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Sekimoto Y, Matsuo K, Sakai A, Shibata S, Minakuchi S. Improvement of oral function and its impact on oral food intake in subacute stroke patients: A prospective study with dental intervention. J Oral Rehabil 2024; 51:1365-1372. [PMID: 38651211 DOI: 10.1111/joor.13711] [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: 11/24/2023] [Revised: 03/19/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The association between oral food intake and oral function during the subacute stage of stroke is not well known. OBJECTIVE To investigate (1) oral function changes in subacute stroke patients and (2) association between oral function and oral intake status at several time points. METHODS In a prospective study involving 324 stroke patients at a convalescent rehabilitation unit, four oral function parameters (maximum tongue pressure, MTP; lip-tongue motor function, LTMF; maximum occlusal force, MOF and oral health assessment tool, OHAT) were quantitatively measured upon admission (T0), at 1 month (T1) and 2 months (T2). Oral feeding status was assessed using the Functional Oral Intake Scale (FOIS) and divided based on the FOIS score into the dysphagic and regular diet groups. The changes in oral functions at the three time points were tested using generalized estimating equation analysis. The association between FOIS groups and oral functions at T1 and T2 was analysed by means of logistic regression analysis. RESULTS All oral function parameters improved significantly over time during the hospital stay (mean differences: 4.9 for MTP, 0.6 for LTMF, 1.1 for MOF and -1.8 for OHAT). The FOIS groups were significantly associated with MTP (p < .05) and OHAT (p < .05) at both T1 and T2. CONCLUSION Our findings suggest that oral function significantly improves in patients during subacute stroke rehabilitation and better oral health can be associated with better oral intake. Improved oral function through dental intervention and oral rehabilitation may contribute to gains in oral food intake.
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Affiliation(s)
- Yu Sekimoto
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Dentistry, PL General Hospital, Medical Corporation Hosho, Tokyo, Japan
- Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Koichiro Matsuo
- Department of Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayu Sakai
- Department of Dentistry and Oral-Maxillofacial Surgery, Fujita Health University Hospital, Toyoake, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Nakamori M, Toko M, Yamada H, Hayashi Y, Ushio K, Yoshikawa K, Haruta A, Hiraoka A, Yoshikawa M, Nagasaki T, Mikami Y, Maruyama H. Association between motor symptoms of Parkinson's disease and swallowing disorders. Neurol Sci 2024; 45:2021-2026. [PMID: 38055077 PMCID: PMC11021328 DOI: 10.1007/s10072-023-07238-1] [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: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Parkinson's disease (PD) presents with motor symptoms that hinder physical activity. This study aimed to thoroughly investigate swallowing dysfunction in patients with PD using videofluoroscopy (VF) and the Movement Disorder Society (MDS)-Unified PD Rating Scale (UPDRS) sub-scores. METHODS This study was part of an intervention project to evaluate the effectiveness of cervical percutaneous interferential current stimulation in patients with Hoehn and Yahr stages 2-4 PD. Baseline data, including swallowing-related indicators such as VF, were obtained and compared to the MDS-UPDRS sub-scores including rigidity, tremor, postural instability/gait difficulty, and limb scores. RESULTS Twenty-seven patients were included in this study. In the VF analysis, laryngeal penetration/aspiration, oral cavity residue, epiglottic vallecular residue, and pharyngeal residue were observed with remarkable frequency. The multivariate analysis revealed that the mean rigidity score of UPDRS was an independent and significantly correlated factor with laryngeal penetration/aspiration during the ingestion of 10 mL of water (odds ratio 1.294, 95% confidence interval 1.035-1.617; p = 0.024). CONCLUSION This study revealed a correlation between muscle rigidity and laryngeal penetration or aspiration risk. The detailed comparative analysis of various individual PD symptoms and swallowing disorders was substantial, which enabled early detection of the risk of swallowing disorder and the implementation of appropriate measures. TRIAL REGISTRATION NUMBER jRCTs062220013.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Megumi Toko
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuki Hayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kai Ushio
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Kohei Yoshikawa
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Azusa Haruta
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Aya Hiraoka
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Mineka Yoshikawa
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Chen YC, Ku EN, Lin CW, Tsai PF, Wang JL, Yen YF, Ko NY, Ko WC, Lee NY. Tongue pressure during swallowing is an independent risk factor for aspiration pneumonia in middle-aged and older hospitalized patients: An observational study. Geriatr Gerontol Int 2024; 24 Suppl 1:351-357. [PMID: 38111274 DOI: 10.1111/ggi.14769] [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: 08/17/2023] [Revised: 10/29/2023] [Accepted: 11/26/2023] [Indexed: 12/20/2023]
Abstract
AIM To evaluate oral frailty features present in hospitalized older patients with aspiration pneumonia. METHODS We enrolled hospitalized patients aged ≥50 years and classified them into three groups: the community-acquired, aspiration, and non-community-acquired pneumonia groups. Oral frailty was defined as meeting three or more criteria from the following: choking, and decreased occlusal force, masticatory function, tongue-lip motor function, tongue pressure, and tongue pressure during swallowing. RESULTS Of 168 patients enrolled, the incidence of aspiration pneumonia was 23.9% (17/71) in patients admitted with pneumonia as the primary diagnosis. The occlusal force and masticatory function were significantly poorer and tongue pressure and tongue pressure during swallowing were significantly lower in the aspiration pneumonia group than in the other two groups. A higher number of chronic comorbidities, poor oral health, and lower tongue pressure during swallowing were significantly associated with aspiration pneumonia. A tongue pressure during swallowing of <10.32 kPa might be a cutoff point for predicting the risk of aspiration pneumonia. CONCLUSIONS Hospitalized patients aged ≥50 years with multiple comorbidities, poor oral hygiene, and oral frailty during swallowing are at a higher risk of developing aspiration pneumonia, especially when their tongue pressure during swallowing is <10.32 kPa. Aspiration pneumonia is a preventable disease. Healthcare professionals should incorporate tongue pressure measurements or other screening tools into routine clinical practice to facilitate the early detection of this condition and intervention. Geriatr Gerontol Int 2024; 24: 351-357.
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Affiliation(s)
- Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - En-Ni Ku
- Department of Nursing, Taipei Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Che-Wei Lin
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Fang Tsai
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Fen Yen
- Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chieh Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Yao Lee
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Zhao F, Zhang YW, Xie CQ, Yang C, Dou ZL, Wei XM. Characteristics of Tongue Pressure Measured by Novel Multisite Flexible Sensors in Nasopharyngeal Carcinoma Patients With Dysphagia. Arch Phys Med Rehabil 2024; 105:531-538. [PMID: 37871671 DOI: 10.1016/j.apmr.2023.10.004] [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: 12/26/2022] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE To explore characteristics of tongue pressure changes in nasopharyngeal carcinoma (NPC) patients with dysphagia after radiotherapy using a novel system with multisite flexible sensors. DESIGN Prospective observational study. SETTING Inpatient rehabilitation centers and community dwellings. PARTICIPANTS Nineteen patients with dysphagia after radiotherapy for NPC and 19 healthy participants were recruited for this study (N=38). INTERVENTION Not applicable. MAIN OUTCOME MEASURES A new 9-site (3 × 3) flexible tongue pressure sensor was used to measure tongue-to-palate pressure across different parts of the tongue. The oral tongue was divided into 3 parts: anterior tongue region (TAR), central tongue region (TCR), and posterior tongue region (TPR); 3 sensors were placed on each part. The mean tongue pressure and endurance time at the 3 sites in the TAR, TCR, and TPR were analyzed. The ratios of the mean TAR, TCR, and TPR values were calculated. RESULTS Pressures of TAR, TCR, and TPR in NPC patients with dysphagia were significantly lower than those in healthy participants (P<.05). The pressure in TPR decreased most significantly, followed by that in TCR. The endurance times of TAR and TCR were longer than those of healthy participants (P<.05). The endurance time of TPR was not significantly different between the patients and healthy participants (P>.05). Ratios of pressure between TAR and TCR and TAR and TPR in patients were lower than that in healthy participants (P<.05). There was no significant difference in the TCR to TPR pressure ratio between patients and healthy participants (P>.05). CONCLUSIONS Tongue pressure significantly decreased in NPC patients with dysphagia, and the drop in pressure was most pronounced in the TPR area. The results of our study indicate that we should pay attention to the pressure training of the TPR during treatments. The endurance time of the TAR and TCR increased significantly, which may be due to bolus transport compensation. Therefore, clinical rehabilitation strategies should aim to increase the endurance time training in NPC patients after radiotherapy to help increase the effectiveness of the swallowing process in patients.
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Affiliation(s)
- Fei Zhao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yao-Wen Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chun-Qing Xie
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chen Yang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zu-Lin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Xiao-Mei Wei
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Nakamori M, Imamura E, Maetani Y, Yoshida M, Yoshikawa M, Nagasaki T, Masuda S, Kayashita J, Mizoue T, Wakabayashi S, Maruyama H, Hosomi N. Prospective Observational Study for the Comparison of Screening Methods Including Tongue Pressure and Repetitive Saliva Swallowing With Detailed Videofluoroscopic Swallowing Study Findings in Patients With Acute Stroke. J Am Heart Assoc 2024; 13:e032852. [PMID: 38293925 PMCID: PMC11056116 DOI: 10.1161/jaha.123.032852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Simple, noninvasive, and repeatable screening methods are essential for assessing swallowing disorders. We focused on patients with acute stroke and aimed to assess the characteristics of swallowing screening tests, including the modified Mann Assessment of Swallowing Ability score, tongue pressure, and repetitive saliva swallowing test (RSST), compared with detailed videofluoroscopic swallowing study (VFSS) findings to contribute as a helpful resource for their comprehensive and complementary use. METHODS AND RESULTS We enrolled first-ever patients with acute stroke conducting simultaneous assessments, including VFSS, modified Mann Assessment of Swallowing Ability score, tongue pressure measurement, and RSST. VFSS assessed aspiration, laryngeal penetration, oral cavity residue, vallecular residue, pharyngeal residue, and swallowing reflex delay. Screening tests were compared with VFSS findings, and multiple logistic analysis determined variable importance. Cutoff values for each abnormal VFSS finding were assessed using receiver operating characteristic analyses. We evaluated 346 patients (70.5±12.6 years of age, 143 women). The modified Mann Assessment of Swallowing Ability score was significantly associated with all findings except aspiration. Tongue pressure was significantly associated with oral cavity and pharyngeal residue. The RSST was significantly associated with all findings except oral cavity residue. Receiver operating characteristic analyses revealed that the minimum cutoff value for all VFSS abnormal findings was RSST ≤2. CONCLUSIONS The modified Mann Assessment of Swallowing Ability is useful for broadly detecting swallowing disorders but may miss mild issues and aspiration. The RSST, with a score of ≤2, is valuable for indicating abnormal VFSS findings. Tongue pressure, especially in oral and pharyngeal residues, is useful. Combining these tests might enhance accuracy of the swallowing evaluation.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and TherapeuticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
- Department of NeurologySuiseikai Kajikawa HospitalHiroshimaJapan
| | - Eiji Imamura
- Department of NeurologySuiseikai Kajikawa HospitalHiroshimaJapan
| | - Yuta Maetani
- Department of Clinical Neuroscience and TherapeuticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
- Department of NeurologySuiseikai Kajikawa HospitalHiroshimaJapan
| | - Mitsuyoshi Yoshida
- Department of Dentistry and Oral‐Maxillofacial Surgery, School of MedicineFujita Health UniversityToyoakeAichiJapan
- Department of Advanced ProsthodonticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Mineka Yoshikawa
- Department of Advanced ProsthodonticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial RadiologyHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Shin Masuda
- Department of Children SensoryHiroshima Prefectural HospitalHiroshimaJapan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and SciencesPrefectural University of HiroshimaHiroshimaJapan
| | - Tatsuya Mizoue
- Department of NeurosurgerySuiseikai Kajikawa HospitalHiroshimaJapan
| | | | - Hirofumi Maruyama
- Department of Clinical Neuroscience and TherapeuticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Naohisa Hosomi
- Department of NeurologyChikamori HospitalKochiJapan
- Department of Disease Model, Research Institute of Radiation Biology and MedicineHiroshima UniversityHiroshimaJapan
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Yoshikawa M, Nishikawa Y, Kitagawa M, Nagao A, Hiraoka A, Haruta A, Takeuchi M, Yoshida M, Tsuga K. Low tongue pressure and depression using Kihon Checklist for assessing frailty status among community-dwelling Japanese older adults: A pilot study. J Oral Rehabil 2024; 51:334-342. [PMID: 37775517 DOI: 10.1111/joor.13596] [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: 03/20/2023] [Revised: 08/04/2023] [Accepted: 09/07/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Evaluation of low tongue pressure is used to diagnose oral hypofunction. The pathophysiology of oral hypofunction is hypothesized to be associated with oral dysfunction related to ageing. Depression in older adults is a major problem and is related to handgrip strength, which is related to tongue pressure. We hypothesized that low tongue pressure could indicate depression mood in community-dwelling older adults. OBJECTIVES This study aimed to measure maximum tongue pressure and compare it to the responses to the Kihon Checklist (KCL), which is used to check mental and physical deterioration of community-dwelling older adults. METHODS A total of 49 community-dwelling independent older adults with stable dental condition (23 men, 26 women; median age, 79 years) answered the KCL, which contained questions on frailty status, cognitive function, nutritional and sarcopenia status. Oral function was measured to assess oral hypofunction. The relationship between tongue pressure differences and frailty status, cognitive function, nutritional and sarcopenia status was analysed using logistic regression analyses after adjusting for age and sex. RESULTS Nine participants (6 men and 3 women; median age, 81 years) had a tongue pressure <23.0 kPa, which was the lowest limit of the standard value of maximum tongue pressure in patients aged ≥70 years. Logistic regression analyses showed that only Question 21, which is related to a lack of fulfilment in daily life, was significantly associated with low tongue pressure (p = .027). CONCLUSION Low tongue pressure may be associated with sociopsychological factors in older adults.
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Affiliation(s)
- Mineka Yoshikawa
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuichi Nishikawa
- Faculty of Frontier Engineering, Institute of Science & Engineering, Kanazawa University, Kanazawa, Japan
| | - Masae Kitagawa
- Center of Clinical Oral Examination, Hiroshima University Hospital, Hiroshima, Japan
| | - Akiko Nagao
- Department of Dietary Management, Hiroshima University Hospital, Hiroshima, Japan
| | - Aya Hiraoka
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Azusa Haruta
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Maho Takeuchi
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuyoshi Yoshida
- Department of Dentistry and Oral-Maxillofacial Surgery, Fujita Health University, Toyoake, Japan
| | - Kazuhiro Tsuga
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Komorita Y, Ide H, Yoshinari M, Ohta Y, Nakamichi I, Fujisawa R, Fujii W, Fukuhara M. Decreased serum creatinine to cystatin C ratio is associated with low tongue pressure. Geriatr Gerontol Int 2024; 24:102-108. [PMID: 38110724 DOI: 10.1111/ggi.14780] [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: 06/28/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Abstract
AIM Tongue strength plays an important role in the process of food intake, and low tongue pressure has been associated with aspiration pneumonia, cognitive decline, and mortality. However, special equipment for tongue pressure measurement is uncommon in general practice. Recently, the serum creatinine-to-cystatin C (Cr/CysC) ratio has been validated as a marker of muscle volume mass. Thus, we aimed to investigate the association of the serum Cr/CysC ratio with tongue pressure in a cross-sectional study. METHODS This single-center, cross-sectional study enrolled 73 participants (mean age, 71.7 years; men, 49.3%) who regularly attended the hospital for treatment of chronic disease. A tongue pressure of <30 kPa was defined as low tongue pressure. We evaluated the relationships between the serum Cr/CysC ratio and tongue pressure using multiple regression analysis. RESULTS The serum Cr/CysC ratio was correlated with tongue pressure (R2 = 0.25, P < 0.0001). In multiple regression analyses adjusted for confounders including age, sex, body mass index, and serum albumin, the association remained significant (P = 0.0001). In logistic analyses, the multivariable-adjusted odds ratios of the Cr/CysC ratio for tertiles 1 and 2 compared with tertile 3 for low tongue pressure were 7.81 (95% confidence interval, 1.45-51.73) and 2.71 (95% confidence interval, 0.60-13.19), respectively. CONCLUSIONS We demonstrated that a decreased serum Cr/CysC ratio was associated with a higher risk of low tongue pressure. Our findings suggest that this simple serum surrogate marker may be a first step toward an intervention for oral function by general practitioners. Geriatr Gerontol Int 2024; 24: 102-108.
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Affiliation(s)
- Yuji Komorita
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hitoshi Ide
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
- Diabetes Center, Hakujyuji Hospital, Fukuoka, Japan
| | | | - Yuko Ohta
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Ikuo Nakamichi
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Ritsuko Fujisawa
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Wataru Fujii
- Yoshinari Naika Clinic, Fukuoka, Japan
- Unit of Interdisciplinary Promotion School of Oral Health Sciences, Kyushu Dental University, Kitakyushu, Japan
| | - Masayo Fukuhara
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
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Cho Y, Kim T, Kim G, Do HW, Kim SR, Park JW, Myoung JM, Shim W. Three-Dimensional Touch Device with Two Terminals. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2305697. [PMID: 37616471 DOI: 10.1002/adma.202305697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/02/2023] [Indexed: 08/26/2023]
Abstract
A crossbar array is an essential element that determines the operating position and simplifies the structure of devices. However, in the crossbar array, wiring numerous electrodes to address many positions poses significant challenges. In this study, a method is proposed that utilizes only two electrodes to determine multiple positions. The method significantly simplifies the wiring and device fabrication process. Instead of defining the node location of the crossbar, it is experimentally demonstrated that the x-y-z coordinates can be determined from i) the resistance change as a function of distance, ii) the resistance variation influenced by the electrode composition, and iii) capacitance fluctuation resulting from changes in the dielectric thickness. By employing two-terminal transparent electrodes, a fully functional 3D touch device is successfully fabricated, introducing a groundbreaking approach to simplify input device architectures.
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Affiliation(s)
- Youngjun Cho
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
- Center for Multi-Dimensional Materials, Yonsei University, Seoul, 03722, South Korea
- Yonsei IBS Institute, Yonsei University, Seoul, 03722, South Korea
| | - Taehoon Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
- Center for Multi-Dimensional Materials, Yonsei University, Seoul, 03722, South Korea
| | - Gwangmook Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
- Center for Multi-Dimensional Materials, Yonsei University, Seoul, 03722, South Korea
| | - Hyung Wan Do
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
- Center for Multi-Dimensional Materials, Yonsei University, Seoul, 03722, South Korea
| | - Seung-Rok Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
| | - Jin-Woo Park
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
| | - Jae-Min Myoung
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
| | - Wooyoung Shim
- Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, South Korea
- Center for Multi-Dimensional Materials, Yonsei University, Seoul, 03722, South Korea
- Yonsei IBS Institute, Yonsei University, Seoul, 03722, South Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, South Korea
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Lu F, Okazaki T, Okuyama J, Izumi S. Impacts of body positions on the geniohyoid muscle contraction and swallowing difficulty in healthy adults. Clin Exp Dent Res 2023; 9:670-678. [PMID: 37408360 PMCID: PMC10441597 DOI: 10.1002/cre2.760] [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: 01/21/2023] [Revised: 06/01/2023] [Accepted: 06/17/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Body positions affect swallowing and gastroesophageal reflux. Swallowing impairment is one of the main causes of aspiration pneumonia. To prevent pneumonia, evaluation of body positions on gastroesophageal reflux recommended 30 degrees or higher semi-recumbent positions. The geniohypoid muscle and tongue play central roles in swallowing. However, the effects of body positions on contracting rates in the geniohyoid muscle and tongue pressure are unclear. Moreover, correlations between geniohyoid muscle contracting rates and subjective swallowing difficulties are unclear. AIMS This study aimed to identify the proper body positions on contracting rates in the geniohyoid muscle, tongue pressure, and subjective swallowing difficulties. MATERIALS & METHODS Twenty healthy adults swallowed 15- or 50 ml of water at 90 degrees sitting, 60- and 30 degrees semi-recumbent, and 0 degrees supine positions. We scored the subjective swallowing difficulties and measured the tongue pressure and the number of swallows. An ultrasound evaluated the geniohyoid muscle size and contracting rates. RESULTS At sitting and 60 degrees semi-recumbent positions, the geniohyoid muscle showed greter contracting rates than at 30 degrees semi-recumbent and supine postions (P < 0.05), which resulted in easier swalloiwng. Greater tongue pressure was weakly correlated with fewer swallows (r = -0.339, P = 0.002), whereas the body positions did not affect. CONCLUSION Considering swallowing and gastroesophageal reflux together, a trunk angle of 60 degrees or more might be beneficial for reducing the risk of aspiration.
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Affiliation(s)
- Fuwen Lu
- Department of Physical Medicine and RehabilitationTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Tatsuma Okazaki
- Department of Physical Medicine and RehabilitationTohoku University Graduate School of MedicineSendaiMiyagiJapan
- Center for Dysphagia of Tohoku University HospitalSendaiMiyagiJapan
| | - Junko Okuyama
- Department of Physical Medicine and RehabilitationTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Shin‐Ichi Izumi
- Department of Physical Medicine and RehabilitationTohoku University Graduate School of MedicineSendaiMiyagiJapan
- Center for Dysphagia of Tohoku University HospitalSendaiMiyagiJapan
- Department of Physical Medicine and RehabilitationTohoku University Graduate School of Biomedical EngineeringSendaiMiyagiJapan
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Nakamori M, Toko M, Yamada H, Hayashi Y, Yoshikawa K, Yoshikawa M, Nagasaki T, Hiraoka A, Shimizu Y, Mikami Y, Maruyama H. Impact of neck percutaneous interferential current sensory stimulation on swallowing function in patients with Parkinson's disease: A single-arm, open-label study protocol. Contemp Clin Trials Commun 2023; 33:101158. [PMID: 37342176 PMCID: PMC10277457 DOI: 10.1016/j.conctc.2023.101158] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/26/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023] Open
Abstract
Background Parkinson's disease (PD) can lead to swallowing dysfunction, resulting in aspiration pneumonia. Among the types of swallowing disorders, a characteristic and serious problem associated with PD is silent aspiration due to pharyngeal and laryngeal hypoesthesia. Methods This single-arm, open-label study aims to evaluate the effectiveness of percutaneous neck interferential current sensory stimulation in enhancing swallowing function in patients with PD. The efficacy and safety of percutaneous neck interferential current sensory stimulation will be investigated for patients diagnosed with PD, based on the Movement Disorder Society criteria, of Hoehn-Yahr stages 2-4. The patients will receive neck percutaneous interferential current sensory stimulation for 20 min twice a week for 8 weeks using a Gentle Stim® (FoodCare Co., Ltd., Kanagawa, Japan) device. Once the intervention is initiated, evaluations will be performed every 4 weeks for a 16-week period. The primary endpoint to be assessed is the proportion of patients with normal cough with 1% citric acid at the end of the intervention (8 weeks after intervention initiation) compared with that at the beginning. This clinical trial will examine the usefulness of percutaneous neck interferential current sensory stimulation in patients with PD. In addition, this study will use novel instruments, such as multichannel surface electromyography and electronic stethoscope, to evaluate swallowing function. Discussion This novel evaluation can provide insights into dysphagia in patients with PD and the usefulness of percutaneous neck interferential current stimulation. This exploratory study is limited by its single-arm, open-label design and small size. Trial registration number jRCTs062220013; pre-results.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Megumi Toko
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuki Hayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kohei Yoshikawa
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Mineka Yoshikawa
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Aya Hiraoka
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshitaka Shimizu
- Department of Dental Anesthesiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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11
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Yanagida R, Hara K, Namiki C, Okumura T, Saiki A, Nakagawa K, Yamaguchi K, Yoshimi K, Nakane A, Mauclaire JM, Tohara H. Effects of tongue right positioner use on tongue pressure: a pilot study. Sci Rep 2023; 13:3289. [PMID: 36841869 PMCID: PMC9968309 DOI: 10.1038/s41598-023-30450-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/23/2023] [Indexed: 02/27/2023] Open
Abstract
The effectiveness of the tongue right positioner (TRP) use on oral and swallowing functions remains unclear. To investigate the effects of TRP use on tongue function in patients with dysphagia. This interventional study included eight participants with dysphagia who visited a university dental hospital. The measurement variables included tongue pressure (TP) as the primary outcome and lip and tongue movements, peak nasal inspiratory flow, and changes in the tongue and suprahyoid muscle regions on ultrasonography as the secondary outcomes. Each participant was asked to use a TRP for at least 8 h every night for 2 months. The measurement variables before and after the intervention were compared using the paired t test and Wilcoxon signed-rank test. TP after intervention (31.5 ± 13.1 kPa) was significantly higher than that before intervention (23.0 ± 13.4 kPa), while other measurement variables did not significantly improve. Numerous exercises have been suggested to improve TP; however, most require patients' adherence to instructions. In contrast, although participants did not perform active exercises, most participants in this study observed an improved TP. Our findings show that TRP can greatly improve TP after 2 months of usage.Trial registration number: University Hospital Medical Information Network Clinical Trials Registry (UMIN000040253, date of first registration: 27/04/2020).
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Affiliation(s)
- Ryosuke Yanagida
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koji Hara
- Department of Dentistry for the Special Patient, Kanagawa Dental University, 82 Inaokacho, Yokosuka, Kanagawa, 238-8580, Japan.
| | - Chizuru Namiki
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Department of Dentistry for the Special Patient, Kanagawa Dental University, 82 Inaokacho, Yokosuka, Kanagawa, 238-8580, Japan
| | - Takuma Okumura
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akino Saiki
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kazuharu Nakagawa
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kanako Yoshimi
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Ayako Nakane
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | | | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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12
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Kamimura T, Nakamori M, Naito H, Aoki S, Nezu T, Imamura E, Mizoue T, Wakabayashi S, Masuda T, Hattori N, Maruyama H, Hosomi N. Peak expiratory flow, but not tongue pressure, can predict pneumonia development in older adults. Eur Geriatr Med 2023; 14:211-217. [PMID: 36640229 DOI: 10.1007/s41999-023-00744-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
PURPOSE Pneumonia is the leading cause of mortality and morbidity in aging populations. Major causes of pneumonia in older adults are swallowing dysfunction and decreased airway clearance capacity, including an impaired cough reflex. Maximal tongue pressure is useful for evaluating swallowing function, and peak expiratory flow indirectly reflects cough strength. However, it is unclear whether they can predict pneumonia development in older adults. In this study, we investigated whether tongue pressure and peak expiratory flow could predict pneumonia development in older adults. METHODS This two-center prospective observational study included older adults aged 65 years or older without respiratory disease or head and neck cancer. We enrolled 383 consenting participants, many of whom had a history of stroke, and followed them for 2 years. The association between time to pneumonia development and tongue pressure or peak expiratory flow at enrollment was examined in a Cox proportional hazards model. RESULTS The mean age of the participants was 77.1 ± 6.2 years, and 36.0% of them were women. The mean tongue pressure was 35.4 ± 10.5 kPa and median peak expiratory flow was 218 L/min at enrollment. Six patients developed pneumonia during the study period. A low peak expiratory flow at enrollment was significantly associated with pneumonia development in the multivariate Cox proportional hazards model, but this association was not observed for tongue pressure. CONCLUSION Decreased peak expiratory flow may predict pneumonia development in older adults. Future studies should investigate interventions for peak expiratory flow improvement.
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Affiliation(s)
- Teppei Kamimura
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi, Minami-ku, Hiroshima-City, Hiroshima, Japan
| | - Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi, Minami-ku, Hiroshima-City, Hiroshima, Japan.
| | - Hiroyuki Naito
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi, Minami-ku, Hiroshima-City, Hiroshima, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi, Minami-ku, Hiroshima-City, Hiroshima, Japan
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi, Minami-ku, Hiroshima-City, Hiroshima, Japan
| | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | | | - Takeshi Masuda
- Department of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Noboru Hattori
- Molecular and Internal Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi, Minami-ku, Hiroshima-City, Hiroshima, Japan
| | - Naohisa Hosomi
- Department of Neurology, Chikamori Hospital, Kochi, Japan.,Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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Expression of Concern: Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements. PLoS One 2023; 18:e0279804. [PMID: 36630346 PMCID: PMC9833497 DOI: 10.1371/journal.pone.0279804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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14
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Szabó PT, Műhelyi V, Halász T, Béres-Molnár KA, Folyovich A, Balogh Z. Aspiration Risk Screening With Tongue Pressure Measurement in Acute Stroke: A Diagnostic Accuracy Study Using STARD Guidelines. SAGE Open Nurs 2023; 9:23779608231219183. [PMID: 38107651 PMCID: PMC10722921 DOI: 10.1177/23779608231219183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Dysphagia can affect more than 50% of stroke patients in the acute phase. Aspiration pneumonia is a serious complication that can be prevented with dysphagia screening and assessment. Measurement of tongue elevation pressure is suggested to be a useful tool in aspiration risk screening. Objective This study aimed to assess the diagnostic accuracy of maximum anterior tongue elevation strength (Pmax) in acute stroke care. Method In this prospective study, data were collected in a neurology department (stroke center) where patients formed a consecutive case series. The sample consisted of thirty stroke patients who failed an initial dysphagia screening. Patients underwent anterior tongue elevation strength measurement (index test) during bedside dysphagia assessment by a speech-language pathologist and flexible endoscopic evaluation of swallowing (reference test) by an otorhinolaryngologist on the same day. Outcome variables (index values in kPa, reference values interpreted on the penetration-aspiration scale) were used for estimating measures of diagnostic accuracy in aspiration risk screening. Results Ten patients aspirated on instrumental evaluation. At the cut-off point of ≤ 34 kPa the analysis showed 90% sensitivity, 35% specificity, 41% positive predictive value, and 88% negative predictive value. The area under the curve (AUC) for Pmax was AUC = 0.700 (95% CI [0.500-0.900]). Conclusion Although individuals with low anterior tongue elevation strength tend to have a higher risk of aspiration, this variable alone is not capable of screening aspiration in acute stroke. In combination with a thorough noninstrumental bedside examination, it might have the potential to reduce the number of false positive cases. Further studies in this area would be worthwhile.
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Affiliation(s)
- Pál Tamás Szabó
- Doctoral School of Health Sciences, Semmelweis University, Budapest, Hungary
- Department of Neurology–Stroke Centre, Saint John Central Hospital, Budapest, Hungary
| | - Viktória Műhelyi
- Department of Neurology–Stroke Centre, Saint John Central Hospital, Budapest, Hungary
| | - Tímea Halász
- Department of Otorhinolaryngology and Oral Surgery, Saint John Central Hospital, Budapest, Hungary
| | | | - András Folyovich
- Department of Neurology–Stroke Centre, Saint John Central Hospital, Budapest, Hungary
- Doctoral School of Basic and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltán Balogh
- Doctoral School of Health Sciences, Semmelweis University, Budapest, Hungary
- Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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15
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Smaoui S, Peladeau-Pigeon M, Mancopes R, Sutton D, Richardson D, Steele CM. Profiles of Swallowing Impairment in a Cohort of Patients With Reduced Tongue Strength Within 3 Months of Cerebral Ischemic Stroke. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2399-2411. [PMID: 35731684 PMCID: PMC9584135 DOI: 10.1044/2022_jslhr-21-00586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/22/2022] [Accepted: 03/22/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE Patients with poststroke dysphagia may experience inefficient bolus clearance or inadequate airway protection. Following a stroke, impairments in lingual pressure generation capacity are thought to contribute to oropharyngeal dysphagia. The goal of our study was to determine whether similar profiles of swallowing impairment would be seen across a cohort of patients with reduced tongue strength within 3 months after cerebral ischemic stroke. METHOD The sample comprised six adults with reduced tongue strength (i.e., maximum anterior isometric pressure < 40 kPa). Participants underwent a videofluoroscopy according to a standard protocol. Post hoc blinded ratings were completed using the Analysis of Swallowing Physiology: Events, Kinematics and Timing Method and coded as "typical" versus "atypical" (i.e., within vs. outside the healthy interquartile range) in comparison to published reference values. RESULTS The videofluoroscopies suggested that having reduced tongue strength did not translate into a common profile. Of the six participants, two showed Penetration-Aspiration Scale (PAS) scores of ≥ 3 on thin liquids, associated with incomplete laryngeal vestibule closure (LVC). Another two participants displayed PAS scores of 2 (transient penetration), but these were not associated with incomplete LVC. Pharyngeal residue, above the healthy 75th percentile, was seen for three participants. Five participants presented with atypical reductions in hyoid XY peak position. CONCLUSIONS In this cohort of adults within 3 months of cerebral ischemic stroke, reductions in tongue strength presented alongside a variety of changes in swallowing physiology. There was no straightforward relationship linking reduced tongue strength to particular patterns of impairment on videofluoroscopy.
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Affiliation(s)
- Sana Smaoui
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Interprofessional Practice Based Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Canada
| | - Melanie Peladeau-Pigeon
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Renata Mancopes
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Danielle Sutton
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Denyse Richardson
- Department of Medicine, Division of Physiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
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16
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Kusunoki H, Hasegawa Y, Tsuji S, Wada Y, Tamaki K, Nagai K, Mori T, Matsuzawa R, Kishimoto H, Shimizu H, Shinmura K. Relationships between cystatin C and creatinine‐based eGFR with low tongue pressure in Japanese rural community‐dwelling older adults. Clin Exp Dent Res 2022; 8:1259-1269. [PMID: 35749633 PMCID: PMC9562798 DOI: 10.1002/cre2.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Sarcopenia is prevalent in patients with chronic kidney disease (CKD), which is defined as a low estimated glomerular filtration rate (eGFR). It has been reported that oral hypofunction characterized by decreased tongue pressure is related to sarcopenia. Although there are several previous reports regarding the association of renal dysfunction with oral hypofunction characterized by low tongue pressure, the association between tongue pressure and renal function is not fully understood. Methods This cross‐sectional study included 68 men aged 79.0 ± 4.8 years and 145 women aged 77.3 ± 5.4 years from a rural area in Hyogo Prefecture, Japan. We examined the relationships between cystatin C‐based CKD (CKDcys), creatinine‐based CKD (CKDcre), ratio of cystatin C‐based GFR (eGFRcys) divided by creatinine‐based GFR (eGFRcre): eGFRcys/eGFRcre, and tongue pressure in community‐dwelling older adults. Results Tongue pressure was significantly lower in participants with CKDcys than in those without CKDcys in men and women. However, there were no significant differences in tongue pressure with or without CKDcre. Tongue pressure was significantly lower in participants with eGFRcys/eGFRcre <1.0, than in those with eGFRcys/eGFRcre ≧ 1.0 in men. According to the receiver operating characteristic analysis, the optimal cut‐off value of tongue pressure for the presence of CKDcys was 36.6kPa, area under the curve (AUC) 0.74 (specificity 54.8%, sensitivity 84.6%) in men and 31.8kPa, AUC 0.65 (specificity 67.3%, sensitivity 60.5%) in women. Conclusions CKDcys but not CKDcre is associated with low tongue pressure. In addition, a lower eGFRcys/eGFRcre ratio is a useful screening marker of low tongue pressure in community‐dwelling older adults.
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Affiliation(s)
- Hiroshi Kusunoki
- Division of General Medicine, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Hyogo Japan
- Department of Internal Medicine Osaka Dental University Hirakata Osaka Japan
| | - Yoko Hasegawa
- Division of Comprehensive Prosthodontics Niigata University Graduate School of Medical and Dental Sciences Niigata Niigata Japan
- Amagasaki Medical COOP Honden Clinic Amagasaki Hyogo Japan
| | - Shotaro Tsuji
- Department of Orthopaedic Surgery Hyogo College of Medicine Nishinomiya Hyogo Japan
| | - Yosuke Wada
- Division of General Medicine, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Hyogo Japan
| | - Kayoko Tamaki
- Division of General Medicine, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Hyogo Japan
| | - Koutatsu Nagai
- School of Rehabilitation Hyogo University of Health Sciences Kobe Hyogo Japan
| | - Takara Mori
- Division of General Medicine, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Hyogo Japan
- Amagasaki Medical COOP Honden Clinic Amagasaki Hyogo Japan
| | - Ryota Matsuzawa
- School of Rehabilitation Hyogo University of Health Sciences Kobe Hyogo Japan
| | - Hiromitsu Kishimoto
- Department of Dentistry and Oral Surgery Hyogo College of Medicine Nishinomiya Hyogo Japan
| | - Hideo Shimizu
- Department of Internal Medicine Osaka Dental University Hirakata Osaka Japan
| | - Ken Shinmura
- Division of General Medicine, Department of Internal Medicine Hyogo College of Medicine Nishinomiya Hyogo Japan
- Department of Orthopaedic Surgery Hyogo College of Medicine Nishinomiya Hyogo Japan
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17
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Effect of tongue strength on clinical outcomes of patients: A systematic review. Arch Gerontol Geriatr 2022; 102:104749. [PMID: 35724534 DOI: 10.1016/j.archger.2022.104749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Whether decreased tongue strength is associated with poor clinical outcomes is unclear. This systematic review investigated the effect of decreased tongue strength on the clinical outcomes of adults requiring medical treatment. DESIGN Systematic review. SETTING AND PARTICIPANTS Systematic reviews, randomized control trials, intervention studies, and longitudinal observational studies involving patients with decreased tongue strength requiring medical treatment were included. METHODS Articles published between January 2000 and June 2021 were retrieved from MEDLINE, CINAHL, Ichushi-web (in Japanese), Web of Science, ClinicalTrials.gov, UMIN, the Cochrane Library, and Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the Risk of Bias Assessment Tool for Nonrandomized Studies. The study protocol was pre-registered in XXX. RESULTS After screening 3040 articles and excluding duplicates, 74 articles were retrieved; after full-text evaluation of the 74 articles, seven articles (with 787 patients) were found to meet the inclusion criteria. The cut-off values for determining decreased tongue strength ranged from 13.8 to 21.6 kPa. Patients with decreased tongue strength had poorer recovery of their swallowing function, higher incidence of pneumonia, and poorer life expectancy than those with high tongue strength. However, tongue strength in older patients with decreased tongue strength increased when they performed physical exercise interventions and followed strict nutritional management plans. CONCLUSIONS Decreased tongue strength was related to poor clinical outcomes in in- and outpatients. Oral frailty in older patients should be given increased attention in hospitals, and further research is needed to improve the clinical outcomes for older people with reduced tongue strength.
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18
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Miyata H, Tani R, Toratani S, Okamoto T. Effects of Tongue Pressure on Cerebral Blood Volume Dynamics: A Functional Near-Infrared Spectroscopy Study. Brain Sci 2022; 12:brainsci12020296. [PMID: 35204059 PMCID: PMC8870264 DOI: 10.3390/brainsci12020296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/24/2022] Open
Abstract
Tongue pressure measurement (TPM) is an indicator of oral function. However, the association between tongue pressure and cerebral activation remains unclear. We used near-infrared spectroscopy (NIRS) to examine the correlation between cerebral cortex activation and tongue pressure stimulation against the anterior palatal mucosa. We measured voluntary maximum tongue pressure (MTP) using a TPM device; a pressure value of approximately 60% of the MTP was used for the experimental tongue pressure (MTP60%). We examined the effect of oral functional tongue pressure stimulation against the anterior palatal mucosa on cerebral activation using NIRS in 13 adults. Tongue pressure stimulation caused significant changes in cerebral blood flow in some areas compared with controls (p < 0.05). We performed a correlation analysis (p < 0.05) between MTP60% and changes in oxygenated hemoglobin in all 47 NIRS channels. MTP60% triggered activation of the right somatosensory motor area and right dorsolateral prefrontal cortex and deactivation of the anterior prefrontal cortex (APFC). TPM balloon-probe insertion in the oral cavity activated the bilateral somatosensory motor area and deactivated the wide area of the APFC. Moreover, MTP60% via the TPM balloon probe activated the bilateral somatosensory and motor cortex areas. Tongue pressure stimulation changes cerebral blood flow, and NIRS is useful in investigating the relationship between oral stimulation and brain function.
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Affiliation(s)
- Hidemasa Miyata
- Department of Molecular Oral Medicine and Maxillofacial Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8553, Japan; (H.M.); (S.T.)
| | - Ryouji Tani
- Oral and Maxillofacial Surgery, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8553, Japan
- Correspondence: ; Tel.: +81-82-257-5665; Fax: +81-82-257-5669
| | - Shigeaki Toratani
- Department of Molecular Oral Medicine and Maxillofacial Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8553, Japan; (H.M.); (S.T.)
| | - Tetsuji Okamoto
- School of Medical Sciences, University of East Asia, 2-1 Ichinomiyagakuenchō, Shimonoseki 751-8503, Japan;
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Chen HH, Lin PY, Lin CK, Lin PY, Chi LY. Effects of oral exercise on tongue pressure in Taiwanese older adults in community day care centers. J Dent Sci 2022; 17:338-344. [PMID: 35028056 PMCID: PMC8740383 DOI: 10.1016/j.jds.2021.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/27/2021] [Indexed: 01/29/2023] Open
Abstract
Background/purpose Oral exercise is a training method for swallowing dysfunction in older adults. The study investigated the effect of oral exercise on tongue pressure in older adults in Taiwanese community day care centers over a 3-month period. Materials and methods Participants over age 50 who were able to communicate and participating for the duration of the 12-week period were recruited from five community day care centers. A 15-min weekly group oral exercise activity was conducted. The tongue pressures were measured and multivariable linear regression models were used to assess the effect of oral exercise intervention on the participants’ tongue pressures. Results A total of 66 older adult participants, among whom the mean age was 78.06 ± 10.74 years. Tongue pressure continued improving during the intervention period, and the mean tongue pressure at the end of the study was 20.63 ± 10.45 kPa, which was significantly higher than the baseline measurement (16.92 ± 10.62 kPa, p < 0.001). Participants exhibited significant improvement in tongue pressure regardless of their age groups. Moreover, participants with one to seven pairs of functional tooth units (FTUs) exhibited significantly more improvement in tongue pressure (16.00 kPa, 95% CI = 2.58–29.43) than those without FTUs (p = 0.021). Conclusion Oral exercise over a 3-month period significantly improved tongue pressure among the study participants regardless of their gender or age group. Oral exercise should be integrated into comprehensive health promotion programs to assist in the improvement and maintenance of oral function among older adults.
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Affiliation(s)
- Hsiu-Hsien Chen
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Dentistry, National Defense Medical Center, Taipei, Taiwan
| | - Po-Yen Lin
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Kai Lin
- Department of Dentistry, National Defense Medical Center, Taipei, Taiwan
- Department of Dentistry, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Ping-Yi Lin
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Corresponding author. Department of Dentistry, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City 220, Taiwan.
| | - Lin-Yang Chi
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- Corresponding author. Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei 112, Taiwan.
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Izumi M, Akifusa S. Tongue cleaning in the elderly and its role in the respiratory and swallowing functions: Benefits and medical perspectives. J Oral Rehabil 2021; 48:1395-1403. [PMID: 34612518 DOI: 10.1111/joor.13266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
Abstract
Oral dysfunction, including oral uncleanness and decline in tongue motor function, tongue pressure and swallowing function, precedes frailty. The tongue's dorsum is a reservoir of oral microbiota, desquamated epithelial mucosa and leukocytes due to the multi-papillate anatomy, and leads to tongue coating. The tongue coating is frequently found in older adults because of hyposalivation, immunity's hypoactivity, diminished motor function and compromised tongue's pressure with age. Anaerobe-driven volatile sulphur compounds in tongue coating are a major cause of intra-oral malodor. Dysbiosis of the tongue-coating microbiome rather than the amount of microorganisms is associated with a risk of aspiration pneumonia. Daily tongue cleaning with a brush or scraper is an easy way to control tongue coating deposits and quality. Using mouth wash or rinse-containing germicides is also a way to control the microbiota of tongue coating. The tongue function is closely related to swallowing. Tongue and suprahyoid muscles are linked with respiratory muscles through the endothoracic fascia. The mechanical stimulation during the cleaning of the tongue may stimulate the respiratory muscles. An intervention trial revealed that tongue cleaning by mucosal brush improves tongue pressure, swallowing and respiratory function in old residents of nursing homes, suggesting a rehabilitative effect of tongue cleaning on the swallowing and respiratory functions, preventing aspiration pneumonia. This narrative review assesses the tongue-cleaning benefits for respiratory and swallowing functions and the possibility of preventing aspiration pneumonia.
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Affiliation(s)
- Maya Izumi
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Kitakyushu, Japan
| | - Sumio Akifusa
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Kitakyushu, Japan
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21
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Characteristics and Prognostic Factors of Swallowing Dysfunction in Patients with Lateral Medullary Infarction. J Stroke Cerebrovasc Dis 2021; 30:106122. [PMID: 34583216 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/30/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Lateral medullary infarction mainly impairs the pharyngeal phase of swallowing. We aimed to investigate the utility of the assessment tools of swallowing function in patients with lateral medullary infarction and to determine the factors that could predict the outcomes of swallowing function. MATERIALS AND METHODS 15 patients with lateral medullary infarction who were admitted to Suiseikai Kajikawa Hospital between August 1, 2016, and March 31, 2020 (age 62.7 ± 14.8 years, 5 women) were enrolled in this prospective study. The diagnosis was made using brain magnetic resonance imaging. We analyzed the factors associated with severe swallowing dysfunction, which was defined as the necessity for tube feeding on the 90th day from admission, with multiple logistic regression analysis. RESULTS Multivariate analyses identified the repetitive saliva swallowing test, modified water swallowing test, and vertical spread of stroke lesions as independent significant factors affecting severe swallowing dysfunction (p = 0.002, 0.016, and 0.011, respectively). The sub-scores of the pharyngeal phase of the Mann Assessment of Swallowing Ability were also significantly associated with severe swallowing dysfunction (p < 0.001). However, tongue pressure, severe passage pattern abnormality on videofluoroscopic examination, and vertebral artery dissection were not significantly associated with swallowing dysfunction. CONCLUSIONS Since lateral medullary infarction presents with swallowing dysfunction mainly in the pharyngeal phase, tools that can be used to evaluate the pharyngeal phase of swallowing, such as repetitive saliva swallowing test and modified water swallowing test, are moreuseful than tongue pressure measurement.
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Imamura Y, Chebib N, Ohta M, Maria Schulte-Eickhoff R, Mekki M, Schimmel M, Arakawa I, Graf C, Sato Y, Müller F. Validation of a novel diagnostic tool for decreased tongue pressure. J Oral Rehabil 2021; 48:1219-1225. [PMID: 34425018 PMCID: PMC9291622 DOI: 10.1111/joor.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Reduced tongue pressure may render eating and swallowing difficult. The purpose of this study was to investigate whether the tongue training device can also be used as a diagnostic device and whether its sensitivity and specificity are equal to the numerical tongue pressure measuring device. MATERIAL AND METHODS The target group is patients aged 70 years and over who are hospitalised for rehabilitation. Tongue pressure was measured by both, a tongue pressure measuring instrument and a tongue training tool. The diagnosis of the reduced tongue pressure was made with the tongue pressure measuring instrument and set the verified with the novel tongue training tool. RESULTS Sixty-two participants were included in the study. Forty-five were classified by the tongue pressure measuring device and 53 by the tongue training device as 'low tongue pressure'. Spearman correlation confirmed a positive correlation between the tongue pressure measuring device and the tongue training device rs = 0.800, p = 0.01 level (2-tailed). The tongue training device test identified sensitivity was 100%, and its specificity was 52.9%. The AUC of the ROC curve is 0.901. CONCLUSION The tongue training device seems a simple, safe and readily available alternative to the tongue pressure measuring device for the diagnosis of low tongue pressure, with an excellent sensitivity and very good specificity.
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Affiliation(s)
- Yoshiki Imamura
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Geriatric Dentistry, School of Dentistry, Showa University, Tokyo, Japan.,Yoshiki Imamura Meikai University, School of Dentistry, Division of Fixed Prosthodontics, Saitama, Japan
| | - Najla Chebib
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Midori Ohta
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan
| | | | - Mustapha Mekki
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Martin Schimmel
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Itsuka Arakawa
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Comprehensive Dental Care, The Nippon Dental University Niigata Hospital, Niigata, Japan
| | - Christophe Graf
- Department of Rehabilitation and Geriatrics, University Hospitals Geneva, Geneva, Switzerland
| | - Yuji Sato
- Department of Geriatric Dentistry, School of Dentistry, Showa University, Tokyo, Japan
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Nakamori M, Ishikawa K, Imamura E, Yamamoto H, Kimura K, Ayukawa T, Mizoue T, Wakabayashi S. Relationship between tongue pressure and dysphagia diet in patients with acute stroke. PLoS One 2021; 16:e0252837. [PMID: 34086830 PMCID: PMC8177488 DOI: 10.1371/journal.pone.0252837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/23/2021] [Indexed: 11/25/2022] Open
Abstract
A dysphagia diet is important for patients with stroke to help manage their nutritional state and prevent aspiration pneumonia. Tongue pressure measurement is a simple, non-invasive, and objective method for diagnosing dysphagia. We hypothesized that tongue pressure may be useful in making a choice of diet for patients with acute stroke. Using balloon-type equipment, tongue pressure was measured in 80 patients with acute stroke. On admission, a multidisciplinary swallowing team including doctors, nurses, speech therapists, and management dietitians evaluated and decided on the possibility of oral intake and diet form; the tongue pressure was unknown to the team. Diet form was defined and classified as dysphagia diet Codes 0 to 4 and normal form (Code 5 in this study) according to the 2013 Japanese Dysphagia Diet Criteria. In multivariate analysis, only tongue pressure was significantly associated with the dysphagia diet form (p<0.001). Receiver operating characteristic analyses revealed that the optimal cutoff tongue pressure for predicting diet Codes 1, 2, 3, 4, and 5 was 3.6 (p<0.001, area under the curve [AUC] = 0.997), 9.6 (p<0.001, AUC = 0.973), 12.8 (p<0.001, AUC = 0.963), 16.5 (p<0.001, AUC = 0.979), and 17.3 kPa (p<0.001, AUC = 0.982), respectively. Tongue pressure is one of the sensitive indicators for choosing dysphagia diet forms in patients with acute stroke. A combination of simple modalities will increase the accuracy of the swallowing assessment and choice of the diet form.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
- * E-mail:
| | - Kenichi Ishikawa
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Haruna Yamamoto
- Department of Nursing, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Keiko Kimura
- Department of Nursing, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Tomoko Ayukawa
- Department of Rehabilitation, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan
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Suboptimal Tongue Pressure Is Associated with Risk of Malnutrition in Community-Dwelling Older Individuals. Nutrients 2021; 13:nu13061821. [PMID: 34071812 PMCID: PMC8229542 DOI: 10.3390/nu13061821] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022] Open
Abstract
The tongue plays an important role in swallowing, and its dysfunction theoretically leads to inadequate oral intake and subsequent malnutrition. This study aimed to explore how different levels of tongue pressure are related to malnutrition among community-dwelling older individuals. The target population was community-dwelling adults aged ≥ 65 years. Tongue pressure was measured using the Iowa Oral Performance Instrument, whereas the mini nutrition assessment (MNA) test was administered to determine the nutritional status. A full MNA score of less than 24 points was defined as risk of malnutrition. Multivariate logistic regression analyses were conducted to calculate the odds ratio (OR) of risk of malnutrition among different quartiles of tongue pressure. Among the 362 participants, 26 (7.1%) were classified as having risk of malnutrition. Body weight, body mass index, handgrip strength, skeletal muscle mass index, sum MNA score, and serum levels of albumin were lower in the malnutrition risk groups than in the normal nutrition status group. A positive correlation was identified between tongue pressure and the MNA score (r = 0.143, p < 0.01). Treating the subgroup of the highest quartile of tongue pressure as the reference, the crude odds ratio (OR) of having risk of malnutrition was 5.37 (95% CI, 1.14–25.28) in the subgroup at the third quartile, 3.10 (95% CI, 0.60–15.84) in the subgroup at the second quartile, and 3.95 (95% CI, 0.81–19.15) in the subgroup at the lowest quartile. After adjustment for age and sex, the subgroup in the third quartile still presented with a significantly higher risk (OR, 4.85; 95% CI, 1.02–22.99) of risk of malnutrition. Compared with the subgroup at the highest quartile of tongue pressure, the crude OR for all the subgroups in the lower three quartiles was 4.17 (95% CI, 0.96–18.04), showing borderline significance (p = 0.05). In conclusion, we found hints for an association between decreased tongue pressure and an increased risk of malnutrition in community-dwelling older individuals. Older people with suboptimal tongue pressure should undergo a thorough assessment of their nutritional status and swallowing function for the early identification of subclinical malnutrition and dysphagia.
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Sugiya R, Higashimoto Y, Shiraishi M, Tamura T, Kimura T, Chiba Y, Nishiyama O, Arizono S, Fukuda K, Tohda Y. Decreased Tongue Strength is Related to Skeletal Muscle Mass in COPD Patients. Dysphagia 2021; 37:636-643. [PMID: 34036401 PMCID: PMC8149139 DOI: 10.1007/s00455-021-10314-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/06/2021] [Indexed: 12/15/2022]
Abstract
Dysphagia is frequently observed in patients with chronic obstructive pulmonary disease (COPD). Decreased tongue strength is one of the causes of dysphagia, and it is often observed in patients with sarcopenia. Sarcopenia is also frequently observed in COPD patients. We hypothesized that tongue strength is lower in COPD patients compared to normal subjects. This was a single-center, observational, cross-sectional study. Maximum tongue pressure (MTP) was measured in 27 patients with COPD and 24 age-matched control subjects. We also evaluated handgrip strength, gait speed, and appendicular skeletal muscle mass to define subjects as having sarcopenia. We used bioelectrical impedance analysis to assess body composition. The eating assessment test-10 was used to diagnose dysphagia. MTP was significantly lower in COPD patients than in control subjects (33.8 ± 8.4 vs 38.0 ± 5.3; p = 0.032). All measures of muscle and fat free body mass, handgrip strength, and gait speed were also significantly lower in COPD patients compared to control subjects (p < 0.01). The prevalence of sarcopenia in COPD patients was higher than that in control subjects (6/27 versus 0/24; p = 0.007), but the prevalence of dysphagia was not different between groups (COPD: 5/27, versus control: 1/24; p = 0.112). MTP was moderately correlated with skeletal muscle mass index (r = 0.56, p = 0.003) and handgrip strength (r = 0.43, p = 0.027) in COPD patients. Tongue strength was lower in COPD patients compared to normal subjects, and decreased tongue strength may be correlated with sarcopenia in COPD patients.
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Affiliation(s)
- Ryuji Sugiya
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 5898511, Japan. .,School of Rehabilitation Sciences, Seirei Christopher University, 3453 Mikatahara, Hamamatsu, Shizuoka, 4338558, Japan.
| | - Yuji Higashimoto
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Masashi Shiraishi
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Tomomi Tamura
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Tamotsu Kimura
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Yasutaka Chiba
- Clinical Research Center, Kindai University hospital, 377-2 Ohnohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Osamu Nishiyama
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Shinichi Arizono
- School of Rehabilitation Sciences, Seirei Christopher University, 3453 Mikatahara, Hamamatsu, Shizuoka, 4338558, Japan
| | - Kanji Fukuda
- Department of Rehabilitation Medicine, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 5898511, Japan
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Shimizu A, Fujishima I, Maeda K, Wakabayashi H, Nishioka S, Ohno T, Nomoto A, Shigematsu T, Kayashita J. Effect of low tongue pressure on nutritional status and improvement of swallowing function in sarcopenic dysphagia. Nutrition 2021; 90:111295. [PMID: 34107332 DOI: 10.1016/j.nut.2021.111295] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study aimed to evaluate the effect of low tongue pressure on the improvement of swallowing function in people with sarcopenic dysphagia and ongoing dysphagia or physical rehabilitation. In addition, we investigated whether sarcopenic dysphagia at admission was associated with severity of malnutrition. METHODS This was a prospective cohort study of 146 people with sarcopenic dysphagia (mean age 84.6 ± 7.4 y; 68.4% women, 31.6% men) in a postacute rehabilitation hospital. Sarcopenic dysphagia was defined as the presence of both sarcopenia and dysphagia but not neurogenic dysphagia, such as dysphagia due to stroke. Low tongue pressure was classified as "probable" and normal tongue pressure as "possible" sarcopenic dysphagia. Swallowing function was assessed using the Food Intake Level Scale. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition criteria. Study outcomes included the amount of change in Food Intake Level Scale score during the rehabilitation period and the association between probable sarcopenic dysphagia and the severity of malnutrition on admission. Statistical significance was set at P < 0.05. RESULTS There were 83 participants (58.6%) with probable sarcopenic dysphagia. The severity of malnutrition (moderate malnutrition: adjusted odds ratio, 3.388; P = 0.042) and severe malnutrition (adjusted odds ratio, 3.663; P = 0.015) was a contributing factor to probable sarcopenic dysphagia. Probable sarcopenic dysphagia (regression coefficient, -0.384; P = 0.017) was negatively associated with the amount of change in Food Intake Level Scale score. CONCLUSIONS Probable sarcopenic dysphagia with low tongue pressure was associated with poorer improvement in swallowing function and severe malnutrition during postacute rehabilitation. Patients with probable sarcopenic dysphagia may require aggressive nutritional therapy.
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Affiliation(s)
- Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
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Structural Equation Modeling of Tongue Function and Tongue Hygiene in Acute Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094567. [PMID: 33925775 PMCID: PMC8123496 DOI: 10.3390/ijerph18094567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/17/2022]
Abstract
In acute stroke patients, it is important to maintain tongue hygiene and tongue function for prognosis management. However, the direct relationship between these factors is unclear, since these are often assessed by multiple observables. In this study, we used structural equation modeling (SEM) analysis, a tool to analyze the relationship between concepts that cannot be measured directly, to analyze the relationship between tongue hygiene and tongue function. The subjects were 73 patients with acute stroke admitted to a university hospital who underwent dental intervention. Age, sex, nutritional intake method, clinical severity classification of dysphagia, number of current teeth, number of functional teeth, oral health, tongue movement, tongue coating, number of microorganisms on the tongue surface, tongue surface moisture level, and tongue pressure were measured at the first visit. SEM analysis showed that the relationship between tongue function and tongue hygiene was 0.05 between tongue function and swallowing function was 0.90, and that between tongue hygiene and swallowing function was 0.09. We found no statistical relationship between tongue function and tongue hygiene in acute stroke patients. However, it was reconfirmed that tongue function is strongly related to feeding and swallowing functions.
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Shimizu A, Maeda K, Nagami S, Nagano A, Yamada Y, Shimizu M, Ishida Y, Kayashita J, Fujishima I, Mori N, Murotani K, Suenaga M. Low tongue strength is associated with oral and cough-related abnormalities in older inpatients. Nutrition 2020; 83:111062. [PMID: 33348111 DOI: 10.1016/j.nut.2020.111062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Sarcopenic dysphagia is partly characterized by a decline in the strength of the swallowing muscles. However, its associated characteristics and symptoms are unclear. The aim of this study was to clarify the characteristics and symptoms of swallowing ability associated with low tongue muscle strength, which is one of the swallowing muscles in older adults. METHODS This was a cross-sectional study of 197 older patients admitted to the hospital for orthopedic conditions. We measured the maximum tongue pressure (MTP) against the palate. Swallowing-related characteristics were assessed with the Mann assessment of swallowing ability. Sarcopenia was diagnosed using the 2019 Asian Working Group for Sarcopenia. RESULTS The mean age of patients was 81.3 ± 7.6 y, and 80.2% of patients were women. Forty-two patients (21.3%) showed low MTP, defined as <20 kPa. Approximately 50% of participants had sarcopenia. Patients in the low MTP group had a significantly higher incidence of sarcopenia compared with the normal MTP group (71.4% vs. 48.4%; P = .008). After adjusting for potential confounders in the multivariate analyses, low MTP was found to be independently associated with abnormalities in tongue coordination (odds ratio [OR]: 5.251; 95% confidence interval [CI], 2.336-11.807; P < .001), oral transit (OR: 5.248; 95% CI, 1.424-19.345; P = .013), cough reflex (OR: 2.709; 95% CI, 1.280-5.733; P = .009), and voluntary cough (OR: 7.786; 95% CI, 3.329-18.208; P < .001). CONCLUSIONS Patients with low tongue strength are characterized by abnormal oral and cough-related characteristics.
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Affiliation(s)
- Akio Shimizu
- Department of Nutrition Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.
| | - Shinsuke Nagami
- Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Ayano Nagano
- Department of Nursing Care, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Yumi Yamada
- Rehabilitation Visiting Nursing Station TRY, Aichi, Japan
| | - Midori Shimizu
- Department of Nutrition, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Yuria Ishida
- Department of Nutrition, Aichi Medical University, Nagakute, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | | | - Masaki Suenaga
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan
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Kim H, Cho NB, Kim J, Kim KM, Kang M, Choi Y, Kim M, You H, Nam SI, Shin S. Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study. JMIR Mhealth Uhealth 2020; 8:e22080. [PMID: 33012704 PMCID: PMC7600016 DOI: 10.2196/22080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/07/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023] Open
Abstract
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
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Affiliation(s)
- HyangHee Kim
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam-Bin Cho
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinwon Kim
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Kyung Min Kim
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minji Kang
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Younggeun Choi
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Minjae Kim
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Heecheon You
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Seok In Nam
- Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Soyeon Shin
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Nakamori M, Imamura E, Kuwabara M, Ayukawa T, Tachiyama K, Kamimura T, Hayashi Y, Matsushima H, Funai M, Mizoue T, Wakabayashi S. Simplified cough test can predict the risk for pneumonia in patients with acute stroke. PLoS One 2020; 15:e0239590. [PMID: 32991632 PMCID: PMC7523950 DOI: 10.1371/journal.pone.0239590] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022] Open
Abstract
We investigated the association between the results of a simplified cough test and pneumonia onset in 226 patients with acute stroke admitted to Suiseikai Kajikawa Hospital from April to December, 2018. For the simplified cough test, performed on admission, patients orally inhaled a mist of 1% citric acid–physiological saline using a portable mesh nebulizer. When the first cough was evoked or if it remained absent for 30 seconds (indicating an abnormal result), the test was ended. Patients also completed the repetitive saliva swallowing test (RSST) and modified water swallowing test. We monitored patients for pneumonia signs for 30 days post-admission. Eighteen patients exhibited an abnormal simplified cough test result. On multivariate analysis, an abnormal RSST result was independently associated with an abnormal simplified cough test result. Seventeen patients developed pneumonia. The adjusted Cox proportional hazard model for pneumonia onset revealed that the simplified cough test had predictive power for pneumonia onset (hazard ratio, 10.52; 95% confidence interval, 3.72–29.72). The simplified cough test is a strong indicator for predicting the pneumonia development in patients with acute stroke; it should be added to existing bedside screening tests for predicting pneumonia risk, allowing appropriate and timely intervention.
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Affiliation(s)
- Masahiro Nakamori
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- * E-mail:
| | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Miyu Kuwabara
- Department of Nursing, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Tomoko Ayukawa
- Department of Rehabilitation, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Keisuke Tachiyama
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Teppei Kamimura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuki Hayashi
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hayato Matsushima
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Mika Funai
- Department of Nursing, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan
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Association between stroke lesions and videofluoroscopic findings in acute stroke patients. J Neurol 2020; 268:1025-1035. [PMID: 32979098 DOI: 10.1007/s00415-020-10244-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to assess stroke lesions, which play a key role in determining swallowing dysfunction, and findings of videofluoroscopy (VF), which provides the most accurate instrumental assessment for evaluating swallowing function, in patients with acute stroke. METHODS We enrolled 342 patients with first-time acute stroke (age 70.4 ± 12.6 years, 142 female). Patients with dementia and altered mental status due to severe stroke were excluded. All patients underwent cranial magnetic resonance imaging to identify the location of stroke lesion, VF, and tongue pressure measurement. RESULTS Aspiration was detected in 45 (13.2%) patients. Multivariate analysis identified parietal lobe lesion and the National Institutes of Health Stroke Scale (NIHSS) score as independent significant factors for aspiration (odds ratio 6.33, 95% confidence interval [CI] 2.25-17.84, p < 0.001; odds ratio 1.12, 95% CI 1.03-1.20, p = 0.004, respectively). Swallowing reflex delay was detected in 58 (17.0%) patients. Multivariate analysis identified habitual drinking, basal ganglia lesion, and the NIHSS score as independent significant factors for swallowing reflex delay (odds ratio 0.51, 95% CI 0.26-0.99, p = 0.047; odds ratio 1.91, 95% CI 1.09-3.67, p = 0.041; odds ratio 1.12, 95% CI 1.05-1.20, p < 0.001, respectively). Additionally, oral cavity and pharyngeal residues were independently associated with tongue pressure. CONCLUSION Parietal lobe lesions are associated with aspiration and basal ganglia lesions with swallowing reflex delay.
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Umemoto G, Fujioka S, Arahata H, Kawazoe M, Sakae N, Sasagasako N, Furuya H, Tsuboi Y. Relationship between tongue pressure and functional oral intake scale diet type in patients with neurological and neuromuscular disorders. Clin Neurol Neurosurg 2020; 198:106196. [PMID: 32980799 DOI: 10.1016/j.clineuro.2020.106196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Patients with neurological and neuromuscular disorders (NNMD) frequently experience swallowing disorders that increase aspiration pneumonia risk and therefore require specialized diets or tube feeding. Diet type level usually is assessed by video fluoroscopic swallowing study (VFSS). To identify a simpler assessment method, we examined the association between diet type (based on the Functional Oral Intake Scale [FOIS]) diet type and maximum tongue pressure (MTP). METHODS From 2011-2020, FOIS diet type level and MTP were assessed in a sample of 927 patients. Of these patients, 186 had Parkinson's disease (PD), 69 had Parkinson-related disease (PRD), 61 had multiple system atrophy (MSA), 42 had spinocerebellar degeneration (SCD), 147 had amyotrophic lateral sclerosis (ALS), 180 had myotonic dystrophy type 1 (DM1), and 242 had Duchenne muscular dystrophy (DMD). VFSS was conducted while patients swallowed water and foods containing barium. MTP measurements were collected the same day. Participants' diet type level was adjusted based on the VFSS, with some participants requiring multiple examinations. Relationships between diet type level and MTP were tested using univariate and Spearman rank correlation analyses. RESULTS Mean MTP for the entire NNMD group (25.5 ± 13.1 kPa) was lower than that of healthy elderly individuals, as determined in previous reports. The highest MTP was found in the MSA group (32.2 ± 15.7 kPa) and the lowest in the DM1 group (19.1 ± 9.0 kPa). Diet type level was highest in the MSA group (5.8 ± 1.4) and lowest in the DMD group (5.2 ± 1.7). A significant correlation was observed between diet type level and MTP (R = 0.384, p < 0.001). The optimum MTP cutoff values-detected using ROC curves to predict a requirement to change to a dysphagia diet-was highest in the DMD group (29.0 kPa) and lowest in the ALS group (12.3 kPa). CONCLUSIONS The decision to change NNMD patients to a dysphagia diet can be made based on MTP. Modifying a patient's oral diet (FOIS level ≤ 5) should be considered for those with a MTP of 10-25 kPa, with the cutoff value varying by disease.
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Affiliation(s)
- George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan; Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan.
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hajime Arahata
- Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan
| | - Miki Kawazoe
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Nobutaka Sakae
- Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan
| | - Naokazu Sasagasako
- Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan
| | - Hirokazu Furuya
- Department of Neurology, Faculty of Medicine, Kochi University, Kochi, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Furuya J, Beniya A, Suzuki H, Hidaka R, Matsubara C, Obana M, Yoshimi K, Yamaguchi K, Hara K, Nakagawa K, Nakane A, Tohara H, Minakuchi S. Factors associated with the number of microorganisms on the tongue surface in patients following acute stroke. J Oral Rehabil 2020; 47:1403-1410. [PMID: 33245592 DOI: 10.1111/joor.13074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Oral hygiene management of patients with acute stroke is important for preventing aspiration pneumonia and ensuring oral intake. The tongue coating score can be useful for evaluating the oral hygiene level since it reflects the microorganism number on the tongue surface in elderly patients. However, the relationship between the number of oral microorganisms and the tongue coating score in patients with acute stroke remains unclear. OBJECTIVES We aimed to investigate the relationships between the microorganism number on the tongue surface and oral factors, including tongue coating score, tongue surface moisture level and tongue function. METHODS This cross-sectional study enrolled 73 patients with acute stroke who were hospitalised at an acute care hospital and underwent dental intervention. Potential explanatory factors, including sex, age, Glasgow Coma Scale score, tongue coating score, tongue surface moisture level, nutrition intake method, number of functional teeth and tongue function, were evaluated. Logistic regression analysis determined their association with the microorganism number on the tongue surface. RESULTS The tongue coating score (odds ratio: 1.31) and tongue surface moisture level (odds ratio: 1.10) were significantly associated with increased microorganism numbers on the tongue surface. CONCLUSION The tongue coating score, which reflects the actual number of microorganisms on the tongue surface, could be an effective tool for evaluating oral hygiene level in patients with stroke. Moreover, reducing oral microorganisms in saliva through oral hygiene management, including removing the tongue coating, could contribute towards the prevention of aspiration pneumonia.
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Affiliation(s)
- Junichi Furuya
- Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo, Japan
| | - Akane Beniya
- Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroyuki Suzuki
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Rena Hidaka
- Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Chiaki Matsubara
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Michiyo Obana
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kanako Yoshimi
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kohei Yamaguchi
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koji Hara
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kazuharu Nakagawa
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Ayako Nakane
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Haruka Tohara
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shunsuke Minakuchi
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Nakamori M, Imamura E, Fukuta M, Tachiyama K, Kamimura T, Hayashi Y, Matsushima H, Ogawa K, Nishino M, Hirata A, Mizoue T, Wakabayashi S. Tongue thickness measured by ultrasonography is associated with tongue pressure in the Japanese elderly. PLoS One 2020; 15:e0230224. [PMID: 32764766 PMCID: PMC7413413 DOI: 10.1371/journal.pone.0230224] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 07/11/2020] [Indexed: 11/18/2022] Open
Abstract
The term "oral frailty" reflects the fact that oral health is associated with physical frailty and mortality. The gold standard methods for evaluating the swallowing function have several problems, including the need for specialized equipment, the risk of radiation exposure and aspiration, and general physicians not possessing the requisite training to perform the examination. Hence, several simple and non-invasive techniques have been developed for evaluating swallowing function, such as those for measuring tongue pressure and tongue thickness. The aim of this study was to investigate the relationship between tongue thickness ultrasonography and tongue pressure in the Japanese elderly. We evaluated 254 elderly patients, who underwent tongue ultrasonography and tongue pressure measurement. To determine tongue thickness, we measured the vertical distance from the surface of the mylohyoid muscle to the tongue dorsum using ultrasonography. The results of the analyses revealed that tongue thickness was linearly associated with tongue pressure in both sexes. In male participants, dyslipidemia, lower leg circumference, and tongue pressure were independently and significantly associated with tongue thickness. In female participants, body mass index and tongue pressure were independently and significantly associated with tongue thickness. The optimal cutoff for tongue thickness to predict the tongue pressure of < 20 kPa was 41.3 mm in males, and 39.3 mm in females. In the Japanese elderly, tongue thickness using ultrasonography is associated with tongue pressure. Tongue thickness and tongue pressure, which are sensitive markers for oral frailty, decrease with age. We conclude that tongue ultrasonography provides a less invasive technique for determining tongue thickness and predicts oral frailty for elderly patients.
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Affiliation(s)
- Masahiro Nakamori
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- * E-mail:
| | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Masako Fukuta
- Department of Clinical Laboratory, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Keisuke Tachiyama
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Teppei Kamimura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuki Hayashi
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hayato Matsushima
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Kanami Ogawa
- Department of Clinical Laboratory, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Masami Nishino
- Department of Clinical Laboratory, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Akiko Hirata
- Department of Clinical Laboratory, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan
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Validity of a dysphagia screening test following resection for head and neck cancer. Ir J Med Sci 2020; 190:67-77. [PMID: 32607911 DOI: 10.1007/s11845-020-02286-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the validity of a dysphagia screening test (DST) in patients who have undergone resection for head and neck cancer (HNC). In addition, we examined whether or not combined effects of DSTs improve the detection accuracy of penetration/aspiration. METHODS Thirty-six HNC patients were participated. The DST consisted of the repetitive saliva swallowing test (RSST), the water swallowing test (WST), the modified water swallowing test (MWST), the food test (FT), and tongue pressure. A videofluoroscopic swallowing study was conducted, and the penetration-aspiration scale was used for scoring. For statistical analyses, we used the receiver operating characteristic (ROC) analysis. Furthermore, the accuracy of the determination of penetration/aspiration was evaluated by combining two or three DSTs. RESULTS The penetration/aspiration could be predicted with moderate accuracy based on MWST and FT. The area under the ROC curve (AUC) values of the MWST and FT were 0.76 (p = 0.03) and 0.80 (p = 0.050), and the sensitivity/specificity was 0.9/0.61 (MWST) and 0.8/0.8 (FT), respectively. As a result of combining 2 or 3 DSTs, the combination of "MWST and FT" was the most accurate, with an AUC of 0.87 (p = 0.02). The combination of three tests had lower accuracy than the combination of two tests. CONCLUSION Based on our results, it is recommended that MWST or FT be used when only one type of DST is performed. In addition, the combination of two DSTs may detect aspiration patients more accurately than one alone.
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Yoshikawa M, Fukuoka T, Mori T, Hiraoka A, Higa C, Kuroki A, Takeda C, Maruyama M, Yoshida M, Tsuga K. Comparison of the Iowa Oral Performance Instrument and JMS tongue pressure measurement device. J Dent Sci 2020; 16:214-219. [PMID: 33384800 PMCID: PMC7770307 DOI: 10.1016/j.jds.2020.06.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background/purpose Tongue pressure measurement conveys important information about eating and swallowing function. The Iowa Oral Performance Instrument® (IOPI) and KAY Swallowing Workstation® are internationally used for tongue pressure measurement, but for legal reasons cannot be used in Japan; rather the JMS tongue pressure measurement device® has been approved for use in Japan. However, it is not clear whether measurement obtained with these devices are directly comparable. Materials and methods This study investigated the correlation between the maximum tongue pressure data measured by the IOPI and the JMS tongue pressure measurement device in young healthy participants (34 males; 23.2 ± 2.0 years old, and 40 females; 21.4 ± 1.3 years old). Results Measurements obtained with these two devices showed significant correlations in the total cohort, and in male and female participants, separately (P < 0.05). Conclusion These findings demonstrate that the measurements obtained with the JMS device is comparable to those obtained with the IOPI. In Japan, JMS tongue pressure measurement device is used not only in dysphagia research field, but also geriatrics field, and extensive and detailed investigations has been carried out.
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Affiliation(s)
- Mineka Yoshikawa
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
- Corresponding author. 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan. Fax: +81 92 257 5679.
| | - Tatsuyuki Fukuoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Japan
| | - Takahiro Mori
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Aya Hiraoka
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Chiaki Higa
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Azusa Kuroki
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Chiho Takeda
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Mariko Maruyama
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Mitsuyoshi Yoshida
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kazuhiro Tsuga
- Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
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Matsuo K, Kito N, Ogawa K, Izumi A, Masuda Y. Effects of textured foods on masticatory muscle activity in older adults with oral hypofunction. J Oral Rehabil 2019; 47:180-186. [DOI: 10.1111/joor.12901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/15/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Koichiro Matsuo
- Department of Dentistry and Oral‐Maxillofacial Surgery School of Medicine Fujita Health University Aichi Japan
| | - Norie Kito
- Department of Dentistry and Oral‐Maxillofacial Surgery School of Medicine Fujita Health University Aichi Japan
| | | | | | - Yuji Masuda
- Division of Oral and Maxillofacial Biology Institute for Oral Science Matsumoto Dental University Shiojiri Japan
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Associations between tongue strength and skeletal muscle mass under dysphagia rehabilitation for geriatric out patients. J Prosthodont Res 2019; 64:188-192. [PMID: 31767381 DOI: 10.1016/j.jpor.2019.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 07/05/2019] [Accepted: 07/09/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to examine how skeletal muscle mass influences the effectiveness of dysphagia rehabilitation. METHODS The cross-sectional study and the prospective cohort study were conducted in a clinic, specialized in rehabilitation of patients with dysphagia, located in Tokyo, Japan. Skeletal muscle mass measurement by bioelectrical impedance analysis and tongue strength measurement were performed on 178 outpatients with dysphagia. In addition, the Barthel Index, Mini Nutritional Assessment-Short Form, and Functional Oral Intake Scale values were measured. Dysphagia rehabilitation was performed, and 88 of the patients who were available for follow-up one year later were included in a follow-up study. In the cross-sectional study, the associations between tongue strength and other factors were examined. In the follow-up study, factors associated with rehabilitation effectiveness, shown by tongue strength, were examined. RESULTS Tongue strength and skeletal muscle mass were correlated, and both decreased as eating and swallowing function level decreased. After one year of dysphagia rehabilitation, tongue strength and skeletal muscle mass increased. The factors associated with the amount of increase in tongue strength were initial tongue strength and skeletal muscle mass. CONCLUSIONS For patients with dysphagia, maintenance of skeletal muscle mass was associated with improvement of tongue strength in rehabilitation. This indicates that prevention of sarcopenia in dysphagia patients contributes to the effect of rehabilitation.
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Hase T, Miura Y, Nakagami G, Okamoto S, Sanada H, Sugama J. Food bolus‐forming ability predicts incidence of aspiration pneumonia in nursing home older adults: A prospective observational study. J Oral Rehabil 2019; 47:53-60. [DOI: 10.1111/joor.12861] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/22/2019] [Accepted: 07/04/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Takashi Hase
- Department of Oral and Maxillofacial Surgery Noto General Hospital Ishikawa Japan
| | - Yuka Miura
- Department of Imaging Nursing Science, Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine The University of Tokyo Tokyo Japan
- Global Nursing Research Center, Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Shigefumi Okamoto
- Department of Laboratory Science, School of Health Sciences, College of Medical, Pharmaceutical, and Health Sciences Kanazawa University Ishikawa Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine The University of Tokyo Tokyo Japan
- Global Nursing Research Center, Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Junko Sugama
- Institute for Frontier Science Initiative Kanazawa University Ishikawa Japan
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Hwang NK, Kim HH, Shim JM, Park JS. Tongue stretching exercises improve tongue motility and oromotor function in patients with dysphagia after stroke: A preliminary randomized controlled trial. Arch Oral Biol 2019; 108:104521. [PMID: 31476522 DOI: 10.1016/j.archoralbio.2019.104521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/03/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study investigated the effect of tongue stretching exercises (TSE) on tongue motility and oromotor function in patients with dysphagia after stroke. DESIGN This study was designed as a 4-week, double-blind, two-group, block randomized controlled trial. A total of 25 patients were randomly allocated into either the experimental (n = 13) or the control group (n = 12). The experimental group received TSE from an occupational therapist. TSE were divided into dynamic and static passive stretching exercises (20 repetitions each). The intervention was performed five times a week for four weeks. Tongue motility was measured before and after the intervention as the distance from the lower lip to the tip of tongue during maximum protrusion of the tongue. Measurements were performed twice each time and the mean value recorded. Oromotor function was assessed using the oral phase events of the videofluoroscopic dysphagia scale (VDS) based on a videofluoroscopic swallowing study. RESULTS The experimental group showed significant differences in tongue motility, bolus formation, tongue to palate contact, premature bolus loss, and oral transit time in the oral phase of VDS (p < 0.05 for all) before and after the intervention, whereas the control group showed a significant difference only in lip closure (p < 0.05). CONCLUSION This study demonstrated that TSE have a positive effect on tongue motility and oromotor function in patients with dysphagia after stroke. Therefore, we recommend TSE as an effective treatment for dysphagia.
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Affiliation(s)
- Na-Kyoung Hwang
- Department of Occupational Therapy, Seoul North Municipal Hospital, Seoul, Republic of Korea
| | - Hwan-Hee Kim
- Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea
| | - Je-Myung Shim
- Department of Physical Therapy, Kangwon National University, Samcheok, Republic of Korea
| | - Ji-Su Park
- Advanced Human Resource Development Project Group for Health Care in Aging Friendly Industry, Dongseo University, Busan, Republic of Korea.
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Nakagawa K, Matsuo K. Assessment of Oral Function and Proper Diet Level for Frail Elderly Individuals in Nursing Homes Using Chewing Training Food. J Nutr Health Aging 2019; 23:483-489. [PMID: 31021367 DOI: 10.1007/s12603-019-1192-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aimed to investigate the relationship between the ability to press Process Lead (PL) in the oral cavity and the tongue pressure and recommended diet form for elderly individuals in nursing homes, using PL normalized physical properties. DESIGN Cross-sectional observation study. SETTING Geriatric facilities. PARTICIPANTS A 100 elderly individuals aged between 67-96 years. MEASUREMENTS PL was pressed between the tongue and palate to evaluate its deformation. The thickness was set at 6, 9, and 18 mm. The tongue pressure was measured with a JMS tongue pressure manometer. The number of chewing cycles until an 18-mm thick PL was first swallowed was measured (PL chewing test). The diet was set to level 4, and the recommended form was evaluated by video endoscopic evaluation of swallowing (VE). The results of the PL pressing test and correlations between PL chewing test, tongue pressure, and diet level were statistically examined. RESULTS The tongue pressure was significantly decreased in groups that could not press the PL. The PL pressing test and recommended diet form showed a significant correlation, and the elderly with difficulty in pressing the PL had a lower diet level. In addition, the diet level decreased with decreased PL chewing test performance in those without molar occlusion. CONCLUSIONS The PL pressing and chewing tests may aid in ascertaining the appropriate diet level. In the future, we would like to verify the usefulness of these tests in determining the diet level of elderly people requiring long-term care at the time of entering the facility.
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Affiliation(s)
- K Nakagawa
- Koichiro Matsuo, Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan, Tel: +81-562-93-9098, E-mail: Koichiro Matsuo:
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Kito N, Matsuo K, Ogawa K, Izumi A, Kishima M, Itoda M, Masuda Y. Positive Effects of "Textured Lunches" Gatherings and Oral Exercises Combined with Physical Exercises on Oral and Physical Function in Older Individuals: A Cluster Randomized Controlled Trial. J Nutr Health Aging 2019; 23:669-676. [PMID: 31367733 DOI: 10.1007/s12603-019-1216-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Proper nutrition and physical exercises are essential to prevent frailty in older adults. Proper masticatory performance and oral function may influence on physical activities as well since the mouth is the entrance of nutrition and digestion. Thus, the present study aimed to test the combined program of specially devised lunch gatherings containing textured foods with oral and physical exercises on the improvement of oral and physical function in community-dwelling older adults. DESIGN A Cluster randomized controlled trial; Setting and Participants: Eighty-six community-dwelling older adults in Daito city, Japan, were randomly assigned into control (n = 43) or intervention (n = 43) groups. INTERVENTION The control group performed the physical exercise regimen only. The intervention group participated in a 12-week physical and oral exercise program and ate a so-called "munchy lunch" that introduced textured foods with proper nutrients together after performing the physical exercise twice a week following brief dietary instruction at the intervention onset. Physical training and lunch gatherings were held at local public centers. MEASUREMENTS The differences in measured variables for physical and oral function between baseline and 12 weeks of intervention were statistically tested. RESULTS Oral function as measured by tongue pressure increased significantly in the intervention group (p=0.031), but not in the control group. Physical properties and activities, including body fat percentage and results of the timed up and go test, decreased more significantly in the intervention group than in controls (p<0.05). CONCLUSIONS Our findings suggest that a combined program of textured lunch gatherings with oral and physical exercises may improve physical and oral function as a preventative approach for frailty in community-dwelling older adults.
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Affiliation(s)
- N Kito
- Koichiro Matsuo, DDS, PhD, Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan, Phone: +81-562-93-9098 / Fax: +81-562-93-9098, E-mail:
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Kaji A, Hashimoto Y, Kobayashi Y, Sakai R, Okamura T, Miki A, Hamaguchi M, Kuwahata M, Yamazaki M, Fukui M. Sarcopenia is associated with tongue pressure in older patients with type 2 diabetes: A cross-sectional study of the KAMOGAWA-DM cohort study. Geriatr Gerontol Int 2018; 19:153-158. [PMID: 30585390 DOI: 10.1111/ggi.13577] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/16/2018] [Accepted: 10/24/2018] [Indexed: 12/13/2022]
Abstract
AIM Death as a result of pneumonia is an important issue in patients with diabetes. Tongue pressure is associated with swallowing function, which has a close association with aspiration pneumonia. However, no previous studies have shown the association between sarcopenia and tongue pressure in older patients with type 2 diabetes. METHODS In the present cross-sectional study, we investigated body composition, handgrip strength and tongue pressure. Skeletal muscle mass index (kg/m2 ) was defined as appendicular muscle mass / the square of the height. Sarcopenia was defined when both handgrip strength <26 kg for men and <18 kg for women, and the skeletal muscle mass index <7.0 kg/m2 for men and <5.7 kg/m2 for women existed. RESULTS Among 144 patients (82 men, 71.4 years [SD 6.7 years]), 11.8% had sarcopenia. Tongue pressure was associated with skeletal muscle mass index and handgrip strength (r = 0.361, P < 0.001 and r = 0.387, P < 0.001, respectively, in men; and r = 0.300, P = 0.018 and r = 0.538, P < 0.001, respectively, in women). Tongue pressure was associated with the prevalence of sarcopenia after adjusting for covariates (OR 3.83, 95% CI 1.06-13.9, P = 0.041). According to the receiver operating characteristic curve analysis, the optimal cut-off value of handgrip strength for the presence of low tongue pressure was 27.7 kg (AUC 0.70, 95% CI 0.53-0.83, sensitivity 0.78, specificity 0.64) in men and 18.3 kg (AUC 0.71, 95% CI 0.54-0.84, sensitivity 0.82, specificity 0.54) in women. CONCLUSIONS Sarcopenia, especially handgrip strength, is associated with tongue pressure in older patients with type 2 diabetes. We should consider a decrease of swallowing function when examining patients with sarcopenia. Geriatr Gerontol Int 2019; 19: 153-158.
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Affiliation(s)
- Ayumi Kaji
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yukiko Kobayashi
- Department of Nutrition Science, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Ryosuke Sakai
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Takuro Okamura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Akane Miki
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Masashi Kuwahata
- Department of Nutrition Science, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Decline in tongue pressure during perioperative period in cancer patients without oral feeding. Clin Nutr ESPEN 2018; 29:183-188. [PMID: 30661685 DOI: 10.1016/j.clnesp.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/05/2018] [Accepted: 10/17/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Systemic muscle wasting during perioperative periods has a major impact on postoperative morbidity. However, data on oropharyngeal muscle weakness after surgery are scarce. We examined whether maximum tongue pressure (MTP) and hand grip strength (HGS) diminished during the perioperative period without and with oral feeding in patients receiving cancer surgery. METHODS A total of 258 patients undergoing cancer surgery who had visited a hospital dental clinic were prospectively recruited between October 2015 and February 2016. MTP and HGS were measured on the day before and 4 days after surgery. Data on age, sex, tumor location, surgical procedure, and oral feeding status were obtained from patient medical records. We analyzed for differences in the perioperative changes of MTP and HGS according to surgical procedure, oral feeding, and tumor location using ANOVA. RESULTS Neither MTP nor HGS differed significantly among tumor locations before surgery. The proportion of patients with an oral diet at 4 days after surgery was 36.7% and 34.5% for upper GI and colorectum groups versus 89.2% and 86.4% for genitourinary and lung groups, respectively. During the perioperative period, MTP decreased more significantly in patients without oral feeding than in those with oral feeding at 4 days after surgery (P < 0.01). HGS was not affected by postoperative oral feeding status. Both MTP and HGS decreased more significantly in the upper gastrointestinal group than in the genitourinary and lung groups (P < 0.05), except for MTP between upper GI and genitourinary groups (P = 0.10). CONCLUSIONS MTP, but not HGS, diminishes significantly during the perioperative period without oral feeding. As tongue muscle disuse after surgery may adversely impact postoperative oropharyngeal muscle decline, perioperative tongue muscle strengthening exercises may assist in maintaining muscle strength and good oral feeding.
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Kamijo Y, Kanda E, Ono K, Maeda K, Yanai A, Honda K, Tsujimoto R, Yanagi M, Ishibashi Y, Yoshida M. Low tongue pressure in peritoneal dialysis patients as a risk factor for malnutrition and sarcopenia: a cross-sectional study. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0165-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Minakuchi S, Tsuga K, Ikebe K, Ueda T, Tamura F, Nagao K, Furuya J, Matsuo K, Yamamoto K, Kanazawa M, Watanabe Y, Hirano H, Kikutani T, Sakurai K. Oral hypofunction in the older population: Position paper of the Japanese Society of Gerodontology in 2016. Gerodontology 2018; 35:317-324. [PMID: 29882364 DOI: 10.1111/ger.12347] [Citation(s) in RCA: 240] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is growing international interest in identifying the effects of ageing on oral health and on appropriate strategies for managing oral disorders. The Japanese Society of Gerodontology (JSG), as the official representative of researchers and clinicians interested in geriatric dentistry in Japan, makes several recommendations on the concept of "oral hypofunction." AIMS This study proposes diagnostic criteria and management strategies to reduce the risk of oral hypofunction among older people. CONCEPTUAL FRAMEWORK We define oral hypofunction as a presentation of 7 oral signs or symptoms: oral uncleanness; oral dryness; decline in occlusal force; decline in motor function of tongue and lips; decline in tongue pressure; decline in chewing function; and decline in swallowing function. The criteria of each symptom were determined based on the data of previous studies, and oral hypofunction was diagnosed if the criteria for 3 or more signs or symptoms were met. CONCLUSIONS We recommend that more evidence should be gathered from clinical studies and trials to clarify our diagnostic criteria and management strategies.
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Affiliation(s)
- Shunsuke Minakuchi
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuhiro Tsuga
- Department of Advanced Prosthodontics, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazunori Ikebe
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Takayuki Ueda
- Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Fumiyo Tamura
- Tama Oral Rehabilitation Clinic, The Nippon Dental University, Tokyo, Japan
| | - Kan Nagao
- Department of Oral & Maxillofacial Prosthodontics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Junichi Furuya
- Department of Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichiro Matsuo
- Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Ken Yamamoto
- Department of Community Dentistry, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Manabu Kanazawa
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yutaka Watanabe
- Research on Social and Human Sciences, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Dentistry and Oral Surgery, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takeshi Kikutani
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry at Tokyo, Tokyo, Japan
| | - Kaoru Sakurai
- Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan
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Morita K, Tsuka H, Shintani T, Yoshida M, Kurihara H, Tsuga K. Prevalence of Torus Mandibularis in Young Healthy Dentate Adults. J Oral Maxillofac Surg 2017; 75:2593-2598. [DOI: 10.1016/j.joms.2017.04.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/23/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Chojin Y, Kato T, Rikihisa M, Omori M, Noguchi S, Akata K, Ogoshi T, Yatera K, Mukae H. Evaluation of the Mann Assessment of Swallowing Ability in Elderly Patients with Pneumonia. Aging Dis 2017; 8:420-433. [PMID: 28840057 PMCID: PMC5524805 DOI: 10.14336/ad.2017.0102] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/02/2017] [Indexed: 11/16/2022] Open
Abstract
Elderly pneumonia patients have various underlying diseases and social backgrounds, and it is difficult to predict their mortality using the current severity assessment tools. However, aspiration is a risk factor for mortality in pneumonia patients. In the evaluation of aspiration, endoscopic and video fluoroscopic methods are reliable but cannot be performed in all pneumonia patients. We evaluated the significance of the Mann Assessment of Swallowing Ability (MASA) in these patients. This study was prospectively performed between December 2014 and June 2015, and all adult hospitalized patients with pneumonia were consecutively enrolled. The MASA score was evaluated soon after admission. The outcome measures were in-hospital mortality, a recurrence of pneumonia within 30 days, 6-month mortality, and the detection of antibiotic-resistant bacteria. A total of 153 patients were ultimately included. The proportion of in-hospital mortality was greater among the severe MASA score patients than normal score patients (p < 0.01), as was the proportion of recurrence of pneumonia (p < 0.01) and 6-month mortality (p < 0.01). In addition, patients with a moderate MASA score more often experienced recurrence of pneumonia than normal score patients (p < 0.05). Furthermore, patients with a mild MASA score more often experienced recurrence of pneumonia (p < 0.01) and 6-month mortality (p < 0.05) than normal score patients. The areas under the curve were 0.74 (95% confidence interval [CI], 0.67-0.82) for in-hospital mortality, 0.75 (95% CI, 0.68-0.82) for recurrence of pneumonia, 0.72 (95% Cl, 0.64-0.81) for 6-month mortality, and 0.60 (95% CI, 0.46-0.73) for detection of antibiotic-resistant bacteria. A multivariate analysis showed an abnormal MASA score to be an independent risk factor for the recurrence of pneumonia (p = 0.001) and 6-month mortality (p = 0.005). The MASA is useful for predicting the mortality and recurrence of pneumonia in elderly patients.
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Affiliation(s)
- Yasuo Chojin
- 1Department of Respiratory Medicine, Tobata Kyoritsu Hospital
| | - Tatsuji Kato
- 1Department of Respiratory Medicine, Tobata Kyoritsu Hospital
| | | | - Masami Omori
- 2Department of Rehabilitation, Tobata Kyoritsu Hospital
| | - Shingo Noguchi
- 3Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan.,4Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan
| | - Kentaro Akata
- 3Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Takaaki Ogoshi
- 3Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Kazuhiro Yatera
- 3Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Hiroshi Mukae
- 3Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan.,5Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Umemoto G, Furuya H, Tsuboi Y, Fujioka S, Arahata H, Sugahara M, Sakai M. Characteristics of tongue and pharyngeal pressure in patients with neuromuscular diseases. Degener Neurol Neuromuscul Dis 2017; 7:71-78. [PMID: 30050379 PMCID: PMC6053096 DOI: 10.2147/dnnd.s132745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Tongue and pharyngeal pressure is an essential factor associated with the swallowing function; however, little is known about the difference in tongue and pharyngeal pressure between neuromuscular diseases. This study aimed to characterize tongue and pharyngeal pressure in myotonic dystrophy type 1 (DM1), Duchenne muscular dystrophy (DMD), and amyotrophic lateral sclerosis (ALS) patients. Methods This study recruited 17 DMD patients, 32 DM1 patients, and 26 ALS patients. They underwent separate measurements of tongue and pharyngeal pressure under videofluoroscopy, swallowing 5 mL of barium water. We measured the largest change in pharyngeal pressure in the hypopharynx and the upper esophageal sphincter (UES) over several swallows. Results The mean tongue pressure (TP) was greatest in the DMD group than in the other groups (p<0.01). There was a significant difference in pressure changes in the hypopharynx and UES between the DM1 group and other groups (p<0.01). Significant correlations were observed between pressure change in the UES and the patient’s age in the DMD group (R=–0.500, p=0.045) and between pressure change in the hypopharynx and TP in the DM1 group (R=0.421, p=0.016). There was a significant correlation between pressure change in the hypopharynx and disease severity in the ALS group (R=0.435, p=0.030). Conclusion Patients with DMD, DM1, and ALS have weakness in the muscles involved in swallowing; however, the results of this study suggested that each disorder has a distinctive profile of impairment in the swallowing function.
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Affiliation(s)
- George Umemoto
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University, Fukuoka,
| | - Hirokazu Furuya
- Department of Neurology, Faculty of Medicine, Kochi University, Kochi
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University
| | | | | | - Mitsuaki Sakai
- Department of Rehabilitation, Neuro-Muscular Center, National Omuta Hospital, Fukuoka, Japan
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