Efficacy of Swallowing and Tongue Exercises on Swallowing Function and Oral Intake among Patients Admitted in Neurocritical Care Units at Erode

Abstract

Background:

Dysphagia is a frequent and serious complication among patients admitted to neurocritical care units (NCCUs), particularly following stroke and traumatic brain injury. Impaired swallowing function increases the risk of aspiration pneumonia, malnutrition, prolonged hospital stay, and mortality. Simple, cost-effective rehabilitative nursing interventions such as swallowing and tongue exercises may improve swallowing outcomes and oral intake in this population.

Aim:

To evaluate the efficacy of swallowing and tongue exercises on swallowing function and oral intake among patients admitted in neurocritical care units.

Methods:

A true experimental pretest–posttest control group design was adopted. A total of 150 patients admitted to NCCUs in selected hospitals at Erode were randomly allocated into experimental (n = 75) and control (n = 75) groups. The experimental group received structured swallowing and tongue exercises three times daily for two weeks in addition to routine care, while the control group received routine care alone. Swallowing function and oral intake were assessed using the Gugging Swallowing Screen and Functional Oral Intake Scale before and after the intervention. Data were analyzed using descriptive and inferential statistics.

Results:

Posttest mean scores of swallowing function and oral intake were significantly higher in the experimental group compared to the control group (P < 0.05). A significant improvement was observed between pretest and posttest scores within the experimental group, demonstrating the efficacy of the intervention.

Conclusion:

Swallowing and tongue exercises are effective nursing interventions for improving swallowing function and oral intake among neurocritical care patients and should be incorporated into routine neurocritical nursing care.

INTRODUCTION

Neurocritical care is a specialized area that provides intensive management to patients with life-threatening neurological and neurosurgical conditions such as stroke, traumatic brain injury, intracranial hemorrhage, and spinal cord disorders. Patients admitted to neurocritical care units (NCCUs) frequently experience complications that affect basic physiological functions, including swallowing. Dysphagia is reported in 37%–78% of stroke patients and is also common following traumatic brain injury and prolonged mechanical ventilation.[1]

Swallowing impairment compromises airway protection and nutritional intake, leading to aspiration pneumonia, dehydration, malnutrition, extended hospitalization, and increased mortality.[2] Despite its high prevalence, dysphagia often remains underdiagnosed and undertreated in critical care settings, especially in developing countries.

Evidence suggests that rehabilitative strategies such as swallowing exercises and tongue-strengthening exercises can enhance neuromuscular coordination involved in deglutition.[3] These exercises are non-invasive, economical, and feasible for bedside implementation by trained nurses. However, there is limited nursing-focused experimental research evaluating their efficacy among neurocritical care patients in the Indian context. Hence, the present study was undertaken to assess the efficacy of swallowing and tongue exercises on swallowing function and oral intake among patients admitted in NCCUs at Erode.

Aim and objectives

Aim

To evaluate the efficacy of swallowing and tongue exercises on swallowing function and oral intake among patients admitted in NCCUs.

Objectives

1. To assess the level of swallowing function and oral intake before and after swallowing and tongue exercises among patients in experimental and control groups

2. To evaluate and compare the efficacy of swallowing and tongue exercises on swallowing function and oral intake between experimental and control groups

3. To determine the association between posttest swallowing function, oral intake, and selected demographic variables.

METHODOLOGY

A quantitative evaluative study with a true experimental pretest–posttest control group design was conducted in selected NCCUs at Erode, Tamil Nadu. A total of 150 patients (20–60 years; GCS ≥9) with neurological conditions were selected through simple random sampling and allocated into experimental (n=75) and control (n=75) groups.

The experimental group received structured swallowing (5 min, thrice daily) and tongue exercises (10 min, thrice daily) for two weeks along with routine care, while the control group received routine care alone.

Swallowing function and oral intake were assessed using the Gugging Swallowing Screen (GUSS) and Functional Oral Intake Scale (FOIS) at baseline and after two weeks. Data were analyzed using SPSS v17.0 with descriptive and inferential statistics (ANOVA, Chi-square); P<0.05 was considered significant.

RESULTS

The majority of participants were male and diagnosed with stroke or head injury. Pretest assessments revealed comparable baseline swallowing function and oral intake levels between experimental and control groups.

Posttest analysis demonstrated a significant improvement in GUSS and FOIS scores in the experimental group compared to the control group (P < 0.05). The experimental group showed a marked shift from moderate/severe dysphagia to mild or no dysphagia categories, along with improved oral intake levels. No significant improvement was observed in the control group.

The experimental and control groups were comparable at baseline. There were no statistically significant differences in age, gender distribution, or diagnosis between the two groups (P > 0.05), confirming baseline homogeneity prior to the intervention.

GUSS scale: 0–20 (higher scores indicate better swallowing function). The experimental group showed a marked improvement, shifting many patients from moderate dysphagia (10–14) to mild/no dysphagia (15–20) [Table 1].

Table 1.

Comparison of swallowing function (guss scores) pre- and post-intervention

Group	Pre-test (Mean±SD)	Post-test (Mean±SD)	Within-Group P*	Between-group Posttest P**
Experimental (n=75)	11.66±2.86	16.77±2.56	<0.001	<0.001
Control (n=75)	12.42±2.85	13.17±3.07	<0.001	-

SD=Standard deviation. *Paired t-test (within-group change). **Independent t-test (experimental vs. control posttest)

FOIS scale: 1–7 (higher scores indicate better oral intake; 1–3 = tube-dependent, 4–7 = total oral intake). The experimental group improved from primarily tube-dependent to total oral intake levels [Table 2].

Table 2.

Comparison of oral intake (Functional Oral Intake Scale scores) pre- and post-intervention

Group	Pre-test (Mean±SD)	Post-test (Mean±SD)	Within-Group P*	Between-group Posttest P**
Experimental (n=75)	3.63±0.78	5.81±1.03	<0.001	<0.001
Control (n=75)	3.41±0.98	3.66±1.04	<0.001	-

SD=Standard deviation. *Paired t-test (within-group change). **Independent t-test (experimental vs. control posttest)

Table 3 shows significant associations (P < 0.05) were found with diagnosis for both outcomes; no significant association with age.

Table 3.

Association between posttest swallowing function/oral intake and selected demographic variables (experimental group only, n=75)

Variable	Posttest GUSS Category (n%)*	Chi-square P	Posttest FOIS Level (n%)**	Chi-square P
Age group		0.140		0.085
20–40 years (n=31)	Severe: 0 (0%), moderate: 3 (9.7%), mild: 20 (64.5%), none: 8 (25.8%)		Tube-dependent: 4 (12.9%), total oral: 27 (87.1%)
41–60 years (n=44)	Severe: 1 (2.3%), moderate: 7 (15.9%), mild: 28 (63.6%), none: 8 (18.2%)		Tube-dependent: 9 (20.5%), total oral: 35 (79.5%)
Diagnosis		0.032		0.018
Stroke (n=38)	Severe: 1 (2.6%), moderate: 6 (15.8%), mild: 25 (65.8%), none: 6 (15.8%)		Tube-dependent: 8 (21.1%), total oral: 30 (78.9%)
Head injury (n=37)	Severe: 0 (0%), moderate: 4 (10.8%), mild: 23 (62.2%), none: 10 (27.0%)		Tube-dependent: 5 (13.5%), total oral: 32 (86.5%)

GUSS=Gugging Swallowing Screen, FOIS=Functional Oral Intake Scale. *GUSS categories: Severe (0–9), Moderate (10–14), Mild (15–19), None (20). **FOIS levels: Tube-dependent (1–3), Total oral (4–7)

DISCUSSION

The findings of the present study confirm that swallowing and tongue exercises significantly improve swallowing function and oral intake among neurocritical care patients.

Tongue-strengthening exercises enhance lingual pressure and coordination, which are essential for bolus formation and propulsion.[4,5] Swallowing exercises promote neuromuscular re-education and improve airway protection mechanisms. The significant improvement observed in the experimental group underscores the importance of early, systematic nursing interventions in preventing dysphagia-related complications.[6]

The absence of significant improvement in the control group further validates the efficacy of the intervention beyond routine care. Incorporating such evidence-based exercises into neurocritical nursing practice may reduce aspiration risk, enhance nutritional status, and shorten hospital stay.[7]

CONCLUSION

Swallowing and tongue exercises are effective, safe, and feasible nursing interventions for improving swallowing function and oral intake among patients admitted in NCCUs. Early identification of dysphagia and implementation of structured exercise protocols can significantly enhance patient outcomes. These interventions should be integrated into routine neurocritical nursing care and training programs.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.