Maximum Isometric Tongue Pressure Research Articles

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

The purpose of this study was to investigate the effects of tongue-strengthening exercise (TSE) on tongue strength and effortful swallowing pressure in young healthy adults. Thirteen young healthy volunteers (six men, seven women; M age = 20.5 ± 0.5 years) performed 8 weeks of isometric TSE 3 days per week. A tongue pressure measurement device was used to measure maximum isometric tongue pressure (MITP) and conduct the TSE, and a tactile sensor system attached to the hard palate was used to measure effortful swallowing pressure. MITP and effortful swallowing pressure were measured at baseline, after 4 and 8 weeks of training, and at 4 and 8 weeks after the last training session to examine the detraining effects. The results indicated that both MITP and effortful swallowing pressure increased significantly from baseline to 8 weeks after training. Although the improved MITP significantly decreased at 4 and 8 weeks after training cessation, no detraining effect was observed for effortful swallowing pressure. TSE is an effective method for increasing tongue pressure in wide tongue-palate contact areas during effortful swallow. The effortful swallowing pressure gained with TSE appears to be maintained for at least eight nontraining weeks.

Analysis of Labial and Lingual Strength among Healthy Chinese Adults in Taiwan.

This study collected 11 parameters regarding the labial and lingual strength for maximum isometric and swallowing tasks among 150 healthy Chinese adults in Taiwan. Measurements were performed using the Iowa Oral Performance Instrument (IOPI). All of the labial and lingual strength parameters were measured three times. The maximal value of three trials represents the pressure of every parameter. The overall mean (±standard deviation) and maximum isometric pressures of the lips, anterior tongue, and posterior tongue were 24.81 ± 5.64, 55.95 ± 14.13, and 53.23 ± 12.24 kPa, respectively. The mean value of posterior tongue strength was less than that of the anterior tongue by approximately 5%. The percentages of maximum isometric tongue pressure during the swallowing of saliva and water were 85% and 80% for the anterior tongue and 90% and 81% for the posterior tongue, respectively. The average endurances for the anterior tongue and posterior tongue were 13.86 ± 7.08 and 10.06 ± 5.40 s, respectively. The maximum isometric pressures were greater than both the saliva and water swallowing pressures, and the saliva swallowing pressures were greater than the water swallowing pressures. A value of 33 kPa in maximum isometric pressure could serve as a demarcation of weak tongue strength for healthy Chinese adults. As for the repeated trials of labial and lingual strength, there were no statistically significant differences for any of the pressures obtained from the 11 labial and lingual strength parameters. The normative data can be used for the objective assessment of labial and lingual strength in healthy Chinese adults.

Tongue strength, dysphagia questionnaire, pharyngeal secretions and FEES findings in dysphagia management in amyotrophic lateral sclerosis

ObjectiveDysphagia is common in Amyotrophic lateral sclerosis (ALS). ALS shows significant phenotypic variability. It is characterized by progressive weakness and/or spasticity of muscles. Dysphagia symptoms vary. Aspiration is often silent and cognitive dysfunction is common. The purpose of the study was to evaluate tongue strength measurements, dysphagia questionnaire, the presence of pharyngeal secretions, and FEES findings in dysphagia management in ALS. MethodsTwenty-five patients completed the Eating Assessment Tool-10 (EAT-10), had their Maximum Isometric Tongue Pressure (MITP), and endurance measured and underwent Flexible Endoscopic Evaluation of Swallowing (FEES) providing 31 examinations. ResultsOut of 25 patients, 76% were self-reported as dysphagic (EAT-10≥3) with a mean EAT-10 at 14.95 (±7.96). ALS patients had significantly decreased tongue strength (mean MITPanterior: 31.69 ± 17.32kPa). Comparing examinations of dysphagic and non-dysphagic status the mean MITPa of non-dysphagic was significantly greater (52.33 ± 10.97 kPa versus 20.6 ± 12.67 kPa), p<0.001. FEES detected aspiration in 10 out of 31 examinations [Penetration Aspiration Scale(PAS) ≥6]. Aspirator status examinations showed statistically significantly worse cough (p = 0.001), tongue strength (p = 0.001) and endurance (p = 0.003), pharyngeal secretions (p<0.001), velopharyngeal sufficiency (p = 0.006), pharyngeal squeeze (p = 0.009), vocal cords’ movements (p = 0.001), pharyngeal pooling (p<0.001), EAT-10 (p = 0.001) and bulbar subscale of ALS Functioning Rating Scale-Revised (b-ALSFRS-R) scores (p = 0.014) compared to non-aspirator status. Correlation analysis indicated that the feeding status had strong statistically significant correlations with the EAT-10 score (rho = −0.816), anterior tongue strength (rho = 0.735), secretions (rho = −0.811), pharyngeal pooling (rho = −0.712) and PAS (rho = −0.676) at FEES, and b-ALSFRS-R score (rho = 0.791), all p<0.001. The EAT-10 had strong statistically significant correlations with the MITPa (r = −0.794, p<0.001), secretions (rho = 0.668, p<0.001), and b-ALSFRS-R score (rho = -0.766, p = 0.001). The FEES findings had strong statistically significant correlations with the anterior tongue strength (pooling: rho = −0.784), and secretions (PAS: rho = 0.723; pooling: rho = 0.671), all p<0.001. For the questionnaire, tongue strength and pharyngeal secretions, ROC analysis assessed cut-off points and discriminating ability to predict aspiration status (Area Under the Curve: 0.838; 0.845 and 0.93, respectively). EAT-10 with a cut-off at 8 was able to predict aspirator status with a sensitivity of 100% and a specificity of 42.9% (negative predictive value-NPV = 100%). A cut-off value of 22KPa for the MITPa discriminated aspirator status (sensitivity = 80%, specificity = 89.5%, NPV = 89.5%). The quantity of secretions observed upon endoscopy with a cut-off value at 1 was able to predict aspirator status (sensitivity = 90%, specificity = 80%, NPV = 94.1%). ConclusionReduced tongue strength, questionnaire-reported symptoms, pharyngeal secretions, and FESS findings can guide identification of patients with ALS at risk of inefficient and unsafe swallowing.

P.247Capturing disease progression in oculopharyngeal muscular dystrophy (OPMD)

Oculopharyngeal muscular dystrophy is a rare late onset progressive neuromuscular disorder, characterized by ptosis, dysphagia and muscle weakness in upper and lower extremities. Little is known about the progression of the disease. The objective of this study is to describe the natural history of OPMD using clinical measurements and to identify the most sensitive clinical outcome measure for capturing disease progression. Forty-five genetically confirmed OPMD patients were examined twice at 18 months apart. The study protocol included measurements of muscle strength (maximum isometric tongue pressure, maximum bite force, MRC grading of muscles of the extremities, dynamometry of iliopsoas, quadriceps and deltoid muscles), and functional capacity tests (Motor Function Measure (MFM), 10-step stair test, maximum chewing time, maximum swallowing speed, maximum swallowing volume, maximum phonation time). There was a significant difference between the first and second examination for tongue pressure (p=.000), MRC sumscore (p=.003), dynamometry of the iliopsoas, quadriceps and deltoid muscle (p=.029, p=.002, p=.000), part 1 of the MFM on standing and transfer tasks (p=.004), and the 10-step stair test (p=.001). None of the other measures showed a significant change over 18 months. Despite slow disease progression of OPMD, this study is the first to show a significant progression in several clinical outcome measures over a period of 18 months. Muscle strength by MRC-grading and dynamometry, tongue pressure and part 1 of the MFM, rather than functional capacity tests, are sensitive measures for disease progression and thus potentially useful as clinical outcome measures fur future clinical trials.

Eat-10 Cut-Off Points to Detect Swallow Dysfunction in Head and Neck Cancer Patients during Radiotherapy: Findings from the “Redyor” Study

Dysphagia is a common toxicity of head and neck radiation therapy in patients undergoing chemoradiotherapy (CRT). There are discrepancies between the parameters by the instrumental methods and the perceptions of the patient. The objective of this study is to correlation the 10-item feeding assessment tool (EAT-10) for swallowing disorders, and the Penetration-Aspiration Scale (PAS) score obtained by videofluoroscopy, visual analogic scale (VAS) and functional oral intake scale (FOIS) within 3 months after treatment. We evaluated 46 patients included in “Redyor” study, measured at baseline (diagnosis), before and after initiating CRT, and at 3-month follow-up, were EAT-10, visual analogic scale (VAS) for self-impaired swallow, dysphagia assessed with PAS, functional oral intake scale (FOIS), maximal interincisor opening, and maximum isometric tongue pressure. Who had the EAT-10 test before, the end and 3 months after the treatment, to evaluate the relationship between PAS, VAS, and FOIS. A receiver operating characteristic (ROC) curve determined for the cut-off of the EAT-10. The Spearman correlation coefficients were calculated. A p <0.05 bilateral was considered statistically significant. Functional and self-perception values decreased in weeks 6 to 9 after CRT, coinciding with the worst EAT-10 score. A receiver operating characteristic (ROC) curve determined 3 cut-off points (with their respective sensitivity and specificity): baseline, 3 (86%, 77%); post-CRT, 15 (62.5%, 80%); and 3-month follow-up, 4 (83%, 75%). A strong correlation between VAS, FOIS, and EAT-10 observed at baseline subsequently disappeared. Table 1. New cut-off points for EAT-10 are suggested during the treatment. Our findings confirm the poor relationship between EAT-10 and the instrumental methods and highlight the need to optimize the use of tools to detect and monitor dysphagia in this cohort of patients with high risk of bronchoaspiration EAT-10, Eating Assessment Test; PAS, Penetration-Aspiration scale; VAS visual analogic scale for self-perception swallowing disturbances. Swallowing Rehabilitation in Patients With Head and Neck Cancer Receiving Radiotherapy (ReDyOR) NCT02900911.Abstract 2838; Table 1Spearman correlation coefficients (r) between EAT-10 and PAS, FOIS and VAS in the study periodPASFOISVASBefore chemoradiotherapy (basal)0.314; p=0.0550.340; p=0.0370.451; p=0.005After chemoradiotherapy0.329; p=0.1450.127; p=0.5820.254; p=0.2673-months post-chemoradiotherapy0.275; p=0.3030.008; p=0.9760.005; p=0.987 Open table in a new tab

Validity of maximum isometric tongue pressure as a screening test for physical frailty: Cross-sectional study of Japanese community-dwelling older adults.

Maximum isometric tongue pressure (MIP) seems to have a diagnostic value for oral phase dysphagia. The present study aimed to examine the association between MIP and frailty, and to assess the screening validity of MIP for physical frailty. We carried out a cross-sectional study, and enrolled participants aged ≥60 years from Japanese national medical check-ups in 2015 and 2016. The Fried frailty phenotype model was used. We analyzed odds ratios (OR) and 95% confidence intervals (CI) of physical frailty using one standard deviation increments of tongue pressure. Receiver operating characteristic curves were obtained to predict physical frailty using MIP values. Out of 1603 participants, 968 were categorized as non-frail, 605 as pre-frail and 30 as frail. In logistic regression analysis, one standard deviation increment of MIP significantly differentiated frail and pre-frail: the OR for frail with one standard deviation increment in MIP was 0.37 (95% CI 0.26-0.54, P < 0.001), and the OR for pre-frail was 0.63 (95% CI 0.57-0.70, P < 0.001). The area under the receiver operating characteristic curve for predicting frailty with MIP score was as high as 0.776 (95% CI 0.689-0.862). A point of MIP 35 kPa had a sensitivity of 90.0%, specificity of 40.4%, a positive likelihood ratio of 1.5 and a negative likelihood ratio of 0.2 for predicting frailty. MIP performance is independently associated with frailty. MIP also can be used as a simple screening tool for frailty. Geriatr Gerontol Int 2018; 18: 240-249.

The Influence of Oropalatal Dimensions on the Measurement of Tongue Strength.

Tongue strength is routinely evaluated in clinical swallowing evaluations since lingual weakness is an established contributor to dysphagia. Tongue strength may be clinically quantified by the maximum isometric tongue pressure (MIP) generated by the tongue against the palate; however, wide ranges in normal performance remain to be fully explained. Although orthodontic theory has long suggested a relation between lingual function and oral cavity dimensions, little attention has been given to the potential influence of oral and palatal structure(s) on healthy variance in MIP generation. Therefore, anterior and posterior tongue strength measures and oropalatal dimensions were obtained across 147 healthy adults (aged 18-88years). Age was confirmed as a significant, independent predictor explaining approximately 10.2% of the variance in anterior tongue strength, but not a significant predictor of posterior tongue strength. However, oropalatal dimensions predicted anterior tongue strength with over three times the predictive power of age alone (p<.001). Significant models for anterior tongue strength (R 2=.457) and posterior tongue strength (R 2=.283) included a combination of demographic predictors (i.e., age and/or gender) and oropalatal dimensions. Palatal width, estimated tongue volume, and gender were significant predictors of posterior tongue strength (p<.001). Therefore, oropalatal dimensions may warrant consideration when accurately differentiating between pathological lingual weakness and healthy individual difference.

Alterations of intrinsic tongue muscle properties with aging.

Age-related decline in the intrinsic lingual musculature could contribute to swallowing disorders, yet the effects of age on these muscles is unknown. We hypothesized there is reduced muscle fiber size and shifts to slower myosin heavy chain (MyHC) fiber types with age. Intrinsic lingual muscles were sampled from 8 young adult (9 months) and 8 old (32 months) Fischer 344/Brown Norway rats. Fiber size and MyHC were determined by fluorescent immunohistochemistry. Age was associated with a reduced number of rapidly contracting muscle fibers, and more slowly contracting fibers. Decreased fiber size was found only in the transverse and verticalis muscles. Shifts in muscle composition from faster to slower MyHC fiber types may contribute to age-related changes in swallowing duration. Decreasing muscle fiber size in the protrusive transverse and verticalis muscles may contribute to reductions in maximum isometric tongue pressure found with age. Differences among regions and muscles may be associated with different functional demands. Muscle Nerve 56: E119-E125, 2017.

Food oral breaking and the determining role of tongue muscle strength

Some previous studies have revealed a great variation of tongue muscle strength among healthy individuals. However, the implication of different tongue muscle strengths to individuals' oral capability of food handling is yet to be determined. In this work, vege-gels (with a resilient consistency of jelly) and pastry food (mashed potato) were used to investigate tongue-only oral breaking (smashing) of these foods by individuals who have different tongue muscle strengths. The aim of the work is to determine whether a correlation exists between the tongue muscle strength and its capability of food breaking. A series of vege-gels and mashed potato samples ranging from soft to hard were constituted with increasing consistency. Mechanical/textural properties of test food samples were characterised by a texture analyser. Three experimental tasks were designed: characterisation of individual's tongue muscle strength by measuring the maximum isometric tongue pressure (MITP) (Task 1); assessment of individual's capability of tongue-only food breaking (Task 2); and measurement of tongue–palate pressure generation for food oral breaking (Task 3).Our results confirm the great variability of tongue muscle strength among healthy individuals, with the highest MITP reaching 75kPa and the lowest at only 17kPa. The correlation study of tongue strength and the threshold gel/mashed potato strength for tongue-only oral breaking reveals a positive relationship between the two factors, which suggests that strong tongue muscle strength is always advantageous for oral handling (break/smashing) of viscoelastic and pastry foods. Conclusions obtained from this work can be a useful guidance to food design for elderly consumption.

Variations in tongue-palate swallowing pressures when swallowing xanthan gum-thickened liquids.

Thickened liquids are frequently recommended to reduce the risk of aspiration in patients with oropharyngeal dysphagia. Although it has previously been reported that tongue-palate pressures increase when swallowing spoon-thick and semi-solid consistencies compared to thin liquids, relatively little is known about how swallowing behaviors differ when swallowing liquids of nectar- or honey-thick consistency. Furthermore, previous studies have primarily used starch-based thickeners, and little is known about swallowing behaviors with xanthan gum-thickened liquids, which have recently been introduced for dysphagia management. In this study, we measured variations in tongue-palate pressures during the swallowing of liquids thickened to apparent viscosities of 190, 250, and 380 mPa s at 50/s using increasing concentrations of xanthan gum (0.5, 0.63 and 0.87 w/w%). The viscosity differences between these nectar- and honey-thick stimuli were confirmed to exceed sensory perceptual discrimination thresholds. Data were collected from 78 healthy adults in two sex-balanced age-groups (young; mature) and compared to reference values obtained during water swallowing. The results confirm that increased amplitudes of tongue-palate pressure were used when swallowing the thickened liquid stimuli, compared to swallows of water, and for the honey-thick liquid compared to the two nectar-thick liquids. Age-related reductions were seen in tongue strength but not in swallowing pressures, which fell below 40 % of maximum isometric pressure values. Thus, the use of xanthan gum-thickened liquids is unlikely to tax the swallowing system in terms of tongue pressure generation requirements, even in seniors with reduced maximum isometric tongue pressure measures.

Studies of the Oral Capabilities in Relation to Bolus Manipulations and the Ease of Initiating Bolus Flow

AbstractBolus swallowing can be a difficult task and/or highly hazardous to people with dysphagia (swallowing impairment), involving a risk of choking and airway obstruction. Food and pharmaceutical industries are under growing pressure to design and provide quality food for safe consumption by these disadvantaged populations and urgently need knowledge and a proper understanding of the controlling mechanisms of bolus manipulation and swallowing. In this study, physiological capabilities related to oral food handling, including maximum isometric tongue pressure, the volume of oral cavity, optimum bolus size, and tongue pressures applied during bolus swallowing were investigated. A total of 106 healthy subjects of different ages, genders and ethnic groups were involved in the investigation. A wide range of maximum isometric tongue pressure (from as low as 10 kPa to as high as 70 kPa) and maximum oral volume (from as low as 25 mL to as high as 116 mL) were observed. Further analysis showed that gender had no significant influence on tongue pressure and oral volume capacities. For younger adults (22–64 years), age also appears to have little effect. However, for older adults (&gt;65 years), both maximum isometric tongue pressure and the oral volume showed a gradual decrease with the increasing of age. By investigating basic factors of bolus swallowing, this project aimed to reveal critical controlling factors underlining the process and to test the hypothesis that, because tongue pressure provides the initial driving force for bolus flow, one's capability to generate tongue pressure could be related to the ease with which one can swallow. For this purpose, a selection of subjects with known maximum isometric tongue pressure was further invited to swallow food (bolus) of varying consistencies. A positive correlation was observed between maximum tongue pressure and the maximum consistency of bolus that one can swallow for those who had lower tongue pressure generation capacity (&lt;40 kPa). However, for subjects capable of producing very high tongue pressures (&gt;40 kPa), a tongue pressure reserve (around a third of their maximum capability) was observed during bolus swallowing.Practical ApplicationsThis article investigates a few interesting hypothesis on the bio‐mechanics of food processing, especially tongue pressure for bolus management and transfer during oro‐pharyngeal swallow. Swallowing is the final stage of food oral processing and is crucial for the transportation of orally processed food (the bolus) to the stomach for further digestion and nutrient absorption. As such, safe swallowing is a major concern for many disadvantaged populations, e.g., some elderly populations, infants, oral and/or pharyngeal dysphagia and cerebrovascular accident (stroke) patients, patients in the late‐stage of Alzheimer's disease and other hospital patients. Food and pharmaceutical industries are under an increasing pressure to develop and provide foods that are not only healthy and tasty, but are also safe to consume by these disadvantaged populations. The information presented in this article could be a bridge between oral and food sciences, and also could be of interest to R&amp;D researchers in both food manufacturing and pharmaceutical industries in trying to understand individuals' physiological capability of swallowing and the implications for food provision.

Lingual Propulsive Pressures Across Consistencies Generated by the Anteromedian and Posteromedian Tongue by Healthy Young Adults

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.

Tongue Pressure and Submental Surface Electromyography Measures During Noneffortful and Effortful Saliva Swallows in Healthy Women

The effortful swallow, a compensatory technique frequently employed by speech-language pathologists for their patients with dysphagia, is still not fully understood in terms of how it modifies the swallow. In particular, although age-related changes are known to reduce maximum isometric tongue pressure, it is not known whether age affects people's ability to perform the effortful swallow. In this study, differences were explored between younger and older healthy women in execution of the effortful swallowing maneuver through a comparative analysis of effortful and noneffortful swallows. Eighty healthy women (40 age 18-35 years and 40 age 60 and older) participated. Peak amplitude measures and the timing of signal onset to peak were measured using concurrent tongue pressure and submental surface electromyography. Result Statistically significant main effects of age group were not observed in the amplitude data, but older participants showed slower rise times to peak anterior tongue-palate pressure. Despite the general age-related deterioration of the swallowing musculature due to the phenomenon of sarcopenia, older women can still produce noneffortful and effortful swallows with lingual pressure and submental surface electromyography amplitudes similar to younger women.

Measures of Tongue Function Related to Normal Swallowing

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.

Decreased Tongue Pressure Reflects Symptom of Dysphagia

The tongue plays a key role in oropharyngeal swallowing. It has been reported that maximum isometric tongue pressure decreases with age. The risk for dysphagia resulting from low tongue strength remains unclear. This study was designed to reveal the relationship between tongue pressure and clinical signs of dysphagic tongue movement and cough and to demonstrate the clinical value of tongue pressure measurement in the evaluation of swallowing function. One hundred forty-five institutionalized elderly in five nursing homes participated. Evaluation of physical activity with self-standing up capability and mental condition with Mini Mental Status Examination (MMSE) were recorded. Maximum tongue pressure was determined using a newly developed tongue pressure measurement device. Voluntary tongue movement and signs of dysphagic cough at mealtime were inspected and evaluated by one clinically experienced dentist and speech therapist. The relationship between level of tongue pressure and incidence of cough was evaluated using logistic regression analysis with physical and mental conditions as covariates. Tongue pressure as measured by the newly developed device was significantly related to the voluntary tongue movement and incidence of cough (p < 0.05). The results of this study suggest that tongue pressure measurement reflects clinical signs of dysphagic tongue movement and cough and that measurement of tongue pressure is useful for the bedside evaluation of swallowing.