Tongue Pressure Measurement Research Articles

Investigation of the relationship between videofluoroscopic examination and tongue pressure using a balloon-type device in acute stroke patients

Background: Swallowing dysfunction caused by stroke is a risk factor for aspiration pneumonia. Tongue pressure measurement is a simple and noninvasive method for predicting the risk of pneumonia (Nakamori et al. PLOS ONE, 2016).

English

The tongue is a muscular hydrostat which is a part of oral cavity. The interaction of tongue with palate is essential for articulation of speech and swallowing of food. Patients with neurological disorders have impaired speech and swallowing problem. In this work, a device is envisioned to provide a non-invasive rehabilitation aid for speech and swallowing disorders. The proposed device serves as both diagnostic and therapeutic tool. The parameters of the proposed device are tongue pressure measurement and tongue color detection along with neuromodulation stimulator (tongue stimulator – therapeutic aid). The output, which is a waveform (tongue pressure) and an image (tongue color) are transmitted wirelessly outside the oral cavity to the computer. This device is used to investigate and quantify the degree of tongue disorder. Periodic rehabilitation therapies along with the proposed device, increases the chances of recovery of functional tongue disorders by 50% within a short interval of time.

Change in tongue pressure in patients with head and neck cancer after surgical resection.

Tongue pressure is reportedly associated with dysphagia. This study investigated relationships among characteristics of head and neck cancer, tongue pressure and dysphagia screening tests performed in patients with head and neck cancer during the acute phase after surgical resection. Fifty-seven patients (36 men, 21 women; age range 26-95years) underwent surgical resection and dysphagia screening tests (Repetitive Saliva Swallowing Test, Water Swallowing Test, Modified Water Swallowing Test and Food Test) and pre- and postoperative measurement of tongue pressure at 5 time points (preoperatively, and 1-2weeks and 1, 2, and 3months postoperatively). Progression of cancer (stage), tracheotomy, surgical reconstruction, chemotherapy, radiotherapy and neck dissection were factors associated with postoperative tongue pressure. Data were analyzed by linear mixed-effect model, Spearman correlation coefficient and receiver operating characteristic (ROC) curve. Tongue pressure was significantly reduced 1-2weeks after surgery, and recovered over time. Changes in tongue pressure were significantly associated with stage, radiotherapy and reconstruction. All screening tests showed a significant relationship with tongue pressure. Analysis of ROC and area under the effect curve suggested that a tongue pressure of 15kPa can be used as a cut-off value to detect dysphagia after surgery for head and neck cancer. Our results suggest that tongue pressure evaluation might offer a safe, useful and objective tool to assess dysphagia immediately postoperatively in patients with head and neck cancer.

Electromyographic analysis of hyoid muscles during tongue pressure measurement

Electromyographic analysis of hyoid muscles during tongue pressure measurement

Dysphagia in Multiple System Atrophy of Cerebellar and Parkinsonian Types

Objective: This study aimed to examine the relationship between dysphagia and activities of daily living (ADL) in patients with multiple system atrophy (MSA), and to characterize dysphagia in patients with the cerebellar (MSA-C) and parkinsonian(MSA-P) types. Methods: Sixty-one MSA patients (25 males, 36 females; 40 MSA-C, 21 MSA-P; mean age, 66.3 ± 11.0) were recruited. ADL was assessed on the Barthel index. They underwent tongue pressure measurements and videofluoroscopy (VF) by swallowing barium gelatin jelly. We measured the range of tongue root and mandibular movements during oropharyngeal transit time and used the functional dysphagia scale to rate the oral and pharyngeal stages with the VF images. Results: Significant correlations were found between the ADL and the dysphagia scores (R=−0.654, p<0.001), the ADL score and the tongue pressure (R=0.600, p<0.001), and the dysphagia scores and the tongue pressure (R= −0.679, p<0.001), in the 61 patients. In addition, the oropharyngeal transit time and the tongue pressure in the MSA-C group (R=−0.457, p=0.005), the tongue root and mandibular movements and the tongue pressure in the MSA-P group (R=0.458, p=0.040; R=0.538, p=0.016; respectively) were significantly correlated. Furthermore, the MSA-P group showed a significantly longer oropharyngeal transit time than the MSA-C group (p=0.049). Conclusion: These results suggest a correlation between the degree of dysphagia and deterioration in ADL in MSA patients. MSA-P patients tended to experience problems with propelling a bolus through the oropharynx, whereas MSA-C patients incompletely form a bolus in the oral phase.

The pattern of tongue pressure against the palate during articulating glossal sounds in normal subjects and glossectomy patients.

The purpose of the present study was to measure tongue pressure with the aim of characterizing the pattern of linguopalatal contact during articulating glossal sounds in normal subjects and glossectomy patients. Tongue pressures against the palate were evaluated in 13 normal subjects and 5 glossectomy patients by using three parameters: the duration from the onset of linguopalatal contact to the time of maximum pressure, the maximum pressure, and anterior posterior ratio of the maximum pressure. Three glossal sounds, [ti], [t [symbol: see text] i], and [[symbol: see text] i], which have tendency of mishearing in glossectomy patients, were selected for test sounds. A unique characteristic was demonstrated in normal subjects. The score of the maximum pressure showed an apparent order among the three sounds, while the durations revealed the opposite order. Anterior posterior ratio of the maximum pressure also showed some relationship among three sounds. In glossectomy patients, these characters were not found. The loss of tongue volume or deterioration of tongue mobility causes these results.

Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements.

Swallowing dysfunction caused by stroke is a risk factor for aspiration pneumonia. Tongue pressure measurement is a simple and noninvasive method for evaluating swallowing dysfunction. We have hypothesized that low tongue pressure may be able to predict pneumonia occurrence in acute stroke patients. Tongue pressure was measured using balloon-type equipment in 220 acute stroke patients. The modified Mann Assessment of Swallowing Ability (MASA) score was evaluated independently on the same day. Tongue pressure was measured every week thereafter. An improvement in tongue pressure was observed within the first 2 weeks. Receiver operating curve analysis was performed to determine the ability of tongue pressure to predict modified MASA score <95, which suggests swallowing dysfunction. The optimal cutoff for tongue pressure was 21.6 kPa (χ2 = 45.82, p<0.001, sensitivity 95.9%, specificity 91.8%, area under the curve = 0.97). The tongue pressure was significantly lower in patients with pneumonia than in those without pneumonia. Using a Cox proportional hazard model for pneumonia onset with a cutoff tongue pressure value of 21.6 kPa and adjustment for age, sex, and National Institutes of Health Stroke Scale score at admission, the tongue pressure had additional predictive power for pneumonia onset (hazard ratio, 7.95; 95% confidence interval, 2.09 to 52.11; p = 0.0013). In the group with low tongue pressure, 27 of 95 patients showed improvement of tongue pressure within 2 weeks. Pneumonia occurred frequently in patients without improvement of tongue pressure, but not in patients with improvement (31/68 and 2/27, p<0.001). Tongue pressure is a sensitive indicator for predicting pneumonia occurrence in acute stroke patients.

Measuring inside your mouth! Measurement approaches, design considerations, and one example for tongue pressure monitoring

The tongue is an important muscular organ, and its interaction with the hard palate is fundamental during speech and deglutition (the act or process of swallowing). For example, typical complications of cerebrovascular diseases are speech and deglutition disorders due to limited range of motion and tongue weaknesses. Different measurement approaches of these limitations are described in the literature. The development of low-invasive measuring systems is currently considered a priority. In this paper, we describe different approaches, design considerations, and one example: a new implantable intraoral device that we developed to measure tongue pressure [1]. This paper was first submitted to the IEEE MeMeA Symposium 2014 (© 2014 IEEE, in Proc. IEEE MeMeA, used with permission, [1].) This new device measures tongue pressure on the hard palate directly inside the oral cavity and transmits the data via a wireless link. Since no cable links the pressure sensors inside the oral cavity and the readout unit is located outside of the mouth, this device is low invasive, which represents an important feature for this type of device. We describe a typical experimental setup to study the mechanical behavior of these devices in the laboratory and specific test protocols. The field of application of these devices is the treatment of patients with deglutition and speech disorders or with gnathological (related to the entire chewing apparatus) and dental disturbances.

A Study of Healthy Adults' Oro-lingual Effort During Swallowing Using OroPress, A New Portable Wireless Measurement Tool.

OroPress is a new, low profile, portable, wireless tool that enables stable measurement of tongue pressure during isometric ('pushing') tasks and, more importantly, during swallowing. Using this tool, a pressure-time product, the OroPress Absolute (OPA) parameter, has been developed as a representative measure of lingual effort during swallowing. In a sample of 57 adults aged 20-80+ years, of both sexes and without dysphagia, tongue-palate contact pressures generated while swallowing 5ml, 10ml of water and 5ml custard, were recorded using OroPress. Data were examined for effects of gender, age and bolus condition (consistency, volume). OPA was tested for stability of measure and then correlated with the criterion standard, peak pressure recorded when swallowing (PMax(SW)). Swallowing pressures (PMax(SW), OPA) were positively correlated with bolus viscosity. No significant age and gender differences were found. Excellent stability of measure (test, re-test reliability) was demonstrated and OPA was positively correlated with PMax(SW). OroPress produces valid, reliable and reproducible measurements and improved accuracy of oro-lingual pressure measurement during swallowing. With such a tool, interventions/therapy can be proactive and principled as outcomes are better validated. To enhance specificity of intervention, measurement parameters need to reflect the pressure and temporal qualities of swallow function. OPA has the potential to describe differences in effort made, and ability to sustain pressures, in adults without dysphagia. The results of these studies will enable more accurate examination of the oral phase of swallowing as we establish this highly accurate sensor as a criterion standard for oro-lingual pressure measurement in clinical populations.

A Piezoresistive Sensor for Measuring Tongue Pressure

Dysphagia is common after a cerebral vascular accident (or stroke), and it seriously affects the prognosis. Timely diagnosis in clinical, scientific assessment of dysphagia and correct treatment given to patients are essential. This study is aimed to develop a sensor for measuring tongue pressure during swallowing or other times, and to help doctors make a scientific assessment of dysphagia grade. It is a kind of miniaturization of piezoresistive pressure sensor with an outer diameter of 10mm and a thickness of 3mm. A calibration and data acquisition ARM system is designed, which can continuously record tongue pressure in 8 hours. The sensor has a detection range from 0 to 30kPa, and the measurement error can be controlled in 5%.

Effects of Tongue Strength Training and Detraining on Tongue Pressures in Healthy Adults.

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. Ten young healthy volunteers (21-35 years) were participated in this study. Participants received 8-week tongue strengthening exercise 3 days a week with each session lasting 30 min. Measurement of tongue pressure and tongue strengthening exercise were administrated using Iowa Oral Performance Instrument (IOPI). Training intensity was applied at 60 and 80% of maximal tongue pressure for the first week and the remainder, respectively. Following completion of 8-week training, 28 weeks of detraining period was continued. Training increased tongue tip pressure, tongue base pressure, and tongue pressure during effortful swallowing above pre-training values (p < 0.05). After 28-week detraining, all tongue variables were significantly lower than after 8-week training (p < 0.05) but remained significantly higher than pre-training levels (p < 0.05). These findings demonstrate that high-intensity tongue strengthening exercise can improve tongue pressures. However, training effects were diminished gradually during detraining period. Thus, maintenance programs after strengthening exercise would be required for prolonging training effects.

The study of tongue pressure during swallowing liquid in healthy adults

To investigate the tongue pressure (TP) produced by tongue-hard palate contact in the process of normally swallowing liquid in healthy adults. Thirteen adult male subjects were recruited to perform a single swallow of 5 ml water when sitting with upright position. The tongue pressure sensor sheet was used to monitor TP as a result of tongue-hard palate approximatation in the anteriomedian, midmedian, posteriomedian and circumferential parts, and the swallowing sound was recorded by microphone. The temporal sequence of TP at each measured part was obtained after setting the swallowing sound as the reference time. Also, the total duration, pre-peak duration, post-peak duration, maximum magnitude and integrated value of TP were recorded and compared among the measured parts. TP was produced from anterior to posterior along the midline of hard palate during normal swallowing of water [Ch1: (-0.40 ± 0.22) s, Ch2: (-0.36 ± 0.21) s, Ch3: (-0.24 ± 0.18) s], with the circumferential TP [Ch4: (-0.38 ± 0.23) s, Ch5: (-0.40 ± 0.23) s] occurring nearly to the anteriomedian one (P > 0.05). Before the swallowing sound (P < 0.05), TP at each part reached a peak synchronously [Ch1: (-0.12 ± 0.24) s, Ch2: (-0.16 ± 0.22) s, Ch3: (-0.13 ± 0.21) s, Ch4: (-0.16 ± 0.23) s, Ch5: (-0.17 ± 0.23) s] in a rapid manner (P > 0.05), then decreased gradually until disappeared simultaneously [Ch1: (0.32 ± 0.23) s, Ch2: (0.27 ± 0.21) s, Ch3: (0.23 ± 0.16) s, Ch4: (0.33 ± 0.31) s, Ch5: (0.33 ± 0.29) s] (P > 0.05) after the swallowing sound (P < 0.05). The TP related parameters (the total duration of TP:Ch1: (0.72 ± 0.20) s, Ch2: (0.63 ± 0.16) s, Ch3: (0.47 ± 0.17) s, Ch4: (0.70 ± 0.35) s, Ch5: (0.73 ± 0.29) s; the pre-peak duration of TP: Ch1: (0.28 ± 0.21) s, Ch2: (0.20 ± 0.16) s, Ch3: (0.12 ± 0.10) s, Ch4: (0.21 ± 0.22) s, Ch5: (0.23 ± 0.21) s; the post-peak duration of TP: Ch1: (0.44 ± 0.23) s, Ch2: (0.43 ± 0.18) s, Ch3: (0.36 ± 0.18) s, Ch4: (0.49 ± 0.25) s, Ch5: (0.50 ± 0.23) s; the maximum magnitude of TP: Ch1: (13.80 ± 7.73) kPa, Ch2: (12.40 ± 6.51) kPa, Ch3: (10.26 ± 7.15) kPa, Ch4: (12.16 ± 5.38) kPa, Ch5: (13.08 ± 5.05) kPa; the integrated value of TP: Ch1: (4.99 ± 3.69) kPa×s, Ch2: (4.25 ± 2.13) kPa×s, Ch3: (2.88 ± 1.87) kPa×s, Ch4: (4.32 ± 3.47) kPa×s, Ch5: (4.63 ± 2.49) kPa×s were significantly smaller in the posteriomedian part among all the five parts measured. No laterality was found in TP produced at the circumferential parts of the hard palate (P > 0.05). The TP at each part coordinates precisely during swallowing. The effective measurement of TP by tongue pressure sensor sheet will facilitate the evaluation of oral swallowing and the diagnosis of dysphagia simply and non-invasively.

Effect of the tongue rotation exercise training on the oral functions in normal adults - Part 1 investigation of tongue pressure and labial closure strength.

The aim of this study was to investigate the effect of the tongue rotation exercise training on the oral functions using the measurement of maximum tongue pressure (MTP) and labial closure strength (LCS) in normal adults. In experiment 1, the differences in MTP and LCS at the measurement point for both groups with and without tongue rotation exercise training were examined. We instructed subjects to perform the tongue rotation exercise for 2 months. We measured MTP and LCS at the point before training and at the points of 1 and 2 months after the beginning of training. In experiment 2, the changes of MTP and LCS based on the sex differences and the measurement points in training were examined. We instructed subjects to perform the tongue rotation exercise for 3 months, and measured MTP and LCS at the point before training and at the points of 2 weeks and 1, 2 and 3 months after the beginning of training. The results of experiment 1 showed MTP and LCS increased with the progress of continuous training. The results of experiment 2 showed MTP and LCS were always higher in men than in women and increased significantly at 2 weeks of training in both sexes (P < 0.01). These results might be suggested that the tongue rotation exercise training was effective for the recovery of the activity of the stomatognathic system.

Relationship between the nutritional status and the oral function among community-dwelling dependent elderly persons

We herein examined the relationship between the nutritional status and the oral function among community-dwelling dependent elderly persons. The subjects included 218 community-dwelling dependent elderly persons. The data were collected via questionnaires, including information regarding age, sex, the level of care required, nutritional status and swallowing function. We used the Mini Nutritional Assessment-Short Form (MNA-SF) to measure the nutritional status and the Dysphagia Risk Assessment for the Community-dwelling Elderly (DRACE) to evaluate the swallowing function. The tongue pressure and the labial closure force were measured using a tongue pressure measurement system (JMS Co. Ltd., Hiroshima, Japan) and the Lip de Cum (Cosmo-Instruments Co, Ltd, Tokyo, Japan). The mean MNA-SF score was 10.07±2.58. The mean DRACE score was 4.39±3.80. The mean tongue pressure was 23.89±10.61 kPa. The mean labial closure force was 10.17±6.04 N. The results of bivariate regression analyses showed that there was a poor correlation between the MNA-SF and the DRACE, tongue pressure and labial closure force. Furthermore, the multiple regression analysis with the MNA-SF as the dependent variable revealed a correlation between the DRACE and labial closure force (p<0.01, R(2)=0.02). Our results suggest that the nutritional status is significantly related to the swallowing function and labial closure force among community-dwelling dependent elderly persons.

Caracterização da pressão da língua em idosos

Objetivo Caracterizar a pressão da língua em idosos. Métodos Estudo transversal, com a participação de 45 idosos, de 61 a 96 anos, sendo 34 (75,6%) do gênero feminino e 11 (24,4%) do masculino, sem distúrbios neurológicos e cognitivos, sem histórico de câncer de cabeça e pescoço e de procedimento radioterápico. Consistiu na aplicação de questionário, com registro da presença ou ausência de queixa de problemas na deglutição, seguido da avaliação miofuncional orofacial, enfocando a mobilidade e tensão de língua. Para a mensuração da pressão da língua, foi utilizado o Iowa Oral Performance Instrument (IOPI). A análise dos dados foi descritiva, com nível de significância de 5%. Resultados A média do pico pressórico foi de 44,6 KPa (±16), com os valores mínimo e máximo entre 9 e 88 KPa. Houve correlação moderada negativa entre pico pressórico e idade. Os longevos apresentaram a menor média de pico pressórico e inferior ao padrão de normalidade. Houve diferença entre a média de pico pressórico e uso de próteses, tensão de língua e mobilidade de língua no estalo. Conclusão Houve diminuição moderada do pico pressórico da língua com o aumento da idade e redução pressórica com o decréscimo da tensão da língua e de sua mobilidade no estalo. Em contrapartida, os valores de pico foram maiores nos idosos que utilizam próteses dentárias, quando comparados aos que destas não fazem uso.

Tongue pressure in patients with tongue cancer resection and reconstruction.

Assessment of tongue function following tongue reconstruction is important to evaluate patient status. To assess tongue function in patients who had undergone tongue reconstruction, the surgical team used a simple, hand-held tongue pressure measurement device to measure tongue power. Tongue power of 30 patients (25 males, 5 females; average age: 53.6±15.0 years) was calculated using a hand-held tongue pressure measurement device, six months postoperation. The defects were classified into minimal glossectomy (MG) (n=8), near-half partial glossectomy of the mobile tongue (PG) (n=5), hemi-glossectomy (HG) (n=4), more than half partial glossectomy of the mobile tongue (SG-MT) (n=7), and subtotal glossectomy (SG) (n=6). As seen in other tongue assessments, a simple articulatory test, food evaluation, and speech intelligibility assessment were also performed; resulting correlations were statistically calculated using tongue pressure values. The tongue pressure values were 94.0±14.5% in MG, 48.5±13.2(a) % in PG, 40.4±18.7(a) % in HG, 19.3±7.7(a,b) % in SG-MT, and 15.3±5.6(a,b) % in SG (a: <0.05 vs. MG, b: <0.05 vs. PG). The Pearson r was 0.77, 0.67, and 0.74 when correlated with simple articulatory test, food evaluation, and speech intelligibility assessment, respectively. Tongue pressure measurement in patients with tongue cancer resection and reconstruction facilitated determination of patients' tongue function status.

Tongue Pressure Modulation for Initial Gel Consistency in a Different Oral Strategy

BackgroundIn the recent hyper-aged societies of developed countries, the market for soft diets for patients with dysphagia has been growing and numerous jelly-type foods have become available. However, interrelationships between the biomechanics of oral strategies and jelly texture remain unclear. The present study investigated the influence of the initial consistency of jelly on tongue motor kinetics in different oral strategies by measuring tongue pressure against the hard palate.MethodsJellies created as a mixture of deacylated gellan gum and psyllium seed gum with different initial consistencies (hard, medium or soft) were prepared as test foods. Tongue pressure production while ingesting 5 ml of jelly using different oral strategies (Squeezing or Mastication) was recorded in eight healthy volunteers using an ultra-thin sensor sheet system. Maximal magnitude, duration and total integrated values (tongue work) of tongue pressure for size reduction and swallowing in each strategy were compared among initial consistencies of jelly, and between Squeezing and Mastication.ResultsIn Squeezing, the tongue performed more work for size reduction with increasing initial consistency of jelly by modulating both the magnitude and duration of tongue pressure over a wide area of hard palate, but tongue work for swallowing increased at the posterior-median and circumferential parts by modulating only the magnitude of tongue pressure. Conversely, in Mastication, the tongue performed more work for size reduction with increasing initial consistency of jelly by modulating both magnitude and duration of tongue pressure mainly at the posterior part of the hard palate, but tongue work as well as other tongue pressure parameters for swallowing showed no differences by type of jelly.ConclusionsThese results reveal fine modulations in tongue-palate contact according to the initial consistency of jelly and oral strategies.

Effects of varying fixed lingual apex positions on tongue pressure during straw drinking

We investigated the impact of tongue-thrusting on lingual pressure during fluid intake with a straw. In this study, 12 healthy young dentate individuals (two women and 10 men; 19-33 years) were instructed to drink 15 mL of water with a regular drinking straw at 37 °C, when indicated by the investigator. Participants drank after adjusting tongue position to one of the following patterns: (i) Holding the tip of the straw between the lips (Normal Position: NP), (ii) Sticking out the tongue to the vermilion zone of the lower lip and inserting the straw 1 cm past the front teeth (Tongue-thrusting Position: TP). Five recordings were conducted for each participant in a randomised order. To measure tongue pressure during swallowing, a specially designed 0.1-mm thick sensor sheet (Nitta, Osaka, Japan) with a tactile system for measurement of pressure distribution (I-SCAN; Nitta) was used. Duration, maximal magnitude and integrated value of tongue pressure were analysed based on the wave of tongue pressure recorded while water was swallowed. Magnitude, duration and integrated value of tongue pressure were significantly lower in TP than in NP at the median line (Ch1-3). Magnitude and integrated value of tongue pressure at the lateral part of the tongue (Ch5) were significantly lower in TP than in NP. When duration, maximal magnitude and integrated values were compared by channel, no significant differences were observed in NP, but a significant difference was found between Ch3 and the lateral areas Ch4/Ch 5 in TP. When the tongue was thrust forward, movement dynamics of the entire tongue changed and influenced contact between the tongue and palate during liquid intake with a straw. The impact was noticeably weaker on the median line than in lateral areas.

舌圧・喉頭運動計測システムによるパーキンソン病患者の嚥下動態評価

舌圧・喉頭運動計測システムによるパーキンソン病患者の嚥下動態評価

Tongue pressure as a novel biomarker of spinal and bulbar muscular atrophy

This study aimed to explore the reliability and validity of tongue pressure measurement as a quantitative evaluation of swallowing function in patients with spinal and bulbar muscular atrophy (SBMA). This study enrolled 47 genetically confirmed patients with SBMA and 38 age- and sex-matched healthy controls. In both groups we measured tongue pressure using an intraoral pressure probe and assessed questionnaires that evaluated swallowing functions. We then analyzed the relationship between tongue pressure, functional scales, and the muscle weakness of other regions. Levels of tongue pressure were decreased in patients with SBMA within 3 years from the onset of the disease compared to healthy controls (SBMA 15.3 ± 6.4 kPa; healthy controls 37.3 ± 9.6 kPa; p < 0.001). Test-retest analysis showed a high reliability in patients with SBMA (intraclass correlation coefficient = 0.986). Tongue pressure showed a strong correlation with bulbar-related functional scales. Decrease of tongue pressure was detected in patients who reported no subjective dysphagia, and repetition of swallowing compensated for tongue weakness in such subjects. In patients with SBMA, tongue pressure more strongly correlates with the strength of pharyngeal, neck, and upper limb musculatures than with that of the lower limbs. Tongue pressure measurement is reliable and reflects swallowing function in patients with SBMA. The muscle strength of the tongue appears to decrease in SBMA before the awareness of subjective dysphagia, suggesting that tongue pressure measurement is a novel biomarker of SBMA and is applicable to early-stage detection.