Isometric and swallowing tongue strength in healthy adults

Identifying Non-Traditional Approaches to Swallowing Rehabilitation: A Scoping Review

In recent years, dysphagia care has shifted toward a more patient-centered approach. This means that dysphagia clinicians are considering more factors in the treatment process including the goals of care, quality of life, and cultural values. The purpose of this scoping review was to examine relevant research and identify dysphagia interventions outside of those traditionally used by dysphagia clinicians that may improve swallowing function. A review of relevant studies was conducted using search terms related to swallowing and treatment. The search yielded 8439 unique studies. Of the 283 articles that underwent a full-text review, 37 articles were included in the final review. These articles highlighted three potential areas of non-traditional dysphagia intervention that may serve to provide holistic care, while also aiming to improve swallowing mechanisms: acupuncture and Eastern medicine interventions, vocal exercises, and physical function exercises. The results suggest that dysphagia clinicians should work collaboratively with other allied health professionals and consider non-traditional approaches to dysphagia care. Through the identification of potentially effective but non-traditional or non-Eurocentric interventions for dysphagia care, clinicians may promote a culturally relevant, patient-centered approach, in turn increasing patient acceptance of treatment plans and compliance. Future research should explore the efficacy and feasibility of these interventions in dysphagia rehabilitation, as well as their effectiveness compared to more traditional approaches.

Evaluating Anterior and Posterior Oral Tongue Contributions to Pressure Generation: A Comparison Between Regular and Effortful Saliva Swallows

PURPOSE

This study determined the contributions of the anterior and posterior tongue regions in tongue pressure generation during regular saliva swallows (SSs) and effortful swallows (ESs) completed under two different instructions. The association between tongue pressure and perceived effort to swallow was also examined.

METHOD

Forty healthy adults without swallowing disorders participated in this study, divided into two age groups: 20 younger (Mage = 21.95 years, SD = 4.43) and 20 older (Mage = 70.10 years, SD = 4.30). Simultaneous data acquisition involved submental surface electromyography, tongue manometry, and a visual analog scale across swallowing conditions (SS, ES with tongue emphasis, and ES with pharyngeal squeezing). The main outcome measures were tongue pressure during swallowing and perceived effort to swallow.

RESULTS

Overall tongue pressure during ESs with tongue emphasis and with pharyngeal squeezing was greater than that during SSs (R2 = .78, p < .001). Moreover, tongue pressure during the ES with tongue emphasis was greater than that during the ES with pharyngeal squeezing (t = 25.63, p < .001). The posterior tongue region generated more pressure during SSs (R2 = .64, p < .001) and the ES with tongue emphasis (R2 = .55, p < .001) than the anterior tongue. Finally, a positive correlation was found between perceived effort and tongue pressure during swallowing (r = .75, 95% CI [0.72, 0.77]).

CONCLUSIONS

Tongue pressure generation was affected by the type of instruction used to elicit ESs, and the posterior tongue showed relatively greater pressure contributions than the anterior tongue for ESs with tongue emphasis and SSs. Furthermore, age-related declines in pressure generation during swallowing were not evidenced in this study, underscoring the ability of healthy older individuals to appropriately modulate lingual pressure during ESs. Last, our results showed that the visual analog scale is a simple tool for rating swallowing effort during ESs, supporting its potential clinical use to train ESs.

Isometric tongue endurance and incomplete laryngeal vestibule closure in Parkinson's disease

BACKGROUND

Dysphagia is a common symptom of Parkinson's disease (PD). A delay in laryngeal vestibule closure (LVC) and a reduction in tongue pressure, may affect swallowing safety and increase the risk of pulmonary aspiration.

OBJECTIVE

To verify the relationship between tongue pressure and airway protection in PD patients: (1) comparing tongue pressure measures and physiological events in the pharyngeal phase of swallowing between PD and controls and (2) analysing the association between tongue pressure and LVC in the PD group.

METHODS

Twenty-three patients with idiopathic PD (64.9 years) and 24 healthy controls (64.1 years) participated in this study. All participants underwent the following procedures to verify tongue pressure measurements using the Iowa Oral Performance Instrument: maximum anterior and posterior pressure, isotonic and isometric tongue endurance and anterior and posterior tongue pressure during saliva swallowing. To verify swallowing safety, videofluoroscopic swallowing studies focusing on the pharyngeal phase were performed based on the MBSImP protocol.

RESULTS

Compared to healthy controls, PD exhibited a statistically significant decline in tongue pressure tasks: posterior maximum pressure, isotonic endurance, anterior and posterior isometric endurance and tongue pressure during posterior swallowing. Patients with PD had worse pharyngeal scores, including LVC scores, than controls. PD and incomplete LVC had lower anterior isometric endurance scores when compared to those with complete LVC.

CONCLUSION

PD with incomplete LVC scored lower in the anterior isometric endurance task. We observed a potential clinical use of this task for the assessment and management of dysphagia in patients with PD.

Effects of Age and Lingual-Palatal Pressure Levels on Submental Surface Electromyography Measures

Submental surface electromyography (sEMG) may provide information about the lingual-palatal pressure (LPP) during swallowing. However, the extent to which changes in age and LPP levels are reflected in different sEMG measures is unclear. This study aimed to understand the effects of age and different levels of submaximal LPPs on submental sEMG peak, average, and integrated values in healthy adults. Ninety community-dwelling healthy participants were categorized into three age groups (young: 20-39 years, middle age: 40-59 years, older: 60 ≥ years). sEMG and LPP measurements were collected concurrently. After placing the sEMG electrodes, the maximal isometric LPP was established using the Iowa oral performance instrument (IOPI) on the anterior tongue. sEMG recordings were conducted for three submaximal LPP levels, including 40%, 60%, and 80% of the maximum LPP. Two-way repeated measure ANOVAs were conducted to find the effects of age and varying LPP levels on mean sEMG peak, average, and integrated measures. A significant age by LPP level interaction was identified for sEMG peak [F (4, 172) = 4.116, p < 0.007, ηp2 = 0.087], sEMG average [F (4, 170) = 5.049, p < 0.001, ηp2 = 0.106], and sEMG integrated values [F (4, 170) = 4.179, p < 0.003, ηp2 = 0.090]. Post hoc testing demonstrated that, in general, sEMG values significantly increased with rising LPP levels, primarily for younger and middle-aged adults. Furthermore, at 80% of maximum LPP, older adults generated less sEMG average and integrated values than middle age (only significant for sEMG integrated value) and younger adults. Likewise, max LPP was lower in older adults compared with young and middle-aged groups. Submental sEMG has the potential to be incorporated into a skill-based lingual exercise paradigm to improve tongue function during swallowing. Moreover, submental sEMG can characterize some age-related subclinical changes in swallowing.

Tongue strength and endurance among typically developing children and children with idiopathic speech sound disorders in the United Arab Emirates

BACKGROUND

Tongue strength and endurance in adults have been extensively studied, but data on these parameters in young children remain largely unavailable.

AIMS

This study aimed to collect normative objective tongue strength and endurance data from a pediatric population in the United Arab Emirates (UAE) and to examine the effects of age and sex on these parameters.

METHODS

This normative study included a total of 65 typically developing (TD; n = 36) children and children with idiopathic speech sound disorders (ISSDs; n = 29). The participants were assigned to four age groups (range: 3-8 years) and stratified by sex. Data on their tongue strength and endurance were collected using the Iowa Oral Performance Instrument.

RESULTS

Tongue strength scores and endurance time increased with age in both the TD and ISSD groups. Sex had no statistically significant effects on tongue strength or endurance in either group. Furthermore, tongue strength and endurance time scores were higher in the TD group than in the ISSD group.

CONCLUSIONS

The data obtained in this study would add important normative data to the database of standardized measurements for maximal strength and endurance scores in the pediatric population of the UAE. Future research is encouraged to collect additional data that can help healthcare professionals objectively evaluate children with feeding, swallowing, and speech sound production difficulties.

Combined conventional speech therapy and functional electrical stimulation in acute stroke patients with dyphagia: a randomized controlled trial

BACKGROUND

Stroke is the main cause of oropharyngeal neurogenic dysphagia. Electrostimulation has been used as a therapeutic tool in these cases. However, there are few studies that prove its effectiveness. We evaluated the effect of functional electrostimulation as a complement to conventional speech therapy in patients with dysphagia after a stroke in a stroke unit.

METHODS

We performed a clinical, randomized, and controlled trial divided into intervention group (IG) (n = 16) and control group (CG) (n = 17). All patients were treated with conventional speech therapy, and the IG also was submitted to the functional electrotherapy. Primary outcomes were Functional Oral Ingestion Scale (FOIS) and Swallowing videoendoscopy (FEES). The degree of dysphagia was scored in functional, mild, moderate and severe dysphagia according to FEES procedure. Dysphagia Risk Evaluation Protocol (DREP) was considered a secondary outcome.

RESULTS

There was a significant difference regarding FOIS scores after 5 days of intervention in groups. Both groups also showed a tendency to improve dysphagia levels measured by FEES, although not statistically significant. Improvements on oral feeding was seen in both groups. No significant differences between groups before and after the intervention were detected by DREP scores. Electrical stimulation did not show additional benefits beyond conventional therapy when comparing outcomes between groups.

CONCLUSION

Conventional speech therapy improved oral ingestion even regardless the use of electrostimulation in a stroke unit.

TRIAL REGISTRATION

This research was registered in ClinicalTrials.gov (Identifier: NCT03649295 ) in 28/08/2018 and in the Brazilian Registry of Clinical Trials (ReBEC) (Register Number: RBR-56QK5J), approval date: 18/12/2018. HGF Ethics Committee Approval Number: N. 2.388.931.

Effects of tongue strengthening exercises on tongue muscle strength: a systematic review and meta-analysis of randomized controlled trials

Tongue strengthening exercise (TSE) has been proposed as an intervention to increase tongue strength and improve swallowing. However, clinical evidence of its effectiveness is lacking. In this review, seven databases were searched from inception to September 30, 2021 for randomized controlled trials that compared tongue strengths between the TSE intervention and control groups, obtained from maximal tongue elevation peak force in kilopascals (kPa). The Cochrane risk of bias tool was used for quality assessment. In total, 12 studies with 388 participants were included. The pooled meta-analysis demonstrated that the anterior tongue strength (ATS) (MD = 5.34 kPa; 95% CI 3.28–7.40; I² = 71%) and posterior tongue strength (MD = 8.12; 95% CI 3.45–12.79; I² = 90%) were significantly higher in the TSE intervention than that in the control group. Among healthy participants, subgroup analysis showed that TSE had improvements on ATS in all age groups, with the greatest improvement in old people (≥ 65 years) (MD = 8.01; 95% CI 4.39–11.64; I² = 30%). Meta-regression analysis revealed a nonsignificant trend toward greater improvement on tongue strength with increasing TSE duration. This study provides positive evidence that TSE may be beneficial in improving tongue strength and could be applied for adults, especially healthy older adults.

Age-Related Functional Reserve Decline Is Not Seen in Pharyngeal Swallowing Pressures

Purpose Functional reserve represents the difference between an individual's ability to produce a maximum output function and the ability to perform a functional task. Several studies have documented an age-related decrease in functional reserve with oral tongue pressure generation. Whether this pattern is seen in pharyngeal swallowing pressures is unknown. The aim of this study was to investigate pharyngeal functional reserve using high-resolution manometry during normal-effort and effortful swallows. Method Pharyngeal high-resolution manometry was performed on 38 younger healthy individuals (≤ 40 years) and 18 older healthy individuals (≥ 60 years) during normal-effort and effortful water swallows. Pressure metrics included maximum pressure in the velopharynx, tongue base, and hypopharynx, as well as pharyngeal contractile integral and minimum pressure in the upper esophageal sphincter (UES). Repeated-measures analysis of variance was used to determine the effects of swallow task, age, and pharyngeal region on pressure generation. Results Maximum pharyngeal pressures and pharyngeal contractile integral were significantly increased during the effortful swallows compared to normal-effort swallows (p < .001), but there were no interactions between task and age in pharyngeal pressures. In the UES, minimum pressures were significantly elevated in older individuals during effortful swallows compared to normal-effort swallows (p = .007) but did not follow a pattern consistent with reduced functional reserve. Conclusions Healthy individuals increase pharyngeal driving pressures during effortful swallows, without an age-related reduction in the magnitude of pressure increase. Thus, this study did not find evidence for an age-related reduction in pharyngeal functional reserve. The preserved ability to increase pharyngeal pressures during effortful swallowing in aging may support the use of behavioral swallowing interventions in older individuals without neuromuscular conditions. Supplemental Material https://doi.org/10.23641/asha.16606709.

Tongue and Lip Comparisons between Healthy and Nondysphagic Poststroke Individuals

BACKGROUND

The lips and tongue play a substantial role in efficient clearance of food from the mouth and pharynx into the esophagus. No study has compared oral pressures between healthy individuals and poststoke individuals who report functional swallow abilities.

AIM

The current study aimed to investigate the presence of differences in oral pressures between healthy individuals and poststroke individuals who report functional swallowing abilities.

DESIGN

This is a controlled matched pair study.

POPULATION

Eighteen control participants (CG) and 18 nondysphagic poststroke participants (NDSG) were enrolled into this study.

METHODS

The Iowa Oral Performance Instrument (IOPI) was used to measure and compare tongue strength, endurance, and functional lingual and labial pressures between sex and age-matched pairs.

RESULTS

Six paired, two-tailed t tests revealed that tongue and lip pressures were different between the 2 groups. Maximum anterior tongue pressures and posterior tongue pressures were also different, i.e., t(17) = -2.89 (p = 0.010) and t(17) = -2.85 (p = 0.011), with the CG presenting higher pressures. Right lip pressures were significantly lower in the NDSG compared to the CG, i.e., t(17) = 2.45 (p = 0.0001). Left lip pressures were significantly lower in the NDSG compared to the CG, i.e., t(17) = -5.43 (p = 0.0001). Tongue endurance, i.e., t(17) = 0.092 (p = 0.928) and saliva swallow pressures, i.e., t(17) = -0.490 (p = 0.63) were not different.

CONCLUSION

Although poststroke participants reported functional swallowing abilities, there were differences in tongue and lip pressures but not in endurance or saliva swallow pressures.

CLINICAL REHABILITATION IMPACT

Poststroke individuals without complaints of dysphagia who are not assessed may experience subclinical dysphagia that could negatively impact their nutrition and quality of life.

Age and Sex-Related Differences in the Tongue Pressure Generated during Maximum Isometric and Swallowing Tasks by Healthy Chinese Adults

The aims of this prospective observational study were to investigate age, sex, and factors related to the tongue pressure generated. A correlational research design was used. A total of 150 Chinese people who had a normal swallowing condition were enrolled by convenience sampling. Pressure was measured for each participant during maximum isometric press tasks, as well as for saliva and water swallows (5 mL) at the anterior and posterior tongue. The results illustrated that age has an impact on anterior tongue pressure (r = −0.22), posterior tongue pressure (r = −0.26); however, it does not have an impact on the swallowing pressure (SP) of the tongue. Sex differences were noted; males demonstrated a greater strength of the anterior tongue. There was a significant correlation between BMI and the maximum isometric pressure of the anterior tongue (MIP_ant). The pressures between anterior and posterior tongue were not significantly different in the maximum isometric or swallowing tasks. There were significant differences among the maximum isometric pressure (MIP), saliva swallowing pressure, and water swallowing pressure. The MIP generated was greater than the pressure in the swallowing tasks for the younger groups of both sexes. The study supplement the exploration of age-and-sex related differences and the interaction of sex and age in tongue pressure.

Effect of Volitional Effort on Submental Surface Electromyographic Activity During Healthy Swallowing

The effortful swallowing technique aims to compensate for or rehabilitate impaired swallowing by using maximal volitional effort to behaviorally modify aspects of swallowing physiology. Given that swallowing is a submaximal task, swallowing at submaximal levels has recently been suggested as a more task-specific therapeutic technique. The aim of this study was to investigate differences in muscle activity during minimum, regular, and maximum effort swallowing of different boluses and across different ages, with the goal of characterizing the task specificity of minimum effort and maximum effort swallowing. Forty-three healthy adults (22 female) representing four age groups (20-39, 40-59, 60-79, and 80 + years) participated in the study. They were verbally cued to swallow saliva and 5 mL water boluses using participant-determined minimum, regular, and maximum levels of effort, in randomized order. sEMG peak amplitude and duration of each swallow were measured. Linear mixed effects analyses demonstrated that compared to regular effort swallowing, maximum effort swallowing resulted in increased sEMG amplitude (p < .001) and prolonged duration (p < .001), while minimum effort swallowing resulted in decreased amplitude (p < .001) but no significant difference in duration (p = .06). These effects occurred regardless of age or bolus type. Differences in sEMG activity were smaller between regular and minimum effort swallowing than regular and maximum effort swallowing. Both increasing and decreasing volitional efforts during swallowing translate to significant modulation of muscle activity. However, regular swallowing is more similar to minimal effort swallowing. Results reinforce the concept of swallowing as a submaximal task, and provide insight into the development of sEMG biofeedback techniques for rehabilitation.

Relationship between Maximum Tongue Pressure Value and Age, Occlusal Status, or Body Mass Index among the Community-Dwelling Elderly

Background and objectives: In an aging society, the maintenance of the oral function of the elderly is of importance for the delay or prevention of frailty and long-term care. In the present study, we focused on the maximum tongue pressure (MTP) value and analyzed the relationship between MTP and age, occlusal status, or body mass index (BMI). Materials and Methods: This one-center observatory study was conducted using a cohort consisting of 205 community-dwelling outpatients over 65 years old. The MTP values of all subjects were measured using a commercially available tongue pressure measurement device and statistically analyzed. In addition, the correlation between MTP value and BMI was analyzed. Results: The MTP value decreased with age, especially in subjects classified as Eichner B and C. The difference in occlusal status did not show any statistically significant influence on MTP value. The correlation between BMI and MTP value was indicated in the tested groups other than an age of 65–74 and Eichner A groups. Conclusions: Although MTP value decreased with age, the difference in occlusal status did not have an impact on MTP value. The correlation between BMI and MTP value was not shown in the youngest group or a group with sufficient occlusal units. The results presented in the present study may imply that, even if MTP is low, younger age and/or better occlusal status compensate for the inferior MTP value in the cohort studied.

Association Among Age-Related Tongue Muscle Abnormality, Tongue Pressure, and Presbyphagia: A 3D MRI Study

Muscle aging such as sarcopenia adversely affects motor activities. However, few studies have elucidated the aging physiological mechanism of tongue concerted with the changes muscle composition. The present study aimed to examine the tongue composition changes to detect the effect of tongue fat mass on tongue pressure and swallowing function with aging. Twenty community-dwelling elderly without head and neck cancer, stroke, or neuromuscular disease and 20 healthy young were included. Tongue volume, tongue fat mass, tongue lean muscle mass, and tongue fat percentage were evaluated with 3D magnetic resonance imaging (MRI) and Dixon MRI. Tongue pressure was also measured. Swallowing function among elderly individuals was assessed via videofluorography, which was evaluated using the penetration-aspiration scale (PAS) and normalized residue ratio scale (NRRS). Tongue fat mass and tongue fat percentage significantly increased with aging. The tongue fat percentage of elderly participants was 20%, which was two times greater than that of young participants. No significant difference was observed in tongue volume and tongue lean muscle mass. A significantly negative correlation was observed between tongue fat mass and tongue fat percentage as well as tongue pressure. Conversely, tongue volume was not significantly correlated with tongue pressure. Tongue muscle composition exhibited no effect in the PAS and NRRS. Increase of fat mass is a major change in tongue composition with aging, which is associated with low tongue pressure. Thus, attention must be paid not only to tongue quantity but also to the quality of tongue muscles.

Systematic Effortful Swallowing Exercise Without External Resistance Does Not Increase Swallowing-Related Muscle Strength in the Elderly

Effortful swallow (ES) is a maneuver intended to increase pressure on a bolus by swallowing and pushing with sufficient force to facilitate clearance. Although ES is mainly known for its immediate effects, the long-term effects of applying ES as an exercise program remain unclear. This study investigated the effects of a 7-week systematic ES exercise regime on swallowing-related muscle strength in individuals aged 65 years and over. In total, 30 healthy older adults participated in this study (16 women and 14 men, aged 67-90 years). The subjects participated in the exercise program for 20 min a day, twice a week, for 7 weeks. To gradually increase exercise intensity, the number of exercises per session was increased from the initial 60 repetitions (weeks 1-2) to 120 repetitions (weeks 5-7). To measure the effect of the strengthening exercise program, the activation level of suprahyoid muscles was measured using surface electromyography, and a tongue pressure measurement system was used to measure variables related to tongue strength (isometric tongue pressure, swallowing tongue pressure, and tongue endurance). Although the effect of ES exercise on muscle strength through gradual adjustment of exercise frequency was not confirmed, ES remains valuable as an exercise for strengthening the muscles involved in swallowing. Future studies are warranted to determine the effects of ES exercise after adjusting for other variables of exercise intensity.

Swallowing Pressure Variability as a Function of Pharyngeal Region, Bolus Volume, Age, and Sex

OBJECTIVES

Within-individual movement variability occurs in most motor domains. However, it is unknown how pharyngeal swallowing pressure varies in healthy individuals. We hypothesized that: 1) variability would differ among pharyngeal regions; 2) variability would decrease with increased bolus volume; 3) variability would increase with age; and 4) there would be no sex differences.

STUDY DESIGN

Case series.

METHODS

We used pharyngeal high-resolution manometry to measure swallowing pressure in the following regions: velopharynx, tongue base, hypopharynx, and upper esophageal sphincter. Data were collected from 97 healthy adults (41 male) aged 21 to 89 years during thin liquid swallows: 2 mL, 10 mL, and participant-selected comfortable volume. Pressure variability was measured using coefficient of variation. Repeated measures analysis of variance was used to assess impacts of region, bolus volume, age, and sex on pressure variability.

RESULTS

There was a significant region × volume interaction (P < .001) and significant main effect of age (P = .005). Pressures in the hypopharynx region were more variable than all other regions (P ≤ .028), and pressures in the tongue base region were less variable than all other regions (P ≤ .002) except at 2 mL volumes (P = .065). Swallowing pressure variability was significantly different in the velopharynx and upper esophageal sphincter regions, with comfortable volume and 2 mL swallows having greater variability than 10 mL swallows (P ≤ .026). Pressure variability significantly increased with increasing age (P = .002). There were no effects of sex on pressure variability (P ≥ .15).

CONCLUSION

Pharyngeal swallowing pressure variability differs according pharyngeal region, volume, and age but not sex. Abnormal swallowing pressure variability may reflect deviations in motor control in persons with swallowing impairment, and results from this study can be used as normative data for future investigations evaluating swallowing pressure generation.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E52-E58, 2021.

Presbyphagia Diagnostics Using M-Mode Ultrasound: Changes in the Tongue Movement Pattern

Age-related physiological changes of the swallowing act impair particularly the oral phase and the tongue function, which is very important for bolus preparation and transfer. At present, there are no easily applicable methods for measurement of this phase of swallowing. This study was designed to investigate the deglutitive tongue movement by M-mode ultrasound and to compare the collected parameters of different age groups. In this exploratory prospective study, the tongue and its movements of 20 younger and 30 older women were examined during swallowing by B-mode and M-mode ultrasound. Preexisting dysphagia or malnutrition as well as psychic or neurological deficits were excluded by clinical examination and screening with the Mini Nutritional Assessment-Short Form (MNA-SF), the Gugging Swallowing Screen (GUSS), the Mini-Mental State Examination (MMSE) and the Barthel Index. The data were compared with each other and statistically analyzed. With increasing age, a change in the tongue movement pattern becomes apparent. In the group of older women, the vertical lingual movement had a smaller amplitude (p < 0.001) and a shorter time to the maximum amplitude (p < 0.03) than in the group of younger women. However, there were no differences in the tongue diameter (p > 0.4). The tongue movement pattern appears to be subject to age-specific changes, in contrast to anatomy. The use of M-mode ultrasonography is an easy, radiation-free and cost-effective method for the assessment of the oral phase of swallowing. Limitations are the widely scattered values of the ultrasound findings. Further studies are needed for validation and definition of standard values for this promising method.

Differences in maximal strength and endurance of the tongue according to region in healthy adults

[Purpose] The purpose of this study was to identify differences in maximal strength and endurance of the tongue among healthy adults. [Subjects and Methods] A total of 60 healthy volunteers (30 men; 30 women; age range, 20–26 years) were recruited and evaluated for maximal strength and endurance of the anterior and posterior regions of the tongue using the Iowa Oral Performance Instrument. [Results] Tongue strength in the anterior region was greater than that in the posterior region. In contrast, tongue endurance in the posterior region was greater than that in the anterior region. [Conclusion] In conclusion, these results confirm that the anterior region of the tongue exhibits greater strength, whereas the posterior region exhibits greater endurance.

Feasibility of tongue strength measurements during (chemo)radiotherapy in head and neck cancer patients

PURPOSE

The aim of this study was to investigate the feasibility of tongue strength measures (TSMs) and the influence of bulb location, sex, and self-perceived pain and mucositis in head and neck cancer (HNC) patients during chemoradiotherapy (CRT).

METHODS

Twenty-six newly diagnosed HNC patients treated with CRT performed anterior and posterior maximal isometric tongue pressures by means of the Iowa Oral Performance Instrument (IOPI). The Oral Mucositis Weekly Questionnaire (OMWQ) and a Visual Analogue Scale (VAS) for pain during swallowing were completed weekly from baseline to 1 week post CRT.

RESULTS

Feasibility of TSMs during CRT declines significantly from 96 to 100% at baseline to 46% after 6 weeks of CRT. But post-hoc analyses reveal only significant differences in feasibility between baseline and measurements after 4 weeks of treatment. No effect of gender or bulb location was established, but feasibility is influenced by pain and mucositis.

CONCLUSIONS

Feasibility of TSMs declines during CRT and is influenced by mucositis and pain. For the majority of subjects, TSMs were feasible within the first 4 weeks, which provides a window of scientific and clinical opportunities in this patient population.

European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.

European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.

A Study of Healthy Adults' Oro-lingual Effort During Swallowing Using OroPress, A New Portable Wireless Measurement Tool

OroPress is a new, low profile, portable, wireless tool that enables stable measurement of tongue pressure during isometric ('pushing') tasks and, more importantly, during swallowing. Using this tool, a pressure-time product, the OroPress Absolute (OPA) parameter, has been developed as a representative measure of lingual effort during swallowing. In a sample of 57 adults aged 20-80+ years, of both sexes and without dysphagia, tongue-palate contact pressures generated while swallowing 5 ml, 10 ml of water and 5 ml custard, were recorded using OroPress. Data were examined for effects of gender, age and bolus condition (consistency, volume). OPA was tested for stability of measure and then correlated with the criterion standard, peak pressure recorded when swallowing (PMax(SW)). Swallowing pressures (PMax(SW), OPA) were positively correlated with bolus viscosity. No significant age and gender differences were found. Excellent stability of measure (test, re-test reliability) was demonstrated and OPA was positively correlated with PMax(SW). OroPress produces valid, reliable and reproducible measurements and improved accuracy of oro-lingual pressure measurement during swallowing. With such a tool, interventions/therapy can be proactive and principled as outcomes are better validated. To enhance specificity of intervention, measurement parameters need to reflect the pressure and temporal qualities of swallow function. OPA has the potential to describe differences in effort made, and ability to sustain pressures, in adults without dysphagia. The results of these studies will enable more accurate examination of the oral phase of swallowing as we establish this highly accurate sensor as a criterion standard for oro-lingual pressure measurement in clinical populations.

Effects of aging on evoked retrusive tongue actions

OBJECTIVE

Tongue strength, timing, and coordination deficits may underlie age-related swallowing function. Retrusive tongue actions are likely important in retrograde bolus transport. However, age-related changes in retrusive tongue muscle contractile properties have not been identified in animal studies. Because previous studies employed whole hypoglossal nerve stimulation that activated both protrusive and retrusive tongue muscles, co-contraction may have masked retrusive muscle force decrements. The hypotheses of this study were: (1) retrusive tongue muscle contraction forces would be diminished and temporal characteristics prolonged in old rats when lateral nerves were selectively activated, and (2) greater muscle contractile forces with selective lateral branch stimulation would be found relative to whole hypoglossal nerve stimulation.

DESIGN

Nineteen Fischer 344/Brown Norway rats (9 old, 10 young adult) underwent tongue muscle contractile property recording elicited by: (1) bilateral whole hypoglossal nerve stimulation, and (2) selective lateral branch stimulation. Twitch contraction time (CT), half-decay time, maximal twitch and tetanic forces, and a fatigue index were measured.

RESULTS

For whole nerve stimulation, CT was significantly longer in the old group. No significant age group differences were found with selective lateral nerve stimulation. Significantly reduced twitch forces (old group only), increased tetanic forces and significantly less fatigue were found with selective lateral nerve stimulation than with whole hypoglossal stimulation.

CONCLUSIONS

Retrusive tongue forces are not impaired in old rats. Deficits observed in swallowing with aging may be due to other factors such as inadequate bolus propulsive forces, mediated by protrusive tongue muscles, or timing/coordination of muscle actions.