Criteria to assess tongue strength for predicting penetration and aspiration in patients with stroke having dysphagia

Eur J Phys Rehabil Med. 2020 Aug;56(4):375-385. doi: 10.23736/S1973-9087.20.06180-8. Epub 2020 Apr 24.


Background: Instrumental assessments are typically used to assess swallowing function in stroke patients with dysphagia, but these tests cannot be used for all patients or for continuous monitoring. Hence, an adjunctive method is necessary for screening patients who may require such tests.

Aim: The purpose of this study was to analyze tongue strength with respect to the presence or absence of penetration and aspiration, using instrumental assessments, to provide a basis for clinical decision-making.

Design: Prospective observational study.

Setting: University Hospitals in Gwangju, South Korea.

Population: Seventy-nine subjects with dysphagia underwent video fluoroscopic swallowing study (VFSS) and Iowa Oral Performance Instrument evaluations.

Methods: VFSS results were assessed for the presence of penetration and aspiration, according to the penetration-aspiration scale. Receiver operating characteristic curve analysis was conducted with tongue strengths based on penetration and aspiration.

Results: During the swallowing of pureed, liquid, and solid foods, cut-off values of tongue strength for the anterior and posterior elevation and for the protrusion of tongue were suggested in cases of penetration and aspiration, among patients with dysphagia. These criteria had positive and negative predictive values of 54.6-90.2% and 57.5-96.9%, respectively.

Conclusions: This study found that tongue strength has predictive abilities similar to clinical and bedside tests to screen penetration and aspiration in stroke patients with swallowing disorders. Therefore, it is a new screening test that clinical practitioners can choose to reduce the risk of pneumonia caused by post-stroke disorders.

Clinical rehabilitation impact: As a new screening tool, tongue strength can be combined with other clinical and instrumental assessments to predict penetration and aspiration in stroke patients with dysphagia.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Clinical Decision-Making
  • Deglutition Disorders / physiopathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Stroke / physiopathology*
  • Tongue / physiopathology*