|Published Study Title||Date of Publication||Citation||Key Words||Abstract|
|From oral facial dysfunction to dysmorphism and the onset of pediatric OSA.||2018||Guilleminault C, Huang YS. From oral facial dysfunction to dysmorphism and the onset of pediatric OSA. Sleep Med Rev. 2018;40:203–214. doi:10.1016/j.smrv.2017.06.008||Obstructive sleep apnea||The authors review early development of oral-facial structures and the anatomical variants that may be present at birth that can impact nasal breathing. The article reviews the dysfunctions identified to date that may impact orofacial development leading to sleep-disordered-breathing through changes in the orofacial growth. The identification of risk-factors that lead to obstructive sleep apnea may allow early identification and the development of treatments to eliminate or decrease the impact of the problem.|
|Tongue pressure measurement in children with mouth-breathing behaviour.||2018||Azevedo ND, Lima JC, Furlan RMMM, Motta AR. Tongue pressure measurement in children with mouth-breathing behaviour. J Oral Rehabil. 2018;45(8):612–617. doi:10.1111/joor.12653||Orofacial myofunctional therapy, Tongue strength, Breathing||The purposes of this study were to measure the tongue pressure in children with and without mouth-breathing behavior. Forty children aged 5-12 years who either exhibited mouth-breathing (n = 20) to sex and age matched peers with nasal breathing. Tongue pressure was evaluated using the IOPI. Three measurements were recorded for each participant, with a 30-second rest interval. The average tongue pressure in the mouth-breathing group was lower than that in the nasal-breathing group. There was no difference in tongue pressure between genders. There was a strong and direct correlation between tongue pressure and age in the nasal-breathing group. The findings suggest breathing pattern impacts tongue pressure development.|
|How swallow pressures and dysphagia affect malnutrition and mealtime outcomes in long-term care.||2017||Namasivayam-MacDonald AM, Morrison JM, Steele CM, Keller H. How Swallow Pressures and Dysphagia Affect Malnutrition and Mealtime Outcomes in Long-Term Care. Dysphagia. 2017;32(6):785–796. doi:10.1007/s00455-017-9825-z||Nutrition, Dysphagia, Elderly||The current study expanded on the past work examining tongue pressures in the long-term care population. Six hundred thirty-nine participants were given a battery of swallowing screenings, including tongue strength measures using the IOPI. The odds of showing signs of dysphagia were 3.7 times greater in those with swallow saliva pressures less than 26 kPa and the odds of being malnourished were almost double. The group with low swallow pressures consumed less calories and had longer mealtimes. The findings indicate saliva swallow pressure measurements may be helpful to identify dysphagia and nutritional compromise in the long-term care population.|
|The influence of oropalatal dimensions on the measurement of tongue strength.||2017||Pitts LL, Stierwalt JAG, Hageman CF, LaPointe LL. The Influence of Oropalatal Dimensions on the Measurement of Tongue Strength. Dysphagia. 2017;32(6):759–766. doi:10.1007/s00455-017-9820-4||Healthy, Tongue strength||The study examines the impact of oral and palatal structure on maximum tongue pressures in healthy adults. Anterior and posterior tongue pressures were obtained in 147 healthy adults using the IOPI. In addition, oropalatal dimensions were measured. Age was confirmed as a predictor of variance in anterior tongue strength but not posterior tongue strength. Oropalatal dimensions was three time greater at predicting that age. Palatal width, estimated tongue volume, and gender were significant predictors of posterior tongue strength. The authors suggest that oropalatal dimensions should be considered when lingual weakness and healthy individual differences in tongue pressures.|
|Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing?||2017||Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing?. Sleep Breath. 2017;21(4):1025–1032. doi:10.1007/s11325-017-1489-2||Sleep apnea, Orofacial myofunctional therapy, Breathing, Tongue strength, Tongue endurance||The study investigated the effectiveness of myofunctional therapy in reducing respiratory symptoms in children with sleep-disordered breathing by modifying tongue tone. Fifty-four children with obstructive sleep apnea were assigned to one of two groups. One group received myofunctional therapy and one did not. Pre and post tests were performed including measurements of tongue strength and endurance with the IOPI. The myofunctional therapy group exhibited reduced oral breathing, hypotonia, as well as improved tongue position, and strength. Oxygen saturation levels increased and oxygen desaturation index decreased. The information suggests exercise may play a role in the treatment of sleep-disordered breathing in children.|
|Maximal strength and endurance scores of the tongue, lip, and cheek in healthy, normal Koreans.||2017||Jeong DM, Shin YJ, Lee NR, et al. Maximal strength and endurance scores of the tongue, lip, and cheek in healthy, normal Koreans. J Korean Assoc Oral Maxillofac Surg. 2017;43(4):221–228. doi:10.5125/jkaoms.2017.43.4.221||Normal values, Korea, Tongue strength, Tongue endurance, Lip strength, Lip endurance, Cheek strength, Cheek endurance||The study intent is to establish normative data for healthy Korean adults by measuring maximal strength and endurance scores of the tongue, lip and cheek. The study included 120 participants divided into groups by age and sex. Normative data is presented and establishes preliminary standards for measurements of maximal strength and endurance scores for oral structures.|
|Relationship between tongue strength, lip strength, and nutrition-related sarcopenia in older rehabilitation inpatients: a cross-sectional study.||2017||Sakai K, Nakayama E, Tohara H, et al. Relationship between tongue strength, lip strength, and nutrition-related sarcopenia in older rehabilitation inpatients: a cross-sectional study. Clin Interv Aging. 2017;12:1207–1214. Published 2017 Aug 3. doi:10.2147/CIA.S141148||Nutrition, Sarcopenia, Tongue strength, Lip strength, Elderly||The study examined tongue and lip pressures in older, malnourished individuals who exhibited muscle wasting and compared them to a healthy population. Factors such as age, sex, comorbidity, physical function, cognitive function, and oral intake level were also assessed. The median tongue and lip strength were significantly reduced in the malnourished participants regardless of age, sex, physical function, and cognitive function. The authors concluded that tongue and lip strength may be important factors for preventing or rehabilitation patients who exhibit with muscle wasting and malnutrition.|
|Effects of lingual strength training on lingual strength and articulator function in stroke patients with dysarthria.||2017||Moon JH, Hong DG, Kim KH, et al. Effects of lingual strength training on lingual strength and articulator function in stroke patients with dysarthria. J Phys Ther Sci. 2017;29(7):1201–1204. doi:10.1589/jpts.29.1201||Stroke, Dysarthria, Tongue strength, Strength training||This study investigated the effects of lingual strength training on lingual strength and articulator function in sixteen stroke patients with dysarthria. The participants were randomly assigned into two groups. Both groups received the “conventional rehabilitation therapy” at 30 min/day. The experimental group received an additional 30 min of lingual strength training IOPI. The Maximum Isometric Tongue Pressures were used to assess the lingual strength and the Alternating-Motion Rate and Sequential-Motion Rate were used to measure the articulator function. After the intervention, the experimental group showed a significant improvement in maximum tongue pressures and alternating-motion rate (/tə/) than the control group. The findings of this study suggest that lingual strength training provides positive effects on lingual strength and articulator function and should be considered as an interventional method in stroke patients with dysarthria.|
|Tongue strength and endurance: Comparison in active and non-active young and older adults.||2017||VanRavenhorst-Bell HA, Mefferd AS, Coufal KL, Scudder R, Patterson J. Tongue strength and endurance: Comparison in active and non-active young and older adults. Int J Speech Lang Pathol. 2017;19(1):77–86. doi:10.3109/17549507.2016.1154983||Aging, Dysphagia, Tongue strength, Tongue endurance, Healthy||An interesting study examining the possible correlation between tongue strength and endurance in forthy-eight highly active and non-active young and older adults. The IOPI was used for tongue tasks. Tongue strength and endurance were correlated to activity level, particularly in older adults.|
|Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia.||2017||Kim HD, Choi JB, Yoo SJ, Chang MY, Lee SW, Park JS. Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. J Oral Rehabil. 2017;44(1):59–64. doi:10.1111/joor.12461||Stroke, Dysphagia, Tongue strength, Strength training||The study investigated the effect of tongue-to-palate resistance training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia. Thirty-five participants were divided to the experimental group or the control group . The experimental group performed tongue-to-palate resistance training 5 days per week for 4 weeks in addition to “traditional dysphagia therapy.” The control group performed traditional dysphagia therapy on the same schedule. Tongue strength was measured using the IOPI. Swallowing function was measured using the Videofluoroscopic Dysphagia Scale (VDS) and the penetration-aspiration scale (PAS). The experimental group showed more improved in the tongue strength as well as improved scores on the oral and pharyngeal phase of VDS but not on the PAS. This study demonstrated the effectiveness of resistance training in increasing tongue muscle strength and improving swallowing function in patients with post-stroke dysphagia. The authors recommend tongue resistance training as an easy and simple rehabilitation strategy for improving swallowing in patients with dysphagia.|
|Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements.||2016||Nakamori M, Hosomi N, Ishikawa K, et al. Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements. PLoS One. 2016;11(11):e0165837. Published 2016 Nov 1. doi:10.1371/journal.pone.0165837||Stroke, Tongue strength, Pneumonia||This study examined the ability of tongue pressures to predict the occurrence of pneumonia in post stroke patients. Two hundred-twenty acute stroke patients were investigated. Upon initial intake tongue pressure was measured. It was measured again every two weeks. Tongue pressure was significantly lower in patients who developed pneumonia. Using a cut-off of 21.6 kPa, tongue pressure exhibited a predictive power for pneumonia. In the group with low tongue pressure, that did not show improvement in the two-week interval, 45.6% of the patients developed pneumonia compared to 7.4% in the group that showed lingual strength improvement. Tongue pressure may be a sensitive indicator for predicting pneumonia occurrence in acute stroke patients.|
|Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy.||2016||de Felício CM, da Silva Dias FV, Folha GA, et al. Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy. Int J Pediatr Otorhinolaryngol. 2016;90:5–11. doi:10.1016/j.ijporl.2016.08.019||Children, Orofacial myofunctional therapy, Obstructive sleep apnea, Tongue strength, Lip strength||The purpose of this study was to identify possible differences in muscular and orofacial functions between children with obstructive sleep apnea and with primary snoring. Thirty-nine children (27 had obstructive sleep apnea and 12 had primary snoring) were examined. Orofacial characteristics were determined through a validated protocol of orofacial myofunctional evaluation with scores, surface electromyography of masticatory muscles, and measurements of maximal lip and tongue strength with the IOPI. The obstructive sleep apnea group had lower scores in breathing and deglutition, more unbalanced masticatory muscle activities than the primary snoring group, but both groups had similar reductions in orofacial strength. The authors concluded that children with tonsillar hypertrophy and obstructive sleep apnea had relevant impairments in orofacial functions and lesser muscular coordination than children with primary snoring.|
|Effects of change in tongue pressure and salivary flow rate on swallow efficiency following chemoradiation treatment for head and neck cancer.||2016||Rogus-Pulia NM, Larson C, Mittal BB, et al. Effects of Change in Tongue Pressure and Salivary Flow Rate on Swallow Efficiency Following Chemoradiation Treatment for Head and Neck Cancer. Dysphagia. 2016;31(5):687–696. doi:10.1007/s00455-016-9733-7||Dysphagia, Head and neck cancer, Tongue strength||One of the purposes of this study was to determine effects of chemoradiation on tongue pressures, as a surrogate for strength. Twenty-one patients treated with chemoradiation were assessed before and after treatment and matched with 21 healthy control participants. The IOPI was used to obtain oral tongue maximum pressure and endurance measures. Lower tongue endurance measures were found in patients post-treatment when compared to controls It appears that chemoradiation treatment affects tongue endurance and may impact swallow efficiency. The paper suggests tongue endurance should be considered when planning treatment for dysphagia post chemoradiation.|
|The effect of tongue strength on meal consumption in long term care.||2016||Namasivayam AM, Steele CM, Keller H. The effect of tongue strength on meal consumption in long term care. Clin Nutr. 2016;35(5):1078–1083. doi:10.1016/j.clnu.2015.08.001||Nutrition, Dysphagia, Tongue strength, Elderly||The study compared the outcomes of eleven post-stroke, adult participants practicing tongue resistance under two conditions. One group focused on gradual pressure release and saliva swallowing tasks. The second group emphasized strength and accuracy in tongue-palate pressure generation and did not include swallowing tasks. Outcome measures of posterior tongue strength, oral bolus control, penetration-aspiration and vallecular residue were made based on videofluoroscopy. Improvements were noted in tongue strength and post-swallow vallecular residue with thin liquids, regardless of treatment condition.|
|Effect of orofacial myofunctional exercise on the improvement of dysphagia patients’ orofacial muscle strength and diadochokinetic rate.||2016||Byeon H. Effect of orofacial myofunctional exercise on the improvement of dysphagia patients' orofacial muscle strength and diadochokinetic rate. J Phys Ther Sci. 2016;28(9):2611–2614. doi:10.1589/jpts.28.2611||Orofacial myofunctional therapy, Tongue strength, Lip strength||This study investigated the effect of a three-week period of orofacial myofunctional exercise on the improvement of cheek, tongue, and lip muscle strength and diadochokinetic rate in dysphagia patients. One group of 23 participants received orofacial myofunctional exercise and a “temperature-tactile stimulation” technique. The other group, consisting of 25 participants, only received the “temperature-tactile stimulation” technique. Tongue elevation, tongue protrusion, cheek compression, lip compression, and alternating motion rate were more significantly improved in the group that included myofunctional exercise. The authors conclude that orofacial myofunctional exercise may be effective in the rehabilitation of oral phase swallowing function in dysphagia patients.|
|Effects of tongue pressing effortful swallow in older healthy individuals.||2016||Park T, Kim Y. Effects of tongue pressing effortful swallow in older healthy individuals. Arch Gerontol Geriatr. 2016;66:127–133. doi:10.1016/j.archger.2016.05.009||Healthy, Tongue strength, Elderly||This study appraised the value of a preventative approach to age changes in the oral musculature by developing a tongue pressing effortful swallow for a home-based exercise program. The technique was developed by combining two swallowing exercises: tongue strengthening exercise and the effortful swallow. Twenty-seven older individuals performed 4 weeks of exercise. The maximum tongue pressure was measured by the IOPI and peak amplitude of submental muscle activity by surface electromyography. The results of this study suggest that performing effortful swallows with an IOPI had positive effects on increasing maximum tongue pressure.|
|A randomized trial comparing two tongue-pressure resistance training protocols for post-stroke dysphagia.||2016||Steele CM, Bayley MT, Peladeau-Pigeon M, et al. A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia. Dysphagia. 2016;31(3):452–461. doi:10.1007/s00455-016-9699-5||Dysphagia, Tongue strength, Strength training, Stroke||This study was to compare the outcomes of two tongue training protocols in 14 participants. One group required the participants to performed pressure-timing patterns that are typically seen in healthy swallows, focusing on gradual pressure release and a saliva swallow task. The second group practiced strength and accuracy in tongue-palate pressure generation and did not include swallowing tasks. Outcome measures of posterior tongue strength using the IOPI, oral bolus control, penetration-aspiration and vallecular residue were made based on videofluoroscopy. Improvements were seen in tongue strength and post-swallow vallecular residue with thin liquids, regardless of treatment condition. This study suggests tongue strength can be improved with resistance training following stroke. The authors concluded that tongue-pressure resistance training does appear to be effective for reducing thin liquid vallecular residue.|
|The effect of orofacial myofunctional treatment in children with anterior open bite and tongue dysfunction: a pilot study.||2016||Van Dyck C, Dekeyser A, Vantricht E, et al. The effect of orofacial myofunctional treatment in children with anterior open bite and tongue dysfunction: a pilot study. Eur J Orthod. 2016;38(3):227–234. doi:10.1093/ejo/cjv044||Orofacial myofunctional therapy, Anterior open bite, Tongue strength||This prospective pilot study investigates the effects of orofacial myofunctional therapy on tongue behavior in children with anterior open bite and a visceral swallowing pattern. Twenty-two children were randomly assigned into orofacial myofunctional therapy and non- orofacial myofunctional therapy groups. Maximum tongue pressure was measured at intervals using the IOPI. Functional characteristics such as tongue posture at rest, swallowing pattern and articulation and the presence of an anterior open bite were observed. Orofacial myofunctional therapy changed tongue elevation strength, tongue posture at rest, and tongue position during swallowing of solid food. Articulation of /s,l,n,d,t/ was not improved by orofacial myofunctional therapy. It was concluded that orofacial myofunctional therapy may positively influence tongue behavior. The authors suggest additional research is needed to clarify the success of orofacial myofunctional therapy as an adjunct to orthodontic treatment.|
|Effect of tongue strength training using the Iowa Oral Performance Instrument in stroke patients with dysphagia.||2015||Park JS, Kim HJ, Oh DH. Effect of tongue strength training using the Iowa Oral Performance Instrument in stroke patients with dysphagia. J Phys Ther Sci. 2015;27(12):3631–3634. doi:10.1589/jpts.27.3631||Dysphagia, Stroke, Tongue strength, Strength training||This study evaluated the effectiveness of tongue resistance training to improve swallowing function in stroke patients with dysphagia. Twenty-seven stroke patients with dysphagia were randomly divided into two groups. One group participated in a resistance-training program involving a 1-repetition maximum, with an intensity of 80%, along with 50 repetitions per day each for the anterior and posterior regions of the tongue. Both groups received “conventional therapy.” The group performing tongue resistance exercises showed significant improvements in the anterior and posterior regions of the tongue. The other group showed significant improvements only in the anterior region of the tongue. The Videofluoroscopic Dysphagia Scale showed improvement in the oral and pharyngeal stages in the tongue exercise group. Significant improvements were only seen in the oral stage and total score in the conventional therapy group. The authors suggest tongue resistance training is an effective intervention for stroke patients with dysphagia.|
|Analysis of tongue pressure in Brazilian young adults.||2015||Prandini EL, Totta T, Bueno Mda R, Rosa RR, Giglio LD, Trawitzki LV, Berretin-Felix G, Felicio CM, Genaro KF||Normal values, Brazil, Tongue strength, Tongue endurance||The purpose of this study was to establish normal values for tongue elevation, protrusion, endurance, swallowing and lateralization in Brazilian young adults. The study presents normative data based on sex.|
|Differences in orofacial muscle strength according to age and sex in East Asian healthy adults.||2015||Park JS, You SJ, Kim JY, Yeo SG, Lee JH||Normal values, Korea, Tongue strength, Lip strength||This study investigated the differences in orofacial muscle strength in 382 healthy adults. Analysis was performed by age groups and sex. Measures for anterior tongue strength, posterior tongue strength, buccal pressure, and lip pressure were obtained using the IOPI. The investigation found significant age-related differences, mainly in the tongue. Males exhibited decreased tongue strength beginning in the seventh decade and females did not show significance until the ninth decade.|
|Facial and lingual strength and endurance in skilled trumpet players.||2015||Potter NL, Johnson LR, Johnson SE, VanDam M||Healthy, Tongue strength, Tongue endurance, Lip strength, Lip endurance||The purpose of this study was to determine if adult trumpet players who practice at least 6 hour per week differed from adult non-trumpet player in strength and endurance of the lips, cheeks, and tongue. Strength and endurance of lip, cheek, and tongue muscles were measured using the IOPI. The findings indicate that trumpet players had greater facial strength and endurance.|
|Effects of tongue strength training and detraining on tongue pressures in healthy adults.||2015||Oh JC||Tongue strength, Strength training, Healthy||This study examined the effect of tongue strengthening training and long-term detraining on tongue tip pressure, tongue base pressure, and tongue pressure during effortful swallowing in ten young, healthy participants. An 8-week tongue strengthening exercise 3 days a week with each session lasting 30 minutes was implemented. Measurement of tongue pressure and tongue strengthening exercise were administrated using IOPI at baseline, after training and 28 weeks after training. The authors found a high-intensity tongue strengthening exercise can improve tongue pressures. However, training effects were diminished gradually during detraining period. It is suggested maintenance programs after strengthening exercise would be required to prolong training effects.|
|Effects of one-week tongue task training on sleep apnea severity: A pilot study.||2015||Rousseau E, Silva C, Gakwaya S, Series F||Sleep apnea, Task training||The aim of the present study was to assess the effects of one-week tongue-task training on sleep apnea severity in ten patients. Subjects participated in a one hours tongue training task for seven consecutive days. One-week of training was associated with a global apnea hypoxia index The authors consider these results to be potentially relevant and worthy of further investigation in a large randomized trial.|
|Quantitative assessment of lingual strength in late-onset Pompe disease.||2015||Jones H, Crisp K, Asrani P, Sloane R, Kishnani, P||Pompe disease, Tongue strength, Dysarthria||The study examined tongue strength to determine the frequency and severity of lingual weakness in 24 patients with late-onset Pompe disease. In addition, the authors applied the findings to determine the correlation with dysarthria. Eighty percent of the sample exhibited tongue strength outside of the normal range. Patients with identifiable dysarthria exhibited great lingual weakness than those without dysarthria. The authors concluded that their work is evidence to support the presence of bulbar muscle disease in patients with late-onset Pompe disease.
|Tongue weakness and somatosensory disturbance following oral endotracheal extubation.||2015||Su H, Hsiao TY, Ku S, Wang T, Lee JJ, Tzeng WC, Huang GH, Chen CC||Tongue strength, Intubation, Dysphagia||The sensorimotor and function of 30 post-extubation patients was examined. Tongue strength was examined using the IOPI. Sensory disturbance was evaluated by light touch sensation, oral stereognosis, and a two-point discrimination test. Age matched pairs were recruited for comparison. Impaired participants were tested within 48 hours and at 7 and 14 days. The results revealed sensory measures matched healthy peers at 14 days but tongue strength remained diminished.|
|Oropharyngeal exercises to reduce symptoms of OSA after AT.||2015||Villa MP, Brasili L, Ferretti A, Vitelli O, Rabasco J, Mazzotta AR, Pietropaoli N, Martella S||Obstructive sleep apnea||This study evaluated the efficacy of oropharyngeal exercises in 27 children with symptoms of obstructive sleep apnea syndrome after adenotonsillectomy. The study was comprised of two groups, an exercise group and an no exercise group. The exercise group demonstrated a reduction in oral breathing, increased labial seal, increased lip tone, and other positive findings. The authors conclude oropharyngeal exercises may be considered as complementary therapy to adenotonsillectomy to effectively treat pediatric obstructive sleep apnea.|
|Muscle weakness and speech in oculopharyngeal muscular dystrophy.||2015||Neel AT, Palmer PM, Sprouls G, Morrison L||Oculopharyngeal muscular dystrophy, Speech, Tongue strength||Twelve individuals with oculopharyngeal muscular dystrophy(OMPD) and 12 healthy age-matched controls underwent comprehensive assessment of the speech mechanism including spirometry, nasometry, phonatory measures, articulatory measures, tongue-to-palate strength measures during maximal isometric and speechlike tasks, quality-of-life questionnaire, and perceptual speech ratings by listeners. The authors found individuals with OPMD had substantially reduced tongue strength compared to the controls. However, little impact on speech and voice measures or on speech intelligibility was observed except for slower diadochokinetic rates. The authors concluded Despite having less than half the maximal tongue strength of healthy controls, the individuals with OPMD exhibited minimal speech deficits. The threshold of weakness required for noticeable speech impairment may not have been reached by this group.|
|Tongue forces and handgrip strength in normal individuals: association with swallowing.||2015||Mendes AE, Nascimento L, Mansur LL, Callegaro D, Jacob Filho W||Tongue strength, Aging, Sarcopenia||Tongue force was evaluated using the IOPI and grip strength using the Hand Grip in 90 normal individuals, divided into three groups: young, adult, and elderly. The time and number of swallows required for the continuous ingestion of 200 ml of water was also measured. A reduction in tongue force and grip strength, as well as an increase in the time required to drink 200 ml of water, was observed with increasing participant age. There was no difference in the number of swallows among the three groups. The decrease in tongue force in the elderly seemed to be offset by the increase in time required to complete the swallowing task. The results of this study may be applied clinically and may act as a basis for guidelines in healthy or vulnerable elderly populations.|
|Oral strength in subjects with a unilateral cleft lip and palate.||2014||Van Lierde KM, Bettens K, Luyten A, Plettinck J, Bonte K, Vermeersch H, Roche N||Cleft lip and palate, Lip strength, Tongue endurance, Tongue strength||The purpose of this controlled study was to measure the tongue and lip strength and endurance in boys and girls with a cleft lip and palate (CLP). Twenty-five subjects with a unilateral CLP and a sex- and age- matched control group were investigated. The IOPI was used to measure lip and tongue strength and tongue endurance. The measurements showed no significant differences between the subjects with a unilateral cleft lip and palate and the age and sex matched control group. There appears to be no significant differences in lip and tongue strength and endurance between subjects with and without a unilateral cleft lip and palate.|
|A survey of variables used by speech-language pathologists to assess function and predict functional recovery in oral cancer patients.||2014||Husaini H, Krisciunas GP, Langmore S, Mojica JK, Urken ML, Jacobson AS, Lazarus CL||Head and neck cancer||This study examined the variables speech pathologists consider important when assessing and documenting oral motor function after head and neck cancer treatment. Results of a survey of 292 speech pathologists who work with HNC patients are reported. Results revealed that although 95 % of SLPs assess tongue strength, only 13 % use instrumental methods. Although 98 % assess tongue ROM, 88 % estimate range of motion (ROM) based on clinical assessment. Most respondents agreed with the utility of a proposed tongue ROM rating scale. Several variables were identified by respondents as having an impact on overall prognosis for speech and swallow functioning. Tracking progress and change in function with treatment can be accomplished only with measurable assessment techniques. A consistent measuring system may benefit patients with other diagnoses that affect lingual mobility and strength.|
|Functional outcomes and quality of life after chemoradiotherapy: baseline and 3 and 6 months post-treatment.||2014||Lazarus CL, Husaini H, Hu K, Culliney B, Li Z, Urken M, Jacobson A, Persky M, Tran T, Concert C, Palacios D, Metcalfe-Klaw R, Kumar M, Bennett B, Harrison L||Head and neck cancer, Tongue strength||This investigation reports the results of a prospective study that examined functional outcomes and quality of life (QOL) in head and neck cancer patients after chemoradiotherapy over the first 6 months post-treatment. Twenty-nine patients were seen baseline and 3- and 6-months post-treatment. Tongue strength, jaw range of motion, and saliva weight were significantly lower at 3 and 6 months than at baseline. QOL was significantly worse after treatment, although it improved by 6 months. Concomitant chemoradiotherapy for treatment of head and neck tumors may result in impaired performance outcomes and QOL over the first 6 months post-treatment. However, performance status, tongue strength, jaw ROM, and eating QOL were only mildly impaired by 6 months post-treatment. Saliva production and speech QOL remained significantly impaired at 6 months post-treatment.|
|The acute effect of the tongue position in the mouth on knee isokinetic test performance: a highly surprising pilot study.||2014||di Vico R, Ardigo LP, Salernitano G, Chamari K, Padulo J||Physical therapy||The tongue involvement within the isokinetic knee extension/flexion exercises has been investigated. Eighteen participants randomly underwent isokinetic testing at 90 and 180°/s with three different tongue positions: middle position (MID, thrusting on the lingual surface of incisive teeth), lying on the lower arch of the mouth (LOW) and extended up to the palatine spot (UP). Statistical analysis of the data revealed an about 30% significant increase of knee flexion peak torque in UP with respect to MID at both angular speeds. Such a difference could have had a confounding effect on results from numerous past studies using isokinetic knee flexion testing. This study alerts future researchers about standardization of tongue position and warrants further investigations on the explicative processes of this phenomenon.|
|Reliability of measurements of tongue and hand strength and endurance using the Iowa Oral Performance Instrument with healthy adults.||2014||Adams V, Mathisen B, Baines S, Lazarus C, Callister R||Healthy, Tongue strength, Tongue endurance||The purpose of this study was to investigate the reliability of tongue and handgrip strength and endurance measurements in healthy adults using the IOPI. Fifty-one healthy participants were tested on four occasions 1 week apart to determine test-retest reliability. The findings suggest that tongue and handgrip strength values demonstrate acceptable reliability if familiarization is provided. The authors suggest additional investigation is needed to reduce sources of variability in tongue endurance measurements.|
|Age-related differences in tongue-palate pressures for strength and swallowing tasks.||2013||Fei T, Polacco RC, Hori SE, Molfenter SM, Peladeau-Pigeon M, Tsang C, Steele CM||Healthy, Aging, Tongue strength, Swallowing||The purpose of the study was to examine whether older adults have reduced tongue-palate pressures during maximum isometric, saliva swallowing, and water swallowing tasks, while controlling for individual variations in strength. Forty 40 healthy younger adults and 38 healthy mature adults were included. The older participants exhibited significantly lower maximum isometric pressures. Swallowing pressures differed significantly by task, with higher pressures seen in saliva swallows than in water swallows. Age-group differences were not seen in swallowing pressures. The results show no evidence of differences in swallowing pressures attributable to age.|
|Isometric and swallowing tongue strength in healthy adults.||2013||Todd JT, Lintzenich CR, Butler SG||Healthy, Aging, Tongue strength, Swallowing||One hundred twenty-six healthy individuals were divided into three groups by age. Participants completed three isometric tongue presses and three swallows. Older adults had lower isometric tongue strength than young adults, and females had a greater difference between anterior and posterior tongue strength than males. Tongue strength during swallowing yielded significantly greater anterior versus posterior tongue pressure. This study confirms previous findings that isometric tongue strength decreases with age. In addition, younger and older adults generate similar swallowing pressures|
|A systematic review and meta-analysis of measurements of tongue and hand strength and endurance using the Iowa Oral Performance Instrument (IOPI).||2013||Adams V, Mathisen B, Baines,S, Lazarus C, Callister R||Tongue strength, Tongue endurance, Meta-analysis||This systematic review examined the evidence for the use of the IOPI to measure strength and endurance of the tongue and hand in healthy populations and those with medical conditions. A systematic search of the scientific literature published since 1991 yielded 38 studies that addressed this purpose. Most of the studies utilized the IOPI as an evaluation tool, although four used it for intervention. Half the studies were conducted in healthy. In studies related to disordered populations, most participants had dysphagia, primarily Parkinson's disease or head or neck cancer. Age and sex, as well as several medical conditions, influence the values of tongue and hand strength. There is sufficient evidence to support the use of the IOPI as a suitable tool for measuring tongue strength and endurance and as an assessment tool for intervention studies, and there is growing support for its use to assess hand strength and endurance in healthy and clinical populations.|
|Tongue strength as a predictor of functional outcomes and quality of life after tongue cancer surgery.||2013||Lazarus CL, Husaini H, Anand SM, Jacobson AS, Mojica JK, Buchbinder D, Urken ML||Head and neck cancer, Tongue strength||This pilot study assessed tongue strength and other oral outcomes and their relationship to performance status for speech, swallowing, and quality of life after partial glossectomy. The aim was to establish normative data for this population. Patients with tongue strength of at least 30 kPa performed better on the performance status scales and various quality of life measures. The authors conclude a cutoff score of 30 kPa for tongue strength measures is predictive of performance on the scales used and QOL measures.|
|Changes in tongue pressure, pulmonary function, and salivary flow in patients with amyotrophic lateral sclerosis.||2013||Easterling C, Antinoja J, Cashin S, Barkhaus PE||Amyotrophic lateral sclerosis, Tongue strength, Swallowing||Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving nerve cells that control voluntary muscle movement (Rowland LP, Shneider NA, N Engl J Med 344(22):1688-1700, 2001). The aim of this study was to determine the pattern of neurodegenerative change in isometric tongue strength and spontaneous saliva swallow pressure, saliva weight, and forced vital capacity in patients with amyotrophic lateral sclerosis who present with primary spinal versus primary bulbar symptoms. Twenty-three patients were enrolled in the study. Findings indicate the spinal group experienced a slower decline in spontaneous saliva swallow pressure. Saliva production did not show a significant change in the bulbar symptom group but did in the spinal group. In addition, functional vital capacity may be a complimentary measure to gauge ALS patient's ability to efficiently take oral nutrition and to support required alterations in diet consistency.|
|The influence of age, sex, bulb position, visual feedback, and the order of testing on maximum anterior and posterior tongue strength and endurance in healthy Belgian adults.||2013||Vanderwegen J, Guns C, Van Nuffelen G, Elen R, DeBodt M||Normal values, Belgium, Tongue strength, Tongue endurance||This study collected data on the maximum anterior and posterior tongue strength and endurance in 420 healthy Belgians across the adult life span to explore the influence of age, sex, bulb position, visual feedback, and order of testing. Measures were obtained using the Iowa Oral Performance Instrument (IOPI). Older participants (more than 70 years old) demonstrated significantly lower strength than younger persons at the anterior and the posterior tongue. Endurance remains stable throughout the major part of life. Gender influence remains significant but minor throughout life, with males showing higher pressures and longer endurance. The anterior part of the tongue has both higher strength and longer endurance than the posterior part. Mean maximum tongue pressures in this European population seem to be lower than American values and are closer to Asian results. The normative data can be used for objective assessment of tongue weakness and subsequent therapy planning of dysphagic patients.|
|Motor and speech disorders in classic galactosemia.||2013||Potter NL, Nievergelt Y, Shriberg LD||Speech, Galactosemia, Children||Purpose To test the hypothesis that children with classic galactosemia and speech disorders are at risk for co-occurring strength and coordination disorders. Method This is a case-control study of 32 children (66% male) with galactosemia and neurologic speech disorders and 130 controls (50% male) ages 4-16 years. Speech was assessed using the Percentage of Consonants Correct (PCC) metric from responses to the Goldman-Fristoe Test of Articulation-2 and from a 5-min recorded speech sample, hand and tongue strength using the Iowa Oral Performance Instrument, and coordination using the Movement Assessment Battery for Children. The number of days on milk during the neonatal period was obtained by parent report. Analyses of covariance, distributions, and correlations were used to evaluate relationships among speech, strength, coordination, age, gender, and days on milk. Results Children with galactosemia had weaker hand and tongue strength and most (66%) had significant coordination disorders, primarily affecting balance and manual dexterity. Among children with galactosemia, children with more speech errors and classified as childhood apraxia of speech (n = 7) and ataxic dysarthria (n = 1), had poorer balance and manual dexterity, but not weaker hand or tongue strength, compared to the children with fewer speech errors. The number of days on milk during the neonatal period was associated with more speech errors in males but not in females. Conclusion Children with galactosemia have a high prevalence of co-occurring speech, coordination, and strength disorders, which may be evidence of a common underlying etiology, likely associated with diffuse cerebellar damage, rather than distinct disorders.|
|Oropharyngeal dysphagia may occur in late-onset Pompe disease, implicating bulbar muscle involvement.||2013||Hobson-Webb LD, Jones HN, Kishnani PS||Pompe disease, Dysphagia, Tongue strength||Late-onset Pompe disease (presenting after 12 months of age) often presents with limb-girdle and respiratory weakness, but oropharyngeal dysphagia has not been reported previously. A retrospective review of all late-onset Pompe disease patients evaluated in the neuromuscular clinic at Duke University Medical Center from 1999-2010 was performed. Twelve patients were identified and 3 had symptoms of oropharyngeal dysphagia. The medical record was reviewed, including the results of electromyography, videofluroscopic swallow examinations, and motor speech examination including instrumental assessment of lingual force with the Iowa Oral Performance Instrument. Oropharyngeal dysphagia was mild in two cases and severe in one. One of the two patients with mild severity demonstrated oral stage swallow signs; in the other, residual material was observed in the area of the cervical esophagus. In the patient with severe oropharyngeal dysphagia, both the oral and pharyngeal stages of swallowing were affected with penetration and aspiration documented. The degree of swallowing impairment appeared to correlate with overall physical strength and function. Oropharyngeal dysphagia may occur in patients with late-onset Pompe disease, implicating bulbar muscle involvement. Screening for symptoms of dysphagia may help reduce morbidity and mortality, while improving understanding of the late-onset Pompe disease phenotype. Further studies, including examination of the relationship between lingual weakness and oropharyngeal dysphagia, are warranted.|
|The effects of lingual intervention in a patient with inclusion body myositis and Sjögren's syndrome: a longitudinal case study.||2012||Malandraki GA, Kaufman A, Hind J, Ennis S, Gangnon R, Waclawik A, Robbins J||Inclusion body myositis, Tongue strength, Strength training||OBJECTIVE: To report the 5-year course of a patient's swallowing disorder in the context of progressive neuromuscular disease and the effectiveness of a lingual strengthening treatment program. DESIGN:
This is a case report that describes a lingual treatment protocol that was repeated 3 times over a 5-year period with and without maintenance periods. SETTING: The study was completed in 2 settings-an outpatient swallowing clinic at an acute care hospital and the patient's home. PARTICIPANT: The subject was a 77-year-old woman who was diagnosed with inclusion body myositis and Sjögren's syndrome. INTERVENTION:
The patient participated in an intensive 8-week lingual strengthening protocol 3 times (at years 1, 4, and 5) and a subsequent maintenance program twice (at years 4 and 5). MAIN OUTCOME MEASURES:
Three outcome measures were collected during the study: (1) lingual manometric pressures at the anterior and posterior tongue, measured by using a lingual manometric device, (2) airway invasion measured by using an 8-point Penetration-Aspiration Scale, and (3) clearance of the bolus measured by using a 3-point residue scale. RESULTS: Isometric lingual strengthening was effective in maintaining posterior tongue lingual pressure and Penetration-Aspiration Scale scores during the treatment periods. Residue scale scores did not significantly change during treatment. CONCLUSIONS: We conclude that, in this patient, lingual strengthening slowed the progression of disease-related lingual strength loss and extended functional swallowing performance. Thus, this type of intervention may hold promise as an effective swallowing treatment option for patients with neurodegenerative inflammatory diseases such as inclusion body myositis and Sjögren's syndrome.
|Lingual propulsive pressures across consistencies generated by the anteromedian and posteromedian tongue by healthy young adults.||2012||Gingrich LL, Stierwalt JA, Hageman CF, LaPointe LL||Healthy, Swallowing||PURPOSE:
In the present study, the authors investigated lingual propulsive pressures generated in the normal swallow by the anterior and posterior lingual segments for various consistencies and maximum isometric tasks.
Lingual pressures for saliva, thin, and honey-thick liquid boluses were measured via the Iowa Oral Performance Instrument (IOPI Medical, Carnation, WA) at both anteromedian and posteromedian lingual segments of 62 healthy participants, ages 18-34 years (30 men, 32 women).
A repeated-measures analysis of variance revealed that all lingual swallowing pressures were significantly greater at the anteromedian segment than at the posteromedian segment. Gender was not a significant factor; however, women exhibited greater swallowing pressures across all conditions. Lingual pressures increased as bolus viscosity increased. No significant interactions existed. Analysis of a subset of 30 participants revealed that men exhibited greater maximal isometric pressure at the anteromedian segment than women, with no significant gender difference at the posteromedian segment. A significantly higher percentage of maximum isometric tongue pressure was exerted by the posteromedian tongue than by the anteromedian tongue.
Findings suggest that greater amplitudes of lingual pressures are generated during normal swallowing at the anteromedian lingual segment; however, a greater percentage of maximum isometric tongue pressure was exerted by the posteromedian lingual segment, suggesting increased effort by the posterior tongue during bolus propulsion.
|"Pharyngocise": randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy.||2012||Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R||Head and neck cancer, Swallowing||PURPOSE:
Dysphagia after chemoradiotherapy is common. The present randomized clinical trial studied the effectiveness of preventative behavioral intervention for dysphagia compared with the "usual care." METHODS AND MATERIALS:
A total of 58 head-and-neck cancer patients treated with chemoradiotherapy were randomly assigned to usual care, sham swallowing intervention, or active swallowing exercises (pharyngocise). The intervention arms were treated daily during chemoradiotherapy. The primary outcome measure was muscle size and composition (determined by T(2)-weighted magnetic resonance imaging). The secondary outcomes included functional swallowing ability, dietary intake, chemosensory function, salivation, nutritional status, and the occurrence of dysphagia-related complications. RESULTS:
The swallowing musculature (genioglossus, hyoglossuss, and mylohyoid) demonstrated less structural deterioration in the active treatment arm. The functional swallowing, mouth opening, chemosensory acuity, and salivation rate deteriorated less in the pharyngocise group. CONCLUSION:
Patients completing a program of swallowing exercises during cancer treatment demonstrated superior muscle maintenance and functional swallowing ability.
|Age and sex differences in orofacial strength.||2012||Clark HM, Solomon NP||Normal values, United States, Tongue strength, Lip strength||This study explored age- and sex-related differences in orofacial strength. Healthy adult men (N = 88) and women (N = 83) participated in the study. Strength measures were obtained using the Iowa Oral Performance Instrument (IOPI). Anterior and posterior tongue elevation strength measures were obtained using a standard method. Tongue protrusion and lateralization, cheek compression, and lip compression measures utilized adaptors allowing the participant to exert pressure against the bulb in different orientations. Lip and cheek strength measures were greater for men than women, but tongue strength did not differ between sex groups. Strong correlations between age and strength were not observed. However, group comparisons revealed lower tongue protrusion and lateralization strength in the oldest participants. The oldest participants also exhibited lower anterior and posterior tongue elevation strength relative to the middle-age group. Cheek and lip compression strength demonstrated no age-related differences. The current study supplements and corroborates existing literature that shows that older adults demonstrate lower tongue strength than younger adults. Sex differences were noted such that men demonstrated greater lip and cheek strength but not tongue strength. These data add to the literature on normal orofacial strength, allowing for more informed interpretations of orofacial weakness in persons with dysphagia.|
|Is tongue strength an important influence on rate of articulation in diadochokinetic and reading tasks?||2012||Neel AT, Palmer PM||Tongue strength, Speech||PURPOSE: The purpose of this study was to assess the relationship between tongue strength and rate of articulation in 2 speech tasks, diadochokinetic rates and reading aloud, in healthy men and women between 20 and 78 years of age. METHOD: Diadochokinetic rates were measured for the syllables /p/, /t/, /k/, and /ptk/, and articulation rates were calculated for a reading of the Rainbow Passage for 57 adult volunteers. The Iowa Oral Performance Instrument (LLC Northwest) was used to obtain maximum tongue pressure, tongue pressure exerted during production of /t/, and tongue endurance. Correlation analyses were performed to determine the relation among articulation rate and tongue pressure and endurance measures. RESULTS: Maximum tongue pressure, the pressure used to produce /t/, the proportion of maximum pressure used to produce /t/, and tongue endurance were poor predictors of diadochokinetic rates and articulation rate in reading for healthy speakers. Discussion Focus must remain on factors beyond strength, such as movement precision and coordination, to improve researchers' understanding of normal and disordered speech production in adults.|
|Comparison of three types of tongue pressure measurement devices.||2011||Yoshikawa M, Yoshida M, Tsuga K, Akagawa Y, Groher ME||Tongue strength||A new tongue pressure device consisting of a simple and safe disposable probe and manometer has been developed. This report describes a study that examined the validity of the new device, comparing it to a widely used tongue pressure manometer, the Iowa Oral Performance Instrument (IOPI), and to the stable adhered three air-filled bulbs manometry system. The first test compared maximum tongue pressure measured with the new device and the IOPI (13 male, 9 female, 25.0 years). The second test compared maximum tongue pressure and swallowing tongue pressure measured with the new device and the three-bulb device (13 male, 9 female, 31.0 years). Significant correlations of maximum tongue pressure were found between the new device and the IOPI in the first test (p < 0.05). In the second test, significant correlations of maximum tongue pressure were found between the new device at the anterior and middle sensors (p < 0.05) but not at the posterior sensor of the three-bulb device. Significant correlations of swallowing tongue pressure between the new device and the three-bulb device were found (p < 0.05). These findings demonstrate that the measurements by the new simple tongue pressure device are closely equivalent to those of the IOPI and three-bulb devices, demonstrating that the new device is capable of accurately measuring the pressure generated by the whole tongue.|
|The relationship of aspiration status with tongue and handgrip strength in healthy older adults.||2011||Butler SG, Stuart A, Leng X, Wilhelm E, Rees C, Williamson J, Kritchevsky SB||Healthy, Elderly, Tongue strength, Swallowing||BACKGROUND:
Recently, subclinical aspiration has been identified in approximately 30% of community-dwelling older adults. Given that the tongue is a key component of the safe swallow, we hypothesized healthy older adults who aspirate will generate less tongue strength than adults who do not aspirate. Furthermore, as muscle weakness may reflect a global effect of aging, we further investigated whether tongue strength is correlated with handgrip strength. METHODS: We assessed 78 healthy community-dwelling older adults (M = 77.3 years, SD = 7.26) for aspiration status (37% aspirators) via flexible endoscopic evaluation of swallowing. Maximal isometric anterior and posterior tongue strength, anterior and posterior swallowing tongue strength, and maximum handgrip strength were measured. RESULTS: Isometric tongue strength was significantly lower in aspirators versus nonaspirators (p = .03) at both the anterior (463 vs 548 mmHg, respectively) and posterior lingual locations (285 vs 370 mmHg, respectively). Likewise, swallowing tongue strength was significantly lower in aspirators versus nonaspirators at both the anterior (270 vs 317 mmHg, respectively) and posterior lingual locations (220 vs 267 mmHg, respectively). There was no difference between aspirators and nonaspirators' handgrip strength (p > .05), although handgrip strength was correlated with posterior tongue strength (r = .34, p = .005). CONCLUSIONS: Lower anterior and posterior isometric and swallowing tongue strength were dependent on aspiration status. Lower lingual strength in healthy adults may predispose them to aspiration. The correlation between tongue and handgrip strength is consistent with the hypothesis that impaired oropharyngeal strength reflects global age-related declines in muscle strength.
|Effects of strength training on neuromuscular facial rehabilitation.||2011||Perry ES, Potter NL, Rambo KD, Short R||Lip strength, Facial nerve||OBJECTIVE:
Physical trauma is the third leading cause of facial nerve damage, which can disrupt communication, social interaction and emotional expression. The objective of this report was to investigate the effects of facial muscle exercise as a stand-alone treatment in a young adult with unilateral facial nerve damage 13-years post-onset. METHOD: This single case study examines the long-term results of a 7-week intensive facial exercise programme followed by a 16-week moderate facial exercise programme. RESULTS: Intensive exercise increased facial strength and upper lip elevation on the affected side and upper and lower lip strength on the affected and non-affected sides. With subsequent moderate exercise followed by 24 weeks of rest, strength was maintained but not increased. CONCLUSION:
With intensive facial exercise, muscle weakness resulting from facial nerve damage sustained during childhood can be improved years after injury.
|Swallow characteristics in patients with oculopharyngeal muscular dystrophy.||2010||Palmer PM, Neel AT, Sprouls G, Morrison L||Oculopharyngeal muscular dystrophy, Tongue strength, Tongue endurance, Swallowing||PURPOSE: This prospective investigation evaluates oral weakness and its impact on swallow function, weight, and quality of life in patients with oculopharyngeal muscular dystrophy (OPMD). METHOD: Intraoral pressure, swallow pressure, and endurance were measured using an Iowa Oral Performance Instrument in participants with OPMD and matched controls. Timed water swallow, weight, and quality of life were also assessed. RESULTS: Participants with OPMD were weaker than controls. Oral weakness impacted strength, swallow pressure, swallow capacity, swallow volume, swallow time, and quality of life. Tongue endurance was not affected by oral weakness. CONCLUSION:
This investigation provides further insight into the swallow function of patients with myopathic disease. Muscle fiber loss leads to weakness, which results in reductions in swallow function and quality of life. Weight and endurance are not greatly altered.
|Effects of dining on tongue endurance and swallowing-related outcomes.||2010||Kays SA, Hind JA, Gangnon RE, Robbins J||Aging, Tongue strength, Tongue endurance||PURPOSE:
The purpose of this study was to test the hypothesis that eating a meal reduces tongue strength and endurance in healthy old and young adults. It was predicted that older adults would show greater declines in tongue endurance while demonstrating higher perceived effort, longer meal durations, and clinical signs of swallowing difficulty. METHOD: Twenty-two healthy adults were enrolled into 2 groups (ages 20-35 years and ages 65-82 years; 5 males and 6 females each). Maximum tongue strength (Pmax) and endurance (duration 50% of Pmax could be maintained) were measured twice at baseline and once postmeal. Subjects consumed half of a bagel with peanut butter, carrot sticks, and milk between measures. RESULTS: All subjects demonstrated reduced tongue strength and endurance postmeal. Young adults showed a greater decline in anterior tongue endurance compared with older adults (p=.05). There was no evidence that changes in tongue strength, perceived effort, or meal duration varied by age or gender. The 3 oldest subjects reported the highest effort and displayed signs of difficulty swallowing while dining. CONCLUSIONS:
Young and old adults demonstrated reduced tongue strength and endurance after dining, but younger subjects showed greater declines in anterior tongue endurance, whereas older adults exhibited signs of swallowing difficulty.
|Effect of age on tongue strength and endurance scores of healthy Portuguese speakers.||2010||Vitorino J||Normal values, Brazil, Tongue strength, Tongue endurance||In order to diagnose abnormality in tongue strength and endurance and to obtain more precise rehabilitation planning, the aims of this study were to examine typical tongue strength and endurance of 75 healthy Portuguese speakers. The tongue strength and endurance scores were obtained using the Iowa Oral Performance Instrument (IOPI Model 2.0). The participants ranged in age from 20 to 77 years of age. To assess whether there were differences across age and gender, the participants were divided into three age categories (20-40; 41-60; 61-80) and both genders to establish a total of 6 groups. The results revealed that there were no significant differences across age and gender and that the healthy speakers of Portuguese were able to maintain 50% maximum pressure for a shorter period of time than those documented in English speakers. The data collected will provide an important database for speech-language pathologists with the purpose of diagnosis of tongue dysfunction.|
|Tongue pressure modulation during swallowing: water versus nectar-thick liquids.||2010||Steele CM, Bailey GL, Molfenter SM||Healthy, Swallowing||PURPOSE: Evidence of tongue-palate pressure modulation during swallowing between thin and nectar-thick liquids stimuli has been equivocal. This mirrors a lack of clear evidence in the literature of tongue and hyoid movement modulation between nectar-thick and thin liquid swallows. In the current investigation, the authors sought to confirm whether tongue-palate pressures are modulated between discrete swallows of water and nectar-thick juice. METHOD:
Tongue-palate pressures were measured at 3 sites (anterior, medial, and posterior palate) using an adhered 3-bulb pressure strip in 20 healthy, young adults during discrete swallows of water and nectar-thick apple juice. RESULTS: Pressure modulation was not noted with respect to pressure amplitudes (in mm Hg), but was identified both in the pressure patterns observed (the sites and number of bulbs activated) and temporal aspects of pressure duration. CONCLUSION:
Tongue-palate pressure amplitude modulation does not occur for nectar-thick swallows compared to thin liquid swallows. Modulation does, however, occur with respect to the tongue-palate contact surface area and pressure durations. The authors introduce the concept of pressure slope as a meaningful way to examine tongue-palate pressure application in swallowing.
|Pressure profile similarities between tongue resistance training tasks and liquid swallows.||2010||Steele CM, Bailey GL, Molfenter SM, Yeates EM, Grace-Martin K||Healthy, Tongue strength, Strength training, Swallowing||Tongue-pressure resistance training is known to increase tongue strength in seniors and individuals with stroke-related dysphagia. However, evidence of associated functional improvements in swallowing is equivocal. We investigated similarities in pressure waveform profiles between swallowing and several tongue-palate pressure tasks to identify tasks that may be best suited for inclusion in tongue-pressure resistance training protocols for patients who are unable to safely perform real bolus swallows in treatment. Tongue-palate pressures were recorded in 20 healthy young adults. Participants performed water and nectar-thick juice swallows, effortful and noneffortful saliva swallows, and "half-maximum" tongue-palate partial-pressure tasks emphasizing either anterior or posterior tongue-palate contact at different speeds. Pressure slopes (amplitude change over time) during the pressure application (rise) and withdrawal (release) phases were analyzed. A subset of four tasks with the greatest similarity in slope characteristics to those seen in bolus swallows was identified: anterior-emphasis half-maximum tongue-palate presses, posterior-emphasis maximum isometric tongue-palate presses, posterior-emphasis half-maximum slow tongue-palate presses, and effortful saliva swallows. We propose that future research should explore the degree to which swallowing improvements are obtained from treatment protocols that emphasize these tasks.|
|Maximal tongue strength in typically developing children and adolescents.||2009||Potter NL, Short R||Normal values, Children, Tongue strength||Evaluating tongue function is clinically important as the generation of adequate pressure by the anterior tongue against the hard palate is crucial for efficient oropharyngeal swallowing. Research in the evaluation of tongue function in pediatric populations is limited due to questions about the reliability of children's performance on objective measures of tongue strength and the lack of comparative data from typically developing children. The present study examined tongue strength in 150 children and adolescents, 3-16 years of age, with no history of speech or swallowing disorders using the Iowa Oral Pressure Instrument (IOPI). Children as young as 3 years of age were able to tolerate the IOPI standard tongue bulb and were reliable performers on measures of tongue strength with an unconstrained mandible. Tongue strength measurements were elicited in blocks of three trials with a 30-s rest between the trials and a 20-min rest between blocks. Tongue strength increased with age with no consistent best trial across ages and participants. Males showed a slight increase in tongue strength over females at ages 14 and 16. This study suggests maximum pediatric tongue strength may be reliably evaluated using commercially available equipment and provides a limited sample comparative database.|
|Tongue movements during water swallowing in healthy young and older adults.||2009||Steele CM, Van Lieshout P||Aging, Swallowing||PURPOSE: The purpose of this study was to explore the nature and extent of variability in tongue movement during healthy swallowing as a function of aging and gender. In addition, changes were quantified in healthy tongue movements in response to specific differences in the nature of the swallowing task (discrete vs. sequential swallows). METHOD:
Electromagnetic midsagittal articulography (EMMA) was used to study the swallowing-related movements of markers located in midline on the anterior (blade), middle (body), and posterior (dorsum) tongue in a sample of 34 healthy adults in 2 age groups (under vs. over 50 years of age). Participants performed a series of reiterated water swallows, in either a discrete or a sequential manner. RESULTS:
This study shows that age-related changes in tongue movements during swallowing are restricted to the domain of movement duration. The authors confirm that different tongue regions can be selectively modulated during swallowing tasks and that both functional and anatomical constraints influence the manner in which tongue movement modulation occurs. Sequential swallowing, in comparison to discrete swallowing, elicits simplification or down-scaling of several kinematic parameters. CONCLUSION: The data illustrate task-specific stereotyped patterns of tongue movement in swallowing, which are robust to the effects of healthy aging in all aspects other than movement duration.
|Effects of directional exercise on lingual strength.||2009||Clark HM, O’Brien K, Calleja A, Corrie SN||Normal values, United States, Tongue strength, Strength training||PURPOSE:
To examine the application of known muscle training principles to tongue strengthening exercises and to answer the following research questions: (a) Did lingual strength increase following 9 weeks of training? (b) Did training conducted using an exercise moving the tongue in one direction result in strength changes for tongue movements in other directions? (c) Were differential training effects observed for participants completing exercises sequentially (in isolation) versus concurrently (several exercises in combination)? (d) Were strength gains maintained after exercise was discontinued? Methods Participants were 39 healthy adults assigned to sequential or concurrent lingual strength training. Lingual exercise (elevation, protrusion, and/or lateralization) was conducted for 9 weeks, with lingual strength and cheek strength (control variable) assessed weekly. RESULTS: All lingual strength measures increased with training, but cheek strength remained unchanged. Training effects were not related to training condition (sequential vs. concurrent), nor were specificity effects observed for direction of exercise. Significant decreases in lingual strength were noted 2-4 weeks after exercise was discontinued. CONCLUSIONS: The findings replicate those of earlier studies demonstrating that lingual strength may be increased with a variety of exercise protocols and confirm that detraining effects may be observed when training is discontinued. The findings further suggest that the lingual musculature may demonstrate less dramatic training specificity than what has been reported for skeletal muscles.
|A comparison of the reliability and stability of oro-lingual swallowing pressures in patients with head and neck cancer and healthy adults.||2009||White R, Cotton SM, Hind J, Robbins J, Perry A||Head and neck cancer, Swallowing||The ability to measure normality and abnormality and to accurately assess true changes in swallowing function over time, is important for the management of dysphagia. Despite this, there is a paucity of information regarding the stability and reliability of measurements tools used for dysphagia research. As both head and neck (H&N) cancer and its treatment(s) have been shown to significantly affect deglutitive tongue function, it is important that we have a reliable method to measure swallowing tongue function in this population. In this study we evaluate the reliability and stability of oro-lingual swallowing pressures captured from H&N cancer patients and from healthy, age- and gender-matched controls using the Kay Swallowing Workstation (KSW) fixed, three-transducer tongue pressure array. Significant differences between the two samples (H&N cancer and controls), with respect to mean peak oro-lingual pressures were recorded during swallowing. Furthermore, reliability of these measures was lower in H&N cancer patients. These differences highlight the importance of obtaining information about the reliability of dysphagia assessment tools with the specific population with whom they will be used.|
|Differences in tongue strength across age and gender: Is there a diminished strength reserve?||2009||Youmans SR, Youmans GL, Stierwalt JAG||Normal values, United States, Tongue strength, Swallowing||Maximum tongue strength was investigated and compared to mean swallowing pressure elicited by the anterior tongue to calculate the percentage of maximum tongue strength used during swallowing in 96 participants with normal swallowing, divided into three 20-year age groups. The purposes of this investigation were to investigate normal swallowing physiology and to determine whether tongue strength reserves diminished according to age or gender. The results of the study yielded significant maximum tongue strength differences between the youngest and oldest and middle and oldest age groups; the oldest group had the weakest tongues. Mean swallowing pressure did not differ based on age, but women were found to have significantly higher pressures than men. The percentage of maximum tongue strength used during swallowing did not vary as a function of age, but women used a significantly higher percentage of tongue strength to swallow than men. Based on the results, it appears that a diminishing strength reserve does not exist based on age, but it does exist based on gender. Specifically, it appears that women have a reduced tongue strength reserve compared to men. Clinical implications are discussed.|
|Assessment of orofacial strength in patients with dysarthria.||2008||Solomon NP, Clark HM, Makashay MJ, Newman LA||Dysarthria, Tongue strength||Assessment of orofacial weakness is common during the evaluation of patients with suspected dysarthria. This study addressed the validity of clinical assessments of orofacial weakness by comparing clinical (subjective) ratings to instrumental (objective) measures. Forty-four adults referred to a speech pathology clinic for dysarthria evaluation were tested for strength of the tongue during elevation, lateralization, and protrusion, and for the strength of the muscles of the lower face during buccodental and interlabial compression. Subjective assessment of weakness involved rating maximum resistance against a firmly held tongue depressor, using a 5-point scale. Objective assessment involved the Iowa Oral Performance Instrument (IOPI), measured as the maximal pressure generated against an air-filled bulb. A recent adaptation to the IOPI permitted testing of tongue and cheek strength using tasks that are comparable to the subjective tasks. Moderate correlations were found between the objective and subjective evaluations, with the strongest correlations for tongue lateralization. Lower pressure values were associated with higher subjective ratings of weakness for each task, although there was substantial overlap in the data. These results, combined with the notion that examiner bias is inherent to clinical assessment, support the use of instrumentation to improve objectivity and precision of measurement in the clinic.|
|Standard values of maximum tongue pressure taken using newly developed disposable tongue pressure measurement device.||2008||Utanohara Y, Hayashi R, Yoshikawa M, Yoshida M, Tsuga K, Akagawa Y||Tongue strength||It is clinically important to evaluate tongue function in terms of rehabilitation of swallowing and eating ability. We have developed a disposable tongue pressure measurement device designed for clinical use. In this study we used this device to determine standard values of maximum tongue pressure in adult Japanese. Eight hundred fifty-three subjects (408 male, 445 female; 20-79 years) were selected for this study. All participants had no history of dysphagia and maintained occlusal contact in the premolar and molar regions with their own teeth. A balloon-type disposable oral probe was used to measure tongue pressure by asking subjects to compress it onto the palate for 7 s with maximum voluntary effort. Values were recorded three times for each subject, and the mean values were defined as maximum tongue pressure. Although maximum tongue pressure was higher for males than for females in the 20-49-year age groups, there was no significant difference between males and females in the 50-79-year age groups. The maximum tongue pressure of the seventies age group was significantly lower than that of the twenties to fifties age groups. It may be concluded that maximum tongue pressures were reduced with primary aging. Males may become weaker with age at a faster rate than females; however, further decreases in strength were in parallel for male and female subjects.|
|Quantitative contributions of the muscles of the tongue, floor-of-mouth, jaw, and velum to tongue-to-palate pressure generation.||2008||Palmer PM, Jaffe DM, McCulloch TM, Finnegan EM, Van Daele DJ, Luschei ES||Healthy, Tongue strength||PURPOSE:
The purpose of this investigation was to evaluate the relationship between tongue-to-palate pressure and the electromyography (EMG) measured from the mylohyoid, anterior belly of the digastric, geniohyoid, medial pterygoid, velum, genioglossus, and intrinsic tongue muscles. Methods Seven healthy adults performed tongue-to-palate pressure tasks at known percentages of their maximum pressure while intramuscular EMG was recorded from the muscles stated above. Multiple regression analysis was performed. RESULTS: Predictors of pressure included the posterior fibers of the genioglossus, mylohyoid, anterior belly of digastric, medial pterygoid, and intrinsic tongue. CONCLUSIONS: Increasing tongue-to-palate pressure coincides with increased muscle activity. Activation of the floor-of-mouth, tongue, and jaw closing muscles increased tongue-to-palate pressure. These findings support the use of a tongue-press exercise to strengthen floor-of-mouth muscles, tongue, and jaw-closing muscles.
|Early radiation effects on tongue function for patients with nasopharyngeal carcinoma: a preliminary study.||2008||Chang CW, Chen SH, Ko JY, Lin YH||Head and neck cancer, Tongue strength, Tongue endurance||The purpose of this study was to investigate early radiation effects on tongue function for patients with nasopharyngeal carcinoma (NPC) and to provide a scientific database for early intervention plans. Twelve subjects with NPC and 12 age- and sex-matched normal subjects were included. Tongue maximum isometric strength and endurance at 50% of maximum strength were obtained once from normal subjects with the Iowa Oral Performance Instrument (IOPI) and twice from the NPC subjects: before and 2 months after radiation treatment. No significant differences were found in tongue function evaluation for normal or NPC groups in either pre- or post-treatments. However, this study showed that significant decreases in tongue function may not start until 2 months after treatment.|
|Improvements in tongue strength and pressure-generation precision following a tongue-pressure training protocol in older individuals with dysphagia: Three case reports.||2008||Yeates EM, Molfenter SM, Steele CM||Dysphagia, Sarcopenia, Tongue strength, Strength training||Dysphagia, or difficulty swallowing, often occurs secondary to conditions such as stroke, head injury or progressive disease, many of which increase in frequency with advancing age. Sarcopenia, the gradual loss of muscle bulk and strength, can place older individuals at greater risk for dysphagia. Data are reported for three older participants in a pilot trial of a tongue-pressure training therapy. During the experimental therapy protocol, participants performed isometric strength exercises for the tongue as well as tongue pressure accuracy tasks. Biofeedback was provided using the Iowa Oral Performance Instrument (IOPI), an instrument that measures tongue pressure. Treatment outcome measures show increased isometric tongue strength, improved tongue pressure generation accuracy, improved bolus control on videofluoroscopy, and improved functional dietary intake by mouth. These preliminary results indicate that, for these three adults with dysphagia, tongue-pressure training was beneficial for improving both instrumental and functional aspects of swallowing. The experimental treatment protocol holds promise as a rehabilitative tool for various dysphagia populations.|
|Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research.||2007||Burkhead LM, Sapienza CM, Rosenbek JC||Dysphagia, Strength training||Dysphagia rehabilitation, historically, has focused a great deal on various compensations during swallowing to prevent aspiration and/or improve safety and efficiency. Exercise, in general, has been a part of the dysphagia rehabilitation landscape. However, heightened discussions in the field regarding best practices for exercise training, particularly strengthening, raise more questions than answers. The intent of this paper is to (1) explore the overriding principles of neuromuscular plasticity with regard to strength training, (2) evaluate how current exercise-training interventions in dysphagia rehabilitation correspond to these principles, and (3) postulate directions for future study of normal and disordered swallowing and determine how to incorporate these principles into dysphagia rehabilitation.|
|Tongue measures in individuals with normal and impaired swallowing.||2007||Stierwalt JAG, Youmans SR||Tongue strength, Tongue endurance, Dysphagia||PURPOSE: This investigation sought to add to the extant literature on measures of normal tongue function, to provide information on measures of tongue function in a group of individuals with oral phase dysphagia, and to provide a comparison of these 2 groups matched for age and gender. METHOD: The Iowa Oral Performance Instrument was utilized to measure tongue function (strength and endurance) in a group of individuals with normal (N=200) and impaired (N=50) swallowing. The peak measure of 3 encouraged trials was recorded as participants' strength, and 50% of their peak was sustained as long as possible for endurance. RESULTS: Results for the control group supported previous investigations wherein greater tongue strength was found in males than in females and in the youngest versus oldest groups. The experimental group demonstrated a similar trend in strength for gender. When matched for age and gender, the experimental group demonstrated significantly lower strength. Significant differences were not revealed on measures of tongue endurance. CONCLUSIONS: We were able to extend the normative database on tongue function and document reduced tongue strength in a group of individuals with dysphagia. The findings provide evidence that in this group, tongue weakness coincided with signs of dysphagia, adding justification for tongue-strengthening protocols.
|The effects of lingual exercise in stroke patients with dysphagia.||2007||Robbins J, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, Taylor AJ||Tongue strength, Strength training, Swallowing, Stroke||OBJECTIVE: To examine the effects of lingual exercise on swallowing recovery poststroke. DESIGN: Prospective cohort intervention study, with 4- and 8-week follow-ups. SETTING: Dysphagia clinic, tertiary care center. PARTICIPANTS:
Ten stroke patients (n=6, acute: < or =3mo poststroke; n=4, chronic: >3mo poststroke), age 51 to 90 years (mean, 69.7y). INTERVENTION: Subjects performed an 8-week isometric lingual exercise program by compressing an air-filled bulb between the tongue and the hard palate. MAIN OUTCOME MEASURES: Isometric and swallowing lingual pressures, bolus flow parameters, diet, and a dysphagia-specific quality of life questionnaire were collected at baseline, week 4, and week 8. Three of the 10 subjects underwent magnetic resonance imaging at each time interval to measure lingual volume. RESULTS: All subjects significantly increased isometric and swallowing pressures. Airway invasion was reduced for liquids. Two subjects increased lingual volume. CONCLUSIONS: The findings indicate that lingual exercise enables acute and chronic dysphagic stroke patients to increase lingual strength with associated improvements in swallowing pressures, airway protection, and lingual volume.
|Tongue strength and exercise in healthy individuals and in head and neck cancer patients.||2006||Lazarus C||Head and neck cancer, Tongue strength, Swallowing||The tongue plays a critical role in bolus propulsion through the oral cavity and pharynx. This manuscript reviews the types of lingual impairment and overall oropharyngeal swallowing impairment present after treatment for head and neck cancer; specifically, surgery and primary chemoradiotherapy. Oral tongue impairment in surgically treated patients can include reduced range of motion, reduced control, and reduced ability to manipulate, seal, and propel a bolus into the pharynx. Tongue base impairment can result in reduced bolus clearance through the pharynx, resulting in pharyngeal residue and aspiration. The biologic effects of radiotherapy are described, with tissue fibrosis being a primary contributor to development of oropharyngeal swallow disorders. In patients treated with primary chemoradiotherapy, lingual strength has been found to be reduced, as has oral and pharyngeal structural movement during the swallow. The effects of skeletal muscle strengthening programs on muscle physiology are discussed, as are the effects of tongue strengthening exercise programs on tongue strength and swallowing. Future research needs are addressed.|
|Measures of tongue function related to normal swallowing.||2006||Youmans SR, Stierwalt JAG||Normal values, United States, Swallowing, Tongue strength||The availability of objective measures of tongue function presents a possible supplement to the clinical dysphagia evaluation. The purpose of this study was to improve our understanding of normal tongue physiology during swallowing and maximum isometric tasks, establish a preliminary database of tongue function variables, and determine if differences existed among the variables as a function of age, gender, or varied bolus consistency. Ninety subjects, divided into age and gender groups, participated in tasks that determined maximum isometric tongue pressure, mean tongue pressure during swallowing, and percentage of maximum isometric pressure used during swallowing. Descriptive statistics, correlations, and analyses of variance were computed to analyze the data. Results indicated that males had significantly higher maximum isometric pressures than females, and the youngest group had significantly higher maximum pressures than the oldest group. Mean swallowing pressures and percentage of maximum isometric pressures used during swallowing differed as a function of bolus type but did not differ as a function of age or gender. In addition, maximum isometric pressures were correlated with mean swallowing pressures, and mean swallowing pressures and percentage of maximum isometric pressures used during swallowing were correlated between consistencies.|
|The effects of lingual exercise on swallowing in older adults.||2005||Robbins JM, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA||Strength training, Elderly||OBJECTIVES:
To determine the effects of an 8-week progressive lingual resistance exercise program on swallowing in older individuals, the most "at risk" group for dysphagia. DESIGN: Prospective cohort intervention study. SETTING: Subjects were recruited from the community at large. PARTICIPANTS: Ten healthy men and women aged 70 to 89. INTERVENTION:
Each subject performed an 8-week lingual resistance exercise program consisting of compressing an air-filled bulb between the tongue and hard palate. MEASUREMENTS:
At baseline and Week 8, each subject completed a videofluoroscopic swallowing evaluation for kinematic and bolus flow assessment of swallowing. Swallowing pressures and isometric pressures were collected at baseline and Weeks 2, 4, and 6. Four of the subjects also underwent oral magnetic resonance imaging (MRI) to measure lingual volume. RESULTS:
All subjects significantly increased their isometric and swallowing pressures. All subjects who had the MRI demonstrated increased lingual volume of an average of 5.1%. CONCLUSION:
The findings indicate that lingual resistance exercise is promising not only for preventing dysphagia due to sarcopenia, but also as a treatment strategy for patients with lingual weakness and swallowing disability due to frailty or other age-related conditions. The potential effect of lingual exercise on reducing dysphagia-related comorbidities (pneumonia, malnutrition, and dehydration) and healthcare costs while improving quality of life is encouraging.
|The effect of jaw position on measures of tongue strength and endurance.||2004||Solomon NP, Munson B||Normal values, United States, Tongue strength, Tongue endurance||Assessment of tongue strength and endurance is common in research and clinical contexts. It is unclear whether the results reveal discrete function by the tongue or combined abilities of the tongue and jaw. One way to isolate the movement of the tongue is to constrain the jaw kinematically by using a bite block. In this study, 10 neurologically normal young adults performed tongue strength and endurance tasks without a bite block ("jaw-free") and with bite blocks of various heights (2, 5, 10, and 15 mm for strength; 5 mm for endurance). Data signals included tongue pressure exerted on an air-filled bulb, surface electromyography (SEMG) from the superior tongue blade, and SEMG from 1 masseter. On average, tongue strength (pressure in kPa) was greatest with no bite block and generally decreased as bite blocks increased in height. Pairwise analyses revealed statistically significant differences for all but 3 comparisons (jaw-free to 2 mm, 2 to 5 mm, and 5 to 10 mm). After removing outlying data from 1 participant, tongue endurance at 50% of tongue strength was significantly greater without a bite block than with one. SEMG data did not differ significantly for the strength task across bite block conditions, but inspection of the individual data revealed a tendency for masseter activity to be lower when the jaw was unconstrained. These results suggest that maximal tongue strength and endurance are best assessed with an unconstrained mandible or with a very small bite block.|
|Effects of two types of tongue strengthening exercises in young normals.||2003||Lazarus C, Logemann JA, Huang CF, Rademaker AW||Normal values, United States, Tongue strength, Strength training||This pilot study examines the effects of two types of tongue strengthening exercises on tongue function measures of strength and endurance in a group of 31 healthy young subjects. Subjects underwent baseline and 1 month post-baseline assessments of tongue function and were randomized to one of three groups, including: (1) no exercise; (2) exercise group receiving standard tongue strength exercises using a tongue depressor, and (3) exercise group receiving tongue strengthening exercises using the Iowa Oral Performance Instrument. Results revealed a significantly greater change in maximum tongue strength in the group that received any treatment compared with the group receiving no treatment (p = 0.04). Results provide support for the theory that tongue strengthening exercises improve tongue strength in healthy young subjects.|
|Relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments.||2003||Clark HM, Henson PA, Barber WD, Stierwalt JA, Sherrill M||Tongue strength, Swallowing||A growing literature documents the relationship between tongue strength and oral phase swallowing function. Objective measures of strength have been recommended as more valid and reliable than subjective measures for the assessment of tongue function, yet subjective measures remain the more commonly used clinical method for assessing tongue strength. This study assessed the relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments. Both subjective and objective measures of tongue strength were observed to be good predictors of the presence of oral phase swallowing impairments. The specific oral phase swallowing functions of bolus manipulation, mastication, and clearance were moderately correlated with subjective ratings of tongue strength. Experienced and inexperienced raters appeared to judge tongue strength differently, with the ratings of experienced raters being more predictive of swallowing function.|
|Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults.||2001||Hind JA, Nicosia MA, Roecker EB, Carnes ML, Robbins J||Aging, Swallowing||OBJECTIVE:
To assess the effects of effortful swallowing, a common compensatory strategy for dysphagia, on the bolus and swallowing mechanism of middle-aged and older men and women. DESIGN:
Case-controlled design in which subjects completed both the intervention technique and the control behavior. SETTING:
A university hospital. PARTICIPANTS:
Sixty-four healthy men and women between 45 and 93 years of age from the community. INTERVENTIONS:
Participants swallowed 3-mL thin liquid boluses both normally and using the effortful swallow strategy. MAIN OUTCOMES MEASURES:
The biomechanics and bolus flow patterns of swallows were analyzed from videofluoroscopic and simultaneous oral pressure data. RESULTS:
Subjects at all ages generated significantly increased oral pressures at each sensor location using the effortful swallow (p = .0001), with the pressure increase greater for the middle-aged subjects compared with older subjects. Several durational measures were significantly longer with the effortful swallow including: hyoid maximum anterior excursion (p < .04), laryngeal vestibule closure (p < .0001), and duration of the upper esophageal sphincter opening (p =.0001). The hyoid bone moved further in the superior direction with the effortful swallow (p = .002). There was a trend of decreased oral residue with the effortful swallow (p = .06). CONCLUSION:
Biomechanical and bolus flow aspects of swallowing changed when healthy individuals performed effortful swallows with 3-mL boluses.
|Age effects on the temporal evolution of isometric and swallowing pressure.||2000||Nicosia MA, Hind JA, Roecker EB, Carnes M, Doyle J, Dengel GA, Robbins J||Aging, Swallowing||BACKGROUND: The tongue plays a key role in bolus propulsion through the oropharyngeal chamber. In this study, possible age effects on the magnitude and timing of lingual pressure generation were analyzed. METHODS:
Oral pressure was measured during isometric and swallowing tasks for 10 elderly (mean age = 81 years) and 10 young (mean age = 51 years) subjects. Three trials each of the isometric task and swallows of three different boluses (3 ml semisolid, 3 ml liquid, and 10 ml liquid) were performed by each subject. The timing and magnitude of isometric and swallowing pressure generation along with the pattern of the swallowing pressure waveform were analyzed. RESULTS: Whereas maximum lingual isometric pressures decreased with age (p < .001). no significant age difference was found for swallowing pressure. Time taken to reach peak pressure also was reduced with age in both the isometric task and swallows of liquid boluses (p < .05), while no significant age effect was found for semisolid swallows. Finally, only elderly subjects showed a pattern of liquid swallowing pressure generation in which multiple lingual gestures were required to reach peak pressure (termed "pressure building"), a pattern demonstrated by both young and elderly groups for semisolids. CONCLUSIONS:
Decreased lingual strength with age combined with unchanging swallowing pressure leads to a decreased "pressure reserve," perhaps leaving older individuals more at risk for dysphagia resulting from insults directly or indirectly to the swallowing system. Additionally, swallowing is generally "slowed" with age, apparently due to both central and peripheral factors, and this change may have an impact on bolus flow outcomes.
|Swallowing and tongue function following treatment for oral and oropharyngeal cancer.||2000||Lazarus CL, Logemann JA, Pauloski BR, Rademaker AW, Larson CR, Mittal BB, Pierce M||Head and neck cancer, Tongue strength, Tongue endurance, Swallowing||This study examined tongue function and its relation to swallowing in 13 subjects with oral or oropharyngeal cancer treated with primary radiotherapy +/- chemotherapy and 13 age- and sex-matched control subjects. Measures of swallowing and tongue function were obtained using videofluoroscopy, pretreatment and 2 months posttreatment. Maximum isometric strength and endurance at 50% of maximum strength were obtained with the Iowa Oral Performance Instrument (IOPI). Control subjects were tested once. All subjects with head and neck cancer were evaluated pretreatment and 2 months posttreatment. No significant differences were found for the tongue function measures pre- and 2 months posttreatment in the group with head and neck cancer. Significantly higher tongue strength was observed in the control than in the group with head and neck cancer both pre- and posttreatment. No significant differences were found for the 2 groups for tongue endurance measures. Significant correlations of tongue strength and endurance and some swallow measures were found pre- and posttreatment for the group with head and neck cancer and for the control group. These correlations included oral and pharyngeal temporal swallow measures and oropharyngeal swallow efficiency. Pretreatment differences between the 2 groups in tongue strength were likely related to tumor bulk, pain, and soreness. Two-month posttreatment differences were likely related to radiation +/- chemotherapy changes to the oral and pharyngeal mucosa. This study provides support for the hypothesis that tongue strength plays a role in oropharyngeal swallowing, particularly related to the oral phase of the swallow.|
|Strength, endurance, and stability of the tongue and hand in Parkinson Disease.||2000||Solomon NP, Robin RA, Luschei ES||Parkinson's disease, Tongue strength, Tongue endurance, Dysarthria||Weakness and fatigue in the orofacial system often are presumed to contribute to the dysarthria associated with neuromotor disorders, although previous research findings are equivocal. In this study, tongue strength, endurance, and stability during a sustained submaximal effort were assessed in 16 persons with mild to severe Parkinson disease (PD) and a perceptible speech disorder. The same measures were taken from one hand for comparison. Only tongue endurance was found to be significantly lower in these participants than in neurologically normal control participants matched for sex, age, weight, and height. Analyses of data from a larger sample comprising the present and retrospective data revealed lower-than-normal tongue strength and endurance in participants with PD. No significant correlations were found between tongue strength and endurance, interpause speech rate, articulatory precision, and overall speech defectiveness for the present and previously studied participants with PD, bringing into question the influence of modest degrees of tongue weakness and fatigue on perceptible speech deficits.|
|Tongue strength and endurance in different aged individuals.||1996||Crow HC, Ship JA||Aging, Tongue strength, Tongue endurance, Healthy||BACKGROUND:
It is generally accepted that age-related changes occur in voluntary muscle. Studies of hand grip strength and aging demonstrate a decrease in strength with age; however, there are little data regarding tongue function. The purpose of this study was to determine the relationship of increased age to tongue strength and endurance. METHODS:
A pressure transducer, the Iowa Oral Performance Instrument, was used to measure maximal strength and endurance of both the hand and tongue. Ninety-nine healthy volunteers from the oral physiology component of the Baltimore Longitudinal Study of Aging were divided into four age groups, ranging from 21 to 96 years of age. A multivariate analysis of variance was used to determine differences in strength and endurance between age groups and genders. Regression analysis was done to determine the relationship of strength and endurance with age. RESULTS:
Gender analysis indicated that both tongue and hand strength were greater in males; however, tongue and hand endurance demonstrated no gender differences. The strength in both the tongue and hand decreased with age. Individuals over the age of 79 years showed statistically decreased tongue strength, and individuals over the age of 59 years showed statistically decreased hand strength. There was no significant change in the tongue and hand endurance with age. CONCLUSIONS:
The results of this study suggest that tongue function is gender- and age-dependent and follows the same trends as hand function. Tongue strength is decreased in older individuals and females, while tongue endurance is gender- and age-independent.
|Sense of effort and the effects of fatigue in the tongue and hand.||1996||Solomon NP, Robin DA, Mitchinson SI, VanDaele DJ, Luschei ES||Healthy, Tongue strength||Fatigue and increased effort are common symptoms for people with movement disorders and dysarthria, but they are rarely quantified. In an attempt to develop a clinically useful and physiologically meaningful measure of fatigue, we used a task that involves sustaining a target effort level without visual feedback while squeezing a bulb connected to a pressure transducer. In the first experiment, 12 healthy young adults performed the constant-effort task with the tongue and the preferred hand at 3 submaximal levels of effort. The resulting pressure declined over time as a negative exponential function with a nonzero asymptote. In the second experiment, 6 subjects performed the constant-effort task before and after acutely fatiguing the tongue and hand. The rate of pressure decline was significantly greater after fatigue. One possible mechanism for the characteristic negative exponential function is that it reflects a constant descending drive from higher centers in the CNS to the appropriate motoneuron pools. Thus, this technique may elucidate the contribution of central fatigue to normal and disordered speech.|
|Age effects on lingual pressure generation as a risk factor for dysphagia.||1995||Robbins J, Levine R, Wood J, Roecker EB, Luschei E||Normal values, United States, Tongue strength, Swallowing, Aging||BACKGROUND:
Tongue activity plays a crucial role in both oral and pharyngeal phases of swallowing. In this study, maximum lingual isometric and swallowing pressures were quantified in two groups of healthy men to investigate possible age effects on performance. Magnetic resonance images of the brain were also obtained to examine the relationship between age-related anatomical changes and swallowing function. METHODS:
Pressures were recorded at three lingual sites (tip, blade, and dorsum) during a maximal isometric task and during saliva swallows. Task order was randomized, and subjects performed three trails per placement site. Additionally, t2-weighted MRIs were obtained on 9 of the 10 young subjects (mean age = 25 years) and all 15 older subjects (mean age = 75 years). RESULTS:
Maximal isometric pressures were significantly greater for younger subjects at the tongue blade site (p = .002), whereas peak swallowing pressures remained similar across both age groups. Within-subject comparisons of maximum isometric to swallowing pressures, a measure of reserve capacity, revealed reduced difference scores at the tongue blade in the older group (p = .02). Older subjects exhibited significantly more cerebral atrophy (p = .001) and greater incidence of periventricular white matter lesions (p = .0001) than did younger subjects. CONCLUSIONS:
While swallowing pressures remain similar across the life span, overall pressure reserve declines with age. The implications are: (a) older people may be working harder to produce adequate swallowing pressures, and (b) age-related illness may put geriatric patients at higher risk for dysphagia, thus further complicating recovery.
|A physiological analysis of articulatory dysfunction in dysarthric speakers following severe closed-head injury.||1995||Theodoros DG, Murdoch BE, Stokes P||Tongue strength, Tongue endurance, Lip strength, Lip endurance, Traumatic brain injury||A physiological analysis of the lip and tongue function of a group of 18 severely closed-head injured (CHI) subjects was performed using lip and tongue force transduction systems. Lip and tongue strength, endurance and rate of repetitive movements were assessed on four non-speech tasks: maximum strength, sustained maximum strength, repetition of 10 maximum strength compressions, and maximum repetition rate. The values recorded were compared to those achieved by a group of 18 non-neurologically impaired subjects, matched for age and sex, who served as the controls. The results of the study indicated that the CHI subjects demonstrated a significant impairment of lip and tongue function based on strength, endurance and rate of repetitive movements, compared to the controls. While lip function was found to be significantly impaired on several measures of strength and endurance, tongue function was noted to be more severely compromised. The CHI subjects were found to exhibit a significantly reduced rate of repetitive movements of the lips and tongue. The results are discussed in relation to the effects of CHI on neuromuscular function and differential subsystem impairment in dysarthria. The clinical implications of these findings are also discussed in relation to the treatment of articulatory disturbances following severe CHI.|
|Impaired tongue strength and endurance in developmental verbal dypraxia: a physiological analysis.||1995||Murdoch BE, Attard MD, Ozanne AE, Stokes PD||Tongue strength, Tongue endurance, Dyspraxia, Speech||Tongue strength and endurance measures were obtained from six children with developmental verbal dyspraxia (DVD) aged between 5;6 years and 11;5 years and compared to those achieved by six normal speaking controls matched for age and sex. The instrument for measuring tongue strength comprised an air-filled soft rubber bulb connected to a pressure transducer. The results indicated that the DVD group had weaker lingual musculature than the controls. In addition the DVD subjects exhibited significantly reduced tongue strength endurance compared with the controls. Overall the findings support the hypothesis that a motor impairment forms at least part of the basis of DVD and may be indicative of the presence of a concomitant dysarthria in children with DVD, or may reflect an underspecification of the motor programme. The need for revision of contemporary taxonomies relating to childhood motor speech disorders is discussed.|
|Effects of age, gender, bolus volume, and bolus viscosity of oropharyngeal pressure during swallowing.||1993||Perlman AL, Guthmiller Schultz J, VanDaele DJ||Tongue strength, Aging||Oropharyngeal pressure during swallowing was studied in a total of 40 healthy adult males and females in two age groups (21-27 yr and 62-75 yr). Effects of bolus volume, bolus viscosity, age, and gender were analyzed, and dry and bolus swallows were compared. The duration of the intrabolus pressure, reflecting the pressure exerted by the tongue on the bolus and preceding the generation of the pharyngeal pressure, was significantly affected by bolus volume. The duration of oropharyngeal pressure was affected by age, gender, and bolus type (bolus vs. dry swallow). Peak oropharyngeal pressure was not affected by any of the test factors, although there was a tendency for older subjects to have higher pressures than young subjects.|
|Tongue strength and endurance: relation to highly skilled movements.||1992||Robin DA, Goel A, Somodi LB, Luschei ES||Tongue strength, Tongue endurance, Healthy||Tongue strength and endurance (fatigue) were examined in subjects who have acquired high skill levels with their tongues (supranormal) and in subjects who use the tongue normally. The supranormal groups were trumpet players and high school debaters who were able to speak intelligibly at rates much faster than normal. Hand strength and fatigue were also assessed. Maximal strength was measured by recording how much pressure an individual could exert on an air-filled bulb. Endurance was measured by determining how long subjects could sustain 50% of their maximal pressure. Results showed that maximal strength of the tongue and hand did not differentiate the supranormal subjects from the normal subjects. Hand endurance did not differentiate the subjects either. However, the supranormal groups had significantly longer tongue endurance times than did the normal subjects.|
|Tongue force in normals and in dysarthric patients with amyotrophic lateral sclerosis.||1980||Dworkin JP, Aronson AE, Mulder DW||Amyotrophic lateral sclerosis, Dysarthria, Tongue strength||Tongue force, rate of syllable repetition, and judgments of articulatory defectiveness were measures obtained on 19 dysarthric adults with amyotrophic lateral sclerosis and on 125 normal adults. Anterior and lateral tongue forces were measured by means of a pressure transducer clasped between the teeth; the tongue forces were recorded on a pen-writing ECG apparatus. Audio-recorded syllable repetitions of /p lambda/, /t lambda/, and /k lambda/ also were transcribed on ECG paper and counted. Three listeners rated articulatory precision on a 7-point scale of severity. The normal males had significantly higher tongue forces than normal females; normal subjects had significantly higher tongue forces than dysarthric patients; and anterior tongue forces were significantly greater than lateral in normal and dysarthric patients. There was a high negative correlation between tongue force and severity of articulatory defect. Syllable repetitions were significantly slower in the dysarthric patients than in the normal patients, and a high negative correlation was obtained between syllabic rate and severity of articulatory defect.|
|Maximum forces exerted on the dentition by the perioral and lingual musculature.||1957||Kydd WL||Tongue strength||N/A|