Tongue-Strengthening Exercises in Healthy Older Adults: Specificity of Bulb Position and Detraining Effects

Biofeedback and Exercise Load Affect Accuracy of Tongue Strength Exercise Performance

Rehabilitative exercises require precise movement coordination and target accuracy for optimal effectiveness. This paper explores the impact of tongue strength exercises (TSE) performance accuracy on exercise outcomes, adherence, and participant confidence and motivation. An 8-week randomized clinical trial included 84 typically aging participants divided into four groups defined by access to biofeedback (present/absent) and TSE intensity dosing (maximal/submaximal) during a home exercise program (HEP). Retention, training, and HEP accuracy were tracked at biweekly visits and during HEP for participants with access to a biofeedback device. Associations with tongue strength outcomes, participant factors, biofeedback, and intensity dosing were analyzed. Exercise accuracy measures did not contribute to tongue strength outcomes at the end of 8 weeks. Increased training accuracy (less practice required to achieve competency) was associated with higher participant confidence and better adherence to the HEP. The presence of biofeedback was associated with reduced adherence but better retention accuracy, while maximal intensity was associated with improvements in all accuracy measures compared to submaximal intensity exercise. These findings in typically aging participants suggest the need for tailored approaches in swallowing-related exercise programs, given the effects of biofeedback and exercise intensity on motor learning and exercise retention. Accuracy performance and its effect on clinical outcomes warrants study in clinical populations with dysphagia and with various rehabilitative approaches.Trial Registration Clincialtrials.gov: NCT04809558.

Noninstrumental Dysphagia Assessment and Screening: A Proposed Checklist

PURPOSE

In the field of dysphagia research, there is a need to establish a framework for the critical appraisal of methodological reporting. A working group was formed to develop a tool to aid in such critical appraisal across various domains of dysphagia research (called the FRONTIERS [Framework for RigOr aNd Transparency In REseaRch on Swallowing] Framework). The goal of the current paper is to present and describe one domain of this tool: noninstrumental assessment and screening tools.

METHOD

Methods describing the development of the FRONTIERS Framework and the associated tool are detailed in the prologue of this series.

RESULTS

A set of questions specific to the critical appraisal of transparency and rigor of research involving noninstrumental screening and assessment tools was developed. This included 13 "yes/no" questions, each of which is presented with a rationale for its inclusion and an example of its implementation.

CONCLUSIONS

The use of this framework will serve researchers and those appraising the quality of research that uses noninstrumental dysphagia assessment and screening tools. More broadly, the FRONTIERS Framework will facilitate improved rigor and transparency across dysphagia research. Special considerations and future goals are discussed.

Effect of home-based tongue-strengthening exercise using a portable tool on oropharyngeal muscles in older adults with sarcopenic dysphagia: A randomised controlled study

BACKGROUND

Tongue-strengthening exercises may be used at home to strengthen swallowing-related oropharyngeal muscles in community-dwelling older adults with sarcopenic dysphagia; however, evidence of their effectiveness remains unclear.

OBJECTIVE

This study aimed to investigate the effects of a home-based tongue-strengthening exercise (hTSE) using portable tool on swallowing-related oropharyngeal muscles in community-dwelling older adults with sarcopenic dysphagia.

METHODS

Forth community-dwelling older adults with sarcopenic dysphagia were enrolled in the study. The participants were randomly assigned to the experimental and control groups. 1-Repetition Maximum (1-RM) of tongue muscle was measured in the experimental group using the Iowa Oral Performance Instrument, and hTSE was performed using a portable tool with an intensity corresponding to approximately 70%-80% of the range based on the 1-RM value (90 times/day, 5 days/week, for 8 weeks). The control group did not perform any tongue exercises. The primary outcome measures were tongue strength and thickness. The secondary outcome measure was suprahyoid muscle strength (digastric and mylohyoid muscles).

RESULTS

The experimental group showed significantly greater increases in suprahyoid muscle (mylohyoid and digastric) thickness (p = .01 and .011, d = 1.0 and .55), as well as tongue strength and thickness (p < .001 and .029, d = 2.2 and .6) than the control group.

CONCLUSION

This study confirmed that hTSE using a portable tool is effective in increasing swallowing-related oropharyngeal muscle activity in older adults with sarcopenic dysphagia. Therefore, hTSE is recommended as an inexpensive, safe, and easy-to-use therapy for sarcopenic dysphagia in older adults.

Prophylactic Swallowing Therapy During Head-and-Neck Cancer Radiotherapy: Effect of Service-Delivery Mode and Overall Adherence Level on Swallowing Function and Muscle Strength-the PRESTO Trial

Prophylactic swallowing exercises (PSE) during head-and-neck cancer (HNC) (chemo)radiotherapy (CRT) have a positive effect on swallowing function and muscle strength. Adherence rates to PSE are, however, moderate to low, undermining these effects. PRESTO already showed that the service-delivery mode (SDM), the way the exercises are offered, can influence adherence. The aim of this study was to investigate the effect of SDM on swallowing function and muscle strength during and post-CRT. In addition, the effect of overall adherence (OA), independent of SDM, was also investigated. A total of 148 HNC patients, treated with CRT, were randomly assigned to one of the three SDM's (paper-supported, app-supported, or therapist-supported PSE) and performed a 4-week PSE program. OA was calculated based on the percentage of completed exercises. Patients were divided into OA levels: the OA75+ and OA75- group performed respectively ≥ 75 and < 75% of the exercises. Swallowing function based on Mann Assessment of Swallowing Ability-Cancer (MASA-C), tongue and suprahyoid muscle strength during and up to 3 months after CRT were compared between the SDM's and OA levels. Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction was used. No significant differences were found between the three SDMs. Significant time effects were found: MASA-C scores decreased and muscle strength increased significantly during CRT. By the end of CRT, the OA75+ showed significantly better swallowing function compared to OA75-. Muscle strength gain was significantly higher in the OA75+ group. SDM had no impact on swallowing function and muscle strength; however, significant effects were shown for OA level. Performing a high level of exercise repetitions is essential to benefit from PSE.Trial registration ISRCTN, ISRCTN98243550. Registered December 21, 2018-retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search.

A Comparison of Lingual Pressure Generation Measures Using Two Devices in Community-Dwelling, Typically Aging Adults: An Important Clinical Implication

DESIGN

A multisite, prospective, and randomized within-subject design study.

SETTING

Five university settings in varied geographical areas in the United States.

PURPOSE

The purpose of this study was to compare lingual pressure generation using the Tongueometer (TO) and the Iowa Oral Performance Instrument (IOPI) in typically aging, community-dwelling adults during three measurement tasks: maximum isometric pressure (MIP), regular effort saliva swallow (RESS) pressure, and effortful saliva swallow pressure (ESP).

PARTICIPANTS

Eighty-seven typically aging, community-dwelling adults (aged 55 years and over) with no self-reported history of swallowing or neurological disorders were recruited to complete this study.

RESULTS

Strong positive associations were found between the lingual pressure generation measures from the TO and IOPI in all tasks in typically aging adults, with Pearson correlations ranging from r = .780 to .874, p < .001. Agreement between the devices (Lin's concordance correlation coefficient) ranged from moderate for the MIP (ρc = .78) and ESP (ρc = .61) tasks to weak agreement for the RESS task (ρc = .47). MIP, RESS pressure, and ESP were lower when measured by the TO compared with the IOPI, p < .001.

CONCLUSIONS

The TO measures lingual pressure generation similarly to the IOPI but pressures register lower when using the TO than the IOPI in typically aging persons. This supports the need for developing normative values specific to the TO device or development of a valid and reliable conversion formula from TO to IOPI normative values. At this time, the clinical use of reference values from the TO should not be generalized to IOPI normative values.

Flexibility for Intensity Dosing in Lingual Resistance Exercises: A Large Randomized Clinical Trial in Typically Aging Adults as Proof of Principle

OBJECTIVE

The objective of this study was to determine the effect of intensity dosing during tongue exercise on tongue pressure generation, adherence, and perceived effort.

DESIGN

This was a five-site, prospective, randomized clinical trial. Outcome measures were obtained across multiple baselines, biweekly during exercise, and 4-weeks post-intervention.

SETTING

The general community at each study site.

PARTICIPANTS

Typically aging adults between 55-82 years of age with no history of neurological or swallowing disorders. Eighty-four volunteers completed the study.

INTERVENTIONS

Participants were randomly assigned to one of four exercise groups: (a) maximum intensity/no biofeedback, (b) progressive intensity/no biofeedback, (c) maximum intensity/biofeedback, and (d) progressive intensity/biofeedback. Half of the participants completed a maintenance exercise program.

OUTCOME MEASURES

Maximum isometric pressure (MIP), regular effort saliva swallow pressure, adherence, and the Borg Rating of Perceived Exertion Scale.

RESULTS

All exercise protocols were efficacious for gains in MIP (large effect sizes; Cohen's d). Group 3 made gains in regular effort saliva swallow pressure (medium effect size). There was a significant change in perceived exertion for regular effort saliva swallow pressure at 8 weeks. Tongue pressure gains were maintained at 1 month, regardless of maintenance group status. Mean adherence across groups was high.

CONCLUSIONS

All groups improved pressure generation. Intensity dosing differences did not affect strength gains, adherence, or detraining. Regular effort saliva swallow pressure may be most responsive to maximum intensity with biofeedback. The findings suggest flexibility in approach to tongue exercise protocols. Tongue muscles may differ from limb muscles in terms of dose response and neuroplasticity principles.

Effects of tongue strengthening exercises in healthy adults and elderly: an integrative literature review

PURPOSE

To summarize and discuss the scientific literature on the effects of tongue strengthening exercises on healthy adults and elderly people.

RESEARCH STRATEGIES

We searched two online databases, PubMed and Web of Science.

SELECTION CRITERIA

Studies with evidence of interventions in tongues strengthening exercises in healthy individuals over 18 years of age.

DATA ANALYSIS

Study objectives, design, participants, interventions, gain in the percentage of tongue strength.

RESULTS

Sixteen studies were included. There was an increase in tongue strength after strengthening training in healthy adults and elderly people. This strength was maintained after a short period of detraining. We could not compare the results between age groups due to the different methodological designs. We found that the approach of a less intense training protocol was more effective in gaining tongue strength in the elderly.

CONCLUSION

Tongue strength training proved effective in increasing tongue strength in healthy individuals of different age groups. The benefits reported for the elderly corresponded to the reversal of the progressive loss of strength and muscle mass caused by aging. These findings must be interpreted with caution considering the number of studies on the elderly and their methodological variability.

Masticatory Efficiency in Orthodontic Patients with Craniofacial Disorder

This study evaluates the masticatory efficiency in patients with craniofacial disorders (CD) compared to controls (C). A total of 119 participants (7-21 years), divided into CD group (n = 42, mean age 13.45 ± 5.2 years) and C group (n = 77, mean age 14.3 ± 3.27 years) under an orthodontic treatment were included. Masticatory efficiency was assessed using a standard food model test. The masticated food was examined according to its number of particles (n) and area (mm²), wherein a higher number of particles alongside a smaller area was an indication of better masticatory efficiency. Additionally, the influence of cleft formation, chewing side, dentition stage, age and sex were evaluated. Patients with CD chewed the standardized food in fewer particles (n_CD = 61.76 vs. n_C = 84.58), with a significantly higher amount of area than the controls (A_CD = 192.91 mm² vs. A_C = 146.84 mm²; p = 0.04). In conclusion, patients with CD showed a significantly decreased mastication efficiency compared to healthy patients. Factors such as stage of cleft formation, chewing side, dentition stage and age showed an influence on masticatory efficiency, whereas no gender effect on the masticatory efficiency of CD patients was found.

Effects of Tongue-Strengthening Exercise on Tongue Strength Reserve and Detraining Effects among Healthy Adults: A Randomized Controlled Trial

Introduction: Tongue strength reserve is the difference between the maximum isometric pressure (MIP) and swallowing pressure of the tongue. People with decreased tongue strength reserve may have a higher risk of presbyphagia or dysphagia. Thus, this study explored the effects of tongue strengthening exercise (TSE) on tongue strength reserve and detraining effects in healthy adults. Materials and Methods: In total, 102 healthy volunteers without any reported history of speech or swallowing deficits were recruited and assigned to experimental (n = 50) and control groups (n = 52). Exercises in the experimental group consisted of compressing an air-filled bulb between the tongue and hard palate for 30 min a day, 5 days a week, for 8 weeks. Thereafter, the experimental group underwent a 4-week detraining period. Results: Following the TSE training, posterior tongue strength reserve (F = 4.92, p = 0.029) of the experimental group was significantly higher than that of the control group. No significant detraining effects were observed on the MIP and swallowing pressure from 4 weeks after the completion of TSE training. Conclusions: According to the study results, TSE may be an effective approach for improving swallowing function.

Motor Performance and Skill Acquisition in Oral Motor Training With Exergames: A Pilot Study

Objective

To investigate the effects of oral-motor training with exergames on motor performance and motor skill acquisition in two different age groups.

Methods

Thirty-two healthy participants were recruited in the current pilot study and divided equally into two groups (Gen Z and Baby Boomers) according to their age. A pair of electromyographic (EMG) electrodes were placed on the participants’ masseter muscles. The EMG device communicated via Bluetooth with a mobile video game in response to the electromyographic activity of the masseter muscles during clenching. During the experimental session, participants were asked to play a video game in five blocks of 5 min each, with a 3-min break between each time block. The goal of the game was to collect as many coins (game points) as possible and to dodge/avoid upcoming obstacles (game life). Motor performance was assessed by performance scores and the number of game lives. Skill acquisition was measured by task efficiency (ratio of performance scores and number of game lives) across time blocks.

Results

The results of the study showed significantly lower performance scores (p < 0.001), a higher number of game lives (p < 0.001), and lower task efficiency in the Baby Boomer group compared to the Gen Z group. Specifically, the results showed that there was a significant difference in task efficiency between the first and second, third and fourth, fourth- and fifth-time blocks in the Gen Z group (p < 0.002). However, there was only a significant difference between first- and second-time blocks in the Baby Boomer group (p = 1.012), suggesting that skill acquisition in the Baby Boomer group did not change significantly over the course of the time blocks.

Conclusion

The study showed higher motor performance and superior motor skill acquisition with novel exergame training in the Gen Z group compared to the Baby Boomer group. The results of the study indicate that there is an improvement in oral motor skills with short-term training, yet the differences in oral motor skills between the two groups are still evident. The Baby Boomer group, unlike the Gen Z group, did not show robust improvement in task efficiency over the course of the series.

Effect of Progressive Head Extension Swallowing Exercise on Lingual Strength in the Elderly: A Randomized Controlled Trial

Lingual strengthening training can improve the swallowing function in older adults, but the optimal method is unclear. We investigated the effects of a new progressive resistance exercise in the elderly by comparing with a conventional isometric tongue strengthening exercise. Twenty-nine participants were divided into two groups randomly. One group performed forceful swallow of 2 mL of water every 10 s for 20 min, and a total of 120 swallowing tasks per session at 80% angle of maximum head extension. The other group performed five repetitions in 24 sets with a 30 s rest, and the target level was settled at 80% of one repetition maximum using the Iowa Oral Performance Instrument (IOPI). A total of 12 sessions were carried out by both groups over a 4-week period. Blinded measurements (for maximum lingual isometric pressure and peak pressure during swallowing) were obtained using IOPI before exercise and at four weeks in both groups. After four weeks, both groups showed a significant improvement in lingual strength involving both isometric and swallowing tasks. However, there was no significant difference between the groups in strength increase involving both tasks. Regardless of the manner, tongue-strengthening exercises substantially improved lingual pressure in the elderly with equal effect.

Lingual Exercise in Older Veterans With Dysphagia: A Pilot Investigation of Patient Adherence

Purpose Adherence is a concern in dysphagia management. Poor adherence with recommendations can negatively affect treatment efficacy and patient outcomes. For exercise-based therapies, low adherence can alter the dose of exercise delivered to the muscle, which can diminish impact of exercise. It has been established that low adherence is a problem in dysphagia treatments; however, relationships among levels of adherence and outcomes from exercise-based interventions have not been explored. Method In this retrospective pilot study, data were collected from a multicenter clinical demonstration program in the Veterans Affairs hospital system to examine the relationships between patient adherence with a device-facilitated lingual exercise regimen. Outcomes were compared pre- and posttreatment using a paired t test or Wilcoxon matched-pairs signed-ranks test, and relationships among adherence and outcome measures were evaluated using Pearson or Spearman rank correlation coefficients, as appropriate. Results Patient adherence was evenly distributed across participants: Adherence at the front sensor was 59.3% (SD = 28.2), ranging from 5.5% to 95.8%; the back sensor adherence was 55.9% (SD = 29.8), ranging from 1.1% to 97.2%. Maximum isometric pressure (MIP) generation, at both the front and back sensors, was increased from pre- to posttreatment (p < .0001, front; p = .008, back). Functional Oral Intake Scale (FOIS) scores were also significantly improved at the posttreatment time point as compared to baseline (p = .005). However, there were no significant correlations among adherence and outcome measures (front sensor adherence vs. ΔMIP, r = -.161, p = .342; back sensor adherence vs. ΔMIP, r = .002, p = .991; front sensor adherence vs. ΔFOIS, r = -.183, p = .279; back sensor adherence vs. ΔFOIS, r = -.160, p = .399). Conclusions These findings suggest that patient adherence with this lingual exercise program was not related to the increases in lingual pressure generation or improvement in functional oral intake observed in this cohort. These preliminary findings suggest the need for future, prospective, controlled, and randomized clinical trials to further investigate patient adherence with a lingual exercise program and related impacts of adherence on exercise dose and swallowing-related outcomes.

Effects of Effortful Swallowing Exercise with Progressive Anterior Tongue Press Using Iowa Oral Performance Instrument (IOPI) on the Strength of Swallowing-Related Muscles in the Elderly: A Preliminary Study

The purpose of this study was to confirm the effect of effortful swallowing (ES) exercise programs applied to increase the swallowing-related muscle strength in the elderly. In this study, 20 healthy elderly people (76.65 ± 5.87 years; 10 women and 10 men) participated and exercised for 7 weeks. The experimental group performed ES exercise combined with external resistance using Iowa Oral Performance Instrument (IOPI), and the control group performed pure ES without external resistance. The exercises were performed for 20 min a day, 2 days a week for 7 weeks in both groups. ES was repeated 60 times in weeks 1 and 2, 80 times in week 3 and 4, and 120 times in weeks 5-7. In the experimental group, the isometric and swallowing tongue pressures at week 8 were significantly improved compared to baseline. At week 8, the anterior and swallowing tongue pressures and anterior tongue endurance were significantly higher than those of the control group. In the control group, no significant change in tongue pressure-related variables was observed after 7 weeks of exercise. ES exercise combined with IOPI resistance for 7 weeks tended to increase the suprahyoid muscle activation level without statistical significance. For clinical application of this exercise protocol, further studies including more elderly people and patients with dysphagia are required.

Effects of Tongue-Strengthening Self-Exercises in Healthy Older Adults: A Non-Randomized Controlled Trial

Tongue-strengthening exercises (TSE) using a device have been proposed as an intervention for improving tongue strength and endurance. However, devices for TSE have been expensive and difficult to manipulate and are not commonly used in home or clinical settings. This study therefore aimed to investigate whether tongue-strengthening self-exercises (TSsE) using a tongue-strengthening self-exercise tool at home can improve tongue strength in healthy older adults. This study included 27 participants (exercise group, η = 16, 7 men, 9 women, median age 84.5 years; control group, n = 11, 2 men, 9 women, median age 79.0 years). Exercises in the exercise group consisted of pushing the anterior tongue against the hard palate 30 times, 3 times a day, 5 days a week, for 8 weeks using a tongue-strengthening self-exercise tool. This tool is available in five levels of hardness. The most suitable hardness of the tool for each participant was calculated based on 60% of maximum tongue pressure (MTP) during the first 2 weeks of the training period and 80% of MTP for the remainder of the training period, as assessed using a tongue pressure-measuring device. The exercise group showed a significant improvement of 4.1 kPa in MTP (an 11.53% increase) and 4.53 s in endurance of tongue pressure (ETP) (a 99.86% increase). Furthermore, adherence in the exercise group was 99.2%. In conclusion, performing TSsE for 8 weeks was effective for increasing MTP and ETP in healthy older adults. This indicates that TSsE may be useful in older individuals at home to prevent age-related tongue muscle weakness.

Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study

Background

Tongue pressure is an effective index of swallowing function, and it decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue-strengthening therapy on tongue function. Tongue exercises delivered through mobile health (mHealth) technologies have the potential to advance health care in the digital age to be more efficient for people with limited resources, especially older adults.

Objective

The purpose of this study is to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention with biweekly (ie, every 2 weeks) human mediation aimed at improving the swallowing tongue pressure in older adults.

Methods

We developed an mHealth app intervention that was used for 8 weeks (3 times/day, 5 days/week, for a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age 75.7 years) who complained of swallowing difficulties. The app included a swallowing monitoring and intervention protocol with 3 therapy maneuvers: effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation. The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant’s progress and ability to implement the training sessions according to the given protocol. Preintervention and postintervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument. We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12 weeks postintervention.

Results

Of the 11 participants, 8 adhered to the home-based 8-week app therapy program with the optimal intervention dosage. At the main trial end point (ie, 8 weeks) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median 17.5 kPa before the intervention and 26.5 kPa after the intervention; P=.046). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12 weeks postintervention were not observed.

Conclusions

Swallowing tongue pressure is known to be closely related to dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined methods of effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation using mobile app training accompanied by biweekly human mediation in improving swallowing tongue pressure in older adults. The mHealth app is a promising platform that can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size and observe the long-term effects of the intervention program, further studies are warranted.

International Registered Report Identifier (IRRID)

RR2-10.2196/19585

The Effect of Lingual Resistance Training Interventions on Adult Swallow Function: A Systematic Review

Lingual resistance training has been proposed as an intervention to improve decreased tongue pressure strength and endurance in patients with dysphagia. However, little is known about the impact of lingual resistance training on swallow physiology. This systematic review scrutinizes the available evidence regarding the effects of lingual resistance training on swallowing function in studies using Videofluoroscopic Swallowing Studies (VFSS) with adults. Seven articles met the inclusion criteria and underwent detailed review for study quality, data extraction, and planned meta-analysis. Included studies applied this intervention to a stroke and brain injury patient populations or to healthy participants, applied different training protocols, and used a number of outcome measures, making it difficult to generalize results. Lingual resistance training protocols included anterior and posterior tongue strengthening, accuracy training, and effortful press against hard palate with varying treatment durations. VFSS protocols typically included a thin barium stimulus along with one other consistency to evaluate the effects of the intervention. Swallowing measures included swallow safety, efficiency, and temporal measures. Temporal measures significantly improved in one study, while safety improvements showed mixed results across studies. Reported improvements in swallowing efficiency were limited to reductions in thin liquid barium residue in two studies. Overall, the evidence regarding the impact of lingual resistance training for dysphagia is mixed. Meta-analysis was not possible due to differences in methods and outcome measurements across studies. Reporting all aspects of training and details regarding VFSS protocols is crucial for the reproducibility of these interventions. Future investigations should focus on completing robust analyses of swallowing kinematics and function following tongue pressure training to determine efficacy for swallowing function.

Effect of tongue-to-palate resistance training on tongue strength in healthy adults

OBJECTIVE

Tongue strength is crucial for safe and efficient oropharyngeal swallowing. This study examined the effect of tongue-to-palate resistance training (TPRT) on anterior and posterior tongue strength by conducting a prospective, randomized, parallel allocation trial.

METHODS

Ninety-one healthy adults were recruited in this study and were randomly assigned to an experimental group (n = 44) or a control group (n = 47). The experimental group performed TPRT for 8 weeks (5 days per week), whereas the control group performed the usual daily activities. Tongue strength was measured using the Iowa Oral Performance Instrument (IOPI) before and after the practice program was conducted at weeks 2, 4, 6, and 8, to evaluate the feasibility of the developed training protocol.

RESULTS

This experimental group demonstrated more improvements in both anterior tongue strength (p < .05) and posterior tongue strength (p < .05). The positive effects of the intervention on tongue strength appeared at 8 weeks for the anterior region and 2 weeks for the posterior region.

CONCLUSIONS

These findings illustrate that TPRT can improve tongue strength. It is suggested that people integrate this exercise protocol into their daily life, positive change in tongue strength may prevent or halt presbyphagia.

To Play or Not to Play: Can an Instrument Really Impact Lip and Tongue Performance?

(1) Background: Increasing tongue and lip strength may help improve various speech and swallowing disorders, but it is unclear if instrumentalists who use these muscle groups for long periods of time have greater strength and endurance compared to controls. It is also unclear if instrumentalists can more accurately estimate various exercise intensities. The purpose of this study was to determine differences in lip and tongue strength and endurance between instrumentalists and non-instrumentalists (controls). A secondary purpose was to assess differences in ability to estimate various exercise intensities between the two groups. (2) Methods: Instrumentalists and controls’ maximum strength and endurance were measured using the IOPI Pro medical device. In addition, 40%, 60% and 80% of maximum strength were estimated in a randomized order. (3) Results: No significant differences were found between instrumentalists and controls in strength or endurance or the ability to estimate various intensities. Overall, participants were better at estimating tongue strength at moderate intensities and lip strength at higher intensities. (4) Conclusion: Tongue and lip strength and endurance and the ability to estimate exercise intensities are not impacted by years of instrumentalist training compared to healthy controls.

Comparison of the Iowa Oral Performance Instrument and JMS tongue pressure measurement device

Background/purpose

Tongue pressure measurement conveys important information about eating and swallowing function. The Iowa Oral Performance Instrument® (IOPI) and KAY Swallowing Workstation® are internationally used for tongue pressure measurement, but for legal reasons cannot be used in Japan; rather the JMS tongue pressure measurement device® has been approved for use in Japan. However, it is not clear whether measurement obtained with these devices are directly comparable.

Materials and methods

This study investigated the correlation between the maximum tongue pressure data measured by the IOPI and the JMS tongue pressure measurement device in young healthy participants (34 males; 23.2 ± 2.0 years old, and 40 females; 21.4 ± 1.3 years old).

Results

Measurements obtained with these two devices showed significant correlations in the total cohort, and in male and female participants, separately (P < 0.05).

Conclusion

These findings demonstrate that the measurements obtained with the JMS device is comparable to those obtained with the IOPI. In Japan, JMS tongue pressure measurement device is used not only in dysphagia research field, but also geriatrics field, and extensive and detailed investigations has been carried out.

Effect of tongue-strengthening exercises on tongue strength and swallowing-related parameters in chronic radiation-associated dysphagia

BACKGROUND

Radiation-associated dysphagia (RAD) is highly prevalent in head and neck cancer (HNC) patients, with insufficient tongue strength (TS) as a characteristic of this disabling complication. The effects of tongue-strengthening exercises (TSE) on TS, swallowing, and quality of life (QoL) have not been studied in this population.

METHODS

A prospective phase 2 study using an 8 weeks during TSE protocol was carried out in 15 patients with chronic RAD. Outcome parameters were maximal isometric pressure (MIP), TS during swallowing (Pswal), swallowing function, and QoL. All parameters were evaluated at baseline, after 4 and 8 weeks of training, and 4 weeks after the last training session.

RESULTS

MIP increased significantly, without detraining effects. Pswal did not increase significantly, but relevant effect sizes were measured. Swallowing function ameliorated, but did not result in increased functional oral intake, self-reported outcome or QoL.

CONCLUSION

TSE in patients with RAD results in increased strength and swallowing function.

Dose in Exercise-Based Dysphagia Therapies: A Scoping Review

BACKGROUND

Optimal exercise doses for exercise-based approaches to dysphagia treatment are unclear. To address this gap in knowledge, we performed a scoping review to provide a record of doses reported in the literature. A larger goal of this work was to promote detailed consideration of dosing parameters in dysphagia exercise treatments in intervention planning and outcome reporting.

METHODS

We searched PubMed, Scopus[Embase], CINAHL, and Cochrane databases from inception to July 2019, with search terms relating to dysphagia and exercises to treat swallowing impairments. Of the eligible 1906 peer-reviewed articles, 72 met inclusionary criteria by reporting, at minimum, both the frequency and duration of their exercise-based treatments.

RESULTS

Study interventions included tongue exercise (n = 16), Shaker/head lift (n = 13), respiratory muscle strength training (n = 6), combination exercise programs (n = 20), mandibular movement exercises (n = 7), lip muscle training (n = 5), and other programs that did not fit into the categories described above (n = 5). Frequency recommendations varied greatly by exercise type. Duration recommendations ranged from 4 weeks to 1 year. In articles reporting repetitions (n = 66), the range was 1 to 120 reps/day. In articles reporting intensity (n = 59), descriptions included values for force, movement duration, or descriptive verbal cues, such as "as hard as possible." Outcome measures were highly varied across and within specific exercise types.

CONCLUSIONS

We recommend inclusion of at least the frequency, duration, repetition, and intensity components of exercise dose to improve reproducibility, interpretation, and comparison across studies. Further research is required to determine optimal dose ranges for the wide variety of exercise-based dysphagia interventions.

Study protocol for a randomized controlled trial: prophylactic swallowing exercises in head-and-neck cancer patients treated with (chemo)radiotherapy (PRESTO trial)

Background

Dysphagia is a common and serious complication after (chemo)radiotherapy (CRT) for head-and-neck cancer (HNC) patients. Prophylactic swallowing exercises (PSE) can have a significantly positive effect on post-treatment swallowing function. However, low adherence rates are a key issue in undermining this positive effect. This current randomized trial will investigate the effect of adherence-improving measures on patients’ swallowing function, adherence and quality of life (QOL).

Methods

This ongoing trial will explore the difference in adherence and swallowing-related outcome variables during and after PSE in HNC patients performing the same therapy schedule, receiving different delivery methods. One hundred and fifty patients treated in various hospitals will be divided into three groups. Group 1 performs PSE at home, group 2 practices at home with continuous counseling through an app and group 3 receives face-to-face therapy by a speech and language pathologist. The exercises consist of tongue-strengthening exercises and chin-tuck against resistance with effortful swallow. The Iowa Oral Performance Instrument and the Swallowing Exercise Aid are used for practicing. Patients are evaluated before, during and after treatment by means of strength measurements, swallowing and QOL questionnaires.

Discussion

Since low adherence rates undermine the positive impact of PSE on post-treatment swallowing function, there is need to develop an efficient PSE protocol maximizing adherence rates.

Trial registration

ISRCTN, ID: ISRCTN98243550. Registered retrospectively on 21 December 2018.

Comparison of three exercises on increasing tongue strength in healthy young adults

OBJECTIVES

To compare three different exercises for dysphagia to see if they had effects on tongue strength.

DESIGN

Thirty-one healthy volunteers were randomly divided into three groups. One group (G1, n = 10) performed 24 sets of five repetitions with 30 s rest with the target level set at 80 % of one repetition maximum using Iowa Oral Performance Instrument (IOPI) per day. Another group (G2, n = 10) performed exercise which was consisted of forceful swallow of 5 mL of water in a neutral posture every 10 s for 20 min per day. The other group (G3, n = 11) performed 5 mL of water swallowing exercise in chin-down posture every 10 s for 20 min per day. A total of 12 sessions in four weeks were performed in all groups. Blinded lingual strength measures (maximal isometric pressure) were obtained using IOPI before training and at four weeks after training for the three groups.

RESULTS

After four weeks of training, measures of tongue strength were increased significantly in all groups. However, there was no significant difference in strength increment among groups [average increase in strength ± standard deviation (% of initial value): G1, 10.3 ± 10.4 %; G2, 8.7 ± 9.45 %; G3, 9.9 ± 12.6 %, p = 0.825].

CONCLUSIONS

Regardless of the type, tongue strengthening exercises had good effects in improving the swallowing function with equal superiority.

Effects of gum chewing training on oral function in normal adults: Part 1 investigation of perioral muscle pressure

Background/purpose

The strength of the intraoral and extraoral muscles that assist the function of tooth and jaw movement during mastication is important for performing oral function. The aim of this study was to investigate the usefulness of gum chewing training to improve the swallowing and feeding function.

Materials and methods

In experiment 1, the differences in maximum tongue pressure (TP) and cheek pressure (CP) at the measurement time point for both groups with and without training were examined. We instructed subjects to perform gum chewing training 3 times daily for 3 months. TP and CP were measured before training and at 1, 2, and 3 months after starting training. In experiment 2, the changes of TP and CP based on the sex and duration of training were examined. The effect of the training was evaluated before training, at 2 weeks and 1, 2, and 3 months after starting training, and at 1 and 3 months after cessation of training.

Results

Experiment 1 showed TP and CP increased with the progress of continuous training. In experiment 2, TP and CP were higher in men than in women and markedly increased at 2 weeks and 1 month in both sexes. After cessation of training, TP and CP tended to decrease, but there was no significant difference between 3 months after starting training, and also significantly higher than before training.

Conclusion

This study suggested that gum chewing training is a useful to improve the swallowing and feeding function.