the clinician. Feedback includes specific

information about accuracy of the movement as well as overall

performance. Positive feedback facilitates and increases

motivation.11

SwallowSTRONG provides quantification of therapy

progress and results. The Centers for Medicare and

Medicaid Services (CMS) and other payers require such

objective documentation for reimbursement. Claims without

sufficient objective data may be denied.12

SwallowSTRONG makes it easy to develop objective therapeutic goals with quantifiable outcomes

I-PRO therapy with SwallowSTRONG

Isometric progressive resistance oropharyngeal (I-PRO)

therapy is practiced for improved swallowing function.

It involves an active application of pressure by the tongue

against stable resistance in the mouth.

STANDARD PROTOCOL

10 lingual presses per sensor 3 times a day 3 days a week 8 weeks

SwallowSTRONG Management System

SwallowSTRONG Management System (SSMS)

is a cloud-based system that enables clinicians to:

Remotely view patients’ progress and reports.

Monitor adherence.

Remotely adjust therapy parameters.

Download therapy data for analysis

and report writing.

Compliance with the Health Insurance Portability and Accountability Act (HIPAA):

No protected health information (PHI) is collected or stored on the tablet or SSMS.

A code is assigned by the software and linked to the mouthpiece serial number.

No matter where the patient

“travels” in the care path, the

SwallowSTRONG data targets

and results will be available to

the clinician.

Transfer data from one facility

to another facility.

Clinicians can view and adjust data

from any web-enabled device.

Swallow Solutions Case Study13

Device Helps Patient Regain Ability to Swallow After Two Years on Feeding Tube

JB, a 56-year-old female, suffered a brainstem stroke, which left her unable to swallow and dependent on gastrostomy tube feeding

for two years. She arrived at a university hospital taking all nutrition via feeding tube and expectorating secretions into a spittoon.

The clinical staff carefully evaluated JB and determined that she had diminished tongue strength and would be a good candidate

for oropharyngeal strengthening. JB initiated isometric progressive resistance oropharyngeal (I-PRO) therapy and proved to be a

dedicated, hard-working patient who completed the lingual presses faithfully 3 times a day, 3 days per week.

JB first began taking small sips of liquid by mouth and ultimately progressed to full oral intake of a general diet. She reports that

the day she had her feeding tube removed was “one of the best days.” “It’s so isolating to not swallow. It adds hours to your day.

You can’t go out with friends, have a quick snack or share a meal with family. Now I eat well, I sleep well and I can fully enjoy my

time spent with friends and family.”

Challenge—JB spent the prior two years trying “every therapy known to man,” including swallow-specific maneuvers

such as the Mendelsohn maneuver, electrical stimulation and repeated dilations of the upper esophageal sphincter (UES)

with no appreciable gains in swallowing. Videofluoroscopic evaluation showed severely reduced (almost non-existent)

opening of the UES, significant post-swallow residue in the pyriform sinuses and aspiration on all consistencies.

Results—Findings after 8 weeks of I-PRO therapy were progression to general oral diet, 15 lb. weight gain, increased

isometric pressures (Δ >16 kPa) with transference to swallowing pressures, increased lingual volume (8.3%), reduced

pharyngeal wall residue (P=0.03), increased pharyngeal pressures (Δ > 43 mm Hg) and increased UES opening (nadir)

pressures (Δ > 9 mm Hg) with improved time-pressure coordination across the pharynx, and improved quality of life.

After detraining, decreased isometric pressures and reduced UES opening were noted. After I-PRO maintenance,

isometric anterior lingual pressures returned to levels noted after the 8 weeks of intervention.

Conclusion—I-PRO therapy, facilitated by the Swallow Solutions device combined with instrumental UES dilation,

improved swallow safety, increased dietary intake, and facilitated UES opening while enriching quality of life.

“It’s so isolating to not swallow... Now I eat well, I sleep well and I can fully enjoy my time spent with friends and family.”

Swallow Solutions is dedicated to the advancement of the health and

quality of life of patients with swallowing disorders. Swallow Solutions

was founded in 2004 by Dr. JoAnne Robbins, PhD, a professor at the

University of Wisconsin School of Medicine.

For more information on Swallow Solutions or the

SwallowSTRONG device, visit swallowsolutions.com.

About Swallow Solutions

Contact Swallow Solutions to secure pricing

for individual and multiple purchases as well

as for information on any new products being

introduced. Contact us at 608-238-6678 or info@swallowsolutions.com

SWALLOW SOLUTIONS

401 Charmany Drive, Suite 315

Madison, WI 53719

(phone) 608-238-6678

(fax) 608-238-1662

swallowsolutions.com

1. Cabré M, Serra-Prat M, Force L, Almirall J, Palomera E, Clavé P. Oropharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: observational prospective study. J Gerontol A Biol Sci Med Sci. 2014;69(3):330-337.

2. Hirota N, Konaka K, Ono T, et al. Reduced tongue pressure against the hard palate on the paralyzed side during swallowing predicts dysphagia in patients with acute stroke. Stroke. 2010;41(12):2982-2984.

3. Steele, C. M., Cichero, J. A. Physiological Factors Related to Aspiration Risk: A Systematic Review. Dysphagia. 2014: 1-10.

4. Smithard DG, O’Neill PA, England RE, et al. The natural history of dysphagia following a stroke. Dysphagia. 1997;12(4):188-193.

5. Langmore SE, Terpenning MS, Schork A, et al. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13(2):69-81.

6. Langmore SE, Skarupski KA, Park PS, Fries BE. Predictors of aspiration pneumonia in nursing home residents. Dysphagia. 2002;17(4):298-307.

7. Robbins J, Kays SA, Gangnon RE, et al. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007;88(2):150-158.

8. Hutcheson KA, Bhayani MK, Beadle BM, et al. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol Head Neck Surg. 2013;139(11):1127-1134.

9. Carroll WR, Locher JL, Canon CL, Bohannon IA, McColloch NL, Magnuson JS. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008;118(1):39-43.

10. Duarte VM, Chhetri DK, Liu YF, Erman AA, Wang MB. Swallow preservation exercises during chemoradiation therapy maintains swallow function. Otolaryngol Head Neck Surg. 2013;149(6):878-884.

11. Wulf G, Lee TD, Schmidt RA. Reducing knowledge of results about relative versus absolute timing: differential effects on learning. J Mot Behav. 1994;26(4):362-369.

12. Overview for documentation of Medicare outpatient therapy services. American Speech-Language-Hearing Association. http://www.asha.org/practice/reimbursement/medicare/medicare_documentation/.

13. Juan J, Hind J, Jones C, McCulloch T, Gangnon R, Robbins J. Case study: application of isometric progressive resistance oropharyngeal therapy using the Madison Oral Strengthening Therapeutic device. Top Stroke Rehabil. 2013;20(5):450-470.

SwallowSTRONG and Swallow Solutions are registered trademarks of Swallow Solutions, LLC.