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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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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: 3] [Impact Index Per Article: 3.0] [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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Sano T, Umemoto G, Fujioka S, Iwashita Y, Dotsu Y, Wada N, Tsuboi Y. Relationship between motor dysfunction and chewing movement in patients with Parkinson's disease: A transversal study. Front Neurol 2022; 13:1062134. [PMID: 36570461 PMCID: PMC9780282 DOI: 10.3389/fneur.2022.1062134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Objective To assess the impact of chewing movement in patients with Parkinson's disease (PD), we examined the relation between chewing movement and motor dysfunction in association with PD progression. Methods Thirty patients with PD (mean age, 68.9 ± 9.0 years; mean Hoehn and Yahr stage, 3.0 ± 0.7) were recruited. The PD condition was assessed in each patient by using the score of Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS) part III score, body mass index (BMI), serum albumin (Alb), and tongue pressure, number of chews, mealtime, and chewing speed were collected. The patients were divided into two groups (mild and moderate PD groups) based on an MDS-UPDRS part III cut-off value of 32. Results The chewing speed positively correlated with tongue pressure (rho = 0.69, p < 0.01) in the mild group, and with BMI (rho = 0.54, p = 0.03), serum Alb (rho = 0.63, p = 0.02), and number of chews (rho = 0.69, p < 0.01) in the moderate group. The MDS-UPDRS part III scores for all participants correlated negatively with chewing speed (rho = -0.48, p < 0.01), serum Alb (rho = -0.49, p < 0.01), and positively with mealtime (rho = 0.43, p = 0.01). Tongue pressure and serum Alb were identified to be as factors affecting the chewing speed (β= 0.560, p < 0.01; β= 0.457, p < 0.01, respectively). Conclusions These results indicated that the progression of motor dysfunction in patients with PD is likely to affect chewing speed and the nutritional status decline may be linked to the impairment of chewing movement in these patients.
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Affiliation(s)
- Taisei Sano
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan,Department of General Dentistry, Division of Interdisciplinary Dentistry, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan,Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan,*Correspondence: George Umemoto
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yuki Iwashita
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan
| | - Yuriko Dotsu
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan
| | - Naohisa Wada
- Department of General Dentistry, Division of Interdisciplinary Dentistry, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Kulvanich S, Sakai H, Takanami R, Yamada M, Sasa A, Ito K, Tsujimura T, Magara J, Inoue M. Impact of oral function on regaining oral intake and adjusting diet forms for acute stroke patients. J Stroke Cerebrovasc Dis 2022; 31:106401. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/02/2022] [Accepted: 02/05/2022] [Indexed: 10/19/2022] Open
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Nagashima K, Kikutani T, Takahashi N, Kato Y, Sagawa K, Tohara T, Tamura F. Development of the Sakiika Transport Test: A Practical Screening Method for Patients with Oral-phase Dysphagia. J Prosthodont Res 2021; 66:409-415. [PMID: 34789609 DOI: 10.2186/jpr.jpr_d_20_00290] [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] [Indexed: 11/06/2022]
Abstract
PURPOSE This study aimed to develop a simple screening test for mastication, "the Sakiika (squid jerky) transport test (STT), which evaluates the vertical jaw movement coordinated with the lateral tongue movement during stage I transport, and investigate the possibility of its clinical application. METHODS The study included 73 people with dysphagia (mean age, 78.5 ± 7.8 years; median age, 79.0 years; interquartile range, 75.0-84.0). The STT evaluated the ability of a participant to transport a piece of squid jerky placed on the midline of the tongue to the molar region. The STT score was defined as the number of vertical jaw movements occurring as the tongue transported food to the molars. A cutoff value was set by comparing the STT scores with masticatory function evaluated via a videofluoroscopic swallowing study and with food texture evaluated using the Food Intake LEVEL Scale (FILS). RESULTS The STT scores counted by the two examiners had a κ coefficient of 0.79, indicating good reliability. The STT score was significantly associated with both the presence of masticatory movement ( p = 0.019) and food texture classified by FILS ( p = 0.032) at cutoff value of "3" (3 vertical movements). The STT showed 62% sensitivity and 75% specificity for masticatory movements. CONCLUSION The STT could be a useful screening test to assess the presence or absence of food transportation to the molars for mastication in older patients with dysphagia. In addition, the STT could be useful in identifying the need to modify food texture to meet functions.
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Affiliation(s)
- Keigo Nagashima
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry, Tokyo
| | - Takeshi Kikutani
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry, Tokyo.,Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo.,Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo
| | - Noriaki Takahashi
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo
| | - Yoko Kato
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry, Tokyo
| | - Keiichiro Sagawa
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo
| | - Takashi Tohara
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo
| | - Fumiyo Tamura
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo.,Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo
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Izumi M, Akifusa S. Tongue cleaning in the elderly and its role in the respiratory and swallowing functions: Benefits and medical perspectives. J Oral Rehabil 2021; 48:1395-1403. [PMID: 34612518 DOI: 10.1111/joor.13266] [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: 05/20/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
Abstract
Oral dysfunction, including oral uncleanness and decline in tongue motor function, tongue pressure and swallowing function, precedes frailty. The tongue's dorsum is a reservoir of oral microbiota, desquamated epithelial mucosa and leukocytes due to the multi-papillate anatomy, and leads to tongue coating. The tongue coating is frequently found in older adults because of hyposalivation, immunity's hypoactivity, diminished motor function and compromised tongue's pressure with age. Anaerobe-driven volatile sulphur compounds in tongue coating are a major cause of intra-oral malodor. Dysbiosis of the tongue-coating microbiome rather than the amount of microorganisms is associated with a risk of aspiration pneumonia. Daily tongue cleaning with a brush or scraper is an easy way to control tongue coating deposits and quality. Using mouth wash or rinse-containing germicides is also a way to control the microbiota of tongue coating. The tongue function is closely related to swallowing. Tongue and suprahyoid muscles are linked with respiratory muscles through the endothoracic fascia. The mechanical stimulation during the cleaning of the tongue may stimulate the respiratory muscles. An intervention trial revealed that tongue cleaning by mucosal brush improves tongue pressure, swallowing and respiratory function in old residents of nursing homes, suggesting a rehabilitative effect of tongue cleaning on the swallowing and respiratory functions, preventing aspiration pneumonia. This narrative review assesses the tongue-cleaning benefits for respiratory and swallowing functions and the possibility of preventing aspiration pneumonia.
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Affiliation(s)
- Maya Izumi
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Kitakyushu, Japan
| | - Sumio Akifusa
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Kitakyushu, Japan
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Podgórska-Bednarz J, Perenc L, Drużbicki M, Guzik A. Nutritional Disorders in a Group of Children and Adolescents with Syndromes or Diseases Involving Neurodysfunction. Nutrients 2021; 13:nu13061786. [PMID: 34073813 PMCID: PMC8225066 DOI: 10.3390/nu13061786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023] Open
Abstract
A study of the literature shows the lack of data on a comprehensive analysis of eating disorders in children with neurodysfunction, which constitute a clinical subgroup with an increased risk of abnormalities in this area. Therefore, the aim of this study was to determine the relationship between the coexistence of nutritional disorders and diseases or syndromes associated with neurodysfunction based on data collected during hospitalization at a rehabilitation center for children and adolescents. A retrospective analysis was carried out in a group of 327 children and adolescents aged 4–18 years. The study group covered various types of diseases or syndromes involving damage to the central nervous system. A retrospective analysis of baseline data (age, sex, main and additional diagnosis and Body Mass Index—BMI) was performed. Two assessment criteria of nutritional status were taken into account (z-score BMI and other previously published normative values). In the study group, malnutrition was found more frequently (18.0% of the respondents) than obesity (11.3% of the subjects). Hypothyroidism coexisting with malnutrition was identified in the study group (N% = 43.8%, p = 0.011) and malnutrition with tetraplegia in the subgroup of spastic cerebral palsy (N% = 34.2 %, p = 0.029).
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Affiliation(s)
- Justyna Podgórska-Bednarz
- Institute of Health Sciences, Medical College of Rzeszów University, Warzywna 1A, 35-310 Rzeszów, Poland; (L.P.); (M.D.); (A.G.)
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland
- Correspondence:
| | - Lidia Perenc
- Institute of Health Sciences, Medical College of Rzeszów University, Warzywna 1A, 35-310 Rzeszów, Poland; (L.P.); (M.D.); (A.G.)
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland
| | - Mariusz Drużbicki
- Institute of Health Sciences, Medical College of Rzeszów University, Warzywna 1A, 35-310 Rzeszów, Poland; (L.P.); (M.D.); (A.G.)
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland
| | - Agnieszka Guzik
- Institute of Health Sciences, Medical College of Rzeszów University, Warzywna 1A, 35-310 Rzeszów, Poland; (L.P.); (M.D.); (A.G.)
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland
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