When it comes to dysphagia therapy, lingual strengthening has become a hot topic—especially with the growing body of research supporting its use. If you’ve followed the work of Dr. Carolyn Baylor, Dr. JoAnne Robbins, or Dr. Susan Langmore, you already know how much attention the tongue has received in the literature—and for good reason.

Let’s break it down.

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Why the Tongue Matters

The tongue is often referred to as the driving force in the swallow. It’s responsible for bolus manipulation, propulsion, and initiation of the swallow. Weakness in the tongue can lead to decreased control, reduced pressure generation, and ultimately, impaired swallow function.

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The Research Behind Tongue Strengthening

Several studies led by researchers such as Dr. Robbins and Dr. Lazarus have shown that resistance-based lingual strengthening can:

• Improve tongue strength and in some cases, tongue mass
• Enhance the efficiency and safety of the swallow
• Reduce penetration and aspiration scores

In one of Dr. Robbins’ studies, participants completed 8 weeks of lingual resistance training using the Iowa Oral Performance Instrument (IOPI). Results included increased tongue pressure, increased tongue mass (via MRI), and better Penetration-Aspiration Scale scores (Robbins et al., 2005).

And here’s the kicker: a tongue depressor can be just as effective as an IOPI device when used correctly (Lazarus et al., 2003). Cost-effective and evidence-based? Yes, please.

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What Is Lingual Exercise, Exactly?

We’re not talking about sticking your tongue out 10 times and calling it therapy.

Lingual strengthening often involves isometric exercises, where the tongue pushes against resistance (like a bulb, depressor, or device) and holds that contraction. According to exercise science, the sweet spot for gains is:

10 repetitions, 3 times/day, 3 days/week for 8 weeks.

Why resistance? Because movement alone won’t build strength—just like curling your arms with no weights won’t build biceps. Resistance is where the magic happens.

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A Case Study Worth Noting

In a case study by Juan et al. (2013), a 56-year-old female, 27 months post-CVA, went from NPO with expectoration of saliva to a full, unrestricted oral diet after a structured lingual strengthening program using isometric progressive resistance (I-PRO) therapy.

Key findings:

• Increased lingual strength
• Improved UES and pharyngeal pressures
• Improved VFSS outcomes
• Improved quality of life (SWAL-QOL)

This study highlighted not only the gains during therapy but also the loss of progress during detraining and how strength returned with a lower-frequency maintenance program.

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Let’s Talk Devices

IOPI
A computerized tool with a tongue bulb and visual feedback. It provides real-time data on effort exerted and tracks progress over time. Excellent for measurable outcomes and setting patient-specific goals.

Tongue Press
A simple, non-digital alternative created by the same folks behind TheraSip. It uses water levels in clear plastic tubes to provide visual feedback—no bells or whistles, but for $20, it’s a budget-friendly option that gets the job done.

Tongue Depressors
Yep, good old-fashioned wooden sticks. They’re backed by research and easily accessible—ideal for clinics without big budgets.

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Takeaway

Lingual strengthening is a powerful, evidence-based tool in our dysphagia therapy toolbox. Whether you’re working with high-tech gadgets or budget-friendly alternatives, what matters most is using evidence-based protocols and staying consistent.

The evidence is clear: when we make exercise count, we can help our patients move from NPO to oral intake, from aspiration to safety, and from frustration to improved quality of life.

Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation?   Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care?  You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes.   You can get your copy here.  

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References

• Lazarus, C., Logemann, J.A., Huang, C.F., & Rademaker, A.W. (2003). Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatrica et Logopaedica, 55, 199–205.
• Robbins, J.A., Gangnon, R.F., Theis, S.M., Kays, S.A., Hewitt, A.L., & Hind, J.A. (2005). The effects of lingual exercise on swallowing in older adults. Journal of the American Geriatrics Society, 53(9), 1483–1489.
• Robbins, J.A. (2003). Oral strengthening and swallowing outcomes. Perspectives on Swallowing and Swallowing Disorders, 12(1), 16–19.
• Juan, J., Hind, J., Jones, C., McCulloch, T., Gangnon, R., & Robbins, J. (2013). Application of Isometric Progressive Resistance Oropharyngeal Therapy Using the Madison Oral Strengthening Therapeutic Device: A Case Study. Topics in Stroke Rehabilitation, 20(5), 450–470.