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Mir MJ, Childers JT, Wheeler-Hegland K. Cough Correlates of Functional Swallow Outcomes in Atypical Parkinsonism. Mov Disord Clin Pract 2024; 11:265-275. [PMID: 38229245 DOI: 10.1002/mdc3.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Swallow and cough impairments lead to aspiration and reduced clearance of aspirate material. Both behaviors are impaired in Parkinson's disease, but it is unknown whether a similar relationship of dysfunction exists in forms of atypical Parkinsonism (APD). Elucidating this association in APD may lead to early, comprehensive airway protection treatment. OBJECTIVES We tested the hypotheses that swallow deficits in APD are associated with impaired cough and that airway protective dysfunction is associated with longer disease duration. METHODS Swallowing difficulty was described by 11 participants with APD. Penetration-Aspiration Scale (PAS) and DIGEST scores for thin liquid trials were extracted from medical records of videofluoroscopic swallow study reports. Voluntary and capsaicin induced-reflex cough measures of flow, volume, and timing were analyzed. RESULTS While most participants did not have post-swallow residue, ~80% received abnormal PAS scores and reported swallowing difficulty. Those with abnormal PAS scores had lower voluntary cough expired volume (P = 0.037; mean rank difference = 5.0); lower reflex inspiratory flow rate (P = 0.034; mean rank difference = 5.5); and longer reflex expiratory flow rise time (P = 0.034; mean rank difference = 5.5). Higher PAS scores and reduced reflex cough volume acceleration were significantly correlated (r = -0.63; P = 0.04) and longer disease duration predicted larger voluntary cough expired volume (R2 = 0.72) and longer flow rise times (R2 = 0.47). CONCLUSIONS As swallow safety worsens, so might the ability to clear the airways with effective cough in in APD; particularly with longer disease duration. Assessing cough in conjunction with swallowing is important for informing airway protection treatment plans in APD.
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Affiliation(s)
- Michela J Mir
- Breathing Research and Therapeutics Center, Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
- Brooks Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida, USA
| | - Justin T Childers
- College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Karen Wheeler-Hegland
- Norman Fixel Institute for Neurological Diseases, UF Health, Gainesville, Florida, USA
- Upper Airway Dysfunction Lab, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, USA
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Fujita H, Ogaki K, Shiina T, Sakuramoto H, Nozawa N, Suzuki K. Impact of autonomic symptoms on the clinical course of Parkinson's disease. Neurol Sci 2024:10.1007/s10072-024-07422-x. [PMID: 38400889 DOI: 10.1007/s10072-024-07422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Patients with Parkinson's disease (PD) exhibit various degrees of autonomic symptoms, which may be associated with Lewy body pathology distributed extensively in the autonomic nervous system. We hypothesized that the severity of autonomic symptoms reflects the severity of PD-related pathology, resulting in poor outcomes. The purpose of this study was to evaluate the impact of autonomic symptoms on PD progression. METHODS We conducted a follow-up study among consecutive patients with PD at Dokkyo Medical University Hospital. Patients underwent comprehensive baseline evaluations and were classified into high and low autonomic symptom groups using the Scale for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT). The Kaplan‒Meier survival curves were used to analyze the time to discontinuation of their visits because of PD-related endpoints and to evaluate the association with high SCOPA-AUT scores. RESULTS Of the 101 patients, 74 (73%) met the inclusion criteria. During the follow-up period (mean 1654 days), 22/74 patients reached PD-related endpoints (death, 4; hospitalization, 9; nursing home institutionalization, 9). PD patients with high SCOPA-AUT scores reached the endpoints faster than those with low SCOPA-AUT scores. A high SCOPA-AUT score, including gastrointestinal, urinary, and thermoregulation domains; high motor symptom scores; and low specific binding ratios (SBRs) on 123I FP-CIT-SPECT (DAT-SPECT) were associated with reaching PD-related endpoints. A high SCOPA-AUT score was associated with reaching the endpoints even after adjustment for covariates. CONCLUSIONS Patients with high autonomic symptom scores had a greater risk of reaching PD-related endpoints than patients with low autonomic symptom scores.
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Affiliation(s)
- Hiroaki Fujita
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Keitaro Ogaki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Tomohiko Shiina
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Hirotaka Sakuramoto
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Narihiro Nozawa
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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Fukuoka T, Hori K, Ono T. Quantitative evaluation of swallowing function in Parkinson's disease using tongue pressure measurement: a mini-review. Front Neurol 2024; 15:1355627. [PMID: 38414553 PMCID: PMC10897025 DOI: 10.3389/fneur.2024.1355627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024] Open
Abstract
Dysphagia is a common symptom of Parkinson's disease (PD) associated with aspiration pneumonia, choking, malnutrition, and a decreased quality of life, and is a leading cause of death among patients with PD. Tongue dysfunction in patients with PD affects the oral phase of swallowing, including the formation and propulsion of a bolus into the pharynx. Assessing tongue pressure, generated between the tongue and palate, is a method that quantitatively measures tongue function and is related to dysphagia in PD. Two assessment methods are used to measure tongue pressure: tongue strength and tongue pressure during swallowing. Previous studies measuring tongue pressure in PD have reported decreased tongue strength and pressure during swallowing, as well as a prolonged tongue pressure rise time, which are symptoms associated with PD severity and dysphagia. In this mini-review, we present a method for measuring tongue pressure and discuss its relationship with dysphagia in PD. We also describe limitations and future perspectives in tongue pressure measurement research.
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Affiliation(s)
- Tatsuyuki Fukuoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, Japan
| | - Kazuhiro Hori
- Division of Comprehensive Prosthodontics, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takahiro Ono
- Department of Geriatric Dentistry, Osaka Dental University, Osaka, Japan
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Bratland V, Coda K, Merei M, Ahmadian L, Babbitt EM, Patton JL, Esmailbeigi H. Statistical evaluation of tongue capability with visual feedback. J Neuroeng Rehabil 2024; 21:2. [PMID: 38166962 PMCID: PMC10763040 DOI: 10.1186/s12984-023-01293-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Analysis of tongue movement would benefit from a reference showcasing healthy tongue capability. We aimed to develop a reference of tongue capability and evaluated the role of visual feedback on the expression of movement. METHODS Using a wireless tracking intraoral wearable device, we composed probability distributions of the tongue tip as subjects were asked to explore the entire sensing surface area. Half of the 32 subjects received live visual feedback of the location of the center of the tongue tip contact. RESULTS We observed that the visual feedback group was 51.0% more consistent with each other in the position domain, explored 21.5% more sensing surface area, and was 50.7% more uniformly distributed. We found less consistent results when we evaluated velocity and acceleration. CONCLUSION Visual feedback best established a healthy capability reference which can be used for designing new interfaces, quantifying tongue ability, developing new diagnostic and rehabilitation techniques, and studying underlying mechanisms of tongue motor control.
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Affiliation(s)
- Veronica Bratland
- Department of Biomedical Engineering, University of Illinois at Chicago, 218 SEO, 851 South Morgan Street, Chicago, IL, 60607, USA
| | - Kyle Coda
- Department of Biomedical Engineering, University of Illinois at Chicago, 218 SEO, 851 South Morgan Street, Chicago, IL, 60607, USA
| | - Mohamad Merei
- Department of Electrical & Computer Engineering, University of Illinois at Chicago, 851 South Morgan Street, Chicago, IL, 1020 SEO, 60607, USA
| | - Leila Ahmadian
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, 801 S Paulina St, Chicago, IL, 60612, USA
| | - Edna M Babbitt
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, 355 E Erie St, Chicago, IL, 60611, USA
| | - James L Patton
- Department of Biomedical Engineering, University of Illinois at Chicago, 218 SEO, 851 South Morgan Street, Chicago, IL, 60607, USA
- RobotLab, Center for Neuroplasticity, Shirley Ryan AbilityLab, 355 E Erie St, Chicago, IL, 60611, USA
| | - Hananeh Esmailbeigi
- Department of Biomedical Engineering, University of Illinois at Chicago, 218 SEO, 851 South Morgan Street, Chicago, IL, 60607, USA.
- Department of Computer Science, University of Illinois at Chicago, 11th floor SEO, 851 South Morgan Street, Chicago, IL, 60607, USA.
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Tanaka A, Uemura H, Kimura T, Nishimura A, Aoki K, Otsuka S, Ueda K, Kitahara T. Evaluation of usefulness of tongue pressure measurement device for dysphagia associated with treatment of patients with head and neck cancer (ELEVATE). Medicine (Baltimore) 2023; 102:e33954. [PMID: 37390259 PMCID: PMC10313278 DOI: 10.1097/md.0000000000033954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Dysphagia is often caused by radiotherapy (RT) in patients with head and neck cancer (HNC), and reduced tongue pressure (TP) is often associated with swallowing dysfunction in the oral stage. However, the evaluation of dysphagia by measuring TP has not yet been established in HNC patients. Herein, we conducted a clinical trial to evaluate the usefulness of TP measurement using a TP-measuring device as an objective indicator of dysphagia induced by RT in HNC patients. METHODS AND ANALYSIS This ELEVATE trial is a prospective, single-center, single-arm, non-blind, non-randomized trial to evaluate the usefulness of a TP measurement device for dysphagia associated with the treatment of HNC. Eligible participants include patients with oropharyngeal or hypopharyngeal cancer (HPC) undergoing RT or chemoradiotherapy (CRT). The TP measurements are conducted before, during, and after RT. The primary endpoint is the change in the maximum TP values from before RT to 3 months after RT. Moreover, as secondary endpoints, the correlation between the maximum TP value and the findings of video-endoscopic and video-fluoroscopic examinations of swallowing will be analyzed at each evaluation point, as well as changes in the maximum TP value from before RT to during RT and at 0, 1, and 6 months after RT. DISCUSSION This trial aimed to investigate the usefulness of evaluation by measuring TP for dysphagia associated with HNC treatment. We expect that an easier evaluation for dysphagia will improve rehabilitation programs for dysphagia. Overall, we expect this trial to contribute to the improvement of patients' quality of life (QOL).
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Affiliation(s)
- Akihisa Tanaka
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hirokazu Uemura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Takahiro Kimura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Ari Nishimura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kumiko Aoki
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Shintaro Otsuka
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Keita Ueda
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
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Santos-García D, de Deus Fonticoba T, Cores Bartolomé C, Feal Painceiras MJ, Íñiguez-Alvarado MC, Jesús S, Buongiorno MT, Planellas L, Cosgaya M, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Gómez Mayordomo V, Nogueira V, Puente V, Dotor García-Soto J, Borrué C, Solano Vila B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Kulisevsky J, Blázquez Estrada M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, de Fábregues O, González Ardura J, Alonso Redondo R, Ordás C, López Díaz LML, McAfee D, Martinez-Martin P, Mir P, COPPADIS SG. Prevalence and Factors Associated with Drooling in Parkinson’s Disease: Results from a Longitudinal Prospective Cohort and Comparison with a Control Group. PARKINSON'S DISEASE 2023; 2023:3104425. [PMID: 37065970 PMCID: PMC10101739 DOI: 10.1155/2023/3104425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 04/09/2023]
Abstract
Introduction. Drooling in Parkinson’s disease (PD) is frequent but often goes underrecognized. Our aim was to examine the prevalence of drooling in a PD cohort and compare it with a control group. Specifically, we identified factors associated with drooling and conducted subanalyses in a subgroup of very early PD patients. Patients and Methods. PD patients who were recruited from January 2016 to November 2017 (baseline visit; V0) and evaluated again at a 2-year ± 30-day follow-up (V2) from 35 centers in Spain from the COPPADIS cohort were included in this longitudinal prospective study. Subjects were classified as with or without drooling according to item 19 of the NMSS (Nonmotor Symptoms Scale) at V0, V1 (1-year ± 15 days), and V2 for patients and at V0 and V2 for controls. Results. The frequency of drooling in PD patients was 40.1% (277/691) at V0 (2.4% (5/201) in controls;
< 0.0001), 43.7% (264/604) at V1, and 48.2% (242/502) at V2 (3.2% (4/124) in controls;
< 0.0001), with a period prevalence of 63.6% (306/481). Being older (OR = 1.032;
= 0.012), being male (OR = 2.333;
< 0.0001), having greater nonmotor symptom (NMS) burden at the baseline (NMSS total score at V0; OR = 1.020;
< 0.0001), and having a greater increase in the NMS burden from V0 to V2 (change in the NMSS total score from V0 to V2; OR = 1.012;
< 0.0001) were identified as independent predictors of drooling after the 2-year follow-up. Similar results were observed in the group of patients with ≤2 years since symptom onset, with a cumulative prevalence of 64.6% and a higher score on the UPDRS-III at V0 (OR = 1.121;
= 0.007) as a predictor of drooling at V2. Conclusion. Drooling is frequent in PD patients even at the initial onset of the disease and is associated with a greater motor severity and NMS burden.
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Affiliation(s)
| | | | | | | | | | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Seville, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | | | | | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - Ines Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Jorge Hernández Vara
- Hospital Universitario Vall d’Hebron, Barcelona, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | - Isabel González Aramburu
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | - Maria A. Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L´Hospitalet, L´Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | | - Berta Solano Vila
- Institut d’Assistència Sanitària (IAS), Institut Català de La Salut, Girona, Spain
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - Sonia Escalante
- Hospital de Tortosa Verge de La Cinta (HTVC), Tortosa, Tarragona, Spain
| | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | | | | | - Maria G. Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | | | - Jaime Kulisevsky
- Hospital de Sant Pau, Barcelona, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | | | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | | | | | | | | | | | | | | | - Darrian McAfee
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Seville, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
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Plaza E, Busanello-Stella AR. Tongue strength and clinical correlations in Parkinson's disease. J Oral Rehabil 2023; 50:300-307. [PMID: 36681882 DOI: 10.1111/joor.13417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/10/2022] [Accepted: 01/13/2023] [Indexed: 01/23/2023]
Abstract
BACKGROUND Individuals with Parkinson's disease present affected lingual functioning at some stage of the progression of the disease. The objective was to determine the strength and endurance values of the tongue in PD subjects and whether weakness in tongue lift may be an indicator of disease progression. OBJECTIVE To determine the strength and endurance values of the tongue in PD subjects and whether weakness in tongue lift may be an indicator of disease progression. METHODS Sixty subjects performed tasks of tongue to palate maximum isometric pressure (MIP) and sustained 50% of MIP for endurance. The Iowa Oral Performance Instrument was used as evaluation tool. Selected domains of the Swallowing Quality of Life Questionnaire (SWAL-QOL) related to tongue pressure were considered. Variables of sex, age, disease duration, disease progression (Hoehn & Yahr stage) and body mass index were selected for association analysis. RESULTS Tongue MIP ranged from 16 to 48 kPa (mean = 33.43 kPa), which was significantly lower than normal reference values. Likewise, tongue endurance was significantly diminished. Analysis of variance showed differences in tongue strength between stages of disease progression F(3) = 6.503, p = .001, but not for endurance. Subjects in stage IV exhibited the lowest values. No sex effect was found. Tongue strength showed significant correlations with SWAL-QOL domains such as food selection, symptoms frequency and eating duration. CONCLUSION Tongue strength and endurance are significantly reduced in Parkinson's disease. Tongue strength is higher in the early stage of the disease and significantly different from that of more severe stages, emerging the notion that tongue strength is a sensitive indicator of disease progression. Selected items regarding swallowing quality of life are strongly associated with tongue strength.
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Affiliation(s)
- Exequiel Plaza
- Department of Speech-Language Pathology and Audiology, Universidad de Talca, Talca, Chile
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Liu J, Yu S, Xu Y, Li J, Liu B, Liu S, Ning H, Xu D, Low SS. In situ quantitative assessment of food oral processing parameters: A review of feasible techniques and devices. J Texture Stud 2023; 54:3-20. [PMID: 36222444 DOI: 10.1111/jtxs.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/25/2022] [Accepted: 10/01/2022] [Indexed: 11/30/2022]
Abstract
Oral processing is a combination of various actions, the detailed description of which has always been the subject of relevant research. By means of imaging technology and sensory evaluation, more knowledge of oral processing have been accumulated. Presently, the advances in sensory technology have added quantitative parameters to the qualitative description of oral processing, which also enriched the specifics of each action. Previous studies have shown that oral processing includes lip closure, dental occlusion, masticatory muscles activity, tongue movement, and swallowing, whose processing contains rich information such as the movement of organ and the intensity of organ contacts. "Quantification" was taken in this review as the basic feature of in situ detection information, the relevant parameters and feasible methods for the quantitative description of each activity was recorded in detail. In addition, basic problems and feasible optimization schemes of the existing in situ detection device are also proposed in the hope of promoting the development of in situ detection device thus providing available information for the description of oral processing.
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Affiliation(s)
- Jingjing Liu
- College of Automation Engineering, Northeast Electric Power University, Jilin, China
| | - Shixin Yu
- College of Automation Engineering, Northeast Electric Power University, Jilin, China
| | - Yifei Xu
- College of Automation Engineering, Northeast Electric Power University, Jilin, China
| | - Jiangyong Li
- College of Automation Engineering, Northeast Electric Power University, Jilin, China
| | - Boyu Liu
- College of Automation Engineering, Northeast Electric Power University, Jilin, China
| | - Shikun Liu
- College of Automation Engineering, Northeast Electric Power University, Jilin, China
| | - Haohao Ning
- College of Automation Engineering, Northeast Electric Power University, Jilin, China
| | - Dongfu Xu
- College of Automation Engineering, Northeast Electric Power University, Jilin, China
| | - Sze Shin Low
- Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute, Ningbo, China
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9
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The Relationship Between Lingual Strength and Functional Swallowing Outcomes in Parkinson’s Disease. Dysphagia 2022:10.1007/s00455-022-10543-0. [DOI: 10.1007/s00455-022-10543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
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10
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Noninvasive Evaluation of the Biomechanical Accommodations to Bolus Volume during Human Swallowing. Appl Bionics Biomech 2022; 2022:7146947. [DOI: 10.1155/2022/7146947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022] Open
Abstract
Bolus volume is very important in the biomechanics of swallowing. By noninvasively characterizing swallow responses to volume challenges, we can gain more knowledge on swallowing and evaluate swallowing behavior easily. This study aimed to evaluate the impact of bolus volume on the biomechanical characteristics of oropharyngeal swallowing events with a noninvasive sensing system. Fifteen healthy male subjects were recruited and instructed to swallow 5, 10, and 15 ml of water. The sensing system consisted of a tongue pressure sensor sheet, bend sensor, surface electrodes, and a microphone. They were used to monitor tongue pressure, hyoid activity, surface EMG of swallowing-related muscles, and swallowing sound, respectively. In addition to the onset, the peak time and offset of the above four structures, certain characteristics, such as the duration, peak value, and interval of the structure motions, were measured during the different drinking tasks. The coordination between the hyoid movement and tongue pressure was also assessed. Although no sequence of the structural events changed with volume, most of the timings of the structural events were significantly delayed, except for certain hyoid activities. The swallowing volume did not affect the active durations of the monitored structures, the peak values, or intervals of tongue pressure and supra- and infrahyoid muscle activity, but certain hyoid kinetic phases were prolonged when a larger volume was swallowed. Additionally, sequential coordination between hyoid movement and tongue pressure was confirmed among the three volumes. These findings suggest that oropharyngeal structural movements change in response to bolus volume to facilitate safe swallowing. The noninvasive and quantitative measurements taken with the sensing system provide essential information for understanding normal oropharyngeal swallowing.
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Gong S, Gao Y, Liu J, Li J, Tang X, Ran Q, Tang R, Liao C. The prevalence and associated factors of dysphagia in Parkinson's disease: A systematic review and meta-analysis. Front Neurol 2022; 13:1000527. [PMID: 36277913 PMCID: PMC9582284 DOI: 10.3389/fneur.2022.1000527] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background The prevalence and associated factors of dysphagia in Parkinson's disease (PD) are different in studies conducted in different countries. The purpose of our systematic review and meta-analysis was to evaluate the prevalence of dysphagia in PD and to clarify its associated factors. Methods Two researchers systematically searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, SinoMed and VIP databases and manually searched references in the retrieved articles to identify potential research subjects. The last search was conducted on June 28, 2022. Finally, a total of 58 studies including 60 observations with 20,530 PD patients were included in our meta-analysis. Results The meta-analysis estimated that the pooled prevalence rate of dysphagia in PD was 36.9% (95% CI: 30.7–43.6%) and instrumental examination showed a higher prevalence (57.3%, 95% CI: 44.3–69.1%). Oceania showed the highest prevalence of dysphagia in PD (56.3%) compared to Africa (39.5%), Asia (38.6%), Europe (36.1%) and America (28.9%). Dysphagia in PD was associated with older age, lower body mass index, longer disease duration, higher Hoehn and Yahr stage and levodopa equivalent daily dose, PIGD subtype, severe motor symptoms, drooling and higher levels of depression, and lower quality of life. Conclusions In conclusion, our meta-analysis showed that dysphagia occurs in more than one-third of PD patients and was associated with several demographic characteristics and PD-related characteristics, motor symptoms, non-motor symptoms, as well as decreased quality of life. It deserves early screening, diagnosis, and treatment in clinical practice to prevent serious complications from dysphagia.
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Affiliation(s)
- Siyuan Gong
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Gao
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jihong Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Li
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xueqin Tang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Ran
- Endocrinology Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rongzhu Tang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunlian Liao
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Chunlian Liao
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12
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Fukuoka T, Ono T, Hori K, Kariyasu M. Effects of Tongue-Strengthening Exercise on Tongue Strength and Effortful Swallowing Pressure in Young Healthy Adults: A Pilot Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1686-1696. [PMID: 35363546 DOI: 10.1044/2022_jslhr-21-00331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study was to investigate the effects of tongue-strengthening exercise (TSE) on tongue strength and effortful swallowing pressure in young healthy adults. METHOD Thirteen young healthy volunteers (six men, seven women; M age = 20.5 ± 0.5 years) performed 8 weeks of isometric TSE 3 days per week. A tongue pressure measurement device was used to measure maximum isometric tongue pressure (MITP) and conduct the TSE, and a tactile sensor system attached to the hard palate was used to measure effortful swallowing pressure. MITP and effortful swallowing pressure were measured at baseline, after 4 and 8 weeks of training, and at 4 and 8 weeks after the last training session to examine the detraining effects. RESULTS The results indicated that both MITP and effortful swallowing pressure increased significantly from baseline to 8 weeks after training. Although the improved MITP significantly decreased at 4 and 8 weeks after training cessation, no detraining effect was observed for effortful swallowing pressure. CONCLUSIONS TSE is an effective method for increasing tongue pressure in wide tongue-palate contact areas during effortful swallow. The effortful swallowing pressure gained with TSE appears to be maintained for at least eight nontraining weeks.
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Affiliation(s)
- Tatsuyuki Fukuoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Japan
| | - Takahiro Ono
- Division of Comprehensive Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Kazuhiro Hori
- Division of Comprehensive Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Makoto Kariyasu
- Human Communication Science Laboratories, Nobeoka, Japan
- Institute of Junwa Rehabilitation Foundation, Miyazaki, Japan
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13
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Relationship between Rate of Force Development of Tongue Pressure and Physical Performance. J Clin Med 2022; 11:jcm11092347. [PMID: 35566473 PMCID: PMC9101244 DOI: 10.3390/jcm11092347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 02/04/2023] Open
Abstract
In the assessment of skeletal muscle strength, rate of force development (RFD) is clinically identified as a functional index that reflects the effects of aging, but there are few reports on RFD of the tongue. The purpose of this study was to examine the relationship between RFD of tongue pressure (RFD-TP) and oral and whole-body physical performance in older adults, and to clarify its characteristics. We enrolled adults aged ≥65 years with pathological occlusal contact in premolar and molar regions of teeth in the Tamba-Sasayama area, Japan, from 2017 to 2018. Maximum tongue pressure (MTP) and the speed to reach the maximum tongue pressure (RFD-TP) were evaluated as measures of tongue function. Oral functions related to objective measures of tongue function, such as repetitive saliva swallowing test, oral diadochokinesis, and physical status or performance, such as mini mental state examination, body mass index, skeletal mass index, knee extension force, one-leg standing time, grip strength, walking speed, timed up-and-go test, and five-time chair stand speed was evaluated. No significant correlation was found between MTP and age, but RFD-TP had a significant negative correlation with age. Neither RFD-TP nor MTP showed a significant correlation with oral function. RFD-TP was associated with physical performance, such as knee extension force and one-leg standing time. RFD-TP is more sensitive to aging than MTP. In addition, RFD-TP is related to physical performance and may be useful for the early detection of frailty.
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14
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Effect of decreased tongue pressure on dysphagia and survival rate in elderly people requiring long-term care. J Dent Sci 2022; 17:856-862. [PMID: 35756815 PMCID: PMC9201529 DOI: 10.1016/j.jds.2021.09.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/21/2021] [Indexed: 12/11/2022] Open
Abstract
Background/purpose Tongue pressure plays an important role in swallowing function. The purpose of this study is to investigate whether decreased tongue pressure is associated with dysphagia and the development of pneumonia in the elderly requiring long-term care. Materials and methods Tongue pressure measurement and swallowing videoendoscopic (VE) examination were performed in 60 hospitalized elderly people (33 males and 27 females, with an average age of 84.3 years) to investigate the relationship with the clinical course. Factors related with dysphagia was analyzed by Fisher's exact test and one-way ANOVA, followed by multivariate logistic regression. The relationship between each variable and survival were analyzed by cox regression. Results Twenty-one patients had dysphagia by VE examination. Multivariate analysis showed that smaller BMI and reduced tongue pressure were significantly correlated with dysphagia. Smaller number of remaining teeth and dysphagia were significantly related to pneumonia-related death. No patients with tongue pressure of larger than 20 kpa died by pneumonia within one year, while in those with tongue pressure of smaller than 20 kpa, one-year cumulative survival rate by pneumonia was 44.3%. Conclusion Decreased tongue pressure was significantly associated with dysphagia and may increase the risk of pneumonia-related death in the elderly requiring long-term care.
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15
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Plaza E, Ruviaro Busanello-Stella A. Effects of a tongue training program in Parkinson's disease: analysis of electrical activity and strength of suprahyoid muscles. J Electromyogr Kinesiol 2022; 63:102642. [DOI: 10.1016/j.jelekin.2022.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022] Open
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16
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Wang P, Wang B, Chen X, Xiong B, Xie F, Wu S, Tang Y, Chen S, Ding X, Liu P, Luo W. Six-Year Follow-Up of Dysphagia in Patients with Parkinson's Disease. Dysphagia 2021; 37:1271-1278. [PMID: 34826007 DOI: 10.1007/s00455-021-10387-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
The current study sought to examine longitudinal changes of dysphagia in Parkinson's disease, identify predictors of dysphagia aggravation and elucidate the influence of dysphagia on other symptoms in Parkinson's disease patients. Forty-eight patients with Parkinson's disease were enrolled. All patients underwent videofluoroscopic study of swallowing evaluation and a battery of neuropsychological assessments at baseline in 2014 and at follow-up in 2020. We used t-tests or Wilcoxon tests for comparative analysis between patients with/without dysphagia and comparative analysis of longitudinal data. We used Spearman's correlation analysis to examine predictors of dysphagia aggravation, and the Wilcoxon test to compare neuropsychological aggravation between patients with/without dysphagia at baseline. Swallowing function, cognitive function, depression, anxiety, and quality of life were aggravated at follow-up. Dysphagia prevalence increased from 27.08 at baseline to 39.58% at follow-up. Spearman's correlation results showed that dysphagia was more likely to become aggravated in male patients compared with female patients (P = 0.0049). Cognitive impairment at baseline was significantly related to dysphagia aggravation (P = 0.042). Patients with dysphagia at baseline exhibited a significantly greater increase in anxiety scores than patients without dysphagia at baseline (P = 0.021). The results revealed that male sex and cognitive impairment predicted worsening dysphagia in Parkinson's disease patients, and suggested that dysphagia may have a negative impact on anxiety in Parkinson's disease patients. The results highlight the importance of swallowing function screening and necessary instrumental checks, such as videofluoroscopic study of swallowing, in Parkinson's disease patients.
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Affiliation(s)
- Ping Wang
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Department of Rehabilitation, Zhejiang University School of Medicine Second Affiliated Hospital, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Bo Wang
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Xinhui Chen
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Bing Xiong
- Department of Rehabilitation, Zhejiang University School of Medicine Second Affiliated Hospital, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Fangyao Xie
- Department of Rehabilitation, Zhejiang University School of Medicine Second Affiliated Hospital, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Sheng Wu
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Yinshan Tang
- Department of Rehabilitation, Zhejiang University School of Medicine Second Affiliated Hospital, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Shuqi Chen
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Xueping Ding
- Department of Neurology, Haining Chinese Medical Hospital, 177 Changdai Road, Haining, 314400, Zhejiang, China
| | - Peng Liu
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Wei Luo
- Department of Neurology, Zhejiang University School of Medicine Second Affiliated Hospital, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
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17
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Diagnosis of Sarcopenic Dysphagia in the Elderly: Critical Review and Future Perspectives. Dysphagia 2021; 37:1093-1102. [PMID: 34535803 DOI: 10.1007/s00455-021-10371-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/10/2021] [Indexed: 12/14/2022]
Abstract
Sarcopenic dysphagia (SD) is swallowing difficulty associated with loss of generalized skeletal muscles and swallowing-related muscles. Diagnostic criteria for SD were suggested, yet there is a variability in instruments and cut-offs used. The aim of the current review is to critically evaluate tools used in diagnosis of sarcopenic dysphagia in the elderly. Comprehensive review of the literature was performed. Studies were qualitatively evaluated for the diagnostic tools used to make a diagnosis of "sarcopenic dysphagia" and compared to the known diagnostic criteria for SD and other accepted measures. Fourteen studies (N = 10,282) were selected from a search yield of 331 de-duplicated studies. Ninety-three percent of studies (13/14) were conducted in Japan. All subjects included were over the age of 65 years old (mean, 76.5 years). Various tools were used to assess sarcopenia including handgrip strength (14/14 of studies), followed by skeletal muscle mass/index (7/14), tongue pressure, gait speed, and calf circumference in 5/14 studies. The most commonly tool used for dysphagia and/or swallowing dysfunction was the food level intake scale (5/14 of studies) followed by the functional oral intake scale (3/14). The 100-mL water swallow test was used in 2 of the 14 included SD studies. Fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, EAT-10 questionnaire, and standardized swallow assessment were each used in only one SD study. Further research is required to validate SD diagnostic tools, establish cut-offs in different populations, and investigate their role in screening of dysphagia and swallowing dysfunction in the elderly.
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18
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Nakao Y, Uchiyama Y, Honda K, Hasegawa Y, Nanto T, Jomoto W, Domen K. Tongue pressure waveform analysis for ascertaining the influence of tongue muscle composition on articulation. J Oral Rehabil 2021; 48:1347-1353. [PMID: 34491591 DOI: 10.1111/joor.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rate force development is associated with performance and muscle composition in whole-body muscle. Although rate force development on tongue muscle can be examined using tongue pressure waveform, there have been only few investigations on this topic. OBJECTIVES This study's main purpose was to investigate the reliability of tongue pressure waveform analysis and its relationship with articulation and tongue muscle composition. In addition, we also investigated the association between tongue muscle composition and articulation. METHODS Forty-five community-dwelling individuals aged >20 years participated. We analysed tongue pressure waveform, including maximum tongue pressure (MTP), time to peak, mean rate of tongue force development and peak rate of tongue force development (PRTFD). We also assessed oral diadochokinesis. Magnetic resonance imaging of the tongue provided data on tongue muscle composition, including tongue volume, fat mass, lean muscle mass and fat percentage. We evaluated the reliability of tongue pressure waveform analysis. Moreover, we examined the coefficients between tongue pressure waveform analysis, oral diadochokinesis and tongue composition. RESULTS We detected a high reliability of MTP and PRTFD. MTP and PRTFD were significantly correlated with tongue muscle composition. MTP was not significantly correlated with oral diadochokinesis. PRTFD was significantly positively correlated with oral diadochokinesis. Tongue fat mass and fat percentage were negatively correlated with oral diadochokinesis of /ta/ and /ka/. CONCLUSIONS Peak rate of tongue force development is a highly reliable method for tongue pressure analysis and is useful for elucidating the functional importance of tongue muscle function on articulation. We speculated that fatty infiltration of the tongue adversely affects articulation.
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Affiliation(s)
- Yuta Nakao
- Department of Rehabilitation, Hyogo College of Medicine College Hospital, Nishinomiya, Japan.,Department of Rehabilitation Therapy, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kosuke Honda
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoko Hasegawa
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, Nishinomiya, Japan.,Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tomoki Nanto
- Department of Rehabilitation, Hyogo College of Medicine College Hospital, Nishinomiya, Japan
| | - Wataru Jomoto
- Department of Radiological Technology, Hyogo College of Medicine College Hospital, Nishinomiya, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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19
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A Systematic Review and Meta-analysis of Iowa Oral Performance Instrument Measures in Persons with Parkinson's Disease Compared to Healthy Adults. Dysphagia 2021; 37:99-115. [PMID: 34402968 DOI: 10.1007/s00455-021-10254-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 01/27/2021] [Indexed: 10/20/2022]
Abstract
Measures of tongue strength and endurance using the Iowa Oral Performance Instrument (IOPI) may have diagnostic utility during clinical swallowing evaluations for persons with Parkinson's disease (PwPD). Thus, the objective was to systematically analyze the existing literature comparing IOPI values of tongue strength and endurance between age- and sex-match pairs of PwPD and healthy adults as well as across disease stages. A systematic review of 12 databases and Google Scholar identified five peer-reviewed articles published in English (1990-2019) that compared tongue strength and/or endurance between PwPD and controls. Individual-level data were published in two studies and provided by authors for three studies. Study appraisal included the NIH Quality Assessment Tool and STROBE checklists. Limited data for posterior tongue pressures restricted meta-analyses to anterior pressures. Meta-analyses of group means indicated reduced tongue strength across 106 matched pairs (p < .001, I2 = 0%) and a trend for reduced endurance across 41 matched pairs (p = .07, I2 = 54%). Participant-level analyses found reduced strength (96 pairs, p < .001) and endurance (41 pairs, p = .011) secondary to PD. Tongue strength (n = 68), but not endurance (n = 41), inversely correlated with disease stage when controlling for age (p ≤ .018). Overall, clinicians should be aware that reduced anterior tongue strength and endurance are as follows : expected in approximately one-third and one-fourth of PwPD, respectively, and reduced anterior tongue strength may manifest as early as Hoehn and Yahr stage 2 with continual decline as disease progresses. Further investigation is warranted regarding the relation among tongue strength, tongue endurance, and swallowing physiology as well as applications of tongue pressure training within dysphagia rehabilitation for PwPD.
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20
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Adamske D, Heyduck A, Weidenmüller M, Göricke B, Frank T, Olthoff A. Dysphagia in amyotrophic lateral sclerosis: Quantification of bulbar motor dysfunction. J Oral Rehabil 2021; 48:1044-1049. [PMID: 34185922 DOI: 10.1111/joor.13220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/07/2021] [Accepted: 06/24/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Dysphagia as a sequel and possible early sign of amyotrophic lateral sclerosis (ALS) is caused by progressive impaired bulbar motor function. OBJECTIVE To evaluate bulbar motor dysfunction in patients suffering from ALS compared to a healthy reference group. METHODS A clinical study and prospective group comparison was designed. Patients and healthy volunteers were examined in the outpatient clinic of our university medical center. Ten patients with ALS and 20 healthy volunteers were included. All participants underwent a flexible endoscopic evaluation of swallowing (FEES) and a manometric measurement of the maximal sub-palatal atmospheric pressure generated by suction as well as of the prevalent pressure during swallowing. Additionally, the Sydney Swallow Questionnaire (SSQ) was completed by all participants to score the self-rated extent of dysphagia. RESULTS Comparing maximal suction pressures, the group of patients showed significantly lower values (p < .001). There was a significant correlation between reduced pressures and the degree of dysphagia (SSQ score) (r = -0.73). CONCLUSIONS As the oral cavity is an easily accessible compartment of the upper digestive tract, manometric measurements might serve as a simple instrument in order to detect or to monitor bulbar motor dysfunction. Oral manometry may facilitate early detection and monitoring of dysphagia in ALS. Larger studies are required to confirm our findings.
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Affiliation(s)
- Deike Adamske
- Department of Oral and Maxillofacial Surgery, Charité - University Medical Center Berlin, Berlin, Germany
| | - Adrienne Heyduck
- Phoniatrics and Pedaudiology, Department of Otorhinolaryngology, University Medical Center Göttingen, Göttingen, Germany
| | - Matthias Weidenmüller
- Phoniatrics and Pedaudiology, Department of Otorhinolaryngology, University Medical Center Göttingen, Göttingen, Germany
| | - Bettina Göricke
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias Frank
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Arno Olthoff
- Phoniatrics and Pedaudiology, Department of Otorhinolaryngology, University Medical Center Göttingen, Göttingen, Germany
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21
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Noninvasive Measurement of Tongue Pressure and Its Correlation with Swallowing and Respiration. SENSORS 2021; 21:s21082603. [PMID: 33917263 PMCID: PMC8068065 DOI: 10.3390/s21082603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 11/17/2022]
Abstract
Tongue pressure plays a critical role in the oral and pharyngeal stages of swallowing, contributing considerably to bolus formation and manipulation as well as to safe transporting of food from the mouth to the stomach. Smooth swallowing relies not only on effective coordination of respiration and pharynx motions but also on sufficient tongue pressure. Conventional methods of measuring tongue pressure involve attaching a pressure sheet to the hard palate to monitor the force exerted by the tongue tip against the hard palate. In this study, an air bulb was inserted in the anterior oral cavity to monitor the pressure exerted by the extrinsic and intrinsic muscles of the tongue. The air bulb was integrated into a noninvasive, multisensor approach to evaluate the correlation of the tongue pressure with other swallowing responses, such as respiratory nasal flow, submental muscle movement, and thyroid cartilage excursion. An autodetection program was implemented for the automatic identification of swallowing patterns and parameters from each sensor. The experimental results indicated that the proposed method is sensitive in measuring the tongue pressure, and the tongue pressure was found to have a strong positive correlation with the submental muscle movement during swallowing.
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22
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Curtis JA, Laus J, Schneider SL, Troche MS. Examining the Relationships Between Lingual Strength, Perihyoid Strength, and Swallowing Kinematics in Dysphagic Adults: A Retrospective Cross-Sectional Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:405-416. [PMID: 33439740 DOI: 10.1044/2020_jslhr-20-00143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of this study was to examine the relationships of clinical measures of lingual and perihyoid strength with displacement swallowing kinematics and swallowing safety in a heterogenous group of dysphagic adults. Method A retrospective analysis was completed of videofluoroscopic swallow studies of consecutive dysphagic outpatient adults presenting to a tertiary swallowing center from January 1, 2015, to December 31, 2017. Videofluoroscopic swallow study records were included if containing displacement swallowing kinematics of a 20-ml single liquid swallow and clinical measures of anterior (L-MIPA) or posterior (L-MIPP) lingual maximal isometric press, saliva mean swallowing pressures (S-MSP), and/or open mouth-maximal isometric press (OM-MIP). Regression analyses were used to examine the relationships between clinical measures of lingual (L-MIPA, L-MIPP, S-MSP) and perihyoid (OM-MIP) strength and displacement swallowing kinematics, and binomial logistic regressions were used to examine the relationships between clinical measures of lingual and perihyoid strength and swallowing safety (Penetration-Aspiration Scale [PAS]). Results Multivariate regressions revealed significant relationships of L-MIPA, L-MIPP, S-MSP, and OM-MIP with group-level changes to the displacement swallowing kinematics. Univariate analyses revealed significant relationships of L-MIPA and L-MIPP with pharyngeal constriction ratio, maximal extent of upper esophageal segment opening, and PAS. Conclusions Weak relationships were identified of clinical measures of lingual and perihyoid strength with displacement swallowing kinematics. These findings suggest that clinical measures of lingual and perihyoid strength do not fully explain impairments in swallowing kinematics across a heterogenous group of dysphagic patients. Weak-to-moderate relationships were identified between clinical measures of lingual strength and PAS, suggesting that they may have value in predicting functional measures of swallowing safety. Further research is needed to examine how findings may differ between specific patient populations.
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Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Joey Laus
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Sarah L Schneider
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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23
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Oommen ER, Cuellar ME, Scholten A, Rylander B, David M. Objective measures of lingual and jaw function in healthy adults and persons with Parkinson's disease: Implications for swallowing. Physiol Behav 2021; 232:113349. [PMID: 33545210 DOI: 10.1016/j.physbeh.2021.113349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/13/2022]
Abstract
The study examines the effects of age and Parkinson's disease on lingual and jaw function in neurotypical adults, as well as persons with Parkinson's Disease. Preliminary results provide reference measures in these populations and support the systematic collection of objective data regarding lingual strength, lingual range of motion, and jaw range of motion in clinical populations. The application of this clinically meaningful protocol also provides a means to track physiological changes over time in order to maximize the results of rehabilitative efforts to restore swallow function.
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Affiliation(s)
- Elizabeth R Oommen
- Calvin University, Speech Pathology and Audiology Department, 1810 E. Beltline Ave SE, Grand Rapids, MI 49546, United States
| | - Megan E Cuellar
- San José State University, Communicative Disorders & Sciences, One Washington Square, San Jose, CA 95192-0046, United States.
| | - Alyssa Scholten
- Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI 49503, United States
| | - Bethany Rylander
- Colt Early Childhood Center, 4344 W. Michigan Ave, Lansing, MI 48917, United States
| | - Mallika David
- Metro Health, Univ of Michigan, 5900 Byron Center Ave, Wyoming, MI 49519, United States
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24
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Shitara S, Fujiwara S, Okawa J, Kodama S, Hori K, Ono T. Coordination between lingual motion and pressure production during dipper/tipper type swallows. J Oral Rehabil 2020; 47:1479-1488. [DOI: 10.1111/joor.13079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/17/2020] [Accepted: 08/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Satoko Shitara
- Division of Comprehensive Prosthodontics Niigata University Graduate School of Dental and Medical Sciences Niigata Japan
| | - Shigehiro Fujiwara
- Division of Comprehensive Prosthodontics Niigata University Graduate School of Dental and Medical Sciences Niigata Japan
| | - Jumpei Okawa
- Division of Comprehensive Prosthodontics Niigata University Graduate School of Dental and Medical Sciences Niigata Japan
| | - Shohei Kodama
- Division of Comprehensive Prosthodontics Niigata University Graduate School of Dental and Medical Sciences Niigata Japan
| | - Kazuhiro Hori
- Division of Comprehensive Prosthodontics Niigata University Graduate School of Dental and Medical Sciences Niigata Japan
| | - Takahiro Ono
- Division of Comprehensive Prosthodontics Niigata University Graduate School of Dental and Medical Sciences Niigata Japan
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25
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Umemoto G, Fujioka S, Arahata H, Kawazoe M, Sakae N, Sasagasako N, Furuya H, Tsuboi Y. Relationship between tongue pressure and functional oral intake scale diet type in patients with neurological and neuromuscular disorders. Clin Neurol Neurosurg 2020; 198:106196. [PMID: 32980799 DOI: 10.1016/j.clineuro.2020.106196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Patients with neurological and neuromuscular disorders (NNMD) frequently experience swallowing disorders that increase aspiration pneumonia risk and therefore require specialized diets or tube feeding. Diet type level usually is assessed by video fluoroscopic swallowing study (VFSS). To identify a simpler assessment method, we examined the association between diet type (based on the Functional Oral Intake Scale [FOIS]) diet type and maximum tongue pressure (MTP). METHODS From 2011-2020, FOIS diet type level and MTP were assessed in a sample of 927 patients. Of these patients, 186 had Parkinson's disease (PD), 69 had Parkinson-related disease (PRD), 61 had multiple system atrophy (MSA), 42 had spinocerebellar degeneration (SCD), 147 had amyotrophic lateral sclerosis (ALS), 180 had myotonic dystrophy type 1 (DM1), and 242 had Duchenne muscular dystrophy (DMD). VFSS was conducted while patients swallowed water and foods containing barium. MTP measurements were collected the same day. Participants' diet type level was adjusted based on the VFSS, with some participants requiring multiple examinations. Relationships between diet type level and MTP were tested using univariate and Spearman rank correlation analyses. RESULTS Mean MTP for the entire NNMD group (25.5 ± 13.1 kPa) was lower than that of healthy elderly individuals, as determined in previous reports. The highest MTP was found in the MSA group (32.2 ± 15.7 kPa) and the lowest in the DM1 group (19.1 ± 9.0 kPa). Diet type level was highest in the MSA group (5.8 ± 1.4) and lowest in the DMD group (5.2 ± 1.7). A significant correlation was observed between diet type level and MTP (R = 0.384, p < 0.001). The optimum MTP cutoff values-detected using ROC curves to predict a requirement to change to a dysphagia diet-was highest in the DMD group (29.0 kPa) and lowest in the ALS group (12.3 kPa). CONCLUSIONS The decision to change NNMD patients to a dysphagia diet can be made based on MTP. Modifying a patient's oral diet (FOIS level ≤ 5) should be considered for those with a MTP of 10-25 kPa, with the cutoff value varying by disease.
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Affiliation(s)
- George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan; Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan.
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hajime Arahata
- Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan
| | - Miki Kawazoe
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Nobutaka Sakae
- Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan
| | - Naokazu Sasagasako
- Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan
| | - Hirokazu Furuya
- Department of Neurology, Faculty of Medicine, Kochi University, Kochi, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Abstract
Dysphagia is defined as an impairment of this complex and integrated sensorimotor system. It is estimated that 400,000 to 800,000 individuals worldwide develop neurogenic dysphagia per year. Neurogenic dysphagia is typically occurring in patients with neurological disease of different etiologies. A correct and early diagnosis and an appropriate management of dysphagia could be useful for improving patient’s quality of life and may help to prevent or delay death. In the present review, we discuss thoroughly the anatomy and physiology of swallowing and also the pathophysiological mechanisms involved in impaired swallowing, as well as the diagnosis, management, and potential treatments of neurogenic dysphagia. Assessment of neurogenic dysphagia includes medical history, physical exam, and instrumental examinations (fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, electromyography). Pharmacological treatment of these problems includes oral anticholinergic drugs. Surgical myotomy of the cricopharyngeal muscle showed an important improvement of oropharyngeal dysphagia associated to upper esophageal sphincter hyperactivity. Chemical myotomy of the upper esophageal sphincter by local injections of botulinum toxin type A into the cricopharyngeal muscle has been proposed as an alternative less invasive and less unsafe than surgical myotomy.
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27
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Legacy J, Herndon NE, Wheeler-Hegland K, Okun MS, Patel B. A comprehensive review of the diagnosis and treatment of Parkinson's disease dysphagia and aspiration. Expert Rev Gastroenterol Hepatol 2020; 14:411-424. [PMID: 32657208 PMCID: PMC10405619 DOI: 10.1080/17474124.2020.1769475] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/12/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Bulbar dysfunction is common in Parkinson's disease (PD) with more than 80% of affected individuals developing dysphagia during the course of the disease. Symptoms can begin in the preclinical stage and individuals may remain clinically asymptomatic for years. Furthermore, patients may be unaware of swallowing changes, which contributes to the difference between the prevalence of self-reported dysphagia and deficits identified during instrumental evaluations. Dysphagia is underrecognized and contributes to the development of aspiration pneumonia which is the leading cause of death in PD. Dysphagia in PD is complex and not completely understood. Both dopaminergic and nondopaminergic pathways likely underpin dysphagia. AREAS COVERED This comprehensive review will cover the epidemiology, pathophysiology, clinical evaluation, and expert management of dysphagia and aspiration in patients with PD. EXPERT OPINION A multidisciplinary team approach is important to properly identify and manage PD dysphagia. Regular clinical screenings with objective instrumental assessments are necessary for early detection of dysphagia. Studies are needed to better understand the mechanism(s) involved in PD dysphagia, establish markers for early detection and progression, and develop evidence-based treatment options.
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Affiliation(s)
- Joseph Legacy
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
| | - Nicole E. Herndon
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL
| | - Karen Wheeler-Hegland
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL
| | - Michael S. Okun
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
| | - Bhavana Patel
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
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28
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Sawaya Y, Ishizaka M, Kubo A, Shiba T, Sato T, Onoda K, Maruyama H, Urano T. Absolute reliability of tongue pressure measurement in young healthy adults and elderly patients with certification of needing long-term care or support. Geriatr Gerontol Int 2020; 20:488-493. [PMID: 32176436 DOI: 10.1111/ggi.13902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/26/2020] [Accepted: 02/19/2020] [Indexed: 11/29/2022]
Abstract
AIM We aimed to determine systematic bias and the range of random error in tongue pressure measurements among young healthy adults and elderly patients with certification of requiring long-term care or support, considering sex, and to establish a measurement method. METHODS Subjects were 226 adults (88 young healthy adults and 138 elderly patients with certification of requiring long-term care or support). Tongue pressure was measured thrice. Bland-Altman analysis was performed for the first and second trials, and second and third trials. RESULTS Fixed bias was revealed for the first and second trials among young healthy adults. Systematic bias was not found for the second and third trials. Fixed bias was revealed for the first and second trials among elderly patients, with a proportional bias with a negative slope for the second and third trials. For young healthy adults, the minimal detectable change was 6.0 and 5.4 kPa in males and females, respectively. For elderly patients, the limit of agreement ranged from -5.9 to 8.6 and from -5.4 to 8.8 kPa in males and females, respectively. CONCLUSIONS There was a difference in systematic bias in tongue pressure measurement between young healthy adults and elderly patients with certification of needing long-term care or support. In young healthy adults, the third trial results showed stability, whereas they decreased in elderly patients. In elderly patients, it was suggested that the number of measurements reduced from three to two when a maximum value was adopted. No differences were observed among sexes in either young or elderly patients. Geriatr Gerontol Int 2020; 20: 488-493.
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Affiliation(s)
- Yohei Sawaya
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Japan.,Division of Physical Therapy, Doctoral Program in Health Sciences, Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Otawara, Japan.,Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
| | - Masahiro Ishizaka
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Japan
| | - Akira Kubo
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Japan
| | - Takahiro Shiba
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
| | - Tamae Sato
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Japan.,Division of Physical Therapy, Doctoral Program in Health Sciences, Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Otawara, Japan
| | - Ko Onoda
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Japan
| | - Hitoshi Maruyama
- Division of Physical Therapy, Doctoral Program in Health Sciences, Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Otawara, Japan
| | - Tomohiko Urano
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Tochigi, Japan
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29
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Koshi N, Magara J, Sakai S, Tsujimura T, Ono K, Inoue M. Properties of hyoid muscle contraction during tongue lift measurement. J Oral Rehabil 2019; 47:332-338. [DOI: 10.1111/joor.12894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/29/2019] [Accepted: 09/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Naomi Koshi
- Division of Dysphagia Rehabilitation Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Shogo Sakai
- Division of Dysphagia Rehabilitation Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Kazuhiro Ono
- Division of Oral Science for Health Promotion Department of Oral Health and Welfare Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
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30
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Chen Z, Li G, Liu J. Autonomic dysfunction in Parkinson's disease: Implications for pathophysiology, diagnosis, and treatment. Neurobiol Dis 2019; 134:104700. [PMID: 31809788 DOI: 10.1016/j.nbd.2019.104700] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/13/2019] [Accepted: 12/02/2019] [Indexed: 12/17/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disease with a 200 year-long research history. Our understanding about its clinical phenotype and pathogenesis remains limited, although dopaminergic replacement therapy has significantly improved patient outcomes. Autonomic dysfunction is an essential category of non-motor phenotypes that has recently become a cutting edge field that directs frontier research in PD. In this review, we initially describe the epidemiology of dysautonomic symptoms in PD. Then, we perform a meticulous analysis of the pathophysiology of autonomic dysfunction in PD and propose that the peripheral autonomic nervous system may be a key route for α-synuclein pathology propagation from the periphery to the central nervous system. In addition, we recommend that constipation, orthostatic hypotension, urinary dysfunction, erectile dysfunction, and pure autonomic failure should be viewed as prodromal dysautonomic markers in PD prediction and diagnosis. Finally, we summarize the strategies currently available for the treatment of autonomic dysfunction in PD and suggest that high-quality, better-designed, randomized clinical trials should be conducted in the future.
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Affiliation(s)
- Zhichun Chen
- Department of Neurology, Institute of Neurology, Ruijin Hospital affiliated with the Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guanglu Li
- Department of Neurology, Institute of Neurology, Ruijin Hospital affiliated with the Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Neurology, Institute of Neurology, Ruijin Hospital affiliated with the Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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31
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Kwon M, Lee JH. Oro-Pharyngeal Dysphagia in Parkinson's Disease and Related Movement Disorders. J Mov Disord 2019; 12:152-160. [PMID: 31556260 PMCID: PMC6763715 DOI: 10.14802/jmd.19048] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/15/2019] [Indexed: 12/11/2022] Open
Abstract
Oro-pharyngeal dysphagia is a common symptom in patients with Parkinson’s disease (PD) and related disorders, even in their early stage of diseases. Dysphagia in these patients has been underdiagnosed, probably due to poor the self-awareness of the conditions and the underuse of validated tools and objective instruments for assessment. The early detection and intervention of dysphagia are closely related to improving the quality of life and decreasing the mortality rate in these patients. The purpose of this paper is to give an overview of the characteristics of dysphagia, including the epidemiology, pathophysiology, and clinical symptomatology, in patients with PD compared with other parkinsonian disorders and movement disorders. The management of dysphagia and future research directions related to these disorders are also discussed.
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Affiliation(s)
- Miseon Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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