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PresbyphagiaPhase 3NCT07080996

Effect of Biofeedback Tongue Strengthening Program on Tongue Pressure and Swallowing Performance

A Phase 3 study testing Strengthening training with biofeedback and Endurance training with biofeedback in people with Presbyphagia and Abnormal Tongue Pressure, run by Mahidol University at 1 site in Thailand.

Enrolling by invitation

Enrolling by invitation. The study team selects and invites participants, usually from an existing group of patients.

Sites and contacts
Official record
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Trial summary

Aging is often accompanied by a decline in bodily functions, including the swallowing process. Tongue-strengthening exercises have been shown to improve tongue strength and thickness in healthy adults and the elderly, thereby supporting swallowing function. Read more about this study

Who is it for?
Ages 60 years and olderHealthy volunteers can take part
Conditions the study is for
Presbyphagia, Abnormal Tongue Pressure
What is being tested?
Strengthening training with biofeedback and Endurance training with biofeedback
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
52 participants
Where
1 siteThailand
Study dates
25 Mar 2025to 24 Mar 2026
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 60 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Aged 60 years or older.
  • No cognitive impairment, as screened by the Mini-Mental State Examination (MMSE) with a score of 24 or higher.
  • Elderly with abnormal tongue pressure have an anterior maximum isometric tongue pressure (MIP) average of less than 30 kilopascals.

Who cannot join

  • Diagnosed with head and neck cancers, a neurological disorder, or other conditions that affect the tongue muscle strength and training.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Thailand1 site
  • Faculty of Physical Therapy, Mahidol University

    Salaya, Changwat Nakhon Pathom, 73170

Other trials in Thailand

About this study

Official title: Effect of Biofeedback Tongue Strengthening Program on Tongue Pressure and Swallowing Performance in Elderly With Abnormal Tongue Pressure

Aging is often accompanied by a decline in bodily functions, including the swallowing process. Tongue-strengthening exercises have been shown to improve tongue strength and thickness in healthy adults and the elderly, thereby supporting swallowing function. Consistent exercise is key to preventing muscle weakness and preserving their ability to swallow. However, there is limited research on the effects of tongue-strengthening exercises that explores varying intensities and repetitions in elderly with impaired tongue pressure. Consequently, the objective of this study is to investigate the effect of biofeedback tongue strengthening program on tongue pressure and swallowing performance in elderly with abnormal tongue pressure. The results will serve as valuable data for selecting effective interventions to improve tongue strength and swallowing.

Read the detailed description

Sample size calculation: A sample size of 52 participants was determined for this study, accounting for a 20% dropout rate. The calculation was performed using G*Power software (version 3.1.7), based on an effect size of 0.87. This value was derived from a previous study by Van den Steen et al. (21), which measured the difference in mean tongue pressure strength between training and control groups. With an effect size of 0.87, considered a large effect, a minimum of 44 participants was required to achieve 80% statistical power at a significance level of 0.05. Statistical analysis: IBM SPSS Statistics will be used for all data analysis. A chi-squared test and Mann-Whitney U test will be performed to compare the baseline characteristics of participants between the two groups. A two-way ANOVA will be used to analyze differences between the two groups (strengthening training and endurance training) across the three time points (Baseline, Post-test after one day, and Post-test after one month). Subsequently, a Wilcoxon signed-rank test will be used to identify significant changes within each group at each time point.

Being tested
Strengthening training with biofeedback, Endurance training with biofeedback
Keywords
Elderly, Presbyphagia, Dysphagia, Tongue Pressure, Biofeedback
Medical subject headings
Deglutition Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Strengthening training with biofeedbackCombination product

    Participants in this group trained their tongue strength with the Iowa Oral Performance Instrument (IOPI), completing 3 sets of 10 repetitions at 80% of their maximum.

  • Endurance training with biofeedbackCombination product

    Participants in this group trained their tongue endurance with the Iowa Oral Performance Instrument (IOPI), completing 3 sets of 20 repetitions at 60% of their maximum.

Study groups in NCT07080996
Study groupRoleWhat they receive
Strengthening training groupExperimentalParticipants trained their tongue strength three times a week for four weeks.
Receives: Combination Product: Strengthening training with biofeedback
Endurance training groupActive comparatorParticipants trained their tongue endurance three times a week for four weeks.
Receives: Combination Product: Endurance training with biofeedback

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Tongue pressure

    The Iowa Oral Performance Instrument (IOPI Medical LCC, Redmond, WA USA) was used to measure maximum anterior and posterior tongue pressure, as well as tongue pressure during swallowing.

    Measured: Baseline, Post-test after one day of training, Post-test after one month of training

  2. Eating Assessment Tool-10 (EAT-10) score

    The EAT-10 is used to assess swallowing difficulties. The 10 items are scored from 0 to 4, with higher scores indicating more severe dysphagia.

    Measured: Baseline, Post-test after one day of training, Post-test after one month of training

  3. Functional Oral Intake Scale (FOIS)

    The FOIS is a 7-point ordinal scale describing the functional level of oral intake of food and liquids.

    Measured: Baseline, Post-test after one day of training, Post-test after one month of training

  4. Mann Assessment of Swallowing Ability (MASA) score

    The MASA is a standardized clinical swallowing examination, specifically developed as a diagnostic test for the presence of oropharyngeal dysphagia. The total score of the MASA is 200 points and the cutoff value is 177 points. The results of the MASA are interpreted as no abnormality (≥178), mild dysphagia (168-177), moderate dysphagia (139-167), and severe dysphagia (≤138).

    Measured: Baseline, Post-test after one day of training, Post-test after one month of training

  5. Water swallowing test

    The Water Swallow Test is a clinical instrument designed to assess swallowing function. A participant is seated and provided with a cup containing 150 mL of water at a standard temperature. The total time required to ingest the liquid is then recorded.

    Measured: Baseline, Post-test after one day of training, Post-test after one month of training

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Jul 2025
  2. Study start25 Mar 2025
  3. Primary completion24 Feb 2026 (estimated)
  4. Study completion24 Mar 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
All participants are randomly assigned to either the strengthening training or endurance training group using a computer.
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
52 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07080996
Sponsor's protocol ID
MU-CIRB 2025/037.2201
Status last verified
Jul 2025
First submitted
15 Jul 2025
Last updated
28 Jul 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: We will share IPD when we receive the consent from participants.

Publications

  • Nakao Y, Yamashita T, Honda K, Katsuura T, Hama Y, Nakamura Y, Ando K, Ishikura R, Kodama N, Uchiyama Y, Domen K. Association Among Age-Related Tongue Muscle Abnormality, Tongue Pressure, and Presbyphagia: A 3D MRI Study. Dysphagia. 2021 Jun;36(3):483-491. doi: 10.1007/s00455-020-10165-4. Epub 2020 Aug 2.

    PubMed 32743742
  • Hsiao HL, Lou JH, Wang CC, Lai YJ, Wu SJ, Hwu YJ. Effects of Tongue-Strengthening Exercise on Tongue Strength Reserve and Detraining Effects among Healthy Adults: A Randomized Controlled Trial. Int J Environ Res Public Health. 2022 Jun 4;19(11):6878. doi: 10.3390/ijerph19116878.

    PubMed 35682461
  • Feng HY, Zhang PP, Wang XW. Presbyphagia: Dysphagia in the elderly. World J Clin Cases. 2023 Apr 16;11(11):2363-2373. doi: 10.12998/wjcc.v11.i11.2363.

    PubMed 37123321
  • Sarve AR, Krishnamurthy R, Balasubramanium RK. The timed water test of swallowing: Reliability, validity, and normative data from Indian population. Int J Health Sci (Qassim). 2021 Mar-Apr;15(2):14-20.

    PubMed 33708040
  • Park HJ, Jung EH, Kim SM, Park SC, Jo MJ, Lee YS, Kim SH, Han SY. Assessment of oral hypofunction and its association with age among Korean community-dwelling older adults. BMC Oral Health. 2024 Apr 10;24(1):441. doi: 10.1186/s12903-024-04180-2.

    PubMed 38600517
  • Yano J, Nagami S, Yokoyama T, Nakamura K, Kobayashi M, Odan Y, Hikasa M, Hanayama K, Fukunaga S. Effects of Tongue-Strengthening Self-Exercises in Healthy Older Adults: A Non-Randomized Controlled Trial. Dysphagia. 2021 Oct;36(5):925-935. doi: 10.1007/s00455-020-10216-w. Epub 2020 Nov 19.

    PubMed 33215265
  • Sakamoto Y, Oyama G, Umeda M, Funahara M, Soutome S, Nakamura W, Kojima Y, Iwai H. Effect of decreased tongue pressure on dysphagia and survival rate in elderly people requiring long-term care. J Dent Sci. 2022 Apr;17(2):856-862. doi: 10.1016/j.jds.2021.09.031. Epub 2021 Oct 7.

    PubMed 35756815
  • Fei T, Polacco RC, Hori SE, Molfenter SM, Peladeau-Pigeon M, Tsang C, Steele CM. Age-related differences in tongue-palate pressures for strength and swallowing tasks. Dysphagia. 2013 Dec;28(4):575-81. doi: 10.1007/s00455-013-9469-6. Epub 2013 May 16.

    PubMed 23677389
  • Matsuo K, Palmer JB. Coordination of Mastication, Swallowing and Breathing. Jpn Dent Sci Rev. 2009 May 1;45(1):31-40. doi: 10.1016/j.jdsr.2009.03.004.

    PubMed 20161022
  • Kamarunas E, Murray K, Drulia T, Szynkiewicz S, Griffin L, Mulheren R. Biofeedback and Exercise Load Affect Accuracy of Tongue Strength Exercise Performance. Dysphagia. 2025 Apr;40(2):489-500. doi: 10.1007/s00455-024-10751-w. Epub 2024 Aug 18.

    PubMed 39154305
  • Silva JO, Giglio LD, Trawitzki LVV. Effects of tongue strengthening exercises in healthy adults and elderly: an integrative literature review. Codas. 2023 Jun 5;35(3):e20210213. doi: 10.1590/2317-1782/20232021213pt. eCollection 2023.

    PubMed 37283365
  • Smaoui S, Langridge A, Steele CM. The Effect of Lingual Resistance Training Interventions on Adult Swallow Function: A Systematic Review. Dysphagia. 2020 Oct;35(5):745-761. doi: 10.1007/s00455-019-10066-1. Epub 2019 Oct 14.

    PubMed 31612288
  • Takahashi C, Iwasaki M, Motokawa K, Watanabe Y, Hayakawa M, Mikami Y, Shirobe M, Inagaki H, Edahiro A, Ohara Y, Hirano H, Shinkai S, Awata S. Factors Predicting Tongue Pressure Decline among Community-Dwelling Older Adults: The Takashimadaira Study. Int J Environ Res Public Health. 2022 Jun 26;19(13):7850. doi: 10.3390/ijerph19137850.

    PubMed 35805508
  • Yoshikawa M, Fukuoka T, Mori T, Hiraoka A, Higa C, Kuroki A, Takeda C, Maruyama M, Yoshida M, Tsuga K. Comparison of the Iowa Oral Performance Instrument and JMS tongue pressure measurement device. J Dent Sci. 2021 Jan;16(1):214-219. doi: 10.1016/j.jds.2020.06.005. Epub 2020 Jun 10.

    PubMed 33384800
  • McKenna VS, Zhang B, Haines MB, Kelchner LN. A Systematic Review of Isometric Lingual Strength-Training Programs in Adults With and Without Dysphagia. Am J Speech Lang Pathol. 2017 May 17;26(2):524-539. doi: 10.1044/2016_AJSLP-15-0051.

    PubMed 28282484

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Strengthening training with biofeedback and Endurance training with biofeedback in people with Presbyphagia and Abnormal Tongue Pressure, run by Mahidol University at 1 site in Thailand.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: enrolling by invitation, as of the sponsor's last update on 28 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Thailand. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Tongue pressure (time frame: Baseline, Post-test after one day of training, Post-test after one month of training). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07080996, which also lists 34 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Jul 2025.

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