How the Abilex Oral Exerciser was Designed to Help

The Abilex* is an innovative oral motor exerciser designed to help people who have difficulty with swallowing and oral control. These problems may be caused by conditions such as stroke, brain injury, Parkinson’s Disease, Dementia, certain types of head and neck cancer, intubation, medications and more .

For patients living with swallowing challenges, important activities such as eating, drinking and socializing cannot be taken for granted. These simple activities can be extremely challenging, resulting in anxiety, embarrassment and isolation at mealtimes and family gatherings.

Swallowing problems, known medically as dysphagia, are linked with malnutrition, depression, and reduced quality of life and can also lead to aspiration – when food or saliva is inhaled or falls into the airway – which can cause pneumonia and other health complications.[1] Dysphagia can also carry a financial burden. The monthly costs for the thickened liquids alone is estimated at $174 - $289.[2] People with dysphagia will spend more time in the hospital and are at greater risk of severe health consequences in rehabilitation settings.[3]

Typical management of swallowing conditions includes compensatory techniques (for example, postural adjustments and diet modifications), which only produce temporary effects.3 Rehabilitative swallowing treatments (such as strengthening and range of motion exercises) target the underlying physical problems for long-lasting effects and recovery of function.[4]

The Abilex* device is designed to support rehabilitative oral exercise training and targeted swallowing practice. Putting control in your hands with a device that is engaging and easy-to-use, anywhere.

The Tongue

In addition to helping you enjoy the flavors of your meal, your tongue has to be very busy with its functions in chewing and swallowing that meal. Adequate tongue action and strength are necessary for all phases of swallowing. For eating and swallowing, the tongue does the following:

  • helps to bring food and liquid into the mouth,
  • mashes soft food between the tongue and the roof of the mouth,
  • places the food between the back molars for chewing,
  • controls the food and liquid to prevent it from falling out the mouth, into the cheeks, or down the throat too fast,
  • forms the food/liquid into a ball (bolus),
  • strips the bolus out of the mouth or channels the bolus to the back of the mouth,
  • squeezes food between the tongue and the roof of the mouth to propel food and liquid into the throat (pharynx),
  • anchors to the front of the mouth, with the lips closed, to start the swallow.

Then, once the swallow is triggered, a strong tongue push or propulsion helps to drive the bolus cleanly through the pharynx. With that propulsion, the back or base of the tongue comes in contact with the back wall of the throat (pharynx), setting up a peristaltic wave that carries the bolus all the way through the pharynx and food tube (esophagus) to the stomach. There are other structures involved with a normal swallow, but adequate tongue timing, movement, coordination, strength and pressures are essential to a safe and efficient swallow.

We think of the tongue as one muscle, but it is actually made up of four muscles inside the tongue (intrinsic muscles) and four muscles outside the tongue (extrinsic muscles) that are necessary to support its movement. That is a lot to exercise.

Tongue Strength

The tongue, as noted above, performs significant functions in the oral preparatory, oral transit, and pharyngeal phase of swallowing, including major contributions to food manipulations and transport.[5] As a result, tongue strength is important to overall swallowing function, and resistance-based tongue exercises have been shown to improve tongue strength[6]. Tongue strengthening exercises can be performed to prevent swallowing disorders (dysphagia) as well as help recover from it (when caused by tongue/lingual weakness). Tongue strength improvements have also been correlated to higher quality of life, reduced healthcare costs, hospital readmissions, and other health related benefits[7]. The Abilex* oral exerciser is designed to help strengthen the tongue and lips with a variety of exercises designed by Speech-Language Pathologists (SLPs) to improve overall swallowing function.

Tongue Movement & Coordination

Rehabilitating the tongue for a safer and more efficient swallow is not only about how strong the tongue is. It is also about improving coordination, range-of-motion, timing and skill or accuracy. One can imagine how many quick and coordinated movements are needed to speak clearly. Now think about everything the tongue has to do during a meal. The tongue has to know how and when to react to different types of food textures, sizes, and shapes. If the tongue movement and coordination is impaired, then managing the food in the mouth will be difficult. The food may become lodged in the cheeks if the tongue has reduced range-of-motion to sweep it away from the cheeks and form it into a ball. The tongue also needs to know how to control liquids, sensing if it is a small versus large sip. That liquid needs to be contained or controlled by the tongue to prevent liquid from falling out of the mouth, into the cheeks, and/or down into the airway before you are ready to swallow. The best way to improve any skill is through practice and repetition. Thus, the best way to improve tongue coordination is to practice moving the tongue in a safe manner. The Abilex* oral exerciser was developed to allow for the safe practice of skill-based coordination and range-of-motion tasks. 

Oral Control

The Abilex* oral exerciser can also be used by people with tongue impairments not directly related to swallowing. For example, people with Parkinson’s Disease, Cerebral Palsy, stroke, and head and neck cancer, or those experiencing apraxia, or dysarthria, may all have difficulty articulating or controlling their tongue. In the same way that the Abilex* device is designed to strengthen the tongue and lip muscles for swallowing, these same strengthening and coordination activities may have a positive effect on articulation and control.

Swallowing Skills

Like speech and coordination, swallowing is best improved by practicing. Many researchers agree that the best way to improve swallowing is to swallow. However, if one has a swallowing impairment, practicing swallowing with food or liquid could increase the risk of choking (airway blockage) or aspirating (where food and/or liquid goes down the wrong way, entering the lungs instead of the food tube or esophagus). This can lead to respiratory complications and aspiration pneumonia. The unique bulb of the Abilex* oral exerciser was designed simulate a ball of food (bolus) in the mouth so you can safely practice swallowing with the sensation of a bolus while limiting the risk of aspiration or choking. Performing swallowing drills with the tongue pressed into the middle of the Abilex* bulb with the lips closed around the device may help train a better swallowing pattern. For example, the device may facilitate a better pattern in people who have a tongue thrust or a deviant swallowing pattern where the tongue moves too far forward during the swallow, usually with the lips open.

More About the Abilex* Oral Exerciser

The broad air-filled bulb provides tactile feedback for increased oral awareness. The broad surface is easy to push against without your tongue slipping off to the side. There is a thicker ring around the outside and a thinner center section. The varied surfaces could provide different targets for skill or accuracy training. This additional sensory stimulation may help the person trigger many swallows with the device in the mouth or in between exercise sets.

This visible tool reminds people to practice with the goal of increasing the intensity, engagement in, and adherence to an oral exercise program in comparison to exercises performed without a device. It is a soft silicon that feels gentle in the mouth, even in the presence of a dry mouth or a sore tongue.[8] It is comfortable to hold, even with limited dexterity, as it has a non-slippery flexible rubber handle. There is a mouth guard to prevent insertion of the device too far into the mouth, and the bulb is designed to be strong enough to withstand a bite-reflex. Currently, exercises are designed for strength, lateralization, tongue manipulation, and range-of-motion allowing therapists to tailor its use for the specific skill-building needs of their patient.

Brain Activation - Neuroplasticity

Injuries to the brain can damage connections related to swallowing function. These connections can sometimes be remapped through physical exercise. Just like how physical therapy may be performed on arms and legs after an accident, the tongue and lips may benefit from physical exercise too. Specific repeated exercises can activate the brain to make new neural connections around damaged areas. With time, the brain can adapt and relearn how to swallow.

Prevention

As we talk about strengthening the tongue, we have to consider how we do not use our maximum tongue strength to swallow. In fact, we swallow using less than 50% of our maximum pressures (about 17 to 20 kilopascals[9]). We could think about that range between our maximum pressures and our saliva swallow pressures as a protective bank account of extra strength (also called functional reserve). We can ramp up the amount of functional reserve that we have with steady exercise, storing up for prevention later. For example, a frail older woman is often given physical therapy exercises to improve strength and balance to prevent falls, so that same woman should consider a maintenance tongue exercise program to develop a stronger baseline. That way if a sudden illness requires a prolonged hospital stay, she will have less risk for developing generalized weakness. If her strength declines below her baseline that could lead to difficulty swallowing. 

Older individuals have higher rates of dysphagia, and dysphagia is a common problem identified in nursing facilities and care homes. Dysphagia prevalence in the United States range from 40% to 50% of adults aged 60 and older.[10],[11] As many as 80% of elderly individuals residing in skilled nursing facilities have been reported to exhibit observable clinical signs of swallowing difficulty at the mealtime. [12]

A reduced functional reserve has been found in people with dysphagia. An individual at risk for developing dysphagia may benefit from engaging in ongoing exercise for the muscles of swallowing. The Abilex* device could help make a prevention exercise routine easy.

 

 

[1] Cichero, Julie AY, and Kenneth W. Altman. "Definition, prevalence and burden of oropharyngeal dysphagia: a serious problem among older adults worldwide and the impact on prognosis and hospital resources." Stepping stones to living well with dysphagia. Vol. 72. Karger Publishers, 2012. 1-11.

[2] O'Keeffe ST. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?. BMC Geriatr. 2018;18(1):167. Published 2018 Jul 20.

[3] Altman, Kenneth W., Gou-Pei Yu, and Steven D. Schaefer. "Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources." Archives of Otolaryngology–Head & Neck Surgery 136.8 (2010): 784-789.

[4] Malandraki GA, Rajappa A, Kantarcigil C, Wagner E, Ivey C, Youse K. The Intensive Dysphagia Rehabilitation Approach Applied to Patients With Neurogenic Dysphagia: A Case Series Design Study. Arch Phys Med Rehabil. 2016 Apr;97(4):567-574.

[5] Oh, Jong-Chi. Effects of Tongue Strength Training and Detraining on Tongue Pressure in Healthy Adults

[6] Lazarus, Cathy Lynn. Tongue Strength and Exercise in Healthy Individuals and in Head and Neck Cancer Patients. Seminars in Speech and Language, 2006.

[7] Rogus-Pulia, Nicole et al. Effects of Device-Facilitated Isometric Progressive Resistance Oropharyngeal Therapy on Swallowing and Health-Related Outcomes in Older Adults with Dysphagia. Models of Geriatric Care, Quality Improvement, and Program Dissemination, 2016. 

[8] https://www.swallowstudy.com/product/tongue-exercise/

[9] Steele, CM, Molfenter SM, Péladeau-Pigeon M, Polacco RC, Yee C. Variations in tongue-palate swallowing pressures when swallowing xanthan gum-thickened liquids. Dysphagia. 2014;29(6):678-84.

[10] Robbins J, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005 Sep;53(9):1483-9.

[11] Chen, PH., Golub, J.S., Hapner, E.R. et al. Prevalence of Perceived Dysphagia and Quality-of-Life Impairment in a Geriatric Population. Dysphagia 2009 Mar;24(1):1-6

[12] Steele CM, Greenwood C, Ens I, Robertson C, Seidman-Carlson R. Mealtime difficulties in a home for the aged: not just dysphagia. Dysphagia. 1997 Winter;12(1):43-50; discussion 51.