Tongue movements in feeding and speech

Tongue-pressure and hyoid movement timing in healthy liquid swallowing

It was hypothesized that tongue-palate pressure generation might directly facilitate hyoid movement in swallowing through the anatomical connections of the extrinsic tongue muscles. If true, non-invasive measures of tongue-palate pressure timing might serve as a proxy measure of hyoid excursion. The timing relationships between events in the tongue-palate pressure and hyoid movement profiles during water and nectar-thick liquid swallowing in healthy adults were explored. Concurrent intra-oral manometry and submental B-mode midsagittal ultrasound were recorded. It was determined that there is no obligate sequence in the onsets, or offsets, of tongue-palate pressures and hyoid excursion. Timing lags (either of hyoid movement lagging tongue-palate pressures or vice versa) fell within 0.5 s, on average. It is concluded that tongue-palate pressure generation and hyoid movement are separate phenomena in the swallowing sequence and that non-invasive measures of tongue-pressure timing cannot be used reliably as proxy measures of hyoid movement timing.

Effect of complete denture wearing on deglutition time: a cine-magnetic resonance imaging study

Purpose of the study was to evaluate the effect of complete denture wearing on deglutition time (DT), hyoid bone and larynx movements in edentulous patients with real-time balanced turbo field echo cine-magnetic resonance imaging. Subjects were examined by cine-magnetic resonance imaging in supine position during swallowing water. Two sets of images for 23 edentulous (with/without wearing complete dentures) and one for 23 dentulous patients were obtained. Radiographic outputs representing three consecutive deglutition stages (oral, pharyngeal and oesophageal) were provided to perform measurements. Deglutition time significantly increased when edentulous patients wore their dentures (mean 0·75 s increased to 1·17 s), whereas dentulous patients' DT was about 0·91 s (P ≤ 0.05). The duration of deglutition is crucial because prolonged pharyngeal transit times increases the risk of aspiration. Within the limitations of the study, complete denture wearing could increase the shortened DT of the edentulous patients.

Differential articulatory movements during Japanese /s/ and /t/ as revealed by MR image sequences with tooth visualization

OBJECTIVE

To evaluate the spatio-temporal relationships between articulators in the anterior oral cavity, during the production of Japanese fricative and plosive articulation using our proposed method for tooth visualization in MR image sequences.

DESIGN

Ten healthy adults without malocclusion participated in the study. Customized maxillary and mandibular plates with space around the central incisors that was to be filled with MR-compatible contrast medium were made. During image-acquisition by a cine magnetic resonance imaging (MRI) technique, the subjects repeated vowel-consonant-vowel syllables (/asa/ and /ata/) without wearing the plates. The subjects then wore the plates for tooth imaging. All data were acquired in the midsagittal plane. Tooth boundaries were superimposed using landmarks. Several parameters and spatio-temporal changes in the centre of gravity (CoG) of the tongue were measured.

RESULTS

During /t/, the duration and amount of tongue-to-palate/incisor contact were significantly greater and the radius of the inscribed circle between the tongue-maxillary incisor-mandibular incisor was significantly shorter than those during /s/. /t/ also had a more anteriorly located CoG of the tongue than /s/ during maximum constriction. The spatio-temporal changes in the CoG of the tongue were significantly different between /asa/ and /ata/.

CONCLUSIONS

We conclude that increased tongue-to-palate/incisor contact and greater anterior closure are necessary for the production of Japanese /t/ compared to /s/. With the use of this new method for tooth visualization in MR image sequences, it should be possible to evaluate the interaction of teeth and other articulators during speech.

Tongue function in patients treated for malignancies in tongue and/or floor of mouth; a one year prospective study

Progress in (reconstructive) surgery and radiotherapy tends to improve survival and reduce oral functional deficits. Despite the growing sophistication of cancer treatment, patients still report deterioration in tongue function. Sensory function, mobility, and force of the tongue were determined in 45 patients with a carcinoma of tongue and/or floor of mouth. Measurements were performed before surgery, shortly after surgery, shortly after radiotherapy, 6, and 12 months after surgery. Surgery had a negative impact on tongue sensory function and mobility. Post-surgery radiotherapy did not further deteriorate sensory function, mobility, or force of the tongue. Patients in the surgery-radiotherapy group (SRG) had significantly worse tongue sensory function and mobility than patients in the surgery group (SG), probably caused by more advanced tumour stage and more extensive reconstructions and related scar tissue. The tongue force in patients in both groups significantly increased in the first 6 months after surgery, but this increase disappeared in the next 6 months. The authors conclude that surgery had a significant negative influence on tongue function, especially in the group of patients treated with radiotherapy. No further deterioration of tongue function was observed after post-surgical radiotherapy within the first year after surgery.

Quantitative and comparative assessment of learning in a tongue-operated computer input device

Tongue drive system (TDS) is a wireless, wearable assistive technology that enables individuals with severe motor impairments to access computers, drive wheelchairs, and control their environments using tongue motion. In this paper, we have evaluated the TDS performance as a computer input device in four tasks, commonly known as horizontal, vertical, center-out, and multidirectional rapid tapping, based on Fitts' law and ISO9241-9 Standard. Nine able-bodied subjects, who already had tongue piercing, participated in this trial over five sessions during 5 weeks, allowing us to study the TDS learning process and its current limiting factors. Subjects wore tongue rings made of titanium in the form of a barbell with a small rare-earth magnetic tracer hermetically sealed inside the upper ball. Participants performed the same tasks with a mouse (only in the first session) as a reference as well as a standard keypad for benchmarking. Six performance measures were considered, including throughput, error rate, and reaction time, all of these improved significantly from the first to the last session, and some of these plateaued over the course of the experiment. The comparison between tongue-TDS versus index-finger-keypad provides valuable insights into tongue human factors, which can lead the way in improving the usability of the TDS and similar tongue-operated assistive technologies.

Corticomotor plasticity induced by tongue-task training in humans: a longitudinal fMRI study

Corticomotor pathways may undergo neuroplastic changes in response to acquisition of new motor skills. Little is known about the motor control strategies for learning new tongue tasks. The aim of this study was to investigate the longitudinal effect of novel tongue-task training on corticomotor neuroplasticity. Thirteen healthy, right-handed men, aged 24-35 years (mean age ± SD: 27.3 ± 0.3 years), performed a training task consisting of standardized tongue protrusion onto a force transducer. The tongue task consisted of a relax-protrude-hold-relax cycle with 1.0 N as the target at the hold phase lasting for 1.5 s. Subjects repeated this task for 1 h. Functional magnetic resonance imaging was carried out before the tongue-task training (baseline), 1-h after the training, and one-day and one-week follow-up. During scanning, the subjects performed tongue protrusion in blocks interspersed with rest. A region-of-interest (ROI) approach and an explorative search were implemented for the analysis of corticomotor activity across conditions. All subjects completed the tongue-task training (mean success rate 43.0 ± 13.2%). In the baseline condition, tongue protrusion resulted in bilateral activity in regions most typically associated with a motor task including medial frontal gyrus (supplementary motor area [SMA]), precentral gyrus (tongue motor cortex), putamen, thalamus, and cerebellum. The ROI analysis revealed increased activity in the precentral gyrus already 1 h post-training. One day after the training, increased activity was observed in the precentral gyrus, SMA, putamen, and cerebellum. No increase was found 1 week after training. Correlation analyses between changes in success rates and changes in the numbers of voxels showed robust associations for left Area 4a in primary motor cortex 1 h, 1 day, and 1 week after the tongue-task training and for the left Area 4p in primary motor cortex and the left lateral premotor cortex 1 day after the training. In the unrestricted analysis, increased activity was found in the parahippocampal gyrus 1 h after the tongue-task training and remained for a week. Decreased activity was found in right post-central and middle frontal gyri 1 h and 1 week post-training. The results verified the involvement of specific corticomotor areas in response to tongue protrusion. Short-term tongue-task training was associated with longer-lasting (up to 1 week) changes in motor-related brain activity. The results suggested that primary motor areas are involved in the early and late stages, while other motor areas mainly are engaged in the later stage of corticomotor neuroplasticity of the tongue.

Coronal view ultrasound imaging of movement in different segments of the tongue during paced recital: findings from four normal speakers and a speaker with partial glossectomy

The goal of this study was to quantitatively describe aspects of coronal tongue movement in different anatomical regions of the tongue. Four normal speakers and a speaker with partial glossectomy read four repetitions of a metronome-paced poem. Their tongue movement was recorded in four coronal planes using two-dimensional B-mode ultrasound imaging. Quantitative indicators of tongue function (total distance travelled and concavity) were calculated. In all participants, it was observed that the centre of the tongue travelled greater distances than the lateral free margins. The tongues of the female speakers F1 and F2 travelled greater distances than those of the males M1 and M2. The greatest distances travelled were observed in the speaker with partial glossectomy G. In three of the participants, the greatest cumulative distances were recorded for the anterior tongue (F1, M1, and G) and in the other two (F2 and M2) in the posterior tongue. The concavity measure illustrated that the posterior tongue showed consistent grooving during connected speech, in all speakers. Flatness or convexity of the tongue was mainly observed in the anterior tongue. The study provides the first quantitative description of coronal tongue movement in a complex speech passage. Future research will have to further examine the effects of gender and orofacial morphology on the coronal shape and movement of the tongue.

Effects of dining on tongue endurance and swallowing-related outcomes

PURPOSE

The purpose of this study was to test the hypothesis that eating a meal reduces tongue strength and endurance in healthy old and young adults. It was predicted that older adults would show greater declines in tongue endurance while demonstrating higher perceived effort, longer meal durations, and clinical signs of swallowing difficulty.

METHOD

Twenty-two healthy adults were enrolled into 2 groups (ages 20-35 years and ages 65-82 years; 5 males and 6 females each). Maximum tongue strength (Pmax) and endurance (duration 50% of Pmax could be maintained) were measured twice at baseline and once postmeal. Subjects consumed half of a bagel with peanut butter, carrot sticks, and milk between measures.

RESULTS

All subjects demonstrated reduced tongue strength and endurance postmeal. Young adults showed a greater decline in anterior tongue endurance compared with older adults (p=.05). There was no evidence that changes in tongue strength, perceived effort, or meal duration varied by age or gender. The 3 oldest subjects reported the highest effort and displayed signs of difficulty swallowing while dining.

CONCLUSIONS

Young and old adults demonstrated reduced tongue strength and endurance after dining, but younger subjects showed greater declines in anterior tongue endurance, whereas older adults exhibited signs of swallowing difficulty.

Tongue pressure modulation during swallowing: water versus nectar-thick liquids

PURPOSE

Evidence of tongue-palate pressure modulation during swallowing between thin and nectar-thick liquids stimuli has been equivocal. This mirrors a lack of clear evidence in the literature of tongue and hyoid movement modulation between nectar-thick and thin liquid swallows. In the current investigation, the authors sought to confirm whether tongue-palate pressures are modulated between discrete swallows of water and nectar-thick juice.

METHOD

Tongue-palate pressures were measured at 3 sites (anterior, medial, and posterior palate) using an adhered 3-bulb pressure strip in 20 healthy, young adults during discrete swallows of water and nectar-thick apple juice.

RESULTS

Pressure modulation was not noted with respect to pressure amplitudes (in mm Hg), but was identified both in the pressure patterns observed (the sites and number of bulbs activated) and temporal aspects of pressure duration.

CONCLUSION

Tongue-palate pressure amplitude modulation does not occur for nectar-thick swallows compared to thin liquid swallows. Modulation does, however, occur with respect to the tongue-palate contact surface area and pressure durations. The authors introduce the concept of pressure slope as a meaningful way to examine tongue-palate pressure application in swallowing.

Kinematic linkage of the tongue, jaw, and hyoid during eating and speech

OBJECTIVE

Tongue movement is temporo-spatially coordinated with jaw and hyoid movements during eating and speech. As such, we evaluated: (1) the correlation between the tongue with jaw and hyoid movements during eating and speech and (2) the relative influence of the jaw and hyoid on determining tongue movement.

DESIGN

Lateral projection videofluorography was recorded while 16 healthy subjects ate solid foods or read a standard passage. The position of anterior and posterior tongue markers (ATM and PTM, respectively), the jaw, and the hyoid relative to the upper occlusal plane was quantified with the upper canine as the origin (0,0) point for Cartesian coordinates. For vertical and horizontal dimensions, separate multiple linear regression analyses were performed with ATM or PTM position as a function of jaw and hyoid positions.

RESULTS

Vertically, both ATM and PTM positions were highly correlated with the jaw and hyoid during eating (median r=0.87). The relative influence was higher for the jaw than the hyoid for ATM position (P<0.001), but lower for PTM position (P=0.04). Horizontally, tongue marker positions had moderate correlation with the jaw and hyoid during eating (r=0.47), due more to hyoid position than to jaw position. Overall, correlations were lower during speech than eating.

CONCLUSION

This study demonstrated distinct kinematic linkages between the movements of the jaw, the hyoid and the anterior and posterior tongue markers, as well as differing impact of the jaw and the hyoid in determining tongue movement during eating and speech.

Tongue movements during water swallowing in healthy young and older adults

PURPOSE

The purpose of this study was to explore the nature and extent of variability in tongue movement during healthy swallowing as a function of aging and gender. In addition, changes were quantified in healthy tongue movements in response to specific differences in the nature of the swallowing task (discrete vs. sequential swallows).

METHOD

Electromagnetic midsagittal articulography (EMMA) was used to study the swallowing-related movements of markers located in midline on the anterior (blade), middle (body), and posterior (dorsum) tongue in a sample of 34 healthy adults in 2 age groups (under vs. over 50 years of age). Participants performed a series of reiterated water swallows, in either a discrete or a sequential manner.

RESULTS

This study shows that age-related changes in tongue movements during swallowing are restricted to the domain of movement duration. The authors confirm that different tongue regions can be selectively modulated during swallowing tasks and that both functional and anatomical constraints influence the manner in which tongue movement modulation occurs. Sequential swallowing, in comparison to discrete swallowing, elicits simplification or down-scaling of several kinematic parameters.

CONCLUSION

The data illustrate task-specific stereotyped patterns of tongue movement in swallowing, which are robust to the effects of healthy aging in all aspects other than movement duration.

Internal kinematics of the tongue in relation to muscle activity and jaw movement in the pig

To explore the coordinative characteristics of tongue deformation, muscle activity and jaw movement during feeding, six ultrasonic crystals were implanted into the tongue body of ten 12-week-old Yucatan minipigs 1 week before the recording. These crystals formed a wedge-shaped configuration to allow recording dimensional changes in lengths, anterior and posterior widths and posterior thicknesses of the tongue body during feeding. Wire electromyographic activities (EMG) of superior and inferior longitudinalis, verticalis/transversus, genioglossus, styloglossus, masseter and digastricus and jaw movements were recorded simultaneously. Signals from these three sources were synchronized for real-time analyses. The results indicate: (i) dimensional changes were stereotypical in relation to each cycle of all three feeding behaviours; (ii) during chewing, expansion of tongue widths mainly occurred in the occlusal phase of jaw movement and was less coupled with the activity of tongue muscles, but the expansions of length and thickness were seen in the opening and closing phases and were better coupled with the activity of tongue muscles (P < 0.05); (iii) ingestion was characterized by the two-phased jaw opening, early expansion of anterior width prior to the occlusal phase and strong associations between tongue deformation and muscle activity; (iv) during drinking, the duration of the opening and closing phases was significantly prolonged (P < 0.01), the durations of tongue widening and lengthening were significantly shortened (P < 0.05) and anterior widening was predominant in the opening rather than in the closing or occlusal phases as compared with chewing and ingestion; and (v) the intrinsic tongue muscles did not show more or stronger correlations with the tongue deformation than did the extrinsic tongue muscles. These results suggest that (i) regional widening, lengthening and thickening of the tongue body occurs sequentially in relation to jaw movement phases, but the initiation of tongue dimensional expansions does not correspond with the activation of tongue muscles simultaneously; (ii) there is a better coupling between tongue deformations and tongue muscle activations in the sagittal (lengthening and thickening) than the transverse (widening) planes; and (iii) the patterns and ranges of tongue deformation and their relations to muscle activity and jaw movement are task-specific and the expansion magnitudes of tongue deformation does not have closer correlations with the amount of EMG activity in the intrinsic than the extrinsic tongue or jaw muscles.

Tongue base ultrasound: a diagnostic tool for predicting obstructive sleep apnea

OBJECTIVES

We assessed the value of an ultrasound (US) examination in the diagnostic workup of patients with sleep-related breathing disorders by correlating US measurements with known parameters for the presence and severity of obstructive sleep apnea.

METHODS

Forty-one male patients who complained of snoring and/or daytime somnolence participated. The diagnostic protocol included history-taking, physical examination, polysomnography, and transcervical US examination of the tongue. The US results were compared with all of the other parameters.

RESULTS

The US imaging was reliable for demonstrating anatomic structures of the tongue base, discriminating between muscle, mucosa, and blood vessels. The lingual arteries were clearly visualized entering the tongue base at its lower lateral borders. There was a significant relationship between the severity of sleep-related breathing disorders (measured by polysomnography) and the width of the lower tongue base (measured as the distance between the lingual arteries). The distance between the lingual arteries also correlated with physical examination findings and patient complaints of daytime somnolence and the sensation of choking during the night.

CONCLUSIONS

Tongue base width, measured by US, may influence the severity of obstructive sleep apnea. This is the first demonstration of the possible role of US examination, an inexpensive, noninvasive, and non-irradiating office procedure, in the diagnostic workup for sleep-related breathing disorders.

Coordination of Mastication, Swallowing and Breathing

The pathways for air and food cross in the pharynx. In breathing, air may flow through either the nose or the mouth, it always flows through the pharynx. During swallowing, the pharynx changes from an airway to a food channel. The pharynx is isolated from the nasal cavity and lower airway by velopharyngeal and laryngeal closure during the pharyngeal swallow. During mastication, the food bolus accumulates in the pharynx prior to swallow initiation. The structures in the oral cavity, pharynx and larynx serve multiple functions in breathing, speaking, mastication and swallowing. Thus, the fine temporal coordination of feeding among breathing, mastication and swallowing is essential to provide proper food nutrition and to prevent pulmonary aspiration. This review paper will review the temporo-spatial coordination of the movements of oral, pharyngeal, and laryngeal structures during mastication and swallowing, and temporal coordination between breathing, mastication, and swallowing.

Improvements in tongue strength and pressure-generation precision following a tongue-pressure training protocol in older individuals with dysphagia: three case reports

Dysphagia, or difficulty swallowing, often occurs secondary to conditions such as stroke, head injury or progressive disease, many of which increase in frequency with advancing age. Sarcopenia, the gradual loss of muscle bulk and strength, can place older individuals at greater risk for dysphagia. Data are reported for three older participants in a pilot trial of a tongue-pressure training therapy. During the experimental therapy protocol, participants performed isometric strength exercises for the tongue as well as tongue pressure accuracy tasks. Biofeedback was provided using the Iowa Oral Performance Instrument (IOPI), an instrument that measures tongue pressure. Treatment outcome measures show increased isometric tongue strength, improved tongue pressure generation accuracy, improved bolus control on videofluoroscopy, and improved functional dietary intake by mouth. These preliminary results indicate that, for these three adults with dysphagia, tongue-pressure training was beneficial for improving both instrumental and functional aspects of swallowing. The experimental treatment protocol holds promise as a rehabilitative tool for various dysphagia populations.

Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome

RATIONALE

Upper airway muscle function plays a major role in maintenance of the upper airway patency and contributes to the genesis of obstructive sleep apnea syndrome (OSAS). Preliminary results suggested that oropharyngeal exercises derived from speech therapy may be an effective treatment option for patients with moderate OSAS.

OBJECTIVES

To determine the impact of oropharyngeal exercises in patients with moderate OSAS.

METHODS

Thirty-one patients with moderate OSAS were randomized to 3 months of daily ( approximately 30 min) sham therapy (n = 15, control) or a set of oropharyngeal exercises (n = 16), consisting of exercises involving the tongue, soft palate, and lateral pharyngeal wall.

MEASUREMENTS AND MAIN RESULTS

Anthropometric measurements, snoring frequency (range 0-4), intensity (1-3), Epworth daytime sleepiness (0-24) and Pittsburgh sleep quality (0-21) questionnaires, and full polysomnography were performed at baseline and at study conclusion. Body mass index and abdominal circumference of the entire group were 30.3 +/- 3.4 kg/m(2) and 101.4 +/- 9.0 cm, respectively, and did not change significantly over the study period. No significant change occurred in the control group in all variables. In contrast, patients randomized to oropharyngeal exercises had a significant decrease (P < 0.05) in neck circumference (39.6 +/- 3.6 vs. 38.5 +/- 4.0 cm), snoring frequency (4 [4-4] vs. 3 [1.5-3.5]), snoring intensity (3 [3-4] vs. 1 [1-2]), daytime sleepiness (14 +/- 5 vs. 8 +/- 6), sleep quality score (10.2 +/- 3.7 vs. 6.9 +/- 2.5), and OSAS severity (apnea-hypopnea index, 22.4 +/- 4.8 vs. 13.7 +/- 8.5 events/h). Changes in neck circumference correlated inversely with changes in apnea-hypopnea index (r = 0.59; P < 0.001).

CONCLUSIONS

Oropharyngeal exercises significantly reduce OSAS severity and symptoms and represent a promising treatment for moderate OSAS. Clinical trial registered with www.clinicaltrials.gov (NCT 00660777).

The demands of professional opera singing on cranio-cervical posture

Difficulty with singing is a rare but important complication following cervical spine surgery but there is little objective information regarding the cervical and head postural changes taking place during singing. The aim of this study was to identify postural changes in the cranio-cervical region associated with the demands of voice production in professional opera singing. The two Roentgen-cephalograms, one of which are taken whilst performing a specified singing task were taken from 18 professional opera students, 12 females (mean age 20.86 +/- 3.07 years) and six males (18.66 +/- 1.36 years). A paired t test compared mean cranio-cervical postural and pharyngeal/hyoid variables between the two registrations (P = 0.05). The association between the cranio-cervical postural variables and the pharyngeal/hyoid region in each registration position was examined using Spearman's rank correlation coefficient. In singing, the position of the atlas with respect to the true vertical (P < 0.001), the axis (P < 0.001) and the C4 vertebra both with respect to the horizontal (P < 0.001), and the axis with respect to the cranium (P < 0.001), were all significantly different to those at rest. Of the cranio-cervical postural variables in the singing registration, the angles measuring positional change of the atlas and C4 relative to the true horizontal were shown be significantly related to an increased pharyngeal airway space at the C3 level (P < 0.01). An appreciation of the requirement for the cervical spine to undergo postural change during professional opera singing has relevance to the potential impact on voice quality in professional opera singers should they undergo cervical spine surgery.

Dysphagia in stroke and neurologic disease

Dysphagia is a common problem in neurologic disease. The authors describe rates of dysphagia in selected neurologic diseases, and the evaluation and treatment of dysphagia in this population. Applicable physiology and aspects of neural control are reviewed. The decision-making process to determine oral feeding versus alternative means of alimentation is examined.

The neurobiology of swallowing and dysphagia

The neurobiological study of swallowing and its dysfunction, defined as dysphagia, has evolved over two centuries beginning with electrical stimulation applied directly to the central nervous system, and then followed by systematic investigations that have used lesioning, transmagnetic stimulation, magnetoencephalography, and functional magnetic resonance imaging. The field has evolved from mapping the central neural pathway and peripheral nerves, to defining the importance of specific regions of the lower brain stem in terms of interneurons that provide sequential control for multiple muscles in the most complex reflex elicited by the nervous system, the pharyngeal phase of swallowing. The field is now emerging into defining how the higher cortical regions interact with this brain stem control and is providing a broader perspective of how the intact nervous system functions to control the three phases of swallowing (i.e., oral, pharyngeal, and esophageal). Much of the present interest focuses on how to retrain a damaged nervous system using a variety of stimulus techniques, which follow fundamentals in rehabilitation of the nervous system.

Somatosensory-evoked magnetic fields in examining lip area in speech-disordered children

Magnetoencephalography (MEG) is a modern neurophysiological method to study brain activation after sensory stimulation. We aimed at determining the feasibility of MEG and somatosensory-evoked magnetic fields (SEFs) in assessing the lip area in speech-disordered children undergoing oral plate therapy (OPTH) to improve their articulation. Seven subjects (age range, 6-11 years) participated in the study. The speech was perceptually assessed, and the SEFs to tactile stimulation of the lip area were recorded before and after OPTH. Two patients did not attend the posttreatment MEG recording. Clinical perceptual analysis showed remarkable improvement of speech of the studied children after OPTH. Somatosensory-evoked magnetic fields were successfully recorded in 4 of these children, but no constant changes in the responses were found after the therapy.With this small number of patients, the possible modifications in the functioning of the cortical somatosensory area of the lip after OPTH remained undetected. The present method is, however, technically applicable in studying cortical responses to lip stimulation in speech-disordered children. Further studies using stimulation inside the mouth may provide more insight to the cortical effects of OPTH.

Correspondence between food consistency and suprahyoid muscle activity, tongue pressure, and bolus transit times during the oropharyngeal phase of swallowing

This study aimed to evaluate the effects of food texture and viscosity on the swallowing function by measuring tongue pressure and performing a videofluorographic (VF) examination. Eleven normal adults were recruited for this study. Test foods with different consistencies and liquid contents, i.e., a half-solid nutrient made of 0.8 and 1.5% agar powder, syrup, and a liquid containing 40 wt/vol% barium sulfate, were swallowed, and the anterior (AT) and posterior tongue pressures (PT) and electromyographic (EMG) activity of the suprahyoid muscles were recorded, together with VF images. The timing of each event obtained from EMG, tongue pressure, and VF recordings was measured and then compared. We found that the AT and PT activity patterns were similar and showed a single peak. The peak, area, and time duration of all of the variables for AT and PT and EMG burst increased with increasing hardness of the bolus. The onset of the EMG burst always preceded those of the AT and PT activities, while there were no significant differences in peak and offset times among EMG burst, AT, and PT. Total swallowing time and oral ejection time were significantly longer during the swallowing of 1.5% agar than any other boluses, while pharyngeal transit time and clearance time were significantly longer during the swallowing of syrup, which was as hard as the liquid, but showed a higher viscosity than the liquid. The results suggested that the major effects of food hardness were to delay oral ejection time, which strongly delays total swallowing time. In addition, pharyngeal bolus transit is not dependent on the hardness of food but on its viscosity.

Regional volumetric change of the tongue during mastication in pigs

Structure and movement of the tongue have been studied extensively, but little study has been carried on its 3D deformation and ensuing volumetric changes during various functions. The purpose of this study is to investigate the volumetric changes of a regional section of the tongue during feeding. Four 12-week-old Yucatan miniature pigs were used. During natural mastication and water drinking, the width, length, thickness and volumetric changes were measured using six implanted ultrasonic crystals, which circumscribed a wedge-shaped volume in the region of the tongue body. Jaw movements were videotaped and digitized. Signals from these two sources were synchronized to allow real-time analyses. Significant volumetric changes (P < 0.001) were found in chewing, ingestion and drinking, and these changes were stereotypical in relation to rhythmic jaw movements. Volumetric change during chewing was not only more regular, but significantly larger (45.6%, P < 0.001) than that during ingestion (31.4%). The volumetric changes were less regular in drinking and the changing range (30.4%) was close to that during ingestion. Real-time analysis indicated that the volume began increasing at late jaw closing and reached the peak at late power stroke. The increase in duration of volume only took up 33.4% of the total chewing cycle length; significantly shorter than that of volume decrease. Correlation analysis revealed that the change in posterior dorsal and ventral widths had the greatest positive association with volumetric change (r = 0.43) in direction. The covariance calculations further indicated that dimensional changes in length and thickness coupled negatively with volumetric changes in amplitude. These results revealed that regional volumetric change of the tongue occurs during feeding and chewing requires larger volumetric changes than do ingestion and drinking. Volumetric expansion occurs in the phase of power stroke during chewing and is coupled with increases in widths in the direction and with decreases of thickness and length in the amplitude. The results further suggested that the regional volumetric expansion may play the determinant role in functional load production on its surrounding tissues, and may also imply that neuromuscular control of the tongue is region-specific, a notion incompatible with traditional scheme of categorizing muscle function in the tongue.

Development of the supralaryngeal vocal tract in Japanese macaques: implications for the evolution of the descent of the larynx

The configuration of the supralaryngeal vocal tract depends on the nonuniform growth of the oral and pharyngeal portion. The human pharynx develops to form a unique configuration, with the epiglottis losing contact with the velum. This configuration develops from the great descent of the larynx relative to the palate, which is accomplished through both the descent of the laryngeal skeleton relative to the hyoid and the descent of the hyoid relative to the palate. Chimpanzees show both processes of laryngeal descent, as in humans, but the evolutionary path before the divergence of the human and chimpanzee lineages is unclear. The development of laryngeal descent in six living Japanese macaque monkeys, Macaca fuscata, was examined monthly during the first three years of life using magnetic resonance imaging, to delineate the present or absence of these two processes and their contributions to the development of the pharyngeal topology. The macaque shows descent of the hyoid relative to the palate, but lacks the descent of the laryngeal skeleton relative to the hyoid and that of the EG from the VL. We argue that the former descent is simply a morphological consequence of mandibular growth and that the latter pair of descents arose in a common ancestor of extant hominoids. Thus, the evolutionary path of the great descent of the larynx is likely to be explained by a model comprising multiple and mosaic evolutionary pathways, wherein these developmental phenomena may have contributed secondarily to the faculty of speech in the human lineage.

A dynamic model of jaw and hyoid biomechanics during chewing

Our understanding of human jaw biomechanics has been enhanced by computational modelling, but comparatively few studies have addressed the dynamics of chewing. Consequently, ambiguities remain regarding predicted jaw-gapes and forces on the mandibular condyles. Here, we used a new platform to simulate unilateral chewing. The model, based on a previous study, included curvilinear articular guidance, a mobile hyoid apparatus, and a compressible food bolus. Muscles were represented by Hill-type actuators with drive profiles tuned to produce target jaw and hyoid movements. The cycle duration was 732 ms. At maximum gape, the lower incisor-point was 20.1mm down, 5.8mm posterior, and 2.3mm lateral to its initial, tooth-contact position. Its maximum laterodeviation to the working-side during closing was 6.1mm, at which time the bolus was struck. The hyoid's movement, completed by the end of jaw-opening, was 3.4mm upward and 1.6mm forward. The mandibular condyles moved asymmetrically. Their compressive loads were low during opening, slightly higher on the working-side at bolus-collapse, and highest bilaterally when the teeth contacted. The model's movements and the directions of its condylar forces were consistent with experimental observations, resolving seeming discordances in previous simulations. Its inclusion of hyoid dynamics is a step towards modelling mastication.

Influences of body posture on duration of oral swallowing in normal young adults

The primary purpose of this study was to determine whether body posture altered the duration of oral swallowing. To answer this question, we recorded electromyograms (EMGs) from the anterior tongue and suprahyoid (SH) muscles as well as laryngeal movement associated with swallowing in nine normal young subjects. The subjects swallowed a test food after receiving a signal while in four randomly set postures: upright, two inclined (60 degrees and 30 degrees to the horizontal), and supine positions. We measured the durations from the start to the peak and from the peak to the end of the integrated tongue and SH EMGs. We assumed that the duration from the start to the peak of the integrated SH EMG would correspond to the duration of oral swallowing. The average duration from the start to the peak of the integrated SH EMG decreased after moving from the upright to the inclined and supine positions. The decrease in the duration was statistically significant and consistent for three experimental sessions. The duration from the start to the peak of the integrated tongue EMG during swallowing tended to decrease after lying down, but not significantly. The postural changes did not affect the remaining four durations. The decrease in the duration of oral swallowing induced by lying down suggests that the gravitational force placed on the test food facilitates the swallowing reflex. Large variation in the tongue activity during swallowing among the subjects can probably be attributed to the lack of a significant decrease in the duration of the tongue activity.

The three-dimensional architecture of the human styloglossus especially its posterior muscle bundles

The arrangement of the lingual muscles in the interior of the human tongue, particularly the course of the posterior muscle bundles of the styloglossus, was studied by gross anatomical examination and SEM, and its relationship with tongue functions was considered. The styloglossus divided into anterior and posterior fiber bundles. The bilateral anterior fiber bundles ran anteriorly, and fused at the median region of the lower surface of the tongue, forming a large arched structure. The posterior bundles divided into 10 or more smaller bundles and entered the interior of the tongue. These muscle bundles passed through the spaces between the inferior longitudinal and genioglossus and inserted in the lingual septum, forming a small arched structure. These posterior muscle bundles passed near the midpoint between the central third and dorsal third of the line between the mental spine and the dorsal surface of the tongue in the upper half of the root of the tongue, showing a multilayer structure. In many of the areas in which posterior muscle bundles were distributed, muscle bundles in the tongue were arranged along the posterior muscle bundles of the styloglossus, glossopharyngeal bundles of the superior pharyngeal constrictor muscle, and transverse muscle of the tongue from the deep layer to the dorsal surface of the tongue.

Internal kinematics of the tongue during feeding in pigs

Six ultrasonic crystals (Ø2 mm) were implanted into the tongue body to form a wedge-shaped configuration in six 12-week-old Yucatan minipigs. These crystals allow recording of the distance changes in bilateral lengths (RL/LL) and base thicknesses (RT/LT), and anterior (AW) and posterior (dorsal and ventral, PDW and PVW) widths during natural feeding. Results indicated that changes in all measured dimensions were stereotypical with considerable regularity. The greatest dimensional changes during chewing were seen in the AW (33.3%), significantly larger than those in other dimensions (P < 0.05-0.001). During ingestion, change in all widths and thicknesses reduced significantly compared with those during chewing (P < 0.05), but changes in the lengths (RL/LL) were significantly larger than those during chewing (P < 0.01). During drinking, overall dimensional changes reduced and amplitudes were symmetrically distributed in all dimensions. The timing analysis indicated that, during chewing, the reversal of dimensional decrease to increase in the PVW occurred first, followed by those of PDW, AW, RT/LT, and RL/LL (P < 0.05). During ingestion, the AW started widening first. Time sequence of these reversals during drinking was similar to that during chewing, but RT/LT thickening was behind RL/LL lengthening. These results suggested that during natural feeding, regional tongue deformations are rhythmic and stereotypical similar to jaw movement. The reversals of expansion-contraction of various dimensions are not synchronous, but occur in a sequential manner in timing. Tongue internal deformations are task-specific in both timing and amplitude. The dimensional expansions-contractions are dominant in the transverse and sagittal planes during chewing and ingestion, respectively, but are smaller and more symmetrically distributed across various dimensions during drinking.

Stenotic nasopharyngeal dysgenesis in the dachshund: seven cases (2002-2004)

Medical records of seven dachshunds with congenital nasopharyngeal stenosis from abnormally thickened palatopharyngeal muscles were reviewed. The intrapharyngeal ostium in all cases consisted of only a narrow slit. Dogs were presented with various clinical signs--the most common being dyspnea, expiratory cheek puff, salivation, pharyngeal dysphagia, oral dysphagia (to a lesser extent), and macroglossia. Diagnostic procedures included direct pharyngeal inspection, pharyngeal and thoracic radiography, fluoroscopy, lingual ultrasonography, biopsies in two dogs, and a postmortem examination in one dog. Diagnoses were readily made with radiographs and visual examinations. Macroglossia was confirmed with transcutaneous ultrasonography or a transmandibular finger test.

The dynamics of lingual-mandibular coordination during liquid swallowing

Previous literature on tongue-jaw relationships during swallowing has focused on behaviors observed with chewable solid foods. The present investigation was undertaken to evaluate both the nature and stability of coordinative relationships between the jaw and three points located along the midsagittal groove of the tongue--anterior (blade), middle (body), and posterior (dorsum)--during swallowing of thin and honey-thick liquids. A reiterative swallowing paradigm was used, with two task conditions (discrete and sequential), to explore the stability of tongue-jaw coordination across different frequencies of swallowing. Eight healthy participants in two age groups (young, older) performed sets of repeated swallows. Tongue and jaw movements were measured using electromagnetic midsagittal articulography. The data were analyzed in terms of variability in the spatiotemporal movement pattern for each fleshpoint of interest, and the temporal coupling (frequency entrainment) and relative phasing of movement for each tongue segment compared to the mandible. The results illustrate a stereotypical but not invariant sequence of movement phasing in the tongue-jaw complex during liquid swallowing and task-related reductions in variability at higher frequencies of swallowing in tongue dorsum movements. This evidence supports the idea that different segments of the tongue couple with the jaw as a synergy for swallowing, but can modify their coupling relationship to accommodate task demands.

Roles of intrinsic and extrinsic tongue muscles in feeding: electromyographic study in pigs

The performance of tongue muscles in various feeding behaviours is not well defined. This study was undertaken to examine the role of the intrinsic and extrinsic tongue muscles during natural drinking, food ingestion and chewing. Ten 12-week-old Yucatan miniature pigs (5 in each gender) were used. Under anesthesia, fine-wire electrodes were inserted into three intrinsic (verticalis and transversus [V/T]; superior and inferior longitudinalis [SL and IL]) and two extrinsic (genioglossus [GG] and styloglossus [SG]) tongue muscles and two jaw muscles (masseter [MA] and anterior digastricus [DI]). Electromyogram (EMG) and jaw movement were recorded and synchronized when pigs were drinking water, ingesting and chewing food freely. Chewing frequency (CF), onset of activation, burst duration and integrated activity (IEMG) were assessed quantitatively, and EMG activities during drinking and ingestion were examined qualitatively. Results indicate that during chewing, the V/T and GG had one phase of activity starting at early jaw opening, and the V/T activity lasted through late of jaw closing. The SL, IL and SG had double phases with the first starting at jaw opening and the second at late jaw closing phases. The three intrinsic tongue muscles and the SG were active during 35-48% of the chewing cycle. IEMG values of the SL, IL and SG of both sides were significantly greater compared to the other muscles (p<0.05-0.01). Both the SL and the IL showed significantly higher activities in the contralateral than ipsilateral sides (p<0.05). The timing sequences of both extrinsic and intrinsic muscles were similar between ingestion and chewing, but amplitudes of the GG and IL were greatly enhanced and those of the MA and SL were reduced during ingestion. The simultaneous activation of the MA, GG and V/T were seen during drinking, along with major activity in the GG and V/T. These results suggested that the majority of activity in the intrinsic and extrinsic tongue muscles occurred during jaw opening and the occlusal phases of chewing. The activity of the GG and IL played a major role during ingestion, whereas simultaneous activation of jaw, extrinsic and intrinsic tongue muscles and major activity in the GG and V/T occurred during drinking.

Stimulation of the hypothalamic paraventricular nucleus modulates cardiorespiratory responses via oxytocinergic innervation of neurons in pre-Botzinger complex

Previously we reported that oxytocin (OT)-containing neurons of the hypothalamic paraventricular nucleus (PVN) project to the pre-Bötzinger complex (pre-BötC) region and phrenic motoneurons innervating the diaphragm (D). The aim of these studies was to determine pathways involved in PVN stimulation-induced changes in upper airway and chest wall pumping muscle activity. In addition, we determined the role of OT-containing neurons in the PVN in mediating increased respiratory output elicited by PVN stimulation. Neuroanatomical experiments, using pseudorabies virus (PRV) as a transneuronal tracer in C8 spinalectomized animals showed that PVN neurons project to hypoglossal motoneurons innervating the genioglossus (GG) muscle. Furthermore, microinjection of the PVN with bicuculline, a GABA(A) receptor antagonist, significantly increased (P < 0.05) peak electromyographic activity of GG (GG(EMG)) and of D(EMG), frequency discharge, and arterial blood pressure (BP) and heart rate. Prior injection of OT antagonist [d-(CH(2))(5),Tyr(Me)(2),Orn(8)]-vasotocin intracisternally or blockade of OT receptors in the pre-BötC region with OT antagonist l-368,899, diminished GG(EMG) and D(EMG) responses and blunted the increase in BP and heart rate to PVN stimulation. These data show that PVN stimulation affects central regulatory mechanisms via the pre-BötC region controlling both respiratory and cardiovascular functions. The parallel changes induced by PVN stimulation were mediated mainly through an OT-OT receptor signaling pathway.

Oral processing assessed by M-mode ultrasound imaging varies with food attribute

Ultrasonic imaging was used to quantify oral movements made during the oral processing of foods while subjects assessed the intensity of the sensory attributes, thick, creamy, sweet and bitter. A series of four stimuli were prepared with high and low viscosities and high and low sweetness. Over five sessions, subjects (N=8) were asked to consume 5 ml spoonfuls of each of the stimuli while holding an ultrasound probe beneath their chin so as to produce a mid-line sagital image of the floor of the mouth and tongue. In the first session, subjects were asked to swallow the sample. In subsequent sessions, subjects were asked to rate one of the attributes, thickness, sweetness, creaminess or bitterness, in random order. The resulting video recordings were subjected to an image-processing algorithm to quantify the amount of intra-oral manipulation performed. The results demonstrated that oral movements varied with attribute, especially in the period during which the bulk of the food is typically processed and the following swallowing phase. The food's sweetness affected oral movements especially during the bulk phase, whereas the food's viscosity primarily affected movements during the following swallowing and clearance phases.

Myosin heavy chain and fibre diameter of extrinsic tongue muscles in rhesus monkey

OBJECTIVE

The purpose of this investigation was to identify the myosin heavy chain (MHC) phenotype and fibre diameters of hypoglossal innervated extrinsic tongue muscles in rhesus monkey.

METHODS

Genioglossus, styloglossus and hyoglossus muscle samples obtained from three female rhesus monkeys were analysed for MHC isoforms via gel electrophoresis and stained with MHC antibodies to measure least mean diameters.

RESULTS

MHC phenotypes were consistent for all three muscles. Each muscle was predominantly composed of MHC type IIa and I. All three isoforms were significantly different from each other in fibre diameter for styloglossus and genioglossus (IIb>IIa and IIx>I; P<0.001). For hyoglossus, the MHC type II isoforms had larger diameters than the MHC type I isoform (P<0.001).

CONCLUSIONS

While the extrinsic tongue muscle MHC and/or muscle fibre type composition may be different between mammalian species, there are consistent similarities between the intrinsic and extrinsic tongue muscles. We suggest this is necessary for the highly coordinated activities performed by the tongue such as mastication, respiration and swallowing. The differences in fibre diameters among MHC isoforms suggest a large force gradation, which would be consistent with the coordination of these activities. The similarities among primates in MHC and/or muscle fibre composition as well as similar cortical inputs to the hypoglossal nucleus, suggest that we could expect to see similar MHC phenotype for extrinsic tongue muscles in human.

One hour of tongue-task training is associated with plasticity in corticomotor control of the human tongue musculature

Corticomotor control of the human tongue has been reported to undergo neuroplastic changes following several days of training in a tongue-protrusion task. The aims of the present study were to determine if a 1 h tongue-task training is sufficient to induce signs of neuroplastic changes in the corticomotor pathways, and to obtain preliminary information on the time course of such changes. Corticomotor excitability was assessed by changes in electromyographic activity evoked by transcortical magnetic stimulation (TMS) in 11 healthy subjects. Motor evoked potentials (MEPs) recorded in the tongue musculature and the first dorsal interosseous (FDI) muscle were assessed at four sessions: at baseline before training, 30 min after training, and 1 and 7 days after training. All subjects performed successfully the task (success rate: 38+/-4%). Thresholds for evoking MEPs by TMS in the tongue were decreased at 30 min, 1 and 7 days after training compared with baseline (ANOVA: P<0.001). Tongue MEP amplitudes were significantly increased at 1 day follow-up and had returned to baseline values at 7 days follow-up (ANOVA: P<0.001). No significant effect of tongue-task training on FDI MEPs was observed (ANOVA: P=0.160). Corticomotor topographic maps revealed increases (ANOVA: P<0.001) in area at the 1 day follow-up. The success rate was significantly correlated to the net increases in tongue MEPs at 1 day follow-up (Spearman: 0.615; P=0.0039). The present findings confirm that tongue task training is associated with plasticity of corticomotor excitability specifically related to the tongue musculature and further document that plasticity is evident within 30 min post-training and may last up to at least 7 days.