Tongue-strengthening Exercises in People With ALS.

Maximum Anterior Isometric Lingual Pressure Measured Using the TongueMeter Device

Measurement Tool: Lingual pressure is measured using the TongueMeter, a handheld, pressure-sensing device designed to quantify tongue strength during isometric tasks. A calibrated intraoral pressure sensor is positioned against the hard palate. Participants are instructed to press the tongue upward with maximal effort for a standardized duration, and the device records the resulting pressure output. Unit of Measure: Lingual strength is quantified as peak pressure, reported in kilopascals (kPa). Outcome Variable: The primary outcome is the maximum peak lingual pressure (kPa) achieved across trials, with higher values indicating greater lingual strength

Videofluoroscopic Swallow Study

This measure assesses swallowing safety and efficiency in participants using standardized VFSS trials. Safety is quantified using the Penetration-Aspiration Scale (PAS) to capture airway compromise, while swallowing efficiency is measured with the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST), which integrates residue severity and functional impact. Unit of Measure: PAS score for each swallow (ordinal 1-8) DIGEST grade for overall swallowing function (ordinal 0-4) Outcome Variable: The primary outcome is the frequency and severity of airway compromise (PAS) and overall dysphagia severity (DIGEST) during VFSS. Higher PAS and DIGEST scores indicate worse swallowing safety and efficiency.

EAT-10

The Eating Assessment Tool-10 (EAT-10) is a self-administered questionnaire used to screen for swallowing difficulties (dysphagia). It consists of 10 items that ask patients to rate symptoms such as effort during swallowing, coughing, and the impact of swallowing problems on quality of life. Each item is scored from 0 (no problem) to 4 (severe problem), with a total score of 3 or higher indicating possible dysphagia. It is quick, reliable, and widely used in both clinical and research settings.

Test of Mastication and Swallowing Solids

The Test of Masticating and Swallowing Solids (TOMASS) is a clinical assessment tool used to evaluate solid food swallowing efficiency. During the test, a patient is asked to eat a standardized cracker as quickly and safely as possible while the clinician records the number of bites, chews, swallows, and the total time taken. These measures provide insight into the efficiency and safety of oral intake. TOMASS is simple, non-invasive, and useful for identifying swallowing difficulties in both clinical practice and research.

ALS Functional Rating Scale

The ALS Functional Rating Scale (ALSFRS) is a standardized tool used to measure the functional status of individuals with amyotrophic lateral sclerosis (ALS). It assesses daily activities across key domains such as speech, swallowing, mobility, and respiratory function. Each item is scored from 0 (unable) to 4 (normal ability), with higher total scores indicating better functional status. The ALSFRS is widely used in both clinical care and research to track disease progression and treatment outcomes.

The Eating Tool Burden Questionnaire

The Eating Tool Burden Questionnaire (ETBQ) is a patient-reported outcome measure designed to evaluate the burden of eating and swallowing difficulties. It captures the physical, emotional, and social challenges patients experience during mealtimes. Responses are scored to reflect the severity of perceived burden, with higher scores indicating greater impact on daily life. The ETBQ is useful for understanding patient perspectives, guiding clinical care, and measuring changes over time in both practice and research.