Impact of Lingual Endurance Exercise on Rehabilitation of Swallowing Impairments after lschemic Stroke

Project Summary/Abstract This career development award will be essential to Dr. Brittany Krekeler’s success as a clinical-trialist in swallowing rehabilitation research. The mission of Dr. Krekeler’s research is to create and deliver novel, efficacious rehabilitation approaches for individuals with dysphagia after stroke. To achieve this career goal, Dr. Krekeler must be able to design and execute large, multi-site clinical trials. This career development plan was created to provide the training necessary elevate her to this level. Her mentor team includes several NIH funded stroke and dysphagia clinical trials experts (Drs. Broderick, Vagal, Sucharew, Rogus-Pulia). Under their guidance, Dr. Krekeler will complete the outlined career development plan to receive the specific training necessary to succeed. This training plan and clinical trial perfectly build on her existing skill set in translational and clinical research. Her trajectory from K01 pilot to R01 trial is strong. Her primary mentor, Dr. Broderick, directs NIH StrokeNet and is heavily involved in the many on-going, multi-site stroke recovery trials at University of Cincinnati and has enthusiastically welcomed Dr. Krekeler into this research consortium. The opportunities to engage in on-going stroke recovery trials at this institution are unparalleled. These specific engagements, outlined in the training plan, will be supplemented by formal coursework in clinical trials and neuroscience. In addition to the excellent mentorship, research environment, and training opportunities outlined in this award, Dr. Krekeler will also collect essential primary data regarding clinical efficacy of lingual endurance exercise to inform the next phase of study. This pilot trial will evaluate the effect of lingual endurance exercise (vs sham exercise) on recovery of swallow function after stroke. The Primary Aim of this study is to evaluate the effect of lingual endurance exercise vs sham on swallow function in individuals with post-stroke dysphagia. We hypothesize that lingual endurance training will result in greater improvement in measures of oral swallow physiology as compared to sham. The Exploratory Aim of this work will allow for Dr. Krekeler to gain experience in MRI sequencing and analysis and will collect preliminary data regarding changes in white matter tract diffusion and cortical thickness in endurance vs sham exercise. We hypothesize that lingual endurance exercise will be associated with improved integrity of white matter diffusion and increased cortical thickness in the primary motor cortex and as compared to sham. Regardless of outcome, this dataset will provide innovative and highly novel information regarding the relationship between lingual function, swallowing impairments, and cortical representation of dysphagia in a post-stroke population. These pilot data will be essential in providing sufficient power for designing an R01 Phase II intervention trial to investigate how to maximize gains with timing and intensity of therapy delivery to better recover swallow function after stroke.