Effects of directional exercise on lingual strength

Use of Edibles as Effective Tools in Myofunctional Therapy: A Pilot Study

AIM

The aim of this retrospective study is to explore the introduction of edible spread cream and small candies as tools to improve motivation and compliance in young children undergoing myofunctional therapy, with the purpose of optimizing oral functions, including swallowing.

METHODS

Six patients, one female and five males, between the ages of 7 and 14 years, presenting with atypical swallowing, were evaluated and treated at the clinic of the University of L'Aquila. The patients included in the study were randomly divided into two groups and were treated with two different treatment protocols: Group A: traditional myofunctional therapy and traditional tools; Group B: same exercises as group A, but with edible tools (spreadable cream and small candies).

RESULTS

As expected, the two patients who used edible tools demonstrated increased motivation and collaboration during myofunctional therapy.

CONCLUSIONS

Patient compliance, especially in very young patients, limits the effectiveness of myofunctional therapy; therefore, creative solutions are needed to achieve greater cooperation, and edible tools can play a significant part in retraining correct swallowing. Although the sample of this pilot study is small, the results suggest that using actual edible tools in myofunctional therapy could increase compliance and provide better results in myofunctional therapy.

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

OBJECTIVE

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

DESIGN

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

SETTING

The general community at each study site.

PARTICIPANTS

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

INTERVENTIONS

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

OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

RESEARCH STRATEGIES

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

SELECTION CRITERIA

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

DATA ANALYSIS

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

RESULTS

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

CONCLUSION

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

Masticatory Efficiency in Orthodontic Patients with Craniofacial Disorder

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

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

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

Effects of Tongue-Strengthening Exercise on Tongue Strength and Effortful Swallowing Pressure in Young Healthy Adults: A Pilot Study

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.

Oral exercises significantly improve oral functions in people with mild and moderate dementia: a randomized controlled study

BACKGROUND

There have been no standard protocols of oral exercises for maintaining and improving oral function for people with dementia.

OBJECTIVE

This study aimed to determine the effects of home-based oral exercises on the oral function of people with mild to moderate dementia.

METHODS

Twenty-two participants at King Chulalongkorn Memorial Hospital were randomly assigned to exercise group (n = 11) or control group (n = 11). The exercise group was instructed to do three home-based oral exercises, consisting of tongue-strengthening, oral diadochokinesis (ODK), and mouth-opening exercises, for 3 months, while the control group received advice on oral health care. The maximum tongue pressure (MTP) was the primary outcome. MTP, ODK rates of /pa/, /ta/, /ka/, modified water swallowing test (MWST), and oral moisture were measured at baseline, and after 1, 2, and 3 months of training. The generalized estimating equation analysis was used to evaluate the effects of oral exercises on the oral function.

RESULTS

The MTP and all ODK rates in the exercise group were significantly increased after 3 months of training. There were significant interaction effects between time and intervention in MTP and all ODK rates. No significant interaction effects between time and intervention in oral moisture were found. The MWST scores in both groups did not change through the end of study and no adverse effects were reported.

CONCLUSION

Home-based oral exercises were found to be effective for improving tongue strength and tongue-lip motor function in people with mild to moderate dementia.

Orofacial Muscle Strength across the Dysarthrias

This study compared orofacial muscle strength between normal and dysarthric speakers and across types of dysarthria, and examined correlations between strength and dysarthria severity. Participants included 79 speakers with flaccid, spastic, mixed spastic–flaccid, ataxic, or hypokinetic dysarthria and 33 healthy controls. Maximum pressure generation (Pmax) by the tongue, lips, and cheeks represented strength. Pmax was lower for speakers with mixed spastic–flaccid dysarthria for all tongue and lip measures, as well as for speakers with flaccid or spastic dysarthria for anterior tongue elevation and lip compression. Anterior tongue elevation and cheek compression tended to be lower than normal for the hypokinetic group. Pmax did not differ significantly between controls and speakers with ataxic dysarthria on any measure. Correlations were generally weak between dysarthria severity and orofacial weakness but were stronger in the dysarthria groups with more prominent orofacial weakness. The results generally support predictions that orofacial weakness accompanies flaccid and/or spastic dysarthria but not ataxic dysarthria. The findings support including type of dysarthria as a variable of interest when examining orofacial weakness in motor speech disorders.

Tongue cleaning in the elderly and its role in the respiratory and swallowing functions: Benefits and medical perspectives

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.

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

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

Tongue cleaning maintains respiratory function in older individuals: A 1-year randomised controlled trial

OBJECTIVE

The aim of this 1-year longitudinal randomised controlled trial was to evaluate the effectiveness of tongue cleaning on the maintenance of respiratory function in older adults requiring care.

METHODS

The participants included 24 residents of two nursing homes in Kitakyushu, Japan. The participants were randomised to receive tongue cleaning with routine oral care (intervention group, n = 12), or routine oral care alone (control group, n = 12). Among the participants, three in the intervention group and four in the control group had cerebrovascular disease history, four in the intervention group and four in the control group had a history of cardiac disease, and five in the intervention group and four in the control group were without medical history. Respiratory function was assessed on the basis of the peak expiratory flow rate (PEFR). Tongue pressure, swallowing function, oral health status, activities of daily living and nutritional status were also measured at baseline and at the end of the 1-year follow-up period.

RESULTS

The number of analysed participants in each group was 12. In the control group, the PEFR (1.6 [0.4-4.2] L s^-1 vs 1.4 [0.4-3.2] L s^-1 , P = .034) and tongue pressure (16.4 [1.7-35.2] kPa vs 8.0 [1.4-38.6] kPa, P = .032) significantly declined after 1-year. However, the PEFR (1.5 [0.8-2.9] L s^-1 vs 1.6 [0.7-4.2] L s^-1 , P = .366) and tongue pressure (18.1 [4.2-37.1] kPa vs 16.1 [5.2-41] kPa, P = .307) were maintained in the intervention group. The change in the PEFR was significantly greater in the intervention group compared with the control group (0.130 [-0.45-1.70] L s^-1 vs -1.70 [-10.00-10.00] L s^-1 , P = .028).

CONCLUSION

Our findings suggest that tongue cleaning may help maintain tongue and respiratory function in older adults requiring care.

Objective measures of lingual and jaw function in healthy adults and persons with Parkinson's disease: Implications for swallowing

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.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

International Registered Report Identifier (IRRID)

RR2-10.2196/19585

Salivary secretion and salivary stress hormone level changes induced by tongue rotation exercise

PURPOSE

Prevention of xerostomia and stress is important to prolong healthy life expectancy and improve the quality of life. We aimed to investigate the effects of tongue rotation exercise for increasing salivary secretions and stabilizing salivary stress hormone levels.

MATERIALS AND METHODS

Twenty four participants without subjective oral dryness were enrolled. The exercises comprised tongue rotation exercise and empty chewing. The salivary stress hormone level was measured using a Salivary Amylase Monitor. Unstimulated whole saliva volume and salivary amylase activity were measured before tongue rotation exercise or empty chewing and subsequently 5, 10, and 15 minutes after these exercises. Differences in the rates of change of unstimulated whole saliva volume and salivary amylase activity were analyzed by repeated measure analysis of variance.

RESULTS

Statistically significant differences among the rates of change were not observed after empty chewing for unstimulated whole saliva volume and salivary amylase activity at the four measurement times. However, the rate of change of unstimulated whole saliva volume and salivary amylase activity were statistically significantly different among the four time points: before the tongue rotation exercise and 5, 10, and 15 minutes post-exercise (P< .05 and P<.01, respectively).

CONCLUSION

Tongue rotation is effective in increasing saliva secretion, reducing stress, improving oral function, and extending healthy life expectancy.

A Randomized Controlled Trial Comparing Physical and Mental Lingual Exercise for Healthy Older Adults

Mental practice using motor imagery (MP-MI) has been shown to improve motor outcomes of upper and lower extremities especially when combined with physical exercise. Here, we studied community-dwelling, healthy older adults to determine the effects of including an MP-MI component with lingual strengthening exercise. In this pilot study, twenty-nine typically aging participants were assigned to an intervention group: physical lingual exercise (n = 7), physical and MP-MI lingual exercise (n = 8), MPMI lingual exercise (n = 7), or a control group (placebo exercise) (n = 7). All participants completed the assigned exercise regimen with three sessions per day, three days a week, for 6 consecutive weeks. Maximum isometric pressure (MIP) and regular effort saliva swallowing (RESS) pressure were collected at baseline and weeks 2, 4, and 6. A post hoc Bonferroni corrected treatment effect from baseline to week 6 was shown for only participants in the MP-MI/Physical exercise group for MIP (p = 0.003 MPMI/ Physical group; p = 0.11 Control group; p = 0.32 Physical only group; p = 0.14 MP-MI only group) and RESS (p = 0.009 MP-MI/Physical group; p = 0.14 Control group; p = 0.10 Physical only group; p = 0.04 MP-MI only group). Findings also indicate spontaneous carryover of significantly increased swallowing pressure when mental and physical exercise are combined. In conclusion, the potential effect of including an MPMI lingual exercise component in preventative and rehabilitative frameworks with older persons to possibly enhance functional swallowing improvement is promising and should be investigated.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The influence of tongue strength on children's performance in computer games reliant on lingual force generation

Oral motor exercises, for recovering tongue strength, can be integrated with computer games to increase motivation, especially for treatments in children. The aim of this study was to investigate the influence of tongue strength on motor performance in computer games reliant on lingual force generation. An observational study was carried out at a speech-language pathology outpatient university clinic. Twenty participants (10 with normal tongue strength and 10 with reduced tongue strength) aged 8-13 years used an intra-oral joystick controlled by the tongue to play six computer games during which they had to reach targets that appeared on the screen. Motor performance was measured by the number of attempts to score and the time during which the target force was maintained. Tongue motor performance was compared between groups and across directions of tongue movement, resistance force levels, order of target appearance, continuous force application time on the target, age and sex. Children with normal tongue strength had a lower number of attempts to score (P = .014) and maintained the target force for longer periods (P = .002) than those with reduced tongue strength. The performance was better for both groups (a) in the downward direction compared with the performance in other directions, (b) in games with the lowest resistive force level (0.5 N) compared to those with other levels of resistive force and (c) in the second and third rounds compared with the first round. There were no gender-related differences in performance. Older participants performed better than younger participants. Tongue strength, direction of movement, force to reach the target, time of continuous force application, order of target appearance and age influenced tongue motor performance.

Orofacial functions and forces in male and female healthy young and adults

ABSTRACT Purpose: To determine reference values of orofacial myofunctional condition and orofacial forces in healthy young and adults. Methods: Fifty young and adults were selected from a total of 316 voluntaries. Participants were assessed with the Orofacial Myofunctional Evaluation with Scores (OMES) for the investigation of orofacial myofunctional condition. The maximum forces of bite, cheeks, tongue (anterior and posterior regions), and lips were assessed with an electronic dynamometer (values expressed in Newtons). Force values were obtained by average of three repeated measurement. The technical error of measurements was calculated for all variables. Results: There were no differences in orofacial myofunctional condition between men and women. Men presented higher values of orofacial forces compared to women. Conclusion: The normal values of orofacial myofunctional condition and orofacial forces were determined in healthy and adults Brazilian men and women. The values obtained in this study from healthy Brazilian may help in the diagnosis of alterations in orofacial motor function and contribute for their therapeutic management.

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

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Investigating Tongue Strength and Endurance in Children Aged 6 to 11 Years

Objective measures of tongue strength and endurance are used to assess lingual weakness and fatigue, and may have significant clinical value for dysphagia management. Recent studies investigating age and gender effects on tongue strength in children are limited by small sample sizes. The current study investigated age and gender effects on tongue strength with a larger sample size, and collected preliminary normative data for a paediatric population. This study also investigated the reliability of tongue endurance measures in children using a modified method, which has not previously been investigated. Using a cross-sectional design, this study examined tongue strength and endurance in 119 children aged 6 to 11 years, with no history of speech sound disorders, oro-motor deficits, dysphagia or cognitive impairment. Measures were collected using the Iowa Oral Performance Instrument. Children participated in two sessions, 45 min and 10 min in duration. Tongue strength was found to significantly increase with age (p < 0.001), while no gender effects were found. Modified tongue endurance measures involved using only one measure of maximal tongue strength to set parameters for tongue endurance scores. Despite this modification, data did not reach acceptable test-retest reliability, ICC = 0.68, p < 0.001; however, reliability improved from previous studies. These findings provide normative data for tongue strength, as a basis to compare individuals, and highlights the need for more reliable protocols for measuring tongue endurance. Normative data was collected from city-dwelling Australian children.

Tongue peak pressure: a tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome

Purpose of this study was to evaluate whether tongue peak pressure measured using the Iowa Oral Performance Instrument is correlated with the topographic site of obstruction in patients with obstructive sleep apnea/hypopnea syndrome observed during drug-induced sleep endoscopy. Thirty-five consecutive adult patients (29 men, 6 women) were prospectively enrolled after having been diagnosed with severe obstructive sleep apnea/hypopnea syndrome by polysomnography. An apnea-hypopnea index > 30 was confirmed, and age, gender, and body mass index were recorded by Epworth Sleepiness Scale questionnaire, and a thorough evaluation of the upper airway by video-flexible endoscopy. Twenty healthy controls according to age and sex were chosen for IOPI measurements. After drug-induced sleep endoscopy, a topographic diagnosis was done using the VOTE classification. Tongue and lip peak pressures were both measured using the Iowa Oral Performance Instrument in all patients and in 20 healthy controls. Main outcomes and measures: the correlations between office findings, Iowa Oral Performance Instrument measures, and the VOTE tongue classification during drug-induced sleep endoscopy (T0, T1, T2) were then investigated. RESULTS: The average Iowa Oral Performance Instrument tongue and lip pressure were 44.02 ± 12.29 and 15.03 ± 3.71 kPa, respectively. The Iowa Oral Performance Instrument scores were both significantly lower than values in healthy controls (P < 0.001). The VOTE classification referring to the tongue position was T0 in 13 cases (37.1%), T1 in 12 cases (34.3%), and T2 in 10 cases (28.6%). A significant correlation was found between the Iowa Oral Performance Instrument tongue pressure and the T size during drug-induced sleep endoscopy (Kruskal-Wallis χ² 25.82; P ≤ 0.001). CONCLUSIONS: In our experience, the Iowa Oral Performance Instrument is a useful tool for evaluating tongue collapse for the topographic diagnosis of patients with obstructive sleep apnea/hypopnea syndrome.

Tongue strength rehabilitation using biofeedback: a case report

This research had the objective of reporting a clinical case in which the rehabilitation of tongue strength with biofeedback strategy was performed. This case report addresses a 20-year-old patient whose orofacial myofunctional evaluation revealed a severe decrease in the force of the anterior third of the tongue and changes in lingual mobility and coordination. The measurement of tongue pressure was performed using the Iowa Oral Performance Instrument (IOPI) during elevation, protrusion and lateralization, and it was verified a reduction in the values ​​obtained in all measured directions, compared with normality patterns. We performed 11 sessions of therapy, with weekly frequency, using a biofeedback strategy that consisted of computer games controlled by the tongue. An instrument embedded in the oral cavity functioned as a joystick as the input method for specific digital games. The patient performed at home the isometric exercises of pressing the tip of the tongue against a spatula, exaggerated retraction of tongue, tongue tapering, and isotonic exercise of touching the commissures and lips alternately, daily. After eight sessions, in relation to the elevation pressure, there was an improvement of 28.6% for the apex and 7.1% for the dorsum. As for protrusion, there was an improvement of 123.5%. In the measurements of left and right lateralization, the values ​​increased 53.8% and 7.4%, respectively. After twelve sessions, it was observed an improvement of 35.7%, 7.4%, 164%, 76.9% and 40.7% in relation to the initial evaluation, for apex elevation, dorsum elevation, protrusion, and lateralization to left and right, respectively. Despite the increase, values ​​recommended in the literature as normal for sex and age were not reached after 12 therapy sessions.

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

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

Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: a literature review of clinical use and pharmacological aspect

Background: Botulinum toxin (Botox) consists of 7 types of neurotoxins; however, only toxins A and B are used clinically. Botox A is used for several disorders in the field of medicine, particularly in dermatology, for cosmetic purposes. It is produced by the bacterium Clostridium botulinum and can be used as a treatment to reduce the appearance of wrinkles in the upper areas of the face, elevate the eyebrows and treat problems such as hyperhidrosis, lichen simplex, pompholyx (dyshidrotic eczema) and acne vulgaris.

Objectives: This article provides a literature review regarding the general issue of Botox as a treatment for reducing facial wrinkle.

Discussion: Botox works by blocking the release of acetylcholine, resulting in paralysis of the local muscles, which usually occurs 24 hrs to two weeks following Botox injection. This effect will last three to six months. The optimal dose of cosmetic Botox in dermatology is 20 units. Botox is relatively safe and does not result in any adverse side effects. However, in certain circumstances, the effect of Botox will gradually resolve, resulting in reduced muscle paralysis over time.

Conclusion: Botox is good and safe medicine to reduce the appearance of facial wrinkles.

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

Background/purpose

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

Materials and methods

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

Results

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

Conclusion

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

Effects of an Oral-Pharyngeal Motor Training Programme on Children with Obstructive Sleep Apnea Syndrome in Hong Kong: A Retrospective Pilot Study

Background

This study aimed to investigate the effects of an oropharyngeal motor training programme on children with Obstructive Sleep Apnea Syndrome (OSAS) in Hong Kong.

Methods

In this retrospective study, we reviewed the outcomes of 10 children with OSAS who had received an oropharyngeal motor training programme in Occupational Therapy Department of an acute hospital in Hong Kong over a 1-year programme. Each participant attended an individual oropharyngeal motor training programme plus a follow-up session after 2 months. The training programme consisted of 10 individual mobilization exercises involving the orofacial and pharyngeal area for 45 minutes. Each exercise had to be repeated for 10 times. Three outcome measures were chosen to study the effectiveness of the training programme including tongue strength, tongue endurance level and orofacial function. Tongue strength and tongue endurance level were assessed using the Iowa Oral Pressure Instrument (IOPI). The Nordic Orofacial Test-Screening (NOT-S) Assessment was used to assess the orofacial function. Seven out of 10 participants completed the training programme and attended the follow-up session after two months.

Results

The tongue strength and the scores of NOT-S of the 7 participants were found to have significant improvement after training. However, there was no significant difference in tongue endurance level.

Conclusion

The findings of this study support the role of occupational therapist in oromotor training modalities to improve the respiratory function for children with OSAS in Hong Kong. Copyright © 2017, Hong Kong Occupational Therapy Association. Published by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Submental Muscle Activation During Lingual Tasks in Healthy Adults

OBJECTIVE

Lingual strengthening exercises are established to improve lingual function, thereby oral swallowing. This study measured submental muscle activation during maximum isometric pressure (MIP) lingual tasks in healthy adults, tasks that are or can be adopted in lingual strengthening exercises. In addition, the effects of age and gender on submental muscle activation are examined.

METHOD

Forty-nine participants between the ages of 18 to 35 years and greater than 60 years were included in the study. Participants completed trials of intraoral MIP lingual elevation, protrusion, and depression, during which submental muscle activation was measured using surface electromyography (sEMG). Peak amplitude measures were normalized and log transformed, following which a three-way ANOVA was performed.

RESULTS

Peak amplitudes of submental muscle activation were highest during lingual MIP protrusion, followed by lingual depression, and were least during lingual elevation. No significant differences in peak amplitudes were observed between older and younger adults, but higher peak amplitudes were recorded in women.

CONCLUSION

The differential effects of lingual task, age, and gender on peak submental muscle activation are examined. The potential impact of incorporating tasks adopted in this study in lingual strengthening exercises to improve oral and pharyngeal swallowing is discussed.

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

Clinical tongue-strengthening therapy programs are generally based on the principles of exercise and motor learning, including the specificity paradigm. The aim of this study was to investigate the specific effect of anterior and posterior tongue-strengthening exercises (TSE) on tongue strength (TS) in healthy older adults and to measure possible detraining effects. Sixteen healthy elderly completed 8 weeks of TSE by means of the Iowa Oral Performance Instrument (IOPI). They were distributed in two different treatment arms and performed either exclusively anterior or posterior TSE (ATSE, n = 9 or PTSE, n = 7) depending on the treatment arm. Anterior and posterior maximal isometric pressures (MIP_A, MIP_P) were measured at baseline, halfway, and after completion of the training sessions. Detraining was measured by repeating MIP_A and MIP_P measures 4 weeks after the last session of TSE. MIP_A and MIP_P increased significantly in both treatment arms. MIP_A was significantly higher in the ATSE group compared to the PTSE group across all measures in time. No significant differences were observed in MIP_P between the ATSE and PTSE groups. Regardless of treatment arm, there was no significant detraining effect measured 4 weeks after the last TSE session. This study suggests that TSE show partial specificity concerning bulb position. We conclude that especially anterior training results in higher anterior TS in comparison with posterior exercises. Furthermore, we found no detraining effects, independent of bulb location.

A Wireless Monitoring System Using a Tunneling Sensor Array in a Smart Oral Appliance for Sleep Apnea Treatment

Sleep apnea is a serious sleep disorder, and the most common type is obstructive sleep apnea (OSA). Untreated OSA will cause lots of potential health problems. Oral appliance therapy is an effective and popular approach for OSA treatment, but making a perfect fit for each patient is time-consuming and decreases its efficiency considerably. This paper proposes a System-on-a-Chip (SoC) enabled sleep monitoring system in a smart oral appliance, which is capable of intelligently collecting the physiological data about tongue movement through the whole therapy. A tunneling sensor array with an ultra-high sensitivity is incorporated to accurately detect the subtle pressure from the tongue. When the device is placed on the wireless platform, the temporary stored data will be retrieved and wirelessly transmitted to personal computers and cloud storages. The battery will be recharged by harvesting external RF power from the platform. A compact prototype module, whose size is 4.5 × 2.5 × 0.9 cm³, is implemented and embedded inside the oral appliance to demonstrate the tongue movement detection in continuous time frames. The functions of this design are verified by the presented measurement results. This design aims to increase efficiency and make it a total solution for OSA treatment.

Neurogenic Orofacial Weakness and Speech in Adults With Dysarthria

PURPOSE

This study compared orofacial strength between adults with dysarthria and neurologically normal (NN) matched controls. In addition, orofacial muscle weakness was examined for potential relationships to speech impairments in adults with dysarthria.

METHOD

Matched groups of 55 adults with dysarthria and 55 NN adults generated maximum pressure (Pmax) against an air-filled bulb during lingual elevation, protrusion and lateralization, and buccodental and labial compressions. These orofacial strength measures were compared with speech intelligibility, perceptual ratings of speech, articulation rate, and fast syllable-repetition rate.

RESULTS

The dysarthria group demonstrated significantly lower orofacial strength than the NN group on all tasks. Lingual strength correlated moderately and buccal strength correlated weakly with most ratings of speech deficits. Speech intelligibility was not sensitive to dysarthria severity. Individuals with severely reduced anterior lingual elevation Pmax (< 18 kPa) had normal to profoundly impaired sentence intelligibility (99%-6%) and moderately to severely impaired speech (26%-94% articulatory imprecision; 33%-94% overall severity).

CONCLUSIONS

Results support the presence of orofacial muscle weakness in adults with dysarthrias of varying etiologies but reinforce tenuous links between orofacial strength and speech production disorders. By examining individual data, preliminary evidence emerges to suggest that speech, but not necessarily intelligibility, is likely to be impaired when lingual weakness is severe.

Effects of lingual strength training on lingual strength and articulator function in stroke patients with dysarthria

[Purpose] This study investigated the effects of lingual strength training (LST) on lingual strength and articulator function in stroke patients with dysarthria. [Subjects and Methods] 16 stroke patients with dysarthria were randomly assigned into two groups: the experimental group (n=8) or the control group (n=8). Both groups received the conventional rehabilitation therapy at 30 min/day, 5 times for week, and during 4 weeks, and the experimental group received an additional 30 min of LST using the Iowa Oral Performance Instrument (IOPI). The Maximum Isometric Tongue Pressures (MIPs) was used to assess the lingual strength and the Alternating-Motion Rate (AMR) and Sequential-Motion Rate (SMR) were used to measure the articulator function. [Results] After the intervention, the experimental group showed a significant improvement in MIPs and AMR (/tə/) than the control group. [Conclusion] Findings of this study suggest that LST provides positive effects on lingual strength and articulator function, and thus can be used as an interventional method in stroke patients with dysarthria.

The Effects of Lip-Closure Exercise on Lip Strength and Function Following Full Facial Transplantation: A Case Report

PURPOSE

Facial transplantation is a relatively new option for individuals with severe facial disfigurements. Clinical case studies on existing patients indicate many instances of persistent facial motor impairment for facial expression, speech, and swallowing. These preliminary findings motivate additional research on the impact of lip-strengthening exercises following facial transplantation.

METHOD

In this study, we assessed the efficacy of an 8-week, biofeedback-driven, lip closure-strengthening exercise program in a single patient 1-year status post-full facial transplantation. Exercise was at 60% of peak strength. Outcome measures included instrumental measures of lip strength and mobility, clinical measures of speech, and patient-reported outcomes in feeding and facial expression.

RESULTS

Results revealed improvements in labial strength, speed of lip movement, and range of motion during speech. A 3-point improvement in sentence speech intelligibility was also observed following strength-training exercise. The patient reported improvements in her ability to drink from a straw and communicate via facial expression.

CONCLUSION

These preliminary findings motivate additional research on the efficacy of lip-strengthening exercises following facial transplantation.

A Systematic Review of Isometric Lingual Strength-Training Programs in Adults With and Without Dysphagia

PURPOSE

This systematic review summarizes the effects of isometric lingual strength training on lingual strength and swallow function in adult populations. Furthermore, it evaluates the designs of the reviewed studies and identifies areas of future research in isometric lingual strength training for dysphagia remediation.

METHOD

A comprehensive literature search of 3 databases and additional backward citation search identified 10 studies for inclusion in the review. The review reports and discusses the isometric-exercise intervention protocols, pre- and postintervention lingual-pressure data (maximum peak pressures and lingual-palatal pressures during swallowing), and oropharyngeal swallowing measures such as penetration-aspiration scales, oropharyngeal residue and duration, lingual volumes, and quality-of-life assessments.

RESULTS

Studies reported gains in maximum peak lingual pressures following isometric lingual strength training for both healthy adults and select groups of individuals with dysphagia. However, due to the variability in study designs, it remains unclear whether strength gains generalize to swallow function.

CONCLUSION

Although isometric lingual strength training is a promising intervention for oropharyngeal dysphagia, the current literature is too variable to confidently report specific therapeutic benefits. Future investigations should target homogenous patient populations and use randomized controlled trials to determine the efficacy of this treatment for individuals with dysphagia.

Lingual-Alveolar Contact Pressure During Speech in Amyotrophic Lateral Sclerosis: Preliminary Findings

PURPOSE

This preliminary study on lingual-alveolar contact pressures (LACP) in people with amyotrophic lateral sclerosis (ALS) had several aims: (a) to evaluate whether the protocol induced fatigue, (b) to compare LACP during speech (LACP-Sp) and during maximum isometric pressing (LACP-Max) in people with ALS (PALS) versus healthy controls, (c) to compare the percentage of LACP-Max utilized during speech (%Max) for PALS versus controls, and (d) to evaluate relationships between LACP-Sp and LACP-Max with word intelligibility.

METHOD

Thirteen PALS and 12 healthy volunteers produced /t, d, s, z, l, n/ sounds while LACP-Sp was recorded. LACP-Max was obtained before and after the speech protocol. Word intelligibility was obtained from auditory-perceptual judgments.

RESULTS

LACP-Max values measured before and after completion of the speech protocol did not differ. LACP-Sp and LACP-Max were statistically lower in the ALS bulbar group compared with controls and PALS with only spinal symptoms. There was no statistical difference between groups for %Max. LACP-Sp and LACP-Max were correlated with word intelligibility.

CONCLUSIONS

It was feasible to obtain LACP-Sp measures without inducing fatigue. Reductions in LACP-Sp and LACP-Max for bulbar speakers might reflect tongue weakness. Although confirmation of results is needed, the data indicate that individuals with high word intelligibility maintained LACP-Sp at or above 2 kPa and LACP-Max at or above 50 kPa.

Assessment of tongue mechanical properties using different contraction tasks

Inadequate upper airway (UA) dilator muscle function may play an important role in the pathophysiology of obstructive sleep apnea (OSA). To date, tongue mechanical properties have been assessed mainly using protrusion protocol with conflicting results. Performance during elevation tasks among patients with OSA remains unknown. This study aimed at assessing tongue muscle strength, strength stability, endurance time, fatigue indices, and total muscle work, using elevation and protrusion tasks with repetitive isometric fatiguing contractions in 12 normal plus mild, 17 moderate, and 11 severe patients with OSA, and to assess the influence of body mass index (BMI) and age. Endurance time was longer in protrusion than elevation task (P = 0.01). In both tasks, endurance time was negatively correlated with baseline value of strength coefficient of variation (P < 0.01). Compared with other groups, patients with moderate OSA had the lowest total muscle work for protrusion (P = 0.01) and shortest endurance time (P = 0.04), regardless of the type of task. Additionally, in patients with moderate-severe OSA, the total muscle work for both tasks was lower in nonobese compared with obese (P < 0.05). Total muscle work for protrusion was positively correlated with apnea hypopnea index (AHI) in obese subjects (P < 0.01). Endurance time was shorter (P < 0.01) and recovery time longer (P = 0.02) in the old compared with young subjects. In conclusion, the tongue is more prone to fatigue during the elevation task and in patients with moderate OSA. Obesity appeared to prevent alteration of tongue mechanical properties in patients with OSA. Baseline strength stability and endurance were related, illustrating the role of central neuromuscular output in tongue resistance to fatigue.NEW & NOTEWORTHY To our knowledge, this is the first study to assess and compare tongue function using both elevation and protrusion tasks with repetitive isometric fatiguing contractions in subjects with different OSA status. Tongue mechanical performance seemed to differ between protrusion and elevation tasks and depend on the severity of OSA.

Caracterização da força da língua por meio de medidas objetivas

RESUMO Objetivo: analisar a força axial da língua e parâmetros relacionados por meio do FORLING. Método: foram analisados os dados de 92 participantes, entre homens e mulheres, com média de 23,3±7,7 anos. Resultados: no parâmetro força média da língua, identificaram-se valores médios de 13,0 N, já para a força máxima observou-se valor médio de 18,3 N. A força média e a máxima da língua apresentaram correlação positiva e associação altamente significante (p<0,001). A energia acumulada pela língua indicou valores de 131,1 N/s. O tempo médio gasto para que se alcance a força máxima da língua foi de 3,8 segundos, indicando um efeito do treinamento ao se comparar a 1ª à 3ª medida, com redução dos valores (p<0,001). Conclusão: o instrumento demonstrou ser capaz de mensurar parâmetros importantes para o fonoaudiólogo, indicando ser uma promissora ferramenta complementar à avaliação clínica fonoaudiológica.

Myofunctional therapy applied to upper airway resistance syndrome: a case report

The literature presents publications on the treatment of patients with obstructive sleep apnea syndrome (OSAS) by myofunctional therapy, but there are no reports of this approach to patients with upper airway resistance syndrome (UARS). The objective was to verify the effect of myofunctional therapy in a case of UARS in relation to morphological and functional aspects of the stomatognathic system, anthropometric data, and quality of sleep. Patient, aged 61 years, diagnosed with UARS, underwent 12 sessions of myofunctional therapy for 3 months with exercises aimed at the suprahyoid, the tongue, and the soft palate muscles. Evaluations were performed before the start of the therapeutic process, right after the end, as well as 1, 2, 4, and 10 months after the completion of the treatment, considering: tonicity and mobility of the suprahyoid muscles, the tongue, and the soft palate; modified Mallampati grade; neck circumference; body mass index; and parameters of sleep quality. After the therapeutic process, there was a decrease in scores related to the tonus of the suprahyoid muscles, mobility, and tonus of the tongue and of the soft palate. The Mallampati grade was IV in the initial evaluation, and III in subsequent assessment. There was a reduction of 2 cm in neck circumference and BMI remained similar over time. In analyzing the three parameters of sleep quality, improvement was observed in all evaluations after discharge. Therefore, the effect of myofunctional therapy in a case of UARS was positive for all parameters.

Cross-activation and detraining effects of tongue exercise in aged rats

Voice and swallowing deficits can occur with aging. Tongue exercise paired with a swallow may be used to treat swallowing disorders, but may also benefit vocal function due to cross-system activation effects. It is unknown how exercise-based neuroplasticity contributes to behavior and maintenance following treatment. Eighty rats were used to examine behavioral parameters and changes in neurotrophins after tongue exercise paired with a swallow. Tongue forces and ultrasonic vocalizations were recorded before and after training/detraining in young and old rats. Tissue was analyzed for neurotrophin content. Results showed tongue exercise paired with a swallow was associated with increased tongue forces at all ages. Gains diminished after detraining in old rats. Age-related changes in vocalizations, neurotrophin 4 (NT4), and brain derived neurotrophic factor (BDNF) were found. Minimal cross-system activation effects were observed. Neuroplastic benefits were demonstrated with exercise in old rats through behavioral improvements and up-regulation of BDNF in the hypoglossal nucleus. Tongue exercise paired with a swallow should be developed, studied, and optimized in human clinical research to treat swallowing and voice disorders in elderly people.

Análise da pressão da língua em indivíduos adultos jovens brasileiros

RESUMO Objetivo: Apresentar valores para a pressão da língua em adultos jovens brasileiros, considerando provas específicas e possíveis diferenças quanto ao gênero e tipo de prova. Método: Foram avaliados 51 voluntários de 18 a 28 anos, ambos os gêneros, com boa relação dento-oclusal e sem alterações de fala. Utilizou-se o Iowa Oral Performance Instrument na avaliação da pressão da língua (Kilopascal) durante as provas de elevação, protrusão, deglutição e lateralização, além do teste de resistência (segundos). Na análise dos resultados foi utilizado o ANOVA, seguido do teste de comparações múltiplas Tukey, adotando o nível de significância de 5%. Resultados: Os valores obtidos, respectivamente para homens e mulheres, na prova de elevação foram 63,94±12,92 e 50,27±15,29, na protrusão 60,22±13,62 e 44,30±12,95, na deglutição 33,94±12,06 e 34,27±13,25, na lateralização à direita 44,15±10,47 e 31,85±8,46, na lateralização à esquerda 43,15±10,22 e 29,55±8,91, e no teste de resistência 24,85±10,95 e 17,35±6,71. Os homens apresentaram valor maior nas provas de protrusão e de lateralização; os valores das provas de protrusão e elevação não diferiram entre si para o gênero masculino, mas foram maiores que a lateralização e a deglutição em ambos os gêneros; não houve diferença na prova de lateralização em relação ao lado em ambos os gêneros. Conclusão: Valores de pressão da língua em adultos jovens brasileiros foram determinados para provas específicas; o gênero influenciou nos valores das provas de protrusão e lateralização; os valores obtidos nas provas de elevação e protrusão foram maiores que na lateralização e deglutição.

Study protocol for a randomized controlled trial: tongue strengthening exercises in head and neck cancer patients, does exercise load matter?

BACKGROUND

Reduced tongue strength is an important factor contributing to early and late dysphagia in head and neck cancer patients previously treated with chemoradiotherapy. The evidence is growing that tongue strengthening exercises can improve tongue strength and swallowing function in both healthy and dysphagic subjects. However, little is known about the impact of specific features of an exercise protocol for tongue strength on the actual outcome (strength or swallowing function). Previous research originating in the fields of sports medicine and physical rehabilitation shows that the degree of exercise load is an influential factor for increasing muscle strength in the limb skeletal muscles. Since the tongue is considered a muscular hydrostat, it remains to be proven whether the same concepts will apply.

METHODS/DESIGN

This ongoing randomized controlled trial in chemoradiotherapy-treated patients with head and neck cancer investigates the effect of three tongue strengthening exercise protocols, with different degrees of exercise load, on tongue strength and swallowing. At enrollment, 51 patients whose dysphagia is primarily related to reduced tongue strength are randomly assigned to a training schedule of 60, 80, or 100% of their maximal tongue strength. Patients are treated three times a week for 8 weeks, executing 120 repetitions of the assigned exercise once per training day. Exercise load is progressively adjusted every 2 weeks. Patients are evaluated before, during and after treatment by means of tongue strength measurements, fiber-optic endoscopic evaluation of swallowing and quality-of-life questionnaires.

DISCUSSION

This randomized controlled trial is the first to systematically investigate the effect of different exercise loads in tongue strengthening exercise protocols. The results will allow the development of more efficacious protocols.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN14447678.

Is There a Role for Exercise in the Management of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis?

PURPOSE

The role of exercise in the management of people with amyotrophic lateral sclerosis (PALS) is controversial and currently unclear. The purpose of this review article is to review literature examining the impact of limb, respiratory, and oral motor exercise on function, disease progression, and survival in PALS and the transgenic ALS animal model.

METHOD

A literature review was conducted to examine relevant studies published in peer-reviewed journals between 1960 and 2014. All studies were appraised for quality of research and were assigned a level of evidence, and treatment outcomes were classified as either positive, negative, or neutral.

RESULTS

A total of 18 exercise-based intervention studies on limb (13), respiratory (3), or speech (2) function were identified. Of the human clinical trials, 6 were experimental and 4 were exploratory. No experimental studies were identified examining the impact of targeted exercise on speech or swallowing function. Mild to moderate intensity limb or respiratory exercise, applied early in the disease, was noted to have a beneficial impact on motor function and survival.

CONCLUSION

Insufficient data exist to support or refute the role of exercise in the management of bulbar dysfunction in PALS. This represents a critical area of future investigation.

Efficacy of exercises to rehabilitate dysphagia: A critique of the literature

PURPOSE

This review critiques the benefit of commonly used rehabilitative exercises for dysphagia.

METHOD

Common goals of rehabilitation for dysphagia and principles of neuroplasticity are introduced as they apply to swallowing and non-swallowing exercises. A critique of published studies is offered regarding their evidence for showing benefit from the exercise.

RESULT

One of five swallow exercises had preliminary evidence for long-term benefit and two of four non-swallow exercises have strong evidence for long-term benefit.

CONCLUSION

Only a minority of exercises prescribed for patients with dysphagia have sufficient evidence for long-term improvement in swallowing.