Motor Imagery Exercise and Tongue Strength

Although motor imagery (MI) has not yet been researched in the field of swallowing
rehabilitation, the potential benefit is far reaching. Difficulty swallowing, or dysphagia,
can occur in people who have a history of stroke, head injury, neurological disease (such as
Parkinson's disease, ALS, etc.), and head/neck cancer. A person with dysphagia may have
difficulty eating everyday foods and may require an altered diet, such as tube feedings or
pureed foods. Because of this, having dysphagia is often associated with increased feelings
of isolation and depression. Speech-language pathologists work with people with dysphagia to
rehabilitate their swallow, with the goal of reducing their risk of choking and improving
their ability to eat normal foods. The use of MI as a way to augment dysphagia rehabilitation
has implications for patients who aren't safe to have any food by mouth as well as those who
fatigue easily.

This research study is a six-week treatment pilot study to determine the effect of motor
imagery for tongue strengthening exercises on measures of tongue strength and swallowing
pressure in typically aging older adults. Typically-aging older adults represent a group "at
risk" for dysphagia secondary to sarcopenia of striated musculature important to swallowing.
Participants at all study sites will be randomly selected into one of four groups: 1) placebo
(active jaw open against resistance/close against resistance/lateralize/protrusion exercises
with relaxation exercises), 2) active tongue exercises against resistance only, 3) active
tongue exercises against resistance + motor imagery of tongue exercises against resistance,
and 4) motor imagery of tongue exercises against resistance only. In some participants the
investigators will also determine cortical activation patterns differences during motor
execution and motor imagery of tongue exercises between the groups using near-infrared
spectroscopy. The results of this study will inform refinement/further development of the
mental practice protocol to use with patients with dysphagia in future studies.

The research questions are as follows:

1. Does a 6 week treatment of motor imagery tongue exercises with or without active tongue
exercise improve tongue strength in healthy older adults compared to a 6 week treatment
of placebo exercises and 6 week treatment of active tongue strengthening exercises?

2. Does a 6 week treatment of motor imagery tongue exercises with or without active tongue
exercise improve swallowing pressures in healthy older adults compared to a 6 week
treatment of placebo exercises and 6 week treatment of active tongue strengthening
exercises?

3. Does a 6 week treatment of motor imagery tongue exercises with or without active tongue
exercise alter cortical hemodynamic response patterns in healthy older adults compared
to a 6 week treatment of placebo exercises and 6 week treatment of active tongue
strengthening exercises? (JMU participants only).

The investigators hypothesize, based on previous research, that the group receiving both
active and MI treatment will make the most gains in all three measures, followed by the
active only group, then the MI only group, then the placebo group (control).

Inclusion Criteria:

- Adults aged 60-89

- < 3 on EAT-10 (Eating Assessment Tool-10) (part of health questionnaire)

- Mean of ≥2.5 on the KVIQ-10 questions (Kinesthetic and Visual Imagery Questionnaire,
short version), a screening questionnaire that assesses a person's motor imagery
abilities

- > 24 on MMSE (Mini Mental State Examination), a screening questionnaire that assesses
cognitive abilities

- Availability to complete a consecutive 6-week exercise regimen

- Access to reliable transportation to and from study site for in-person experimental
sessions

- There are certain conditions that are common to the aging study population we are
recruiting which will be acceptable: controlled hypertension and controlled diabetes
mellitus

Exclusion Criteria:

- History of diagnosed dysphagia (swallowing disorder)

- History of a seizure(s)

- Current or past problem with pain disorders involving the jaw muscles or joint of the
mandible (e.g., TMJ (temporomandibular) disorder or myofacial pain disorder) - these
are contraindicated for tongue strengthening exercises

- Presence of oral piercings/oral apparatus that may interfere with tongue exercises

- Medical conditions that would affect oral motor performance (e.g., history of acute or
degenerative neurological condition, head/neck cancer), as determined by investigator

- History of a diagnosed dementia or other cognitive impairment

- Uncontrolled high blood pressure