PUBLICATIONS
Stratifying Risk of Nonadherence in Lingual Strengthening Dysphagia Rehabilitation
"The aim of this study was to construct an algorithm for stratifying risk of nonadherence to a lingual strengthening dysphagia treatment program."
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Surgical Outcomes in Zenker Diverticula: A Multicenter, Prospective, Longitudinal Study
This study "compared improvement in patient-reported outcomes (PROM) in persons undergoing endoscopic and open surgical management of Zenker diverticula (ZD)."
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Alterations in White Matter Microstructural Properties after Lingual Strength Exercise in Patients with Dysphagia
"This pilot study measured changes in microstructural white matter to capture alterations in neural signal processing following lingual strengthening exercise."
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Effects of Device-Facilitated Lingual Strengthening Therapy on Dysphagia Related Outcomes in Patients Post-Stroke: A Randomized Controlled Trial
"The purpose of this study was to examine efficacy of progressive lingual resistance training on lingual pressure generative capacity and swallowing outcomes for individuals with dysphagia after stroke."
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"The purpose of this study was to determine whether differences in MBSImP component scores represent differences in underlying swallowing mechanics."
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Dose in Exercise-Based Dysphagia Therapies: A Scoping Review
"This study dives into literature to bridge the unclear gap in optimal exercise does for exercise-based approaches to dysphagia research. This work is largely focused on promoting detailed consideration of dosing parameters in dysphagia exercise treatments in intervention planning and outcome reporting."
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Published September 11th, 2023
Authors: Kailey Vitale, W. Ryan Powell, Brittany N. Krekeler, Joanna Yee, and Nicole Regus-Pulia
Authors: Brittany N. Krekeler, Joanne Yee, Atsuko Kurosu, Fauzia Osman, Rodolfo Peña-Chávez, Glen Leverson, Brittany Young, Justin Sattin, Molly Knigge, Susan Thibeault, Nicole Rogus-Pulia
Published May 17th 2023
Published May 16th, 2023
Authors: Rebecca Howell, Christopher Johnson, Jacqui Allen, Mekibib Altaye, Milan Amin, Semirra Bayan, Peter Belafsky, Brian Cervenka, Brad Desilva, Gregory R. Dion, Dale Ekbom, Aaron Friedman, Mark Fritz, John Paul Giliberto, Elizabeth Guardiani, Jan Kasperbauer, Bradon Kim, Brittany N. Krekeler, Maggie Kuhn, Paul Kwak, Yue Ma, Lyndsay L. Madden, Laura Matrka, Ross Mayerhoff, Mallory McKeon, Cyrus Piraka, Clark A. Rosen, Meredith Tabangin, Shaun A. Wahab, Keith Wilson, Carter Wright, VyVy N. Young, Gregory Postma
Authors: Brittany N. Krekeler, Kate Davidson, Cagla Kantarcigil, William Pearson, Julie Blair, Bonnie Martin-Harris
Published: October 17th, 2022
Published June 8th, 2022
Authors: Brittany N. Krekeler, Jiancheng Hou, Veena A. Nair, Vivek Prabhakaran, Nicole Rusche, Nicole Rogus-Pulia, JoAnne Robbins
Lingual Exercise in Older Veterans With Dysphagia: A Pilot Investigation of Patient Adherence
"It has been established that low adherence is a key issue in dysphagia treatment and management. This article explores the relationship between levels of adherence and outcomes from exercise-based interventions that have yet to be explored."
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Published May 11th, 2021
Authors: Brittany N. Krekeler, Joanne Yee, Sarah Daggett, Glen Leverson, Nicole Rogus-Pulia
Published March 5th, 2020
Authors: Brittany N. Krekeler, Linda M. Rowe, Nadine P. Connor
Device-Assisted Therapy for Lingual Function Rehabilitation: A “How To” Guide for Clinicians
"The article includes a tutorial that aims to provide a detailed guideline for clinicians on how to apply currently available evidence for implementation of lingual rehabilitation exercises."
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Published November 22nd, 2023
Authors: Veena Kallambettu, Farah Kaval, Brittany N. Krekeler
Health Factors Associated with Development and Severity of Poststroke Dysphagia: An Epidemiological Investiagation
"The goal of this research is to investigate incidence of dysphagia after stroke in a large retrospective, population-based data set to determine what patient-specific factors may influence dysphagia status or severity of impairment"
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Published March 27th 2024
Authors: Brittany N. Krekeler, Heidi J. P. Schieve, Jane Khoury, Lili Ding, Mary Haverbusch, Kathleen Alwell, Opeolu Adeoye, Simona Ferioloi, Jason Mackey, Daniel Woo, Matthew Flaherty, Felipe De Los Rios La Rosa, Stacie Demel, Michael Star, Elisheva Colemen, Kyle Walsh, Sabreena Salvin, Adam Jasne, Eva Mistry, Dawn Kleindorfer, Brett Kissela
Cricopharyngeus muscle dysfunction: a poorly defined disorder from diagnosis to treatment
"The purpose of this paper is to review what is known about CPMD and identify areas of future research in CPMD diagnosis and treatment. In summary, CPMD is a poorly defined disease due to a lack of understanding of its pathophysiology and the lack of consensus diagnostic criteria."
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Published March 26th 2024
Authors: Brittany N. Krekeler, Rebecca J. Howell
Post Stroke Lingual Function and Swallowing Physiology
"Poststroke dysphagia is characterized by deficits in lingual function. However, correlations between lingual function and oral and pharyngeal swallowing impairments have not been well defined. The aim of this preliminary study was to explore if tongue pressure generative capacity in patients after ischemic stroke is associated with oropharyngeal swallowing impairments."
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Published April 23rd 2025
Authors: Brittany N. Krekeler, Anna Hopkins, Melissa Cooke, Meredith Tabangin, Mekibib Altaye, Shaun Wahab, Bonnie Martin-Harris
Examining Associations between Manometric Measures of Lingual Function and Swallowing Physiology using the Modified Barium Swallowing Impairment Profile
"Manometric measures of lingual function are widely used in clinical practice, premised on the assumption that lingual impairments affect oropharyngeal swallowing. This study assessed correlations between measures of lingual function and oropharyngeal swallowing impairments using the Modified Barium Swallow Impairment Profile (MBSImP)."
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Published June 4th 2025
Authors: Amna S. Mira, Meredith E. Tabangin, Mekibib Altaye, Britany N. Krekeler
Reliability of 3-D/4-D Ultrasound Contouring of Tongue Surface During Swallowing
"There are limited tools available to characterize tongue motion in a 3-D plane. The purpose of this preliminary study was to apply methodology for ultrasound imaging of the tongue to determine if lingual movement and contour can be reliably quantified during swallowing tasks."
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Published March 30th 2025
Authors: Brittany N. Krekeler, Raele Donetha Roy, Nadeem Shaheen, Steven N. Lulich, Payton Sheridan, Rodolfo E. Peña-Chavez, Nadine P. Connor, Nicole Rogus Puliga
Criterion (Concurrent) Validity and Clinical Utility of the Tongueometer Device
"The purpose of this study was to test concurrent (criterion) validity of the Tongueometer compared to the current standard reference device, the Iowa Oral Performance Instrument (IOPI)."
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Published May 9th 2024
Authors: Brittany N. Krekeler, Anna Hopkins, Meredith E. Tabangin, Mekibib Altaye, Rachel Roberts, Raneh Saadi, Bonnie Martin-Harris, Nicole Rogus-Pulia
“Response to Treatment” in Dysphagia Rehabilitation: Factors for Consideration in Clinical Practice and Future Research
"The purpose of this article is to outline some potential sources for patient nonresponse to dysphagia rehabilitation. We also aim to identify gaps in the literature that should be addressed in future research, to both further our understanding of nonresponse to dysphagia therapies and to better understand how to address nonresponse to improve patient outcomes."
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Published October 20th 2022
Authors: Brittany N. Krekeler and Nicole Rogus-Pulia
Progressive protrusive tongue exercise does not alter aging effects in retrusive tongue muscles
"The purpose of this study was to examine the impact of a progressive resistance tongue exercise regimen on the retrusive tongue musculature in the context of aging."
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Published October 21st 2021
Authors: Tiffany J. Glass, John A. Russell, Joanie E. Figueroa, Brittany N. Krekeler, Nadine P. Connor
Adherence to dysphagia treatment recommendations: a conceptual model.
"The purpose of this article is to integrate relevant factors from the literature into a comprehensive framework that describes adherence to dysphagia treatment."
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Published June 22nd 2020
Authors: Brittany N. Krekeler, Kailey Vitale, Joanne Yee, Ryan Powell, Nicole Rogus-Pulia
Effects of Tongue Exercise Frequency on Tongue Muscle Biology and Swallowing Physiology in a Rat Model
"The purpose of this study was to evaluate effects of varying tongue exercise frequency on tongue force, genioglossus muscle fiber size, composition and metabolism, and swallowing in a rat model."
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Published March 4th 2020
Authors: Brittany N. Krekeler, Jacqueline M Weycker, Nadine P. Connor
Patient Adherence to Dysphagia Recommendations: A Systematic Review
"Our purpose was to systematically review the literature to understand what is known about adherence within the field of dysphagia treatment."
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Published September 30th 2017
Authors: Brittany N. Krekeler, Courtney K. Broadfoot, Steven Johnson, Nadine P. Connor, Nicole Rogus-Pulia
Tongue exercise and ageing effects on morphological and biochemical properties of the posterior digastric and temporalis muscles in a Fischer 344 Brown Norway rat model
"This study sought to examin effects of age and tongue exercise on the posterior digastric (opener) and the temporalis (closer). We hypothesized 1) age would result in differing morphological (cross sectional area) and biochemical (myosin heavy chain isoform) components of these muscles; 2) tongue exercise would result in coactivation of these muscles inducing a decrease in age-related differences between age groups."
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Published February 8th 2018
Authors: Brittany N. Krekeler, Glen Leverson, Nadine P. Connor
Patient-Reported Dysphagia After Thyroidectomy: A Qualitative Study
"Using rigorous qualitative methodology, this study set out to characterize the effect of swallowing-related symptoms after thyroidectomy on patient quality of life and swallowing-related outcomes."
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Published April 1st 2018
Authors: Brittany N. Krekeler, Elizabeth Wendt, Cameron Macdonald, Jason Orne, David O. francis, Rebecca Sippel, Nadine P. Connor
​Differential impact of tongue exercise on intrinsic lingual muscles
"Aging is associated with muscle fiber hypotrophy and decreased percentages of rapidly contracting myosin heavy chain (MyHC) type IIb muscle fibers. Tongue exercise programs used to treat dysphagia target age-related decline in tongue muscle function, but the impact of exercise on the intrinsic tongue muscles is unknown."
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Published December 15th 2017
Authors: Miranda J. Collins, Brittany N. Krekeler, Nadine P. Connor
Age-related changes in mastication are not improved by tongue exercise in a rat model
"The purpose of this study was to 1) quantify the effects of aging on mastication, and 2) determine the effects of tongue exercise on mastication in young adult and old rats."
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Published June 3rd 2016
Authors: Brittany N. Krekeler, Nadine P. Connor
PUBLICATIONS
Krekeler BN, Hopkins A, Vollman C, Davidson K, Broderick E, Altaye M, Tabangin M, Martin-Harris B, Hutcheson KA. (2025) Preliminary Validation of Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) for characterizing Swallow Safety and Efficiency in Post-Stroke Populations. Dysphagia. Accepted
Mira AS, Hopkins AK, Tabangin ME, Altaye M, Krekeler BN. Examining Associations Between Manometric Measures of Lingual Function and Swallowing Physiology Using the Modified Barium Swallow Impairment Profile. Am J Speech Lang Pathol. 2025 Jun 4:1-9. doi: 10.1044/2025_AJSLP-24-00360. Epub ahead of print. PMID: 40466627.
Krekeler BN, Hopkins A, Cooke M, Tabangin M, Altaye M, Wahab S, Martin-Harris B. Poststroke Lingual Function and Swallowing Physiology. J Speech Lang Hear Res. 2025 May 8;68(5):2318-2338. doi: 10.1044/2025_JSLHR-24-00605. Epub 2025 Apr 23. PMID: 40268736.
Krekeler BN, Loy, RD, Shaheen, N, Lulich, S. M, Sheridan, P, Peña-Chávez, RE., ... & Rogus-Pulia, N. (2025). Reliability of 3-D/4-D Ultrasound Contouring of Tongue Surface During Swallowing. Ultrasound in Medicine & Biology.
Krekeler BN, Howell RJ. Cricopharyngeus muscle dysfunction: a poorly defined disorder from diagnosis to treatment. European Archives of Oto-Rhino-Laryngology (2024): 1-9.
Krekeler BN, Hopkins A, Tabangin ME, Altaye M, Roberts R, Saadi R, Martin-Harris B, Rogus-Pulia N. Criterion (Concurrent) Validity and Clinical Utility of the Tongueometer Device. Am J Speech Lang Pathol. 2024 Jul 3;33(4):1763-1773. doi: 10.1044/2024_AJSLP-23-00478. Epub 2024 May 9. PMID: 38723207; PMCID: PMC11253644.
Krekeler BN, Schieve HJP, Khoury J, Ding L, Haverbusch M, Alwell K, Adeoye O, Ferioloi S, Mackey J, Woo D, Flaherty M, De Los Rios La Rosa F, Demel S, Star M, Coleman E, Walsh K, Slavin S, Jasne A, Mistry E, Kleindorfer D, Kissela B. Health factors associated with development and severity of post-stroke dysphagia: an epidemiological investigation. medRxiv [Preprint]. 2023 Aug 31:2023.08.29.23294807. doi: 10.1101/2023.08.29.23294807. Update in: J Am Heart Assoc. 2024 Apr 2;13(7):e033922. doi: 10.1161/JAHA.123.033922. PMID: 37693442; PMCID: PMC10491359.
Kallambettu, V., Kaval, F., Krekeler, BN. (2023) Device assisted therapy for lingual function rehabilitation: a “how to” guide for clinicians. Perspectives of the ASHA Special Interest Groups, (2013): 1-15.
Vitale K, Powell WR, Krekeler BN, Yee J, Rogus-Pulia N. Stratifying Risk of Nonadherence in Lingual Strengthening Dysphagia Rehabilitation. Am J Speech Lang Pathol. 2023 Sep 11;32(5):2111-2127. doi: 10.1044/2023_AJSLP-22-00338. Epub 2023 Aug 11. PMID: 37566883; PMCID: PMC10569446.
Howell R, Johnson C, Allen J, Altaye M, ... Krekeler BN, ... Postma G; Prospective OUtcomes of Cricopharyngeal Hypertonicity (POUCH) Collaborative. Surgical Outcomes in Zenker Diverticula: A Multicenter, Prospective, Longitudinal Study. Laryngoscope. 2024 Jan;134(1):97-102. doi: 10.1002/lary.30753. Epub 2023 May 16. PMID: 37191092.
Krekeler BN, Yee J, Kurosu A, Osman F, Peña-Chávez R, Leverson G, Young B, Sattin J, Knigge M, Thibeault S, Rogus-Pulia N. Effects of Device-Facilitated Lingual Strengthening Therapy on Dysphagia Related Outcomes in Patients Post-Stroke: A Randomized Controlled Trial. Dysphagia. 2023 Dec;38(6):1551-1567. doi: 10.1007/s00455-023-10583-0. Epub 2023 May 17. PMID: 37195518; PMCID: PMC10615659.
Krekeler, BN, Rogus-Pulia, NP. “Response to Treatment” in Dysphagia Rehabilitation – Factors for Consideration in Clinical Practice and Future Research, Perspectives of the ASHA Special Interest Groups, (2022): 1-6.
​Krekeler BN, Davidson K, Kantarcigil C, Pearson W, Blair J, Martin-Harris B. Determining Swallowing Biomechanics Underlying Modified Barium Swallow Impairment Profile Scoring Using Computational Analysis of Swallowing Mechanics. J Speech Lang Hear Res. 2022 Oct 17;65(10):3798-3808. doi: 10.1044/2022_JSLHR-22-00047. Epub 2022 Sep 8. PMID: 36075206; PMCID: PMC9927620.
Krekeler BN, Hou J, Nair VA, Prabhakaran V, Rusche N, Rogus-Pulia N, Robbins J. Alterations in white matter microstructural properties after lingual strength exercise in patients with dysphagia. Neuroreport. 2022 Jun 8;33(9):392-398. doi: 10.1097/WNR.0000000000001796. Epub 2022 May 11. PMID: 35594433; PMCID: PMC9141426.
Glass TJ, Figueroa JE, Russell JA, Krekeler BN, Connor NP. Progressive Protrusive Tongue Exercise Does Not Alter Aging Effects in Retrusive Tongue Muscles. Front Physiol. 2021 Oct 21;12:740876. doi: 10.3389/fphys.2021.740876. PMID: 34744782; PMCID: PMC8567011.
Krekeler BN, Yee J, Daggett S, Leverson G, Rogus-Pulia N. Lingual Exercise in Older Veterans With Dysphagia: A Pilot Investigation of Patient Adherence. J Speech Lang Hear Res. 2021 May 11;64(5):1526-1538. doi: 10.1044/2021_JSLHR-20-00461. Epub 2021 Apr 12. PubMed PMID: 33844587; PubMed Central PMCID: PMC8608159.
Krekeler BN, Rowe LM, Connor NP. Dose in Exercise-Based Dysphagia Therapies: A Scoping Review. Dysphagia. 2021 Feb;36(1):1-32. doi: 10.1007/s00455-020-10104-3. Epub 2020 Mar 5. Review. PubMed PMID: 32140905; PubMed Central PMCID: PMC7483259.
Krekeler BN, Weycker JM, Connor NP. Effects of Tongue Exercise Frequency on Tongue Muscle Biology and Swallowing Physiology in a Rat Model. Dysphagia. 2020 Dec;35(6):918-934. doi: 10.1007/s00455-020-10105-2. Epub 2020 Mar 4. PubMed PMID: 32130514; PubMed Central PMCID: PMC7483947.
Krekeler BN, Vitale K, Yee J, Powell R, Rogus-Pulia N. Adherence to Dysphagia Treatment Recommendations: A Conceptual Model. J Speech Lang Hear Res. 2020 Jun 22;63(6):1641-1657. doi: 10.1044/2020_JSLHR-19-00270. Epub 2020 May 20. PubMed PMID: 32432958; PubMed Central PMCID: PMC7839030.
Krekeler BN, Leverson G, Connor NP. Tongue exercise and ageing effects on morphological and biochemical properties of the posterior digastric and temporalis muscles in a Fischer 344 Brown Norway rat model. Arch Oral Biol. 2018 May;89:37-43. doi: 10.1016/j.archoralbio.2018.02.002. Epub 2018 Feb 8. PMID: 29438907; PMCID: PMC5869113.
Krekeler BN, Wendt E, Macdonald C, Orne J, Francis DO, Sippel R, Connor NP. Patient-Reported Dysphagia After Thyroidectomy: A Qualitative Study. JAMA Otolaryngol Head Neck Surg. 2018 Apr 1;144(4):342-348. doi: 10.1001/jamaoto.2017.3378. PubMed PMID: 29522149; PubMed Central PMCID: PMC5876907.
Krekeler BN, Broadfoot CK, Johnson S, Connor NP, Rogus-Pulia N. Patient Adherence to Dysphagia Recommendations: A Systematic Review. Dysphagia. 2018 Apr;33(2):173-184. doi: 10.1007/s00455-017-9852-9. Epub 2017 Sep 30. PubMed PMID: 28965240; PubMed Central PMCID: PMC5866734.
Cullins MJ, Krekeler BN, Connor NP. Differential impact of tongue exercise on intrinsic lingual muscles. Laryngoscope. 2018 Oct;128(10):2245-2251. doi: 10.1002/lary.27044. Epub 2017 Dec 15. PMID: 29243257; PMCID: PMC6003827.
Krekeler BN, Connor NP. Age-related changes in mastication are not improved by tongue exercise in a rat model. Laryngoscope. 2017 Jan;127(1):E29-E34. doi: 10.1002/lary.26045. Epub 2016 Jun 3. PMID: 27260802; PMCID: PMC5136355.