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Lorenz M, Goetze D, Sargolzaei K, Frank U. The test of masticating and swallowing solids (ToMaSS): An investigation of applicability and clinical utility in children with orofacial myofunctional disorders. J Oral Rehabil 2024. [PMID: 38873707 DOI: 10.1111/joor.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/08/2023] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Orofacial myofunctional disorders (OMD) are often associated with limitations of oral ingestion of solid food. The Test of Masticating and Swallowing Solids (ToMaSS) is a simple diagnostic tool to assess and quantify oropharyngeal efficiency while eating a standardised cracker. OBJECTIVES The objective of this study was to investigate the applicability and clinical utility of the ToMaSS in children with OMD. METHODS In this case-control study, data were collected from 18 children between 4 and 11 years with confirmed OMD. Inter-rater reliability and age effects on the ToMaSS parameters were investigated and the specific performance profile of the OMD children was identified. RESULTS Inter-rater reliability was excellent for the ToMaSS parameters 'bites' (ICC = .999), 'masticatory cycles' (ICC = .961), 'time'(ICC≧ .999) and good for 'number of swallows' (ICC = .810). 'Masticatory cycles' and 'time' decreased as a function of age with a significant difference in the 'number of masticatory cycles' between the youngest (4-6 years) and oldest (10-14 years) participants (p = .006, Z = -2.739). Deviations from normative data in at least one of the four ToMaSS parameters were found in 90% of the OMD children with 'bites', and 'masticatory cycles' predominantly corresponding to the performances expected in typically-developing children in younger age groups. CONCLUSIONS The ToMaSS is a reliable diagnostic instrument and clinically useful to detect limited efficiency of oral solid bolus intake and specific impairments in chewing function and duration of food intake in children with OMD. Our data suggest that OMD is associated with delayed development of efficient solid bolus preparation.
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Affiliation(s)
- Marlene Lorenz
- Praxis für Logopaedie und Dysphagietherapie, Berlin, Germany
- Linguistic Department, Swallowing Research Lab, University of Potsdam, Potsdam, Germany
| | - Danae Goetze
- Linguistic Department, Swallowing Research Lab, University of Potsdam, Potsdam, Germany
- Ludwig-Maximilians-University, Munich, Germany
| | | | - Ulrike Frank
- Linguistic Department, Swallowing Research Lab, University of Potsdam, Potsdam, Germany
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Aseef A, Dodderi T, Muthukumar V, Krishnamurthy R, Balasubramanium RK, Kothari M. Test of mastication and swallowing solids in healthy individuals aged 6 to 20 years: A normative study in an Indian context. J Oral Rehabil 2024. [PMID: 38767112 DOI: 10.1111/joor.13741] [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: 04/17/2023] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The Test of Mastication and Swallowing Solids (TOMASS) is a reliable tool for assessing chewing and swallowing in healthy adults, using commercially available crackers. TOMASS-Children (TOMASS-C) is the paediatric version of TOMASS. OBJECTIVE The present study aimed to establish normative data for TOMASS-C using a validated regional commercial cracker among healthy individuals aged between 6-20 years of India. METHODS 327 healthy individuals between 6-20 years were recruited in a cross-sectional study design following a convenient sampling procedure. Participants consumed one validated regional cracker and the procedure was video recorded. Data were stratified according to age groups (6-7, 8-9, 10-13, 14-17 and 18-20 years) and sex (boys and girls). Two Speech Language Pathologists independently analysed the video recordings to derive discrete bites, masticatory cycles, swallows and total swallow time indices. Using them, time/swallow, masticatory cycles/bite, swallows/bite and time/bite were calculated. RESULTS All parameters of TOMASS-C had moderate to good (0.6-0.85) test-retest reliability and moderate to excellent (0.69-0.99) inter-rater reliability at p > .000. Younger participants took more bites, chewed more times and swallowed more frequently with longer chewing and swallowing time. Boys exhibited a lower number of swallows, shorter swallow time and reduced total masticatory time at p > .05. Additionally, girls demonstrated fewer bites and chewing cycles compared to boys at p > .05. CONCLUSION TOMASS-C using a validated regional cracker was feasible and reliable. Normative data established for healthy boys and girls between 6-20 years offers much-needed quantitative data to objectively delineate individuals with and without chewing and swallowing solid food difficulties.
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Affiliation(s)
- Ambreen Aseef
- Department of Audiology and Speech Language Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, India
| | - Thejaswi Dodderi
- Department of Audiology and Speech Language Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, India
| | - Varsha Muthukumar
- Department of Audiology and Speech Language Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, India
| | - Rahul Krishnamurthy
- Special Education and Communication Disorders (SECD), University of Nebraska-Lincoln, Lincoln, USA
| | - Radish Kumar Balasubramanium
- Department of Audiology and Speech Language Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, India
| | - Mohit Kothari
- Department of Audiology and Speech Language Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, India
- Hammel Neurorehabilitation Center and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
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Porter K, Smart S, Hennessey N, Cocks N. Chewing skills in two and three year old children: Gender and age comparisons on an adapted version of the test of mastication and swallowing (TOMASS-C). INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:38-44. [PMID: 36511843 DOI: 10.1080/17549507.2022.2152867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Few assessment tools objectively measure chewing skills in the paediatric population. There is a need for assessment tools that use consistent foods so comparisons can be made between typically developing children and children with paediatric feeding disorders, and to measure the efficacy of treatment. The Test of Masticating and Swallowing Solids for adults (TOMASS) and children (TOMASS-C) are assessments that use a cracker as a consistent measure to assess chewing skills. Normative data exist for children over 4 years, however, no data are available for younger children. This study investigated age and gender-related differences in mastication skills in typically developing children aged 2-3 years when eating a cracker. METHOD Thirty participants aged 2;0-3;10 were assessed using an adapted version of the TOMASS-C. Participants were required to eat a single Arnott's Salada cracker, and the number of bites, masticatory cycles, swallows, and duration of time to finish the cracker were measured. RESULT Two-year-old children used more masticatory cycles and took longer to finish the cracker than 3-year-old children. There were no significant effects of age on the number of swallows and number of bites, and no significant differences between boys and girls. CONCLUSION This study provides preliminary normative data for chewing skills in children aged 2 and 3 years and confirms that the TOMASS-C is sensitive to developmental changes in mastication within this younger age range. These results expand our understanding of oral motor and chewing development in children.
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Affiliation(s)
- Katelin Porter
- Curtin School of Allied Health, Curtin University, Bentley, Australia
| | - Sharon Smart
- Curtin School of Allied Health, Curtin University, Bentley, Australia
| | - Neville Hennessey
- Curtin School of Allied Health, Curtin University, Bentley, Australia
| | - Naomi Cocks
- Curtin School of Allied Health, Curtin University, Bentley, Australia
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Trucco F, Salmin F, Lizio A, Coratti G, Albamonte E, Frisoni MC, Mauro L, Carraro E, Palazzo G, Lops J, Cattaneo C, Pozzi S, Casiraghi J, Di Bari A, Berti B, Stanca G, Ricci M, Pane M, Heatwole C, Dilek N, Mercuri E, Sansone VA. Assessing Prevalence and Characteristics of Oro-bulbar Involvement in Children and Adults with SMA Type 2 and 3 Using a Multimodal Approach. Dysphagia 2023; 38:1568-1580. [PMID: 37289231 PMCID: PMC10611831 DOI: 10.1007/s00455-023-10584-z] [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: 01/13/2023] [Accepted: 04/21/2023] [Indexed: 06/09/2023]
Abstract
Bulbar and jaw muscles are impaired in patients with Spinal Muscular Atrophy (SMA) but the assessment of their severity and progression are limited by the lack of age-appropriate and disease-specific measures. We investigated mastication and swallowing in children and adults with SMA, sitters and walkers. In a 2-year multicentre cross-sectional prospective study, lip and tongue strength (Iowa Oral Performance Instrument), chewing and swallowing (Test of Masticating and Swallowing Solids), active mouth opening (aMMO) were compared to age-appropriate normative data. The perceived burden of oro-bulbar involvement (SMA-Health Index) was recorded. 78 patients were included, 45 children (median age 7.4 years),22 adults (median age 26.8 years) on nusinersen and 11 untreated (median age 32.7 years). Forty-three percent children had reduced mouth opening, 50% had prolonged total time to eat. These issues were more prominent in sitters than in walkers (p = 0.019, p = 0.014). Sixty-six percent needed increased swallows for bolus clearance. Nusinersen treated adults had median aMMO, tongue strength and total time at TOMASS values within normal range (z score: -1.40, -1.22, -1.32, respectively) whereas untreated adults had reduced aMMO (z score: -2.68) and tongue strength (z score: -2.20). Only a minority of children (2/17) and treated adults (5/21) reported burden in swallowing or mastication compared to all untreated adults (5/5). After 16 months, mastication and swallowing were stable in treated children and adults, whether sitters or walkers. The reported multimodal approach to assess oro-bulbar functions demonstrate that swallowing and mastication are impaired in SMA despite patients' perception. These results suggest a trend towards stabilization of oro-bulbar function in patients on long-term treatment with nusinersen.
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Affiliation(s)
- Federica Trucco
- Neurorehabilitation Unit, The NeMo Clinical Center in Milan, University of Milan, ASST Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, UK
- Dept Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | | | - Andrea Lizio
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | - Giorgia Coratti
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Luca Mauro
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | - Elena Carraro
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | | | - Jessica Lops
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | | | - Susanna Pozzi
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | | | | | - Beatrice Berti
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Stanca
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Martina Ricci
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marika Pane
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Chad Heatwole
- Center for Health and Technology (CHeT), The University of Rochester Medical Center, Rochester, NY, USA
| | - Nuran Dilek
- Center for Health and Technology (CHeT), The University of Rochester Medical Center, Rochester, NY, USA
| | - Eugenio Mercuri
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valeria Ada Sansone
- Neurorehabilitation Unit, The NeMo Clinical Center in Milan, University of Milan, ASST Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy.
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Flores-Orozco EI, Ignatova-Mishutina T, Hernandez-Zamora MO, De-Haro-López C, Osuna-Hernández MG, Escobedo-Jiménez XP, Flores-Hernández FL, Rodríguez-Correa L, Rovira-Lastra B, Martinez-Gomis J. Side switch frequency while masticating different chewing materials, and its relationship with other masticatory behaviors and sensory perceptions. Arch Oral Biol 2023; 155:105804. [PMID: 37722154 DOI: 10.1016/j.archoralbio.2023.105804] [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: 06/29/2023] [Revised: 08/26/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE This cross-sectional study aimed to establish normative values for masticatory side switch (MSS) frequency in young Mexican adults and to assess the relationship between various indices and MSS frequency when masticating different chewing materials. DESIGN We enrolled 101 dentate adults and performed four masticatory assays that involved masticating different chewing materials (i.e., two-colored chewing gum, sweet cracker, salty cracker, and bread). Participants were asked to eat and swallow these foods and to chew the gum for 40 cycles and the following indices were determined: MSS index (MSSI), unilateral chewing index, chewing cycle duration, and number of cycles before terminal swallowing. The participants then rated perceived flavor intensity, salivary flow, and muscle fatigue during each trial. RESULTS The MSSI ranged from 0.03-0.06 (10th percentile) to 0.48-0.54 (90th percentile). A repeated-measures general linear model revealed a mean MSSI value of 0.28 (95 %CI, 0.25-0.30) adjusted by several factors. Male sex, soft food, and the last chewing period were associated with lower MSS frequency. Spearman's test showed a high correlation for the MSSI among the different foods. MSSI correlated negatively with the unilateral chewing index for each chewing material and with number of cycles for the sweet cracker. However, no significant correlation was detected between MSSI and sensory perception. CONCLUSIONS In healthy dentate individuals, the mean MSS relative frequency is 25-30 % with an 80-central percentile of 5-50 % of the maximum possible side changes. Lower MSS frequencies were detected in men, when chewing soft food, and during the final chewing period.
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Affiliation(s)
- Elan Ignacio Flores-Orozco
- Department of Prosthodontics, Faculty of Dentistry, Autonomous University of Nayarit, Edificio de la Unidad Académica de Odontología, Ciudad de la Cultura Amado Nervo, Tepic, C.P. 63155, Nayarit, Mexico
| | - Tatiana Ignatova-Mishutina
- Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona, Campus de Bellvitge, Pavelló de govern, C/Feixa llarga, s/n 08907 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Miranda Oryana Hernandez-Zamora
- Department of Prosthodontics, Faculty of Dentistry, Autonomous University of Nayarit, Edificio de la Unidad Académica de Odontología, Ciudad de la Cultura Amado Nervo, Tepic, C.P. 63155, Nayarit, Mexico
| | - Cristina De-Haro-López
- Department of Prosthodontics, Faculty of Dentistry, Autonomous University of Nayarit, Edificio de la Unidad Académica de Odontología, Ciudad de la Cultura Amado Nervo, Tepic, C.P. 63155, Nayarit, Mexico
| | - Mireya Guadalupe Osuna-Hernández
- Department of Prosthodontics, Faculty of Dentistry, Autonomous University of Nayarit, Edificio de la Unidad Académica de Odontología, Ciudad de la Cultura Amado Nervo, Tepic, C.P. 63155, Nayarit, Mexico
| | - Ximena Paola Escobedo-Jiménez
- Department of Prosthodontics, Faculty of Dentistry, Autonomous University of Nayarit, Edificio de la Unidad Académica de Odontología, Ciudad de la Cultura Amado Nervo, Tepic, C.P. 63155, Nayarit, Mexico
| | - Frida Livier Flores-Hernández
- Department of Prosthodontics, Faculty of Dentistry, Autonomous University of Nayarit, Edificio de la Unidad Académica de Odontología, Ciudad de la Cultura Amado Nervo, Tepic, C.P. 63155, Nayarit, Mexico
| | - Lizbeth Rodríguez-Correa
- Department of Prosthodontics, Faculty of Dentistry, Autonomous University of Nayarit, Edificio de la Unidad Académica de Odontología, Ciudad de la Cultura Amado Nervo, Tepic, C.P. 63155, Nayarit, Mexico
| | - Bernat Rovira-Lastra
- Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona, Campus de Bellvitge, Pavelló de govern, C/Feixa llarga, s/n 08907 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, Campus de Bellvitge, C/Feixa llarga, s/n 08907 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Jordi Martinez-Gomis
- Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona, Campus de Bellvitge, Pavelló de govern, C/Feixa llarga, s/n 08907 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, Campus de Bellvitge, C/Feixa llarga, s/n 08907 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
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Hidaka R, Masuda Y, Ogawa K, Tanaka T, Kanazawa M, Suzuki K, Stading M, Iijima K, Matsuo K. Impact of the Comprehensive Awareness Modification of Mouth, Chewing and Meal (CAMCAM) Program on the Attitude and Behavior Towards Oral Health and Eating Habits as Well as the Condition of Oral Frailty: A Pilot Study. J Nutr Health Aging 2023; 27:340-347. [PMID: 37248757 DOI: 10.1007/s12603-023-1913-1] [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: 02/19/2023] [Accepted: 03/29/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Preserving sufficient oral function and maintaining aadequate nutrition are essential for preventing physical frailty and the following long-term care. We recently developed the 6-month Comprehensive Awareness Modification of Mouth, Chewing And Meal (CAMCAM) program, in which participants gather monthly to learn about oral health and nutrition while eating a textured lunch together. This study examined whether the CAMCAM program could improve attitude and behavior towards oral health, mastication, and diet as well as ameliorate oral frailty in community-dwelling older adults. DESIGN Single-arm pre-post comparison study. SETTING AND PARTICIPANTS A total of 271 community-dwelling adults (72.3 ± 5.7 years of age; 159 women [58.7%]) in 4 Japanese municipalities were recruited, of which 249 participants (92%) were assessed at the final evaluation. INTERVENTION Participants gathered once a month at community centers to learn about oral health and nutrition while eating a "munchy" textured lunch containing proper nutrition. MEASUREMENTS Oral frailty, frailty, and eating behavior were evaluated with the Oral Frailty Index-8 (OFI-8), Kihon checklist (KCL), and CAMCAM checklist, respectively. Participants were divided into Oral frailty (OF) and Robust groups according to OFI-8 scores. The differences in KCL and CAMCAM checklist results between the OF and Robust groups were statistically tested along with changes in scores after the program. RESULTS KCL and CAMCAM checklist scores were significantly lower in the OF group at the initial assessment. OFI-8 and KCL findings were significantly improved in the OF group after completing the program (all P <0.05). Regarding the CAMCAM checklist, awareness of chewing improved significantly in the Robust group (P=0.009), with a similar tendency in the OF group (P=0.080). CONCLUSION The findings of this pilot study suggest that the CAMCAM program may improve both oral and systemic frailty in addition to attitudes towards chewing, oral health, and meals, especially in individuals with oral frailty. The CAMCAM program merits expansion as a community-based frailty prevention program.
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Affiliation(s)
- R Hidaka
- Koichiro Matsuo, Department of Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8549, Japan, Phone: +81-3-5803-4545, E-mail:
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Patterns of Movement Performance and Consistency From Childhood to Old Age. Motor Control 2022; 27:258-274. [PMID: 36351427 DOI: 10.1123/mc.2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/11/2022]
Abstract
It is widely accepted that the general process of aging can be reflected by changes in motor function. Typically, optimal performance of a given motor task is observed for healthy young adults with declines being observed for individuals at either end of the lifespan. This study was designed to examine differences in the average and variability (i.e., intraindividual variability) of chewing, simple reaction time, postural control, and walking responses. For this study, 15 healthy children, 15 young adults, and 15 older adults participated. Our results indicated the movement performance for the reaction time and postural sway followed a U shape with young adults having faster reaction times and decreased postural sway compared to the children and older adults. However, this pattern was not preserved across all motor tasks with no age differences emerging for (normalized) gait speed, while chewing rates followed a U-shaped curve with older adults and children chewing at faster rates. Taken together, these findings would indicate that the descriptive changes in motor function with aging are heavily influenced by the nature of the task being performed and are unlikely to follow a singular pattern.
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8
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Kothari S, Krishnamurthy R, Balasubramanium RK, Huckabee ML. The Test of Masticating and Swallowing Solids (TOMASS): Reliability, Validity and Normative Data for the Adult Indian Population. Indian J Otolaryngol Head Neck Surg 2021; 73:327-332. [PMID: 34471621 DOI: 10.1007/s12070-021-02429-8] [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: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 12/01/2022] Open
Abstract
The Test of Masticating and Swallowing Solids (TOMASS) is a reliable and well-validated tool to assess the effectiveness of solid bolus ingestion. Previous studies have established normative values for 4 to 80+ years across a range of commercially available crackers and countries. The current study aimed to establish normative data for the TOMASS across age and gender groups for a commercially available biscuit (cracker) for the adult Indian population. A total of 300 typical individuals in the age range of 21 to 80 years grouped by age and sex participated in the study. Participants were instructed to eat a commercially (locally) available biscuit 'as quickly and comfortably as possible,' and the task was video recorded. The recorded video samples were analyzed to obtain measures of the number of bites, number of masticatory cycles, number of swallows, and total time taken to complete the ingestion of biscuit. Cronbach's α values revealed a moderate to good (0.71 to 0.82) test-retest reliability; ICC values were suggestive of a high level (> 0.76) of interrater reliability for all the measures of TOMASS. The results of the one-way ANOVA revealed a significant main effect of age (F = 3.12, p < 0.01) and gender (F = 4.37, p < 0.01), but not an interaction between the two. Normative data stratified by age and gender were also generated. The TOMASS assessment procedure was feasible, reliable, and valid. In the current study, we observed that males took fewer bites, took less time, chewed less, and swallowed fewer times than females. A definitive age effect was observed for the number of bites, masticatory cycles, and total time. The normative data generated by the current study can serve as clinical benchmarks to assess the ingestion of solid bouls in the adult Indian population.
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Affiliation(s)
- Siddarth Kothari
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Rahul Krishnamurthy
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Radish Kumar Balasubramanium
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Maggie-Lee Huckabee
- Department of Communication Disorders, The Rose Centre for Stroke Recovery and Research, The University of Canterbury, Christchurch, New Zealand
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9
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van der Heul AMB, van Eijk RPA, Wadman RI, Asselman F, Cuppen I, Nievelstein RAJ, Gerrits E, van der Pol WL, van den Engel-Hoek L. Mastication in Patients with Spinal Muscular Atrophy Types 2 and 3 is Characterized by Abnormal Efficiency, Reduced Endurance, and Fatigue. Dysphagia 2021; 37:715-723. [PMID: 34392389 PMCID: PMC9345836 DOI: 10.1007/s00455-021-10351-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/02/2021] [Indexed: 11/30/2022]
Abstract
Mastication problems can have a negative impact on the intake of food and quality of life. This cross-sectional study characterizes mastication problems using clinical and instrumental assessments in patients with spinal muscular atrophy (SMA) types 2 and 3 with self-reported bulbar problems. We included 27 patients (aged 13–67 years), 18 with SMA type 2 and 9 patients with SMA type 3 (of whom three were still ambulant) and applied a questionnaire, clinical mastication tests (TOMASS and 6-min mastication test), and muscle ultrasound of the mastication muscles. Non-ambulant patients demonstrated inefficient mastication as reflected by median z scores for masticatory cycles (z = 1.8), number of swallows (z = 4.3) and time needed to finish the cracker (z = 3.4), and limited endurance of continuous mastication as demonstrated by the median z scores of the 6-min mastication test (z = − 1.5). Patients reported increased fatigue directly after the 6-min mastication test as well as 5 min after completing the test (p < 0.001; p = 0.003). Reduced maximal mouth opening was associated with mastication problems (p < 0.001). Muscle ultrasound of the mastication muscles showed an abnormal muscle structure in 90% of both ambulant and non-ambulant patients. This study aims to understand the nature and underlying mechanisms of mastication problems in patients with SMA types 2 and 3 with reported bulbar problems.
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Affiliation(s)
- A M B van der Heul
- Department of Neurology & Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R P A van Eijk
- Department of Neurology & Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R I Wadman
- Department of Neurology & Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Asselman
- Department of Neurology & Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Cuppen
- Department of Neurology & Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R A J Nievelstein
- Department of Radiology & Nuclear Medicine, Imaging & Oncology Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Gerrits
- Department of Languages, Literature and Communication, Utrecht Institute of Linguistics OTS, Utrecht University, Utrecht, The Netherlands
| | - W L van der Pol
- Department of Neurology & Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - L van den Engel-Hoek
- Department of Rehabilitation, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
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Todaro F, Pizzorni N, Scarponi L, Ronzoni C, Huckabee ML, Schindler A. The Test of Masticating and Swallowing Solids (TOMASS): Reliability and validity in patients with dysphagia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:558-566. [PMID: 33687133 DOI: 10.1111/1460-6984.12613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Test of Masticating and Swallowing Solids (TOMASS) is an international standardized swallowing assessment tool. However, its psychometric characteristics have not been analysed in patients with dysphagia. AIMS To analyse TOMASS's (1) inter- and intra-rater reliability in a clinical population of patients with dysphagia, (2) known-group validity, (3) concurrent validity and (4) correlation with meal duration. METHODS & PROCEDURES Two age- and gender-matched groups of 39 participants each were recruited: A group of patients with dysphagia and a control group with no history of dysphagia. The TOMASS was carried out in both populations, video-recorded and scored offline by two speech and language therapists (SLT 1 and SLT 2) (inter-rater reliability) and twice by the same SLT (intra-rater reliability). In the clinical group, the TOMASS was carried out three times: (1) to verify understanding of the required tasks, (2) performed concurrently during fibreoptic endoscopic evaluation of swallowing (FEES) to assess validity and (3) during clinical assessment to assess reliability. TOMASS under endoscopic control was recorded and the number of white-out events was counted to compare with the number of observed swallows per cracker during standard TOMASS as a measure of concurrent validity. As additional measures of TOMASS validity, oral dental status, classified as 'functional' or 'partially functional', and duration of a standard meal were assessed by an SLT (SLT 1 or SLT 2), and then correlated with TOMASS. OUTCOME & RESULTS TOMASS's inter- and intra-rater reliability were high (intraclass correlation coefficient (ICC) > 0.95) in both the clinical and the control groups. The number of masticatory cycles (p = 0.020), swallows (p = 0.013) and total time (p = 0.003) of TOMASS were significantly lower in the control group than in the clinical group. Patients with 'partially functional' oral dental status showed a significantly higher number of masticatory cycles per cracker and a longer duration of ingestion than patients with a 'functional' one. Concurrent validity suggested a substantial agreement between TOMASS and FEES in defining the number of swallows per cracker. The mean difference of the two measures was -0.02 (95% confidence interval (CI) = -1.7 to 1.2). Meal duration significantly correlated with the 'number of swallows per cracker' (r = 0.49; p = 0.002) and 'total time' (r = 0.41; p = 0.011). CONCLUSIONS & IMPLICATIONS Preliminary psychometric analysis of TOMASS in a clinical sample of outpatients with dysphagia suggests that it is a reliable and valid (specifically related to the number of swallows per cracker) tool. TOMASS's application in clinical practice to quantitatively measure solid bolus ingestion is recommended. What this paper adds What is already known on the subject The Test of Masticating and Swallowing Solids (TOMASS) is an international standardized swallowing assessment tool to evaluate oral preparation and oral phase of solids. The TOMASS' reliability and validity were tested on healthy subjects and normative data were gained. What this paper adds to existing knowledge The study provides the first data on the validity and reliability of the TOMASS in a clinical population. The TOMASS was proved to be a reliable and valid tool also in patients with dysphagia and to distinguish between patients with dysphagia and healthy subjects. What are the potential or actual clinical implications of this work? The use of the TOMASS in clinical practice is recommended as a valid and reliable tool to quantitatively measure the ingestion of solid in patients with dysphagia.
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Affiliation(s)
- Francesca Todaro
- Department of Biomedical and Clinical Science 'L. Sacco', University of Milan, Milan, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Science 'L. Sacco', University of Milan, Milan, Italy
| | - Letizia Scarponi
- Department of Biomedical and Clinical Science 'L. Sacco', University of Milan, Milan, Italy
| | - Clara Ronzoni
- Department of Biomedical and Clinical Science 'L. Sacco', University of Milan, Milan, Italy
| | - Maggie-Lee Huckabee
- University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
| | - Antonio Schindler
- Department of Biomedical and Clinical Science 'L. Sacco', University of Milan, Milan, Italy
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11
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Borders JC, Sevitz JS, Malandraki JB, Malandraki GA, Troche MS. Objective and Subjective Clinical Swallowing Outcomes via Telehealth: Reliability in Outpatient Clinical Practice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:598-608. [PMID: 33555954 DOI: 10.1044/2020_ajslp-20-00234] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The COVID-19 pandemic has drastically increased the use of telehealth. Prior studies of telehealth clinical swallowing evaluations provide positive evidence for telemanagement of swallowing. However, the reliability of these measures in clinical practice, as opposed to well-controlled research conditions, remains unknown. This study aimed to investigate the reliability of outcome measures derived from clinical swallowing tele-evaluations in real-world clinical practice (e.g., variability in devices and Internet connectivity, lack of in-person clinician assistance, or remote patient/caregiver training). Method Seven raters asynchronously judged clinical swallowing tele-evaluations of 12 movement disorders patients. Outcomes included the Timed Water Swallow Test (TWST), Test of Masticating and Swallowing Solids (TOMASS), and common observations of oral intake. Statistical analyses were performed to examine inter- and intrarater reliability, as well as qualitative analyses exploring patient and clinician-specific factors impacting reliability. Results Forty-four trials were included for reliability analyses. All rater dyads demonstrated "good" to "excellent" interrater reliability for measures of the TWST (intraclass correlation coefficients [ICCs] ≥ .93) and observations of oral intake (≥ 77% agreement). The majority of TOMASS outcomes demonstrated "good" to "excellent" interrater reliability (ICCs ≥ .84), with the exception of the number of bites (ICCs = .43-.99) and swallows (ICCs = .21-.85). Immediate and delayed intrarater reliability were "excellent" for most raters across all tasks, ranging between ICCs of .63 and 1.00. Exploratory factors potentially impacting reliability included infrequent instances of suboptimal video quality, reduced camera stability, camera distance, and obstruction of the patient's mouth during tasks. Conclusions Subjective observations of oral intake and objective measures taken from the TWST and the TOMASS can be reliably measured via telehealth in clinical practice. Our results provide support for the feasibility and reliability of telehealth for outpatient clinical swallowing evaluations during COVID-19 and beyond. Supplemental Material https://doi.org/10.23641/asha.13661378.
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jaime Bauer Malandraki
- Purdue I-EaT Swallowing Research Lab, Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Georgia A Malandraki
- Purdue I-EaT Swallowing Research Lab, Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - 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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12
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Prebor J, Samulski B, Armitano-Lago C, Morrison S. Chewing Entrains Cyclical Actions but Interferes With Discrete Actions in Children. J Mot Behav 2020; 53:364-372. [PMID: 32619148 DOI: 10.1080/00222895.2020.1787319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Functional chewing patterns are achieved early in life prior to other motor skills like walking. Chewing seems to improve specific aspects of attention; however, there is limited research on chewing in dual motor tasks. This study examined relationships between chewing and secondary motor tasks in children. Sixteen typically developing children (13.1 ± 2.3 years) participated in finger tapping, simple reaction time, and walking while chewing at different speeds. The chewing rates varied when produced with a secondary motor task, especially for slow chewing and preferred chewing, and the secondary motor tasks were differentially influenced by the chewing. This relationship was not as strong as what has been reported in adults. It appears the neural oscillatory mechanisms involved in chewing and the secondary motor tasks may not be fully developed in children.
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Affiliation(s)
- Jessica Prebor
- School of Rehabilitation Sciences, Old Dominion University, Norfolk, VA, USA
| | - Brittany Samulski
- School of Rehabilitation Sciences, Old Dominion University, Norfolk, VA, USA
| | - Cortney Armitano-Lago
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steven Morrison
- School of Rehabilitation Sciences, Old Dominion University, Norfolk, VA, USA
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van Rijssel AE, Knuijt S, Veys K, Levtchenko EN, Janssen MCH. Swallowing dysfunction in patients with nephropathic cystinosis. Mol Genet Metab 2019; 126:413-415. [PMID: 30685240 DOI: 10.1016/j.ymgme.2019.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Nephropathic cystinosis is a rare autosomal recessive lysosomal storage disorder caused by mutations in the CTNS gene. Patients with nephropathic cystinosis suffer not only from renal disease but have also other systemic complications like myopathy and swallowing dysfunction. Dysphagia for solid food is mentioned in patients with cystinosis, but in clinical practice swallowing investigations are only performed when the patient has complaints. The aim of this study was to explore the swallowing function in patients with cystinosis by use of the Test of Mastication and Swallowing Solids (TOMASS), and to compare their performance with patients with myotonic dystrophy type 1 - a neuromuscular disease in which dysphagia for solid food is a known problem. METHODS Twenty adult patients with cystinosis (11 men and 9 women, range 19-51 years) and 10 patients with myotonic dystrophy type 1 (5 men and 5 women, range 20-60 years) were included. All cystinosis patients were treated with cysteamine. Data of the two groups were compared with normative data using independent-samples t-tests. In case the variables were not normally distributed, the non-parametric Mann-Whitney U test was used. RESULTS There was a significant difference in the number of bites, masticatory cycles, swallows and total time between the normal values and cystinosis patients. The results of the cystinosis patients were comparable to those of the patients with myotonic dystrophy. DISCUSSION AND CONCLUSION Adult patients with cystinosis have significant dysphagia for solid food. Clinicians treating these patients should be aware of this fact. The TOMASS can be performed easily in clinical practice to investigate whether patients with cystinosis have swallowing dysfunction. The swallowing dysfunction can now be diagnosed by use of a non-invasive, very simple, non-harmful test. It can be discussed whether this should be added to the regular care scheme of cystinosis patients in order to regularly follow-up swallowing function.
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Affiliation(s)
- A E van Rijssel
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - S Knuijt
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - K Veys
- Department of Pediatrics & Department of Growth and Regeneration, University Hospitals Leuven & University of Leuven, Leuven, Belgium
| | - E N Levtchenko
- Department of Pediatrics & Department of Growth and Regeneration, University Hospitals Leuven & University of Leuven, Leuven, Belgium
| | - M C H Janssen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
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