Tongue-palate Pressure Research Articles

Comparison of the Tongue-Palate Pressure Patterns According to the Tongue Pressure in Community-Dwelling Older Adults

Comparison of the Tongue-Palate Pressure Patterns According to the Tongue Pressure in Community-Dwelling Older Adults

Study of tongue-palate pressure patterns during the hold phase in the production of French denti-alveolar and velar stops

ABSTRACT The hold phase of the stop consonants is crucial for a successful production of the release and the acoustic burst. Concurrently, it is also associated with weak acoustic energy and minimal movement, so that conventional acoustic and kinematic approaches are not relevant to investigate motor control. This paper presents an innovative experimental method to study speech motor control during this phase, based on meticulous measurement of the time variation of the mechanical pressure exerted by the tongue against the palate and also characterizing tongue–palate interaction. The concept is based on using miniature transducers with enhanced response characteristics inserted in different locations of the complete denture of edentulous subjects without perturbing the articulation. The study was done with a French-speaking adult whose maxillary denture was duplicated and mounted with six strain gauge transducers. The experiment was done with denti-alveolar and velar stop consonants with two vowel contexts. The results illustrate the potential of such device to analyse speech motor control when contact constrains tongue movements.

The influence of tongue strength on oral viscosity discrimination acuity.

In this article, the relationship between tongue strength and the ability to discriminate small differences in liquid viscosity during oral processing is explored. Given that tongue strength declines with age in healthy adults and is also reduced in individuals with dysphagia, it is interesting to determine whether reduced tongue strength might contribute to difficulties in evaluating liquid viscosity during the oral stage of swallowing. Using an array of mildly to moderately thick xanthan-gum thickened liquids, this experiment failed to find any evidence that reductions in tongue strength influence oral viscosity discrimination acuity.

A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia.

The objective of this study was to compare the outcomes of two tongue resistance training protocols. One protocol ("tongue-pressure profile training") emphasized the pressure-timing patterns that are typically seen in healthy swallows by focusing on gradual pressure release and saliva swallowing tasks. The second protocol ("tongue-pressure strength and accuracy training") emphasized strength and accuracy in tongue-palate pressure generation and did not include swallowing tasks. A prospective, randomized, parallel allocation trial was conducted. Of 26 participants who were screened for eligibility, 14 received up to 24 sessions of treatment. Outcome measures of posterior tongue strength, oral bolus control, penetration-aspiration and vallecular residue were made based on videofluoroscopy analysis by blinded raters. Complete data were available for 11 participants. Significant improvements were seen in tongue strength and post-swallow vallecular residue with thin liquids, regardless of treatment condition. Stage transition duration (a measure of the duration of the bolus presence in the pharynx prior to swallow initiation, which had been chosen to capture impairments in oral bolus control) showed no significant differences. Similarly, significant improvements were not seen in median scores on the penetration-aspiration scale. This trial suggests that tongue strength can be improved with resistance training for individuals with tongue weakness following stroke. We conclude that improved penetration-aspiration does not necessarily accompany improvements in tongue strength; however, tongue-pressure resistance training does appear to be effective for reducing thin liquid vallecular residue.

Electromyography of Swallowing with Fine Wire Intramuscular Electrodes in Healthy Human: Amplitude Difference of Selected Hyoid Muscles

Few studies have examined the intensity of muscle activity during swallowing in healthy humans. We examined selected hyoid muscles using fine wire intramuscular electromyography (EMG) during swallowing of four food consistencies. Thirteen healthy adults were studied using videofluorography and EMG of the anterior belly of digastric (ABD), geniohyoid (GH), sternohyoid (SH), and masseter (MA; surface electrodes) while ingesting thin liquid (three trials) and solid food of three consistencies (banana, tofu, and cookie, three trials each). After rectification, integration, and normalization, peak EMG amplitudes for each muscle in each trial were measured. Hyoid displacements were measured in two dimensions. Data were analyzed using repeated measures ANOVA with Bonferroni correction. GH had the highest adjusted amplitude for both solids and liquid. For MA and ABD, amplitude was highest with triturated cookie. For ABD, amplitude was lowest with liquid. There were no significant food consistency effects for GH or SH. Hyoid displacements were greatest for cookie and the lowest for liquid. EMG amplitude varied with initial food consistency. The high peak EMG amplitude of GH is consistent with its essential role in opening the upper esophageal sphincter. High MA amplitude with hard solid foods is likely due to the higher tongue-palate pressure with triturated solids. The higher ABD amplitude with solid food is associated with greater hyoid displacement. These findings support the existence of a central pattern generator that modifies the level of muscle activity during pharyngeal swallowing in response to input from mechanoreceptors in the oral cavity.

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.

Barium Versus Nonbarium Stimuli: Differences in Taste Intensity, Chemesthesis, and Swallowing Behavior in Healthy Adult Women

The authors examined the impact of barium on the perceived taste intensity of 7 different liquid tastant stimuli and the modulatory effect that these differences in perceived taste intensity have on swallowing behaviors. Participants were 80 healthy women, stratified by age group (<40; >60) and genetic taste status (supertasters; nontasters). Perceived taste intensity and chemesthetic properties (fizziness; burning-stinging) were rated for 7 tastant solutions (each prepared with and without barium) using the general Labeled Magnitude Scale. Tongue-palate pressures and submental surface electromyography (sEMG) were simultaneously measured during swallowing of these same randomized liquids. Path analysis differentiated the effects of stimulus, genetic taste status, age, barium condition, taste intensity, and an effortful saliva swallow strength covariate on swallowing. Barium stimuli were rated as having reduced taste intensity compared with nonbarium stimuli. Barium also dampened fizziness but did not influence burning-stinging sensation. The amplitudes of tongue-palate pressure or submental sEMG did not differ when swallowing barium versus nonbarium stimuli. Despite impacting taste intensity, the addition of barium to liquid stimuli does not appear to alter behavioral parameters of swallowing. Barium solutions can be considered to elicit behaviors that are similar to those used with nonbarium liquids outside the assessment situation.

Effect of the Effortful Swallow and the Mendelsohn Maneuver on Tongue Pressure Production against the Hard Palate

Although effortful swallow and the Mendelsohn maneuver are commonly used in dysphagia rehabilitation, little is known about their effects on tongue-palate pressure production. The purpose of this study was to investigate the effects of effortful swallow and the Mendelsohn maneuver on tongue pressure production. Fourteen healthy volunteers (10 men, 4 women; age range=21-41years) participated. Tongue pressures during dry swallow, water swallow, effortful swallow, and the Mendelsohn maneuver were measured using a sensor sheet system with five measurement points on the hard palate. Sequential order, duration, maximal magnitude, and the integrated value of tongue pressure at each measurement point were compared among the four tasks. Onset of tongue pressure at the posterior-circumferential parts occurred first in the Mendelsohn maneuver; that at the anterior-median part was earlier than at other parts in the effortful swallow. At all measurement points, tongue pressure duration was significantly longer in the Mendelsohn maneuver than in other tasks. Effortful swallow was most effective in increasing tongue pressure. The integrated value of tongue pressure at the posterior-circumferential parts in the Mendelsohn maneuver and at the median parts in the effortful swallow showed a tendency to increase. These results suggest that tongue pressure increases along a wide part of the hard palate in effortful swallow because the anchor of tongue movement is emphasized at the anterior part of the hard palate. The Mendelsohn maneuver provides prolonged and accentuated tongue-palate contact at the posterior-circumferential parts, which might be important for hyoid-laryngeal elevation during swallowing.

Optimal Approaches for Measuring Tongue-Pressure Functional Reserve

Tongue-palate pressure is a parameter of considerable interest in the field of dysphagia. Maximum isometric tongue-palate pressures (MIPs) decline in healthy aging and in dysphagia. Functional reserve (FR) is the difference between MIPs and swallowing pressures. Reduced FR is thought to constitute a risk for developing functional swallowing impairments. We compare different approaches for calculating FR and recommend an optimal approach. Tongue-palate pressure data were collected from 78 healthy adults (40 < age 40; 38 > 60) during anterior and posterior MIPs, regular (RESS) and effortful (ESS) saliva swallows, and water swallows (4 repetitions per task). Six different measures of reserve were calculated using maximum anterior MIPs or ESS pressures at the top, and mean or maximum RESS or water swallow pressures at the bottom of the range. Correlations with age and MIPs were explored to confirm suitability for measuring FR. The impact of normalization to maximum MIP range was explored. We conclude that an optimal measure of FR involves the comparison of maximum MIP with mean saliva swallowing pressures. This parameter declines with age, but when normalized to an individual's MIP range, the relationship is no longer evident. This suggests that FR does not necessarily decline in healthy aging.

Tongue–pressure and hyoid movement timing in healthy liquid swallowing

It was hypothesized that tongue-palate pressure generation might directly facilitate hyoid movement in swallowing through the anatomical connections of the extrinsic tongue muscles. If true, non-invasive measures of tongue-palate pressure timing might serve as a proxy measure of hyoid excursion. The timing relationships between events in the tongue-palate pressure and hyoid movement profiles during water and nectar-thick liquid swallowing in healthy adults were explored. Concurrent intra-oral manometry and submental B-mode midsagittal ultrasound were recorded. It was determined that there is no obligate sequence in the onsets, or offsets, of tongue-palate pressures and hyoid excursion. Timing lags (either of hyoid movement lagging tongue-palate pressures or vice versa) fell within 0.5 s, on average. It is concluded that tongue-palate pressure generation and hyoid movement are separate phenomena in the swallowing sequence and that non-invasive measures of tongue-pressure timing cannot be used reliably as proxy measures of hyoid movement timing.

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.

Pressure profile similarities between tongue resistance training tasks and liquid swallows

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.

Tongue Pressure Modulation During Swallowing: Water Versus Nectar-Thick Liquids

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. 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. 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. 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.