Tongue-strengthening Exercises in People With ALS.

Study Description Brief Summary: This study is designed to evaluate the effects of isometric lingual strengthening exercises on speech and swallowing function in individuals with Amyotrophic Lateral Sclerosis (ALS). By targeting tongue strength, we aim to improve pressure generation, support safer and more efficient swallowing, enhance speech intelligibility, and examine the relationship between lingual strength and patient-reported outcomes. Detailed Description: Amyotrophic Lateral Sclerosis (ALS) often results in progressive weakness of the tongue and other oral structures, which contributes to impaired speech intelligibility, swallowing safety, and overall quality of life. Lingual strengthening exercises may offer a non-invasive, behavioral intervention to preserve oral function in this population. However, the efficacy and broader impact of such exercises remain underexplored. The aims of this study are to: Evaluate the efficacy of isometric lingual strength exercises in improving tongue pressure generation in people with ALS (pALS). Investigate the impact of lingual strengthening exercises on speech intelligibility, swallowing safety, and swallowing efficiency. Assess the relationship between lingual strength, speech intelligibility, swallowing function, and patient-reported outcomes related to motor speech, swallowing-related quality of life, and fatigue. Methods and Study Design: This study uses a delayed-start, repeated-measures design in which participants serve as their own controls. This approach allows all participants to receive the intervention while also accounting for disease heterogeneity and interparticipant variability. Participants will complete two baseline assessments (in-person at Week 0, virtual at Week 5), a 5-week intervention phase (Weeks 5-10), and a final in-person evaluation at Week 10. A follow-up strength assessment will occur at the participant's next scheduled multidisciplinary ALS Clinic visit (\~6 months). Study Procedures and Timeline: Screening / Baseline 1 (Week 0, in-person, 60-90 min): Informed consent and eligibility screening. Assessments: Maximum isometric lingual pressure (Tongueometer), 3D tongue ultrasound, Bamboo Passage (speech rate), oral diadochokinesis (temporal variability), 3-ounce water test (swallowing safety), TOMASS (oral efficiency), videofluoroscopic swallow study (VFSS), and patient-reported measures (Eat-10, ALSFRS-R, ETBQ). Baseline 2 (Week 5, virtual, 60-90 min): Repeat assessments from Baseline 1, excluding VFSS and ultrasound. Introduction of isometric lingual strength training; first training session completed during this visit. Telehealth Training Sessions (Weeks 5-10, weekly, 30-60 min each): Conducted via Zoom. Tongue resistance training, Bamboo Passage, diadochokinesis, 3-ounce water test. Patient-reported measures (ALSFRS-R, ETBQ, Eat-10). Research clinician monitors fidelity, provides progression adjustments, and records data. Active Exercise Training Regimen: Frequency: 5 sessions per week for 5 weeks. Intensity: 60% of each participant's maximum anterior lingual pressure (MAIP). Volume: 6 sets of 5 repetitions/day (30 repetitions/day; 150 repetitions/week). Contraction: 2-second hold for each isometric press. Progression: Training thresholds updated weekly to maintain 60% MAIP. Final Evaluation (Week 10, in-person): Assessments identical to Baseline 2 with inclusion of VFSS, ultrasound, and ETBQ. Follow-up (6 months, routine ALS clinic visit): Isometric lingual strength assessment repeated using the Tongueometer. Exploratory Outcome: Ultrasound imaging will be completed at baseline and final evaluations to quantify morphologic changes in tongue structure related to exercise.