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55% of residents in long-term care facilities have a swallowing problem that can lead to expensive modified diets and hospitalization. Lingual strengthening is an evidence-based therapy to treat swallowing disorders. The SwallowSTRONG system is a rehabilitation device that provides standardized strengthening protocols.

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

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)

Independent variables odds ratio measures of effect and impact based on incidence rates of hospital readmission, according to oropharyngeal dysphagia status (n=2,359)

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

23.5% of Medicare beneficiaries discharged to a skilled nursing facility are readmitted within 30 days.7

The incidence of pneumonia in skilled nursing facilities is up to 48%.8

Mean cost for an aspiration pneumonia episode of care is $17,000.9

Overall mortality rate ranges from 20% to 50% with rates as high as 80% reported. 5

Compensating for dysphagia with modified diets is costly

Providing thickened liquids is a common strategy to minimize aspiration in individuals with dysphagia.

The cost of thickened liquids ranges from $0.30 to $1.41 per serving.10

The total monthly cost for thickened liquids ranges from $174 to $289 per individual.*

Nectar Honey

Water Milk Orange Juice Water Milk Orange Juice

Total $0.54 $1.34 $0.86 $0.75 $1.41 $0.83

Nectar Honey

Water Milk Orange Juice Water Milk Orange Juice

4 oz $0.30 $0.36 $0.31 $0.36

8 oz $0.61 $0.66

Cost of Commercially Prepared Products

Total Cost to Prepare Thickened Liquid

* Based upon a 74 oz. daily intake with 32% water, 32% milk, 19% juice, and 16% coffee, with nectar-thick, commercially-prepared liquids for lower extreme and honey-thick, facility-prepared liquids for higher extreme.

Dysphagia rehabilitation therapy requires skilled direction and oversight by a speech language pathologist, which is reimbursed by most payer sources including Medicare.

CPT 92526, treatment of swallowing dysfunction and/or oral function for feeding.

CPT 92610, evaluation of oral and pharyngeal swallowing function.

In some cases payers reimburse separately for medical devices used in dysphagia treatment.

Improved quality of life11

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

Session Type Incidence Rate: CPTa

Evaluation 1 Time per Patient 92610

Treatment 3 Times per Weekb 92526

a: Billing codes shown for example purposes only. Facility must confirm reimbursement coverage with specific payer(s).

b: Typical therapy lasts 8-12 weeks.

Lingual strengthening improves the ability to swallow and decreases aspiration.11

Decreased frequency of airway invasion.

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 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

SensorTeeth

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.12

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.13

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 SwallowSTRONG device or the 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 therapy 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 Study14

Device Helps Patient Regain Ability to Swallow After Two Years on Feeding TubeJB, 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 improving 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 CM, Cichero JA. 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. Mor V, Intrator O, Feng Z, Grabowski D. The revolving door of rehospitalization from skilled nursing facilities. Health Aff (Millwood). 2010; 29(1):57–64.

8. Loeb M, McGeer A, McArther M, Walter S, Simor AE. Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities. Arch Intern Med. 1999;159:2058-2064.

9. Chichero JA, Altman KW. Definition, prevalence and burden of oropharyngeal dysphagia: a serious problem among older adults worldwide and the impact on prognosis and hospital resources. Nestle Nutr Inst Workshop Ser. 2012;72:1-11.

10. Kotecki S, Schmidt R. Cost and effectiveness analysis using nursing staff-prepared thickened liquids vs. commercially thickened liquids in stroke patients with dysphagia. Nurs Econ. 2010;28(2):106-9, 113.

11. 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.

12. 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.

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

14. 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.