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Tienkamp TB, Rebernik T, Halpern BM, van Son RJJH, Wieling M, Witjes MJH, de Visscher SAHJ, Abur D. Quantifying Articulatory Working Space in Individuals Surgically Treated for Oral Cancer With Electromagnetic Articulography. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:384-399. [PMID: 38289853 DOI: 10.1044/2023_jslhr-23-00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE The purpose of this study was to quantify sentence-level articulatory kinematics in individuals treated for oral squamous cell carcinoma (ITOC) compared to control speakers while also assessing the effect of treatment site (jaw vs. tongue). Furthermore, this study aimed to assess the relation between articulatory-kinematic measures and self-reported speech problems. METHOD Articulatory-kinematic data from the tongue tip, tongue back, and jaw were collected using electromagnetic articulography in nine Dutch ITOC and eight control speakers. To quantify articulatory kinematics, the two-dimensional articulatory working space (AWS; in mm2), one-dimensional anteroposterior range of motion (AP-ROM; in mm), and superior-inferior range of motion (SI-ROM in mm) were calculated and examined. Self-reported speech problems were assessed with the Speech Handicap Index (SHI). RESULTS Compared to a sex-matched control group, ITOC showed significantly smaller AWS, AP-ROM, and SI-ROM for both the tongue tip and tongue back sensor, but no significant differences were observed for the jaw sensor. This pattern was found for both individuals treated for tongue and jaw tumors. Moderate nonsignificant correlations were found between the SHI and the AWS of the tongue back and jaw sensors. CONCLUSIONS Despite large individual variation, ITOC showed reduced one- and two-dimensional tongue, but not jaw, movements compared to control speakers and treatment for tongue and jaw tumors resulted in smaller tongue movements. A larger sample size is needed to establish a more generalizable connection between the AWS and the SHI. Further research should explore how these kinematic changes in ITOC are related to acoustic and perceptual measures of speech.
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Affiliation(s)
- Thomas B Tienkamp
- Center for Language and Cognition Groningen, University of Groningen, the Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, the Netherlands
- Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands
| | - Teja Rebernik
- Center for Language and Cognition Groningen, University of Groningen, the Netherlands
- Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Bence M Halpern
- Netherlands Cancer Institute, Amsterdam, the Netherlands
- Amsterdam Center for Language and Communication, University of Amsterdam, the Netherlands
- Multimedia Computing Group, Delft University of Technology, the Netherlands
| | - Rob J J H van Son
- Netherlands Cancer Institute, Amsterdam, the Netherlands
- Amsterdam Center for Language and Communication, University of Amsterdam, the Netherlands
| | - Martijn Wieling
- Center for Language and Cognition Groningen, University of Groningen, the Netherlands
- Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands
- Haskins Laboratories, New Haven, CT
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, the Netherlands
| | | | - Defne Abur
- Center for Language and Cognition Groningen, University of Groningen, the Netherlands
- Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands
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Kappert KDR, Voskuilen L, Smeele LE, Balm AJM, Jasperse B, Nederveen AJ, van der Heijden F. Personalized biomechanical tongue models based on diffusion-weighted MRI and validated using optical tracking of range of motion. Biomech Model Mechanobiol 2021; 20:1101-1113. [PMID: 33682028 PMCID: PMC8154835 DOI: 10.1007/s10237-021-01435-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/11/2021] [Indexed: 12/13/2022]
Abstract
For advanced tongue cancer, the choice between surgery and organ-sparing treatment is often dependent on the expected loss of tongue functionality after treatment. Biomechanical models might assist in this choice by simulating the post-treatment function loss. However, this function loss varies between patients and should, therefore, be predicted for each patient individually. In the present study, the goal was to better predict the postoperative range of motion (ROM) of the tongue by personalizing biomechanical models using diffusion-weighted MRI and constrained spherical deconvolution reconstructions of tongue muscle architecture. Diffusion-weighted MRI scans of ten healthy volunteers were obtained to reconstruct their tongue musculature, which were subsequently registered to a previously described population average or atlas. Using the displacement fields obtained from the registration, the segmented muscle fiber tracks from the atlas were morphed back to create personalized muscle fiber tracks. Finite element models were created from the fiber tracks of the atlas and those of the individual tongues. Via inverse simulation of a protruding, downward, left and right movement, the ROM of the tongue was predicted. This prediction was compared to the ROM measured with a 3D camera. It was demonstrated that biomechanical models with personalized muscles bundles are better in approaching the measured ROM than a generic model. However, to achieve this result a correction factor was needed to compensate for the small magnitude of motion of the model. Future versions of these models may have the potential to improve the estimation of function loss after treatment for advanced tongue cancer.
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Affiliation(s)
- K D R Kappert
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Robotics and Mechatronics, Faculty of EEMCS, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - L Voskuilen
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Centre for Dentistry Amsterdam and Amsterdam UMC, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - L E Smeele
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A J M Balm
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Robotics and Mechatronics, Faculty of EEMCS, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B Jasperse
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - A J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F van der Heijden
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Robotics and Mechatronics, Faculty of EEMCS, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Kappert KDR, Connesson N, Elahi SA, Boonstra S, Balm AJM, van der Heijden F, Payan Y. In-vivo tongue stiffness measured by aspiration: Resting vs general anesthesia. J Biomech 2020; 114:110147. [PMID: 33276256 DOI: 10.1016/j.jbiomech.2020.110147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022]
Abstract
Tongue cancer treatment often results in impaired speech, swallowing, or mastication. Simulating the effect of treatments can help the patient and the treating physician to understand the effects and impact of the intervention. To simulate deformations of the tongue, identifying accurate mechanical properties of tissue is essential. However, not many succeeded in characterizing in-vivo tongue stiffness. Those who did, measured the tongue At Rest (AR), in which muscle tone subsides even if muscles are not willingly activated. We expected to find an absolute rest state in participants 'under General Anesthesia' (GA). We elaborated on previous work by measuring the mechanical behavior of the in-vivo tongue under aspiration using an improved volume-based method. Using this technique, 5 to 7 measurements were performed on 10 participants both AR and under GA. The obtained Pressure-Shape curves were first analyzed using the initial slope and its variations. Hereafter, an inverse Finite Element Analysis (FEA) was applied to identify the mechanical parameters using the Yeoh, Gent, and Ogden hyperelastic models. The measurements AR provided a mean Young's Modulus of 1638 Pa (min 1035 - max 2019) using the Yeoh constitutive model, which is in line with previous ex-vivo measurements. However, while hoping to find a rest state under GA, the tongue unexpectedly appeared to be approximately 2 to 2.5 times stiffer under GA than AR. Explanations for this were sought by examining drugs administered during GA, blood flow, perfusion, and upper airway reflexes, but neither of these explanations could be confirmed.
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Affiliation(s)
- K D R Kappert
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands; Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - N Connesson
- TIMC-IMAG Laboratory, University Grenoble Alpes & CNRS, Grenoble, France
| | - S A Elahi
- Human Movement Science Department, Mechanical Engineering Department, KU Leuven, Leuven, Belgium
| | - S Boonstra
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands; Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - A J M Balm
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands; Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands; Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F van der Heijden
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands; Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Y Payan
- TIMC-IMAG Laboratory, University Grenoble Alpes & CNRS, Grenoble, France
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Kappert KDR, van Dijk S, Wellenstein D, van Alphen MJA, van Son RJJH, Smeele LE, Balm AJM. Five Specific Tongue Movements in a Healthy Population. Dysphagia 2020; 36:736-742. [PMID: 33040201 PMCID: PMC8289788 DOI: 10.1007/s00455-020-10195-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022]
Abstract
The importance of tongue mobility on speech, oral food transport, and swallowing is well recognized. However, whether the individual tongue mobility influences postoperative function in oral cancer treatment remains to be elucidated. This study assesses the ability to perform five tongue movements as rolling, twisting (two sides), folding, and the 'cloverleaf' in a healthy population. Because a tumor in oral cancer patients often restricts the mobility of the tongue, it might be helpful to know if it is possible to recall any of those movements without demonstrating it. Two observers asked 387 Dutch healthy adults if they could perform one of the five specific tongue movements and were subsequently asked to demonstrate the five movements. The distribution in the Dutch population is: rolling: 83.7%, cloverleaf: 14.7%, folding: 27.5%, twisting left: 36.1% and twisting right: 35.6%. The percentage of people that can fold their tongue is almost ten times higher (3% versus 27.5%) than in previous research, and it was found that the ability to roll the tongue is not a prerequisite for folding of the tongue. A relationship between gender or right-handedness and the ability to perform certain tongue movements could not be found. Of the participants, 9.9% and 13.1% incorrectly assumed that they could demonstrate tongue rolling and cloverleaf. Tongue folding and twisting (left or right) were incorrectly assumed in 36.9%, 24.1%, and 25.4% of the cases. Rolling and cloverleaf are preferred for future prediction models because these movements are easy to recall without demonstrating.
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Affiliation(s)
- Kilian D R Kappert
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Simone van Dijk
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - David Wellenstein
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Maarten J A van Alphen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Rob J J H van Son
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Amsterdam Center for Language and Communication, Universtiy of Amsterdam, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Alfons J M Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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