Biomechanical Biomarkers of Tongue Impairment During Swallowing in Persons Diagnosed with Amyotrophic Lateral Sclerosis.
Bridget J Perry, Kaila L Stipancic, Rosemary Martino and 2 others
PMID 32347416WHAT IT FOUND
In 12 people with ALS, slower tongue movement during thin liquid swallows was strongly linked to aspiration risk.
A tongue speed below 43.8 mm/s detected penetration or aspiration with 100% sensitivity. These biomechanical markers may help identify patients at high risk before clinical signs appear.
Key findings
01Tongue speed during water swallows detected ALS penetrators/aspirators at a cut point of 43.8 mm/s with sensitivity of 100% and a specificity of 88%.
02Strong negative correlations were found between tongue speed and tongue control during bolus hold, bolus transport, swallow initiation, and oral impairment score with cup sips of water.
03Tongue strength detected ALS penetrators/aspirators at a cut point of 21.5 kPa with sensitivity of 100% and a specificity of 87.5%.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Very small sample size (n=12) limits generalizability. Cross-sectional design; cannot establish causality or predict decline over time. Unable to analyze the timing of aspiration events due to sample size. Biomechanical measures were not strongly associated with swallowing efficiency (residue), possibly due to restricted range of scores. Assessments were separated by an average of 12 days, which may introduce variability given the progressive nature of ALS.
Declared interests
The authors declare no conflicts of interest. The study was supported by the NIH.
The easy way to misread this
Do not use the 43.8 mm/s cut point as a definitive clinical diagnostic threshold. These findings come from a very small sample of 12 people with ALS, and the high sensitivity reported (100%) is likely unstable and prone to overestimation in such a small group. Larger validation studies are needed before these specific numbers can be applied to patient care.