Tongue Endurance Research Articles

Systematic Effortful Swallowing Exercise Without External Resistance Does Not Increase Swallowing-Related Muscle Strength in the Elderly.

Effortful swallow (ES) is a maneuver intended to increase pressure on a bolus by swallowing and pushing with sufficient force to facilitate clearance. Although ES is mainly known for its immediate effects, the long-term effects of applying ES as an exercise program remain unclear. This study investigated the effects of a 7-week systematic ES exercise regime on swallowing-related muscle strength in individuals aged 65years and over. In total, 30 healthy older adults participated in this study (16 women and 14 men, aged 67-90years). The subjects participated in the exercise program for 20min a day, twice a week, for 7weeks. To gradually increase exercise intensity, the number of exercises per session was increased from the initial 60 repetitions (weeks 1-2) to 120 repetitions (weeks 5-7). To measure the effect of the strengthening exercise program, the activation level of suprahyoid muscles was measured using surface electromyography, and a tongue pressure measurement system was used to measure variables related to tongue strength (isometric tongue pressure, swallowing tongue pressure, and tongue endurance). Although the effect of ES exercise on muscle strength through gradual adjustment of exercise frequency was not confirmed, ES remains valuable as an exercise for strengthening the muscles involved in swallowing. Future studies are warranted to determine the effects of ES exercise after adjusting for other variables of exercise intensity.

0564 Assessment of Tongue and Soft Palate Muscles Mechanical Properties in Patients with OSA

Abstract Introduction Soft palate muscles are crucial in the maintenance of UA patency. Different contraction tasks have been used to investigate tongue mechanical properties, but not to soft palate muscles. This study aimed to investigate the mechanical consequences of tongue and soft palate muscles fatigue in moderate-severe OSA patients. Methods 12 moderate and 8 severe patients with OSA were enrolled. Measurements include strength, endurance, and fatigue indices. During the soft palate fatiguing protocol, subjects were asked to develop repetitive intra-oral positive pressure during cheek-bulging maneuvers while wearing a mouth piece to keep the jaw opened. Tongue mechanical properties were also assessed using protrusion tasks with similar protocol. Subjects were encouraged to develop sustained maximal bulging pressure or tongue protrusion force for 5 sec every 10 sec until the peak pressure did not reach 85% of baseline maximal pressure for 2 consecutive times. The influence of age and BMI were also investigated. Results The sex, age were not significantly different between the 2 OSA groups. BMI was significantly higher in severe OSA patients (p<0.05). Overall, the tongue maximal voluntary contraction force (MVC), endurance time and total muscle work were respectively positively associated with the ones obtained from the soft palate fatiguing task (rs=0.51, 0.43, 0.66, respectively). The MVC of both tongue and soft palate muscles were positively correlated with BMI in all subjects (rs=0.43, 0.5 respectively). The recovery time from soft palate fatigue was significantly longer in moderate than severe OSA patients (270s ± 192.3s and 120s ± 0, p =0.02). Interestingly, the recovery time was positively correlated with AHI in tongue fatiguing task, while negatively correlated with supine AHI and age in soft palate fatiguing task (p<0.05). In both tasks, MVC was negatively correlated with the endurance time (p<0.05). Conclusion Moderate patients are less likely to recover from soft palate muscle fatigue. A more severe apneic disease is associated with longer recovery time from tongue fatigue, but with shorter recovery time from soft palate fatigue. Our results suggest that alteration in tongue and velopharyngeal muscles function may differ according to the severity of disease. Support SBD from IUCPQ Foundation.

Influence of the Craniocervical Posture on Tongue Strength and Endurance.

Tongue strength has an important role in the swallowing process, and previous research has suggested that tongue position, concerning the craniomandibular region, could affect the oral function. This study aimed to evaluate the strength and endurance of three areas of the tongue in three experimentally induced craniocervical postures. A cross-sectional study with a nonprobabilistic sample of 37 participants (mean age: 3.85 ± 3.64years; 20 men, 17 women) was performed. Tongue strength and endurance were assessed using a pressure device entitled Iowa Oral Performance Instrument (IOPI), in three different craniocervical positions: neutral head position (NHP), anterior head translation-or forward head position (FHP), and posterior head translation-or retracted head position (RHP). Measurements taken using the IOPI system showed significant differences in tongue strength for the anterior (p = 0.015) and middle areas of the tongue (p = 0.01). Significant differences were observed in analysis of variance (ANOVA) in the FHP (p = 0.02) and NHP (p = 0.009). The results of tongue endurance measurements showed statistically significant differences for FHP (p = 0.001), NHP (p = 0.00), and RHP (p = 0.007). The craniocervical position influences tongue strength, especially in the anterior and middle tongue areas, concerning the posterior, and, in the anterior and neutral head posture, regarding the retracted position. No differences were found in tongue resistance between the various craniocervical positions, but differences were found in resistance between the different tongue areas.

Association between maximum tongue pressure and swallowing safety and efficacy in amyotrophic lateral sclerosis.

Oropharyngeal dysphagia (OD) is common in amyotrophic lateral sclerosis (ALS), leading to a reduction of swallowing safety and efficacy. The tongue has an important role in swallowing function for oral processing and bolus propulsion through the pharynx. The study aims to analyze the association between instrumental findings of OD and tongue pressure. Patients with ALS referred for fiberoptic endoscopic evaluation of swallowing (FEES) were recruited. FEES was conducted to test swallowing function with liquid (5, 10, and 20ml), semisolid (5, 10, and 20ml), and solid. FEES recordings were assessed for swallowing safety, using the penetration-aspiration scale (PAS), and for swallowing efficacy, using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). PAS scores >2 were suggestive of penetration, PAS scores >5 of aspiration, and YPRSRS scores >2 of residue. Maximum tongue pressure (MTP) and tongue endurance were measured using the Iowa Oral Performance Instrument. Tongue pressure measurements were compared between patients with and without penetration, aspiration, or residue. Fifty-five patients with ALS were included. Mean MTP was 29.7kPa, and median tongue endurance was 10seconds. Patients with residue in the pyriform sinus had a significantly lower MTP than patients without residue in the pyriform sinus with semisolids 10ml (P=.011) and 20ml (P=.032). Patients with a tongue endurance <10seconds exhibited higher frequency of penetration with liquids 5ml (P=.046), liquids 10ml (P=.015), and solids (P=.22). In patients with ALS, MTP is significantly associated with an impairment of swallowing efficacy and tongue endurance was significantly associated with an impairment of swallowing safety.

Investigating Tongue Strength and Endurance in Children Aged 6 to 11 Years

Objective measures of tongue strength and endurance are used to assess lingual weakness and fatigue, and may have significant clinical value for dysphagia management. Recent studies investigating age and gender effects on tongue strength in children are limited by small sample sizes. The current study investigated age and gender effects on tongue strength with a larger sample size, and collected preliminary normative data for a paediatric population. This study also investigated the reliability of tongue endurance measures in children using a modified method, which has not previously been investigated. Using a cross-sectional design, this study examined tongue strength and endurance in 119 children aged 6 to 11years, with no history of speech sound disorders, oro-motor deficits, dysphagia or cognitive impairment. Measures were collected using the Iowa Oral Performance Instrument. Children participated in two sessions, 45min and 10min in duration. Tongue strength was found to significantly increase with age (p < 0.001), while no gender effects were found. Modified tongue endurance measures involved using only one measure of maximal tongue strength to set parameters for tongue endurance scores. Despite this modification, data did not reach acceptable test-retest reliability, ICC = 0.68, p < 0.001; however, reliability improved from previous studies. These findings provide normative data for tongue strength, as a basis to compare individuals, and highlights the need for more reliable protocols for measuring tongue endurance. Normative data was collected from city-dwelling Australian children.

Dysphagia diagnosis with questionnaire, tongue strength measurement, and FEES in patients with childhood-onset muscular dystrophy

IntroductionDysphagia in progressive muscle diseases is primarily due to muscle weakness. Objective of our study is to investigate the prevalence and phenotypes of dysphagia in patients with childhood onset muscular dystrophy (MD) with the use of a validated questionnaire, the measurement of tongue strength and Flexible Endoscopic Evaluation of Swallowing (FEES). MethodsProspective observational longitudinal study of dysphagia in a cohort of 58 patients attending the Pediatric Department Center for Neuromuscular Diseases. Control participants were 56 age and sex matched healthy volunteers. Dysphagia was evaluated with the Eating Assessment Tool-10 (EAT-10), and the measurement of Maximal Isometric Tongue Pressure (MITP) and tongue endurance (Iowa Oral Performance Instrument-IOPI). Dysphagic patients were submitted to FEES. Recorded data included demographic and anthropometric characteristics, type of MD, feeding status, and spirometry. ResultsOur patients' cohort consisted of 41 children, 11 adolescents, and 6 adults. Based on EAT-10, 20.7% of the patients were dysphagic: 14.63% of children, 27.3% of adolescents and 50% of adults. The main complain was solid food dysphagia. Spirometry parameters mean values for children and adolescent patients corresponded to lower than the fifth percentile. Means of FVC and FEV1 expressed as % predicted for adult patients were 27.8 (SD:25.05) and 28.8 (SD:28.44) respectively. Reduced tongue strength was measured to children aged 9-10, adolescent and adult MD patients. The main FEES findings were pharyngeal residue, spillage of food before the swallow, and supraglottal penetration. DiscussionThis is the first study to use a validated questionnaire to evaluate dysphagia in childhood onset MD and report dyphagia prevalence at different patients' age. This is the first study reporting MITP in children and adults with generalised MD. Tongue pressures are reduced well before clinical signs of dysphagia are present. ConclusionScreening of potentially dysphagic MD patients can be based on a validated questionnaire. Patients with an EAT-10 score suggestive of dysphagia at regular follow-up can have the MITP measured and in the case of reduced values a thorough dysphagia evaluation with FEES is indicated.

The Relationships among Objective Measures of Tongue Strength and Risk of Aspiration

Objective: The objective measures of tongue strength can predict the risk of aspiration. Isometric tongue pressure and endurance have been reported to be lower in patients who have premature spillage, penetration and/or aspiration on endoscopic evaluation. We aimed to study the relationships between the objective measures of tongue strength and risk of aspiration in our population. Methods: Seventy-five participants were enrolled to the study. The mean age of the participants was 58.3 ±13.6 years old. They were divided into three groups (25 participants in each group). The first group was normal participants who have had no history of swallowing problem with normal flexible endoscopic evaluation of swallowing (FEES). The second group was symptomatic patients who have had history of dysphagia and/or aspiration but normal FEES. The third group was patients who have had history of dysphagia and/or aspiration with evidence of premature spillage or laryngeal penetration or aspiration by FEES. All participants underwent objective measurements of the tongue strength including maximal isometric pressure (MIP) and endurance by Iowa Oral Performance Instrument (IOPI). The quantitative data between groups were compared using ANOVA and chi-square test was used for qualitative data. The optimal cut-off points were determined by Receiver Operating Characteristic (ROC) curve. Results: MIP and endurance were significantly lower in patients who have had premature spillage, penetration and/or aspiration on endoscopic evaluation. The appropriate cut-off points for high risk group are 35 and 25 kPa for the anterior and posterior tongue pressure respectively. Conclusion: The tongue pressure can be used to screen patients who are at risk of aspiration, which will lead to early investigation and intervention for the management of these patients.

Tongue pressure and endurance in patients with Class II and Class III malocclusion

ABSTRACT Objective: to evaluate pressure and endurance exerted by the tongue and their association with malocclusion, gender and age in orthognathic surgery candidates. Method: a cross-sectional, descriptive observational study, performed with 34 subjects, i.e., 18 women and 16 men, in the average age 28.7 years, sorted by Angle’s classification. Self-reported complaint of tongue mobility and stomatognathic functions was assessed and the evaluation of tongue mobility carried out. Tongue pressure and endurance were measured with the Iowa Oral Performance Instrument (IOPI). The data were analyzed descriptively and, for inferential analysis, the Pearson Chi-Square test was used. A 5% significance level was considered. Results: the assessed pressure and tongue endurance values of patients with malocclusion were lower than the reference ones, indicating a statistical significance in class II female patients. There was an association between inadequate pressure and tongue endurance in women with class II malocclusion. Pressure and tongue endurance in females were slightly higher than in males and a gradual decrease in averages of pressure and tongue endurance with advancing age was seen. Conclusion: pressure and tongue endurance values in women presented with class II malocclusion were lower than the reference ones, an association between inadequate pressure and tongue endurance being found.

Effects of hypoglossal nerve stimulation on tongue strength and endurance : prospective study

Effects of hypoglossal nerve stimulation on tongue strength and endurance : prospective study

Effects of an oral-pharyngeal motor training programme on children with obstructive sleep apnea syndrome in Hong Kong: A retrospective pilot study

BackgroundThis study aimed to investigate the effects of an oropharyngeal motor training programme on children with Obstructive Sleep Apnea Syndrome (OSAS) in Hong Kong.MethodsIn this retrospective study, we reviewed the outcomes of 10 children with OSAS who had received an oropharyngeal motor training programme in Occupational Therapy Department of an acute hospital in Hong Kong over a 1-year programme. Each participant attended an individual oropharyngeal motor training programme plus a follow-up session after 2 months. The training programme consisted of 10 individual mobilization exercises involving the orofacial and pharyngeal area for 45 minutes. Each exercise had to be repeated for 10 times. Three outcome measures were chosen to study the effectiveness of the training programme including tongue strength, tongue endurance level and orofacial function. Tongue strength and tongue endurance level were assessed using the Iowa Oral Pressure Instrument (IOPI). The Nordic Orofacial Test-Screening (NOT-S) Assessment was used to assess the orofacial function. Seven out of 10 participants completed the training programme and attended the follow-up session after two months.ResultsThe tongue strength and the scores of NOT-S of the 7 participants were found to have significant improvement after training. However, there was no significant difference in tongue endurance level.ConclusionThe findings of this study support the role of occupational therapist in oromotor training modalities to improve the respiratory function for children with OSAS in Hong Kong. Copyright © 2017, Hong Kong Occupational Therapy Association. Published by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Association of Post-extubation Dysphagia With Tongue Weakness and Somatosensory Disturbance in Non-neurologic Critically Ill Patients.

ObjectiveTo prospectively assess the association between impoverished sensorimotor integration of the tongue and lips and post-extubation dysphagia (PED).MethodsThis cross-sectional study included non-neurologic critically ill adult patients who required endotracheal intubation and underwent videofluoroscopic swallowing study (VFSS) between October and December 2016. Participants underwent evaluation for tongue and lip performance, and oral somatosensory function. Demographic and clinical data were retrieved from medical records.ResultsNineteen patients without a definite cause of dysphagia were divided into the non-dysphagia (n=6) and the PED (n=13) groups based on VFSS findings. Patients with PED exhibited greater mean duration of intubation (11.85±3.72 days) and length of stay in the intensive care unit (LOS-ICU; 13.69±3.40 days) than those without PED (6.83±5.12 days and 9.50±5.96 days; p=0.02 and p=0.04, respectively). The PED group exhibited greater incidence of pneumonia, higher videofluoroscopy swallow study dysphagia scale score, higher oral transit time, and lower tongue power and endurance and lip strength than the non-dysphagia groups. The differences in two-point discrimination and sensations of light touch and taste among the two groups were insignificant. Patients intubated for more than 7 days exhibited lower maximal tongue power and tongue endurance than those intubated for less than a week.ConclusionDuration of endotracheal intubation, LOS-ICU, and oromotor degradation were associated with PED development. Oromotor degradation was associated with the severity of dysphagia. Bedside oral performance evaluation might help identify patients who might experience post-extubation swallowing difficulty.

Differences in maximal strength and endurance of the tongue according to region in healthy adults.

[Purpose] The purpose of this study was to identify differences in maximal strength and endurance of the tongue among healthy adults. [Subjects and Methods] A total of 60 healthy volunteers (30 men; 30 women; age range, 20–26 years) were recruited and evaluated for maximal strength and endurance of the anterior and posterior regions of the tongue using the Iowa Oral Performance Instrument. [Results] Tongue strength in the anterior region was greater than that in the posterior region. In contrast, tongue endurance in the posterior region was greater than that in the anterior region. [Conclusion] In conclusion, these results confirm that the anterior region of the tongue exhibits greater strength, whereas the posterior region exhibits greater endurance.

Maximal strength and endurance scores of the tongue, lip, and cheek in healthy, normal Koreans.

ObjectivesThe purpose of this study was to establish normative data for healthy Korean adults by measuring the maximal strength and endurance scores of the tongue, lip, and cheek, and to examine correlations between these measurements.Materials and MethodsThis study included 120 subjects that were divided into three groups according to age: young (20-39 years), middle-aged (40-59 years), and older (over 60 years); and by gender. Measurements were taken using the Iowa Oral Performance Instrument (IOPI).ResultsThe mean maximal tongue strengths were as follows: young men (46.7±10.2 kPa) and women (32.1±7.9 kPa), middle-aged men (40.9±9.3 kPa) and women (36.9±8.6 kPa), and older men (35.2±9.0 kPa) and women (34.5±6.9 kPa). The mean tongue endurance scores were: young men (28.8±12.6 seconds) and women (20.8±13.5 seconds), middle-aged men (17.0±8.5 seconds) and women (15.3±5.2 seconds), and older men (15.8±6.7 seconds) and women (17.9±8.1 seconds). The mean maximal lip strengths were: young men (11.6±3.0 kPa) and women (11.4±3.8 kPa), middle-aged men (11.4±4.2 kPa) and women (11.1±5.1 kPa), and older men (14.5±3.9 kPa) and women (11.7±2.6 kPa). The mean lip endurance scores were: young men (41.1±23.9 seconds) and women (22.4±21.7 seconds), middle-aged men (24.3±10.3 seconds) and women (30.5±13.4 seconds), and older men (24.9±11.0 seconds) and women (12.8±7.6 seconds). The mean maximal cheek strengths were: young men (24.5±4.6 kPa) and women (20.5±4.3 kPa), middle-aged men (25.2±6.4 kPa) and women (21.2±5.5 kPa), and older men (22.4±5.3 kPa) and women (18.0±4.8 kPa). The mean cheek endurance scores were: young men (47.8±24.4 seconds) and women (43.9±25.0 seconds), middle-aged men (27.3±11.3 seconds) and women (20.0±14.6 seconds), and older men (21.7±14.5 seconds) and women (17.2±11.4 seconds).ConclusionThe data collected in this study will provide an important database of standardized measurements for maximal strength and endurance scores of the tongue, lip and cheek in healthy, normal Koreans.

Effects of Change in Tongue Pressure and Salivary Flow Rate on Swallow Efficiency Following Chemoradiation Treatment for Head and Neck Cancer.

Patients treated with chemoradiation for head and neck cancer frequently develop dysphagia. Tissue damage to the oral tongue causing weakness along with decreases in saliva production may contribute to dysphagia. Yet, effects of these variables on swallowing-related measures are unclear. The purpose of this study was (1) to determine effects of chemoradiation on tongue pressures, as a surrogate for strength, and salivary flow rates and (2) to elucidate relationships among tongue pressures, saliva production, and swallowing efficiency by bolus type. Twenty-one patients with head and neck cancer treated with chemoradiation were assessed before and after treatment and matched with 21 healthy control participants who did not receive chemoradiation. Each participant was given a questionnaire to rate dysphagia symptoms.Videofluoroscopic Evaluation of Swallowing (VFES) was used to determine swallowing efficiency; the Saxon test measured salivary flow rate; and the Iowa Oral Performance Instrument (IOPI) was used for oral tongue maximum and endurance measures. Results revealed significantly lower tongue endurance measures for patients post-treatment as compared to controls (p = .012). Salivary flow rates also were lower compared to pre-treatment (p = .000) and controls (p = .000). Simple linear regression analyses showed that change in salivary flow rate was predictive of change in swallow efficiency measures from pre- to post-treatment for 1mL thin liquid (p = .017), 3mL nectar-thick liquid (p = .026), and 3mL standard barium pudding (p = .011) boluses. Based on these findings, it appears that chemoradiation treatment affects tongue endurance and salivary flow rate, and these changes may impact swallow efficiency. These factors should be considered when planning treatment for dysphagia.

Differences in maximal isometric tongue strength and endurance of healthy young vs. older adults.

[Purpose] The aim of this study was to measure and compare the maximal tongue strength and endurance of young and older adults. [Subjects and Methods] This study recruited 60 healthy young (aged 20 to 39 years) and older adults (aged 67 to 75 years) at a university and in public places. The Iowa Oral Performance Instrument was used to measure maximal tongue strength and endurance. [Results] Maximal tongue strength was significantly higher in the young adult group than the older adult group. Maximal tongue endurance was longer in the young adult group than in the older adult group, but the difference between the groups was not significant. [Conclusion] This study confirmed that older adults have a lower maximal tongue strength and endurance than young adults.

Electrical impedance myography in the evaluation of the tongue musculature in amyotrophic lateral sclerosis.

Electrical impedance myography (EIM) quantifies muscle health and is used as a biomarker of muscle abnormalities in neurogenic and myopathic diseases. EIM has yet to be evaluated in the tongue musculature in patients with amyotrophic lateral sclerosis (ALS), who often show clinical bulbar signs. The lingual musculature of 19 subjects with motor neuron disease and 21 normal participants was assessed using EIM, strength and endurance testing, and clinical assessment. Tongue musculature in the ALS group was characterized by significantly smaller phase (Ph) and greater resistance (R) when compared with the healthy cohort. Ph and tongue endurance were correlated in the ALS group. EIM of tongue musculature could distinguish those with ALS from healthy controls. The demonstrated relationship between tongue function and Ph supports further testing of EIM of the tongue as a potential biomarker in ALS.

OroPress a new wireless tool for measuring oro-lingual pressures: a pilot study in healthy adults.

BackgroundCommercially available tools for measuring oro-lingual pressures during swallowing or isometric (tongue ‘pushing’) tasks have either poor, or unknown, psychometric properties (stability, reliability) which means their validity in a clinical setting is unknown. A new wireless tool, OroPress, has been designed to address the shortcomings of existing devices. In this pilot cohort study of normal adults (i.e., people without dysphagia), the face validity of OroPress was examined when it was used to measure oro-lingual pressures during (i) isometric tongue strength (ITS) tasks and (ii) isometric tongue endurance (ITE) tasks.The effects of gender on isometric oro-lingual data, captured using OroPress, were compared to published oro-lingual pressure data recorded using either the Kay Swallowing Workstation or the Iowa Oral Performance Instrument (aka commercial tools).MethodsThirty five adults (17 males, 18 females), were purposefully recruited at the University of Limerick (UL), Ireland. They attended one session at the university-based clinic where their oro-lingual pressures were recorded while undertaking two isometric tasks by speech and language therapy student clinicians. OroPress was used to capture tongue strength and tongue endurance pressures during two trials of each condition and data were downloaded and analysed post-hoc. An independent-samples t-test and an ANOVA were used to examine the effect of gender on ITS pressures (as data were normally distributed) and an independent-samples t-test was used for the effect of gender on ITE pressures (where data were not normally distributed).ResultsOroPress is a portable tool that was reported as being ‘easy to use’ by student SLT clinicians. The intra-oral sensor was reportedly comfortable and ‘felt non-invasive’ for participants. Data from 34 participants (16 males, 18 females) are reported.Males did not demonstrate significantly higher mean ITS pressures than females (P = 0.057), although this approached significance, and there was no gender effect for ITE oro-lingual pressure. These results were consistent with published data from studies where other tools have been used to measure ITS pressures.ConclusionsPreliminary face validity of OroPress as a tool for recording isometric oro-lingual pressures was supported. This new wireless tool shows promise for being a criterion standard for recording oro-lingual pressures during isometric tasks.

Instrumented Assessment of Oral Motor Function in Healthy Subjects and People with Systemic Sclerosis.

The aim of the present study was to provide quantitative data of oral function in healthy subjects (HSs), validity of measurements and estimation of measurement bias, as well as quantify oral impairment in persons with scleroderma (SSc). 151 HSs and 12 subjects with SSc were recruited and assessed using instrumented tools, measuring maximal mouth opening; lip strength; and tongue strength, protrusion, retraction, and endurance. Twenty HSs were also retested 3-5weeks later in order to assess the test-retest reliability of the measurements. Intraclass correlation coefficients proved to be satisfactory (>0.8) for both inter-rater and test-retest reliabilities of all measurements except for tongue retraction. In the HS group, maximal mouth opening and tongue and lips strength values were larger (P<0.05) for males than females, while no significant differences were found for other variables. Older subjects had statistically significantly lower tongue retraction values and tongue endurance values than younger subjects. The SSc group showed a statistically significant decrease (P<0.05) in almost all the measurements. Assessment procedures proved to be valid and reliable. Gender and height were predictors of mouth opening, lip and tongue strength, while age correlates with tongue retraction and endurance. Measurements highlighted the strong impact of SSc on oral functions and in particular on tongue protrusion, tongue strength, and endurance.

Oral strength in subjects with a unilateral cleft lip and palate

PurposeFacial appearance and speech outcome may affect psychosocial functioning in girls and boys. Several studies reported dissatisfaction with facial appearance and more specifically the lip and mouth profile in children with cleft lip and palate (CLP). The purpose of this controlled study was to measure the tongue and lip strength and endurance in boys and girls with CLP. MethodsTwenty-five subjects (mean age: 10.6 years) with a unilateral CLP and a gender- and age- matched control group were selected. All subjects with an unilateral CLP consulted the same craniofacial team and had undergone an identical surgical procedure. Surgical procedure of the lip was performed using a modified Millard technique without primary nose correction at an average age of 5.5 months. The Iowa Oral Performance instrument was used to measure lip and tongue strength and tongue endurance. ResultsThe results of the Iowa Oral Performance measurement showed no significant differences between the subjects with an unilateral cleft lip and palate and the age and gender matched control group without a cleft lip and palate. ConclusionThere is no significant differences regarding oral strength more specifically the lip and tongue strength and endurance between subjects with and without an unilateral cleft lip and palate. ENT specialists and speech pathologists must be aware of this aspect of the normal lip and tongue functions.

Reliability of measurements of tongue and hand strength and endurance using the Iowa Oral Performance Instrument with elderly adults

Purpose: This study investigated the reliability of tongue and hand strength and endurance measurements in old adults using the Iowa Oral Performance Instrument (IOPI). Method: Thirty aged-care residents (6 males and 24 females) aged 79–97 years were tested on four occasions two weeks apart to determine test–retest reliability. The primary outcome measures were isometric anterior and posterior tongue and hand strength (best of three trials) and isometric tongue and hand endurance time at 50% of maximal strength. Results: Changes in the mean between sessions for tongue and hand strength indicated acceptable (< 10%) reliability particularly with familiarisation. The within-subject variation (mean-typical error expressed as a coefficient of variation, CV) indicated higher than acceptable variation for anterior and posterior tongue and hand strength. Intra-class correlations (ICC) indicated moderate to strong reliability for anterior (ICC 0.58–0.77) and posterior (ICC 0.77–0.84) tongue strength and hand strength (ICC 0.79–0.96). No tongue or hand endurance measures were regarded as reliable. Conclusion: These findings indicate that overall tongue and hand strength values demonstrate acceptable reliability in the elderly, especially where familiarisation with the IOPI is provided. Further investigation to reduce sources of variability in tongue endurance measurements is warranted.Implications for RehabilitationExamination of tongue strength is a frequent component of the clinical assessment of swallowing by speech-language pathologists.Frailty is a term used to describe the condition of people who have lost functional abilities and are likely to deteriorate further, and is common in older age.Tools that can reliably measure muscle strength in an elderly population are valuable.The IOPI is reliable for the measurement of tongue and hand strength in an elderly population.