Standard Values of Maximum Tongue Pressure Taken Using Newly Developed Disposable Tongue Pressure Measurement Device

Instrumented Assessment of Oral Motor Function in Healthy Subjects and People with Systemic Sclerosis

The aim of the present study was to provide quantitative data of oral function in healthy subjects (HSs), validity of measurements and estimation of measurement bias, as well as quantify oral impairment in persons with scleroderma (SSc). 151 HSs and 12 subjects with SSc were recruited and assessed using instrumented tools, measuring maximal mouth opening; lip strength; and tongue strength, protrusion, retraction, and endurance. Twenty HSs were also retested 3-5 weeks later in order to assess the test-retest reliability of the measurements. Intraclass correlation coefficients proved to be satisfactory (>0.8) for both inter-rater and test-retest reliabilities of all measurements except for tongue retraction. In the HS group, maximal mouth opening and tongue and lips strength values were larger (P < 0.05) for males than females, while no significant differences were found for other variables. Older subjects had statistically significantly lower tongue retraction values and tongue endurance values than younger subjects. The SSc group showed a statistically significant decrease (P < 0.05) in almost all the measurements. Assessment procedures proved to be valid and reliable. Gender and height were predictors of mouth opening, lip and tongue strength, while age correlates with tongue retraction and endurance. Measurements highlighted the strong impact of SSc on oral functions and in particular on tongue protrusion, tongue strength, and endurance.

The practical approach to the evaluation of methods used to determine the disintegration time of orally disintegrating tablets (ODTs)

Even that orodispersible tablets (ODTs) have been successfully used in therapy for more than 20 years, there is still no compendial method of their disintegration time evaluation other than the pharmacopoeial disintegration test conducted in 800–900 mL of distilled water. Therefore, several alternative tests more relevant to in vivo conditions were described by different researchers. The aim of this study was to compare these methods and correlate them with in vivo results. Six series of ODTs were prepared by direct compression. Their mechanical properties and disintegration times were measured with pharmacopoeial and alternative methods and compared with the in vivo results. The highest correlation with oral disintegration time was found in the case of own-construction apparatus with additional weight and the employment of the method proposed by Narazaki et al. The correlation coefficients were 0.9994 (p < 0.001), and 0.9907 (p < 0.001) respectively. The pharmacopoeial method correlated with the in vivo data much worse (r = 0.8925, p < 0.05). These results have shown that development of novel biorelevant methods of ODT’s disintegration time determination is eligible and scientifically justified.

Tongue forces and handgrip strength in normal individuals: association with swallowing

OBJECTIVES

To describe and correlate tongue force and grip strength measures and to verify the association of these measures with water swallowing in different age groups.

METHOD

Tongue force was evaluated using the Iowa Oral Performance Instrument and grip strength using the Hand Grip in 90 normal individuals, who were divided into three groups: young (18-39 years old), adult (40-59 years old) and elderly (above 60 years old) individuals. The time and number of swallows required for the continuous ingestion of 200 ml of water were also measured.

RESULTS

A reduction in tongue force and grip strength, as well as an increase in the time required to drink 200 ml of water, were observed with increasing participant age. There was no difference in the number of swallows among the three groups. A correlation was observed between reductions in tongue force and grip strength in the groups of young and elderly individuals.

CONCLUSION

There were differences in the measures of tongue force in young, adult and elderly individuals. Greater variations within these differences were observed when repeated movements were performed; in addition, a decrease in strength was associated with an increase in age. The decrease in tongue force among the elderly was offset by the increase in time needed to swallow the liquid. There was an association between the measures of tongue force and grip strength in the different age groups. The results of this study can be applied clinically and may act as a basis for guidelines in healthy or vulnerable elderly populations.

Immediate effects of transcutaneous electrical stimulation on physiological swallowing effort in older versus young adults

OBJECTIVE

This study compared the immediate impact of different transcutaneous electrical stimulation (TES) amplitudes on physiological swallowing effort in healthy older adults versus young adults.

BACKGROUND

Swallowing physiology changes with age. Reduced physiological swallowing effort in older adults including lower lingua-palatal and pharyngeal pressures may increase risk for swallowing dysfunction (i.e. dysphagia). Transcutaneous electrical stimulation (TES) has been advocated as an adjunctive modality to enhance outcomes in exercise-based therapy for individuals with dysphagia. However, significant variation in how TES is applied during therapy remains and the physiological swallowing response to TES is poorly studied, especially in older adults.

MATERIALS AND METHODS

Physiological change in swallowing associated with no stimulation, sensory stimulation and motor stimulation was compared in 20 young adults versus 14 older adults. Lingua-palatal and pharyngeal manometric pressures assessed physiological swallowing effort.

RESULTS

Multivariate analyses identified interactions between age and stimulation amplitude on lingual and pharyngeal functions. Motor stimulation reduced anterior tongue pressure in both age groups but selectively reduced posterior lingua-palatal pressures in young adults only. Sensory stimulation increased base of tongue (BOT) pressures in older adults but decreased BOT pressures in young adults. Motor stimulation increased hypopharyngeal pressures in both groups.

CONCLUSION

Age and TES level interact in determining immediate physiological responses on swallow performance. A one-size-fit-all approach to TES in dysphagia rehabilitation may be misdirected.

Tongue pressure in patients with tongue cancer resection and reconstruction

OBJECTIVE

Assessment of tongue function following tongue reconstruction is important to evaluate patient status. To assess tongue function in patients who had undergone tongue reconstruction, the surgical team used a simple, hand-held tongue pressure measurement device to measure tongue power.

METHODS

Tongue power of 30 patients (25 males, 5 females; average age: 53.6±15.0 years) was calculated using a hand-held tongue pressure measurement device, six months postoperation. The defects were classified into minimal glossectomy (MG) (n=8), near-half partial glossectomy of the mobile tongue (PG) (n=5), hemi-glossectomy (HG) (n=4), more than half partial glossectomy of the mobile tongue (SG-MT) (n=7), and subtotal glossectomy (SG) (n=6). As seen in other tongue assessments, a simple articulatory test, food evaluation, and speech intelligibility assessment were also performed; resulting correlations were statistically calculated using tongue pressure values.

RESULTS

The tongue pressure values were 94.0±14.5% in MG, 48.5±13.2(a) % in PG, 40.4±18.7(a) % in HG, 19.3±7.7(a,b) % in SG-MT, and 15.3±5.6(a,b) % in SG (a: <0.05 vs. MG, b: <0.05 vs. PG). The Pearson r was 0.77, 0.67, and 0.74 when correlated with simple articulatory test, food evaluation, and speech intelligibility assessment, respectively.

CONCLUSION

Tongue pressure measurement in patients with tongue cancer resection and reconstruction facilitated determination of patients' tongue function status.

Variations in tongue-palate swallowing pressures when swallowing xanthan gum-thickened liquids

Thickened liquids are frequently recommended to reduce the risk of aspiration in patients with oropharyngeal dysphagia. Although it has previously been reported that tongue-palate pressures increase when swallowing spoon-thick and semi-solid consistencies compared to thin liquids, relatively little is known about how swallowing behaviors differ when swallowing liquids of nectar- or honey-thick consistency. Furthermore, previous studies have primarily used starch-based thickeners, and little is known about swallowing behaviors with xanthan gum-thickened liquids, which have recently been introduced for dysphagia management. In this study, we measured variations in tongue-palate pressures during the swallowing of liquids thickened to apparent viscosities of 190, 250, and 380 mPa s at 50/s using increasing concentrations of xanthan gum (0.5, 0.63 and 0.87 w/w%). The viscosity differences between these nectar- and honey-thick stimuli were confirmed to exceed sensory perceptual discrimination thresholds. Data were collected from 78 healthy adults in two sex-balanced age-groups (young; mature) and compared to reference values obtained during water swallowing. The results confirm that increased amplitudes of tongue-palate pressure were used when swallowing the thickened liquid stimuli, compared to swallows of water, and for the honey-thick liquid compared to the two nectar-thick liquids. Age-related reductions were seen in tongue strength but not in swallowing pressures, which fell below 40 % of maximum isometric pressure values. Thus, the use of xanthan gum-thickened liquids is unlikely to tax the swallowing system in terms of tongue pressure generation requirements, even in seniors with reduced maximum isometric tongue pressure measures.

Effect of supraglottic and super-supraglottic swallows on tongue pressure production against hard palate

The objectives of this study were to evaluate the state of tongue pressure production during supraglottic swallow (SS) and super-supraglottic swallow (SSS) performed by healthy adults, and to investigate the effects of these swallowing maneuvers on the oral stage of swallowing. The participants were 19 healthy individuals. Tongue pressure against the hard palate during swallowing was measured using a tongue pressure sensor sheet system with five pressure-sensitive points. The tasks comprised swallowing 5 mL of water by normal wet swallow, SS, and SSS, and the parameters for analysis were the duration, the maximal magnitude, and the integrated value of tongue pressure during swallowing. The duration of tongue pressure was significantly longer at the anterior-median part of the hard palate during both SS and SSS than with normal wet swallow. The maximal magnitude increased significantly only at the posterior part of the hard palate during SS, but at all points during SSS. The integrated value increased significantly only at the posterior-median part of the hard palate during SS, but at all points except the mid-median part of the hard palate during SSS. The maximal magnitude and integrated value were also significantly higher at the anterior-median and posterior circumferential parts during SSS than during SS. These results show that these two swallowing maneuvers, which are known primarily as techniques to protect the airway, also function to strengthen the tongue pressure produced by the contact between the tongue and the hard palate during swallowing and this effect is more pronounced during SSS.

Age and strength influences on lingual tactile acuity

Sensory function during the oral processing of liquids is thought to play a key role in informing the tailoring of swallowing motor behaviours to the flow characteristics of the bolus. In addition to taste receptors, the mouth and tongue house trigeminal nerve receptors that support the sensory detection of bolus size, shape (stereognosis), mass, temperature and movement. Recent studies suggest that healthy adults lose tongue strength with advancing age. However, little is known about changes in the sensory function of the tongue attributable to age, or associated with reductions in strength. In this study, we explored lingual tactile acuity in healthy young and older adults, and measured the relationship between tactile acuity and measures of tongue strength. The results showed an age-related reduction in lingual tactile acuity that was not explained by variations in tongue strength.

PRACTICAL APPLICATIONS

Sensory motor interactions are a topic of interest in understanding the processing activities that take place in the mouth during eating and swallowing. In this paper, we explore a test of sensory acuity in the mouth, in which the tongue is used to "read" embossed letters on Teflon strips. Our questions were to determine whether sensory acuity for this task declines with age, or with age-related reductions in tongue strength. We determined that older people perform this task with less accuracy, suggesting some changes in oral sensory function with age. However, these changes were not related to tongue strength. The findings suggest that strength does not play a major role in the kind of sensory discrimination task tested in this study.

Role of tongue pressure production in oropharyngeal swallow biomechanics

The tongue is important for orofacial movements, including swallowing. Although numerous studies have focused on tongue pressure against the palate, its physiological role has not been fully evaluated. The tongue pressure generation may have the temporal coordination with the swallowing relational organs. The aim of this study was to clarify the physiological mechanisms of tongue pressure and to investigate the temporal relationship among tongue pressure, supra-hyoid muscle activity, and videofluorographic (VF) images during swallowing. Fifteen healthy young subjects participated. Tongue pressure measured using a sensor sheet with five channels, electromyographic EMG, and VF was recorded synchronously during 4-ml barium swallowing. Swallowing behavior in VF images with and without the sensor sheet was compared. Furthermore, the temporal relationship between events measured from tongue pressure, EMG, and VF was evaluated. Swallowing behavior on VF images was not affected by placement of the sensor sheet. Tongue pressure at the posterio-lateral point of the hard palate tended to have biphasic peaks. Tongue pressure production with a monophasic pattern appeared during the same period as the second peak in the biphasic pattern. The onset of tongue pressure was later than the start of hyoid movement and onset of EMG, and offset was observed between the hyoid at the up-forward position and reposition. Onset of tongue pressure at the anterior area was correlated with the start of slight hyoid elevation. Offset of tongue pressure at the posterio-lateral points was strongly time locked with the hyoid at the up-forward position. The present results suggested the temporal coordination of tongue pressure generation with the swallowing-related organs. That is, the tongue pressure was produced for bolus propulsion, and was closely related to hyoid movement temporally during swallowing. These results may contribute to clarify the clinical state with the disorder of tongue kinetics.

Isometric and swallowing tongue strength in healthy adults

OBJECTIVES/HYPOTHESIS

The tongue contributes to a safe swallow. It facilitates bolus control during mastication, maintains a bolus in the oral cavity to prevent premature entry of the bolus into the hypopharynx, and helps generate pressure in the hypopharynx during swallowing. This study examined isometric tongue strength and tongue pressure measured during swallowing in healthy young and older adults.

STUDY DESIGN

Prospective group design.

METHODS

One hundred twenty-six healthy individuals who were recruited as part of a larger study on swallowing participated in this study. Participants were divided into three age groups: 20 to 40 years, 41 to 60 years, and ≥61 years. A KayPentax Digital Swallowing Workstation with an air-filled bulb array was placed on the tongue of each participant (anterior to posterior). Participants completed three isometric tongue presses and three swallows.

RESULTS

Repeated measures analyses of variance revealed a significant main effect of age (P = .01) and gender by tongue bulb location interaction (P = .02) for isometric tongue strength. That is, older adults had lower isometric tongue strength than young adults, and females had a greater difference between anterior and posterior tongue strength than males. Tongue strength during swallowing yielded significantly greater anterior versus posterior tongue pressure.

CONCLUSIONS

This study comprises one of the largest in terms of number of healthy participants reported to date and confirms previous findings that isometric tongue strength decreases with age. Furthermore, given young and older adults generate similar swallowing pressures, swallowing is a submaximal strength activity, yet older adults have less functional reserve.

LEVEL OF EVIDENCE

4.

Tongue pressure generation during tongue-hold swallows in young healthy adults measured with different tongue positions

Tongue-hold swallow (THS) has the potential to be a resistance exercise not only for the pharyngeal constrictor but for the tongue muscles. To elucidate the physiological mechanisms of THS, this study investigated intraoral pressure generation during THS in relation to different extents of tongue protrusion. Tongue pressure was measured by a 5-point pressure sensor sheet placed onto the hard palate of 18 healthy young subjects who performed three swallow tasks: normal dry swallow, THS with slight tongue protrusion, and THS with greater tongue protrusion. Subjects randomly repeated each task five times. Maximum range of tongue protrusion was also measured in each subject to estimate lingual flexibility. With an increase in the extent of tongue protrusion, pressure generation patterns became irregular and variable. Duration of pressure generation increased with statistical significance in the posterior circumferential parts of the hard palate (p < 0.05). Maximal magnitude and integrated value of the pressure recorded at these locations increased in eight subjects as the extent of tongue protrusion increased, but it decreased in nine. The former group showed greater lingual flexibility, while the latter group exhibited less flexibility. THS may place different amounts of load on the tongue muscles by adjusting the degree of tongue protrusion.

Age-related differences in tongue-palate pressures for strength and swallowing tasks

The tongue plays a key role in the generation of pressures for transporting liquids and foods through the mouth in swallowing. Recent studies suggest that there is an age-related decline in tongue strength in healthy adults. However, whether age-related changes occur in tongue pressures generated for the purpose of swallowing remains unclear. Prior literature in this regard does not clearly explore the influence of task on apparent age-related differences in tongue pressure amplitudes. Furthermore, differences attributable to variations across individuals in strength, independent of age, have not clearly been elucidated. In this study, our goal was to clarify whether older adults have reduced tongue-palate pressures during maximum isometric, saliva swallowing, and water swallowing tasks, while controlling for individual variations in strength. Data were collected from 40 healthy younger adults (under age 40) and 38 healthy mature adults (over age 60). As a group, the mature participants had significantly lower maximum isometric pressures (MIPs). Swallowing pressures differed significantly by task, with higher pressures seen in saliva swallows than in water swallows. Age-group differences were not seen in swallowing pressures. Consideration of MIP as a covariate in the analysis of swallowing pressures revealed significant correlations between strength and swallowing pressures in the older participant group. Age-group differences were evident only when strength was considered in the model, suggesting that apparent age-related differences are, in fact, explained by differences in strength, which tends to be lower in healthy older adults. Our results show no evidence of independent differences in swallowing pressures attributable to age.

Aging effects on sensorimotor integration: a comparison of effector systems and feedback modalities

Research on motor aging has focused on visuomotor effects in limb musculature, with few comparisons across effectors or feedback modalities. The authors examined steady fine force control in oral and manual effectors under visual and auditory feedback in 13 young (19-23 years old) and 13 older (60-77 years old) participants, hypothesizing that force variability would increase with aging (a) more in the finger than the lip and (b) for both feedback modalities. The magnitude of variability increased with age for both visuomotor and audiomotor tasks but age-related differences were greater in the lip than the finger. These results point to increased variability as a potential early marker of changing motor function (prior to loss of strength) that extends beyond the visuomotor system.

Optimal approaches for measuring tongue-pressure functional reserve

Tongue-palate pressure is a parameter of considerable interest in the field of dysphagia. Maximum isometric tongue-palate pressures (MIPs) decline in healthy aging and in dysphagia. Functional reserve (FR) is the difference between MIPs and swallowing pressures. Reduced FR is thought to constitute a risk for developing functional swallowing impairments. We compare different approaches for calculating FR and recommend an optimal approach. Tongue-palate pressure data were collected from 78 healthy adults (40 < age  40; 38 > 60) during anterior and posterior MIPs, regular (RESS) and effortful (ESS) saliva swallows, and water swallows (4 repetitions per task). Six different measures of reserve were calculated using maximum anterior MIPs or ESS pressures at the top, and mean or maximum RESS or water swallow pressures at the bottom of the range. Correlations with age and MIPs were explored to confirm suitability for measuring FR. The impact of normalization to maximum MIP range was explored. We conclude that an optimal measure of FR involves the comparison of maximum MIP with mean saliva swallowing pressures. This parameter declines with age, but when normalized to an individual's MIP range, the relationship is no longer evident. This suggests that FR does not necessarily decline in healthy aging.

Influence of height, weight and body mass index in the axial tongue force

PURPOSE

To analyze the influence of weight, height and body mass index in the axial tongue force.

METHODS

Medical records with data from 44 subjects aged between 20 and 37 years, 11 (25%) males and 33 (75%) female, were analyzed. The investigated information were weight, height, result of clinical evaluation for tongue force (lingual tonus) and instrumental assessment of axial tongue force, which was accomplished by using the FORLING. Data was statistically analyzed.

RESULTS

No differences were observed between the force values regarding the variables body mass index classification and clinical classification of tongue force. Body mass index and weight had positive correlation with mean tongue force. There was a strong positive correlation between the variables mean force, maximum force and highest maximum force.

CONCLUSION

Although body mass index and weight correlated positively with the mean axial tongue force, there was no association between body mass index classification and the axial tongue forces.

Dysphagia in Duchenne muscular dystrophy versus myotonic dystrophy type 1

INTRODUCTION

In this study we aimed to demonstrate the distinctive features of dysphagia in patients with myotonic dystrophy type 1 (DM1) and Duchenne muscular dystrophy (DMD).

METHODS

Diet-type score (DTS) and maximum tongue pressure (MTP) were measured in 20 DM1 and 24 DMD patients; all patients were also examined by videofluoroscopy (VF). We used VF to measure the range of hyoid bone excursion (RHBE) during pharyngeal transit time and the area of pharyngeal residue (APR) after the first swallow.

RESULTS

RHBE and APR values for DM1 patients were significantly greater than those for DMD patients. DTS and MTP did not differ between patients. A significant correlation was observed between DTS, MTP, and RHBE in DMD patients, but not in DM1 patients.

CONCLUSIONS

Our findings reveal the differences in the distinctive features of dysphagia in DM1 and DMD. Adjustments in the diet of DMD patients in accordance with swallowing ability could be useful.

Assessment of swallowing in motor neuron disease and Asidan/SCA36 patients with new methods

BACKGROUND

We report on a unique complication of cerebellar ataxia and motor neuron disease named Asidan/SCA36 with a high frequency of tongue atrophy. We aimed to elucidate dysphagia in amyotrophic lateral sclerosis (ALS) and spinal, bulbar muscular atrophy (SBMA), and Asidan/SCA36 patients with new methods.

METHODS

Patients diagnosed with ALS (n=20), SBMA (n=6), and Asidan (n=12) were included. A videofluoroscopic swallow study (VFS), an assessment of maximal tongue pressure (MTP), and impedance pharyngography (IPG) were applied.

RESULTS

The frequencies of VFS abnormalities were 70%, 50%, and 33% in ALS, SBMA, and Asidan/SCA36, respectively. Compared with control subjects (31.6 ± 6.3 kPa, mean ± SD), MTP was significantly decreased in ALS patients and SBMA patients, but was relatively preserved in Asidan patients. ALS patients performed more swallowing actions (Ns) detected by IPG than did control subjects, but SBMA and Asidan/SCA36 patients performed similar Ns to control subjects.

CONCLUSIONS

VFS showed a higher frequency of swallowing abnormalities in ALS patients. MTP and IPG measurements showed the most severe involvement in ALS patients and a relatively preserved swallowing function in SBMA and Asidan/SCA36 patients.

Métodos quantitativos para avaliação da força de língua

Por muitos anos, pesquisadores têm procurado métodos para quantificar a força da língua e muitos instrumentos foram construídos para este fim. O objetivo deste trabalho é apresentar uma revisão crítica da literatura sobre instrumentos para quantificar a força de língua. Os 30 aparelhos encontrados foram agrupados em quatro diferentes categorias: bocal contendo sensores (n=9), sensores fixados nos dentes, palato ou em placas palatais (n=8), bulbos preenchidos com fluidos e conectados a sensores de pressão (n=7) e outras tecnologias (n=8). Esses instrumentos podem, potencialmente, auxiliar o fonoaudiólogo na avaliação miofuncional orofacial, fazendo com que o diagnóstico de força da língua seja mais preciso. Alguns aparelhos apresentam desvantagens, tais como não serem sensíveis a pequenas mudanças de força, dificuldades na reprodutibilidade do posicionamento e outros pontos específicos. A grande variação de valores de força/pressão máxima e média encontrados relaciona-se à grande diversidade dos métodos, que empregam diferentes tecnologias.

Lingual propulsive pressures across consistencies generated by the anteromedian and posteromedian tongue by healthy young adults

PURPOSE

In the present study, the authors investigated lingual propulsive pressures generated in the normal swallow by the anterior and posterior lingual segments for various consistencies and maximum isometric tasks.

METHOD

Lingual pressures for saliva, thin, and honey-thick liquid boluses were measured via the Iowa Oral Performance Instrument (IOPI Medical, Carnation, WA) at both anteromedian and posteromedian lingual segments of 62 healthy participants, ages 18-34 years (30 men, 32 women).

RESULTS

A repeated-measures analysis of variance revealed that all lingual swallowing pressures were significantly greater at the anteromedian segment than at the posteromedian segment. Gender was not a significant factor; however, women exhibited greater swallowing pressures across all conditions. Lingual pressures increased as bolus viscosity increased. No significant interactions existed. Analysis of a subset of 30 participants revealed that men exhibited greater maximal isometric pressure at the anteromedian segment than women, with no significant gender difference at the posteromedian segment. A significantly higher percentage of maximum isometric tongue pressure was exerted by the posteromedian tongue than by the anteromedian tongue.

CONCLUSION

Findings suggest that greater amplitudes of lingual pressures are generated during normal swallowing at the anteromedian lingual segment; however, a greater percentage of maximum isometric tongue pressure was exerted by the posteromedian lingual segment, suggesting increased effort by the posterior tongue during bolus propulsion.

Tongue thickness relates to nutritional status in the elderly

Many elderly people under long-term care suffer from malnutrition caused by dysphagia, frequently leading to sarcopenia. Our hypothesis is that sarcopenia may compromise oral function, resulting in dysphagia. The objectives of this study were to evaluate sarcopenia of the lingual muscles by measuring the tongue thickness, and elucidate its relationship with nutritional status. We examined 104 elderly subjects (mean age = 80.3 ± 7.9 years). Anthropometric data, such as triceps skinfold thickness and midarm muscle area (AMA), were obtained. The tongue thickness of the central part was determined using ultrasonography. Measurement was performed twice and the mean value was obtained. The relationship between tongue thickness and nutritional status was analyzed by Pearson’s correlation coefficient and Spearman’s rank correlation coefficient. AMA and age were identified by multiple-regression analysis as factors influencing tongue thickness. The results of this study suggest that malnutrition may induce sarcopenia not only in the skeletal muscles but also in the tongue.

Prognostic value of decreased tongue strength on survival time in patients with amyotrophic lateral sclerosis

Decreased tongue strength (TS) might herald bulbar involvement in patients with amyotrophic lateral sclerosis (ALS) well before dysarthria or dysphagia occur, and as such might be prognostic of short survival. The purpose of this study was to investigate the prognostic value of a decreased TS, in addition to other prognostic factors, such as site of onset, bulbar symptoms, bulbar signs, age, sex, maximum phonation time, time from symptoms to diagnosis, and gastrostomy, for survival time in patients with ALS. TS was measured in four directions in 111 patients who attended the diagnostic outpatient motor neuron clinic of our university hospital. Of these patients, 54 were diagnosed with ALS. TS was considered abnormal if the strength in minimally one direction was at least two standard deviations below the reference values obtained from comparable age category and sex-groups of healthy controls (n = 119). Twenty of the patients with ALS had a decreased TS. Multivariable analysis showed that, in addition to age, TS was an independent prognostic factor for survival time in patients with ALS.

Age and sex differences in orofacial strength

This study explored age- and sex-related differences in orofacial strength. Healthy adult men (N = 88) and women (N = 83) participated in the study. Strength measures were obtained using the Iowa Oral Performance Instrument (IOPI). Anterior and posterior tongue elevation strength measures were obtained using a standard method. Tongue protrusion and lateralization, cheek compression, and lip compression measures utilized adaptors allowing the participant to exert pressure against the bulb in different orientations. Lip and cheek strength measures were greater for men than women, but tongue strength did not differ between sex groups. Strong correlations between age and strength were not observed. However, group comparisons revealed lower tongue protrusion and lateralization strength in the oldest participants. The oldest participants also exhibited lower anterior and posterior tongue elevation strength relative to the middle-age group. Cheek and lip compression strength demonstrated no age-related differences. The current study supplements and corroborates existing literature that shows that older adults demonstrate lower tongue strength than younger adults. Sex differences were noted such that men demonstrated greater lip and cheek strength but not tongue strength. These data add to the literature on normal orofacial strength, allowing for more informed interpretations of orofacial weakness in persons with dysphagia.

Manometric evaluation of oral function with a hand-held balloon probe

Tongue pressure measured with a disposable hand-held balloon probe has been used for assessing tongue function; however, no diagnostic standard for assessing other oral functions exists currently. In this study, to develop a method for multifactorial manometric evaluation of oral functions, 20 men and 20 women (21-32 years of age) were instructed to apply 7-s maximal voluntary muscular effort on a hand-held balloon probe placed against the anterior and lateral parts of the palate, buccal surface of the molars on the habitual chewing side and labial surface of the anterior teeth for measuring anterior and posterior tongue, cheek and lip pressures (LPs), respectively. Intra-session reproducibility was determined by three repeated measurements, and associations between the obtained and the conventional data on oral diadochokinesis were tested. The men exhibited higher values of all the pressure types. Further, both genders showed a positive correlation between anterior and posterior tongue pressures (PTPs) (P < 0·05), but only the women exhibited positive correlations between anterior tongue and cheek pressures, cheek and PTPs, anterior tongue and LPs, and cheek and LPs (P < 0·05). No statistically significant correlation was found between the pressures and the number of syllabic articulations, except between LP and the number of /pa/ articulations in the women (r = 0·524, P < 0·05). In conclusion, the balloon probe method enables objective manometric evaluation of oral functions and could be an effective tool for clinical epidemiological studies and evidence-based decision-making in nursing care.

Age-related Changes in Tongue Pressure during Swallowing

Although swallowing movement is known to change with aging, age-related differences in the tongue pressure for propelling a bolus from the oral cavity into the pharynx have yet to be investigated in a physiological condition. We hypothesized that tongue pressure during swallowing changed with aging and, using a 0.1-mm-thick sensor sheet with 5 measuring points, measured it while a 15-mL quantity of water was swallowed by young and elderly dentate individuals. Both groups showed a similar order of tongue pressure production at each point. However, the elderly group showed longer duration at each point, lower maximal magnitude in the anterio-median part of the hard palate, and higher magnitude in the circumferential parts of the hard palate than the young group. These results provide the first quantitative evidence of the age-related changes in tongue movement during natural swallowing, which could be attributed to muscle weakening and morphological changes in the oropharynx.

Recent advances in sensing oropharyngeal swallowing function in Japan

Dysphagia (difficulty in swallowing) is an important issue in the elderly because it causes aspiration pneumonia, which is the second largest cause of death in this group. It also causes decline in activities of daily living and quality of life. The oral phase of swallowing has been neglected, despite its importance in the evaluation of dysphagia, because adequate protocols and measuring devices are unavailable. However, recent advances in sensor technology have enabled straightforward, non-invasive measurement of the movement of important swallowing-related organs such as the lips and tongue, as well as the larynx. In this article, we report the present state and possibility of clinical application of such systems developed in Japan.

Rationale for Strength and Skill Goals in Tongue Resistance Training: A Review

Recent evidence in the dysphagia literature shows that tongue resistance training can be used to improve tongue strength. In this review article, we summarize what is known about the tongue and its role in swallowing. We review the literature on tongue pressure generation capacity (strength) and response to tongue resistance exercises. Tongue skill is introduced as a possible alternate goal in tongue resistance training, based on consideration of related literature regarding neural adaptation and improvements in motor performance resulting from treatment approaches in which goal-oriented practice and performance-specific feedback are provided.

Impact of swallowing and ventilation on oropharyngeal cortical representation

Our aim was to determine whether ventilation and swallowing tasks can modify oropharyngeal cortical motor organisation. Mylohyoid motor-evoked potentials (MEP) induced by non-focal (NF) and focal (F) magnetic stimulations were recorded in nine healthy volunteers four times, with 1 week between each recording. Baseline values were evaluated and their reproducibility was assessed 1 week later. Thereafter, the subjects were asked to perform swallowing and ventilation tasks in random order 15 min per day for 1 week. The NF MEP amplitudes after the swallowing and ventilation tasks increased after effortful swallows (p<0.001) and ventilation efforts (p<0.001). The F MEP amplitudes obtained after focal cortical stimulations increased after effortful swallows (p<0.01) and ventilation efforts (p<0.05). The cortical magnitude of the oropharyngeal muscle representation increased after swallowing practice (p<0.01). In conclusion, swallowing and ventilation tasks modified the motor cortex of oropharyngeal muscles and should be evaluated for use in rehabilitation strategies.