Feasibility and Physiological Effects of a Home-Based Swallow Exercise Program Using sEMG Biofeedback in Prefrail Older Adults: A Case Series

Age-related decline in swallowing function increases the risk of dysphagia in older adults. Strengthening the muscles involved in swallowing through proactive training may help prevent such decline, particularly in prefrail individuals. This case series evaluated the feasibility and physiological effects of a home-based effortful swallow training program in three prefrail older adults without swallowing impairments. The intervention used a wearable surface electromyography biofeedback device (Mobili-T®) to provide real-time visual feedback on submental muscle activation during effortful swallows. Participants completed six weeks of training at home, five sessions per week, and underwent pre- and post-intervention assessments of tongue pressure and submental muscle activity during regular and effortful swallows across various consistencies. All participants completed the program with high adherence (above 94%). Two participants demonstrated improvements in tongue strength that exceeded minimal detectable change thresholds, while two showed at least 50% increases in submental muscle activity, indicating neuromuscular adaptation. Participants reported positive experiences with the usability and structure of the program. However, perceived functional improvements were limited, consistent with the preventive focus of the intervention. These findings suggest that home-based effortful swallow training supported by real-time biofeedback is feasible and well tolerated in prefrail older adults, with potential for individualized neuromuscular gains. Further research is needed to optimize training parameters, assess long-term effects, and determine whether such programs can reduce future dysphagia risk.