Tongue Strength Research Articles

Effect of tongue‐strengthening exercises on tongue strength and swallowing‐related parameters in chronic radiation‐associated dysphagia

Radiation-associated dysphagia (RAD) is highly prevalent in head and neck cancer (HNC) patients, with insufficient tongue strength (TS) as a characteristic of this disabling complication. The effects of tongue-strengthening exercises (TSE) on TS, swallowing, and quality of life (QoL) have not been studied in this population. A prospective phase 2 study using an 8 weeks during TSE protocol was carried out in 15 patients with chronic RAD. Outcome parameters were maximal isometric pressure (MIP), TS during swallowing (Pswal), swallowing function, and QoL. All parameters were evaluated at baseline, after 4 and 8 weeks of training, and 4 weeks after the last training session. MIP increased significantly, without detraining effects. Pswal did not increase significantly, but relevant effect sizes were measured. Swallowing function ameliorated, but did not result in increased functional oral intake, self-reported outcome or QoL. TSE in patients with RAD results in increased strength and swallowing function.

Biomechanical Biomarkers of Tongue Impairment During Swallowing in Persons Diagnosed with Amyotrophic Lateral Sclerosis.

The impact of tongue dysfunction on deglutition in persons diagnosed with amyotrophic lateral sclerosis (ALS) is not well understood. This information is needed to improve our understanding of the mechanisms of swallowing impairment, for identifying risk factors of dysphagia, and for establishing impairment-specific treatments aimed at slowing the loss of swallow function. The goals of this study were to determine the relation between biomechanical measures of oral tongue movements using electromagnetic articulography (EMA) and measures of swallow physiology, swallow safety and efficiency, and self-reported swallowing function. Participants were diagnosed with ALS by a neurologist following the El Escorial Criteria from the World Federation of Neurology. Twelve participants underwent (1) EMA to derive biomechanical measures of the tongue, (2) videofluoroscopic evaluation to measure swallow physiology, safety, and efficiency, and (3) maximal tongue strength testing using the Iowa Oral Pressure Instrument (IOPI). Participants completed self-reported functional assessments. Spearman's rank correlations assessed for associations between lingual biomechanics and swallowing physiology, swallow safety and efficiency, and self-reported bulbar function. Results demonstrated strong associations between biomechanical and swallowing physiology, swallow safety, and self-reported measures. Notably, swallowing safety during thin liquid intake was associated with tongue speed (r = - 0.7, p < 0.05) and range of motion (r = - 0.71, p < 0.05), and swallowing safety during puree intake was associated with tongue strength (r = - 0.69, p < 0.05). Our findings underscore the importance of tongue movements on swallowing physiology and safety, help improve our understanding of mechanisms of swallowing impairment, and highlight a potential clinical tool to index bulbar impairment.

Criteria to assess tongue strength for predicting penetration and aspiration in patients with stroke having dysphagia.

Instrumental assessments are typically used to assess swallowing function in stroke patients with dysphagia, but these tests cannot be used for all patients or for continuous monitoring. Hence, an adjunctive method is necessary for screening patients who may require such tests. The purpose of this study was to analyze tongue strength with respect to the presence or absence of penetration and aspiration, using instrumental assessments, to provide a basis for clinical decision-making. Prospective observational study. University Hospitals in Gwangju, South Korea. Seventy-nine subjects with dysphagia underwent video fluoroscopic swallowing study (VFSS) and Iowa Oral Performance Instrument evaluations. VFSS results were assessed for the presence of penetration and aspiration, according to the penetration-aspiration scale. Receiver operating characteristic curve analysis was conducted with tongue strengths based on penetration and aspiration. During the swallowing of pureed, liquid, and solid foods, cut-off values of tongue strength for the anterior and posterior elevation and for the protrusion of tongue were suggested in cases of penetration and aspiration, among patients with dysphagia. These criteria had positive and negative predictive values of 54.6-90.2% and 57.5-96.9%, respectively. This study found that tongue strength has predictive abilities similar to clinical and bedside tests to screen penetration and aspiration in stroke patients with swallowing disorders. Therefore, it is a new screening test that clinical practitioners can choose to reduce the risk of pneumonia caused by post-stroke disorders. As a new screening tool, tongue strength can be combined with other clinical and instrumental assessments to predict penetration and aspiration in stroke patients with dysphagia.

Compartmental Surgery for Oral Tongue Cancer: Objective and Subjective Functional Evaluation.

To assess functional outcomes in patients treated by compartmental tongue surgery (CTS) and reconstruction for advanced oral tongue/floor-of-mouth cancer. Retrospective case series. A retrospective cohort of patients (n = 48) treated by CTS and free flap reconstruction was prospectively evaluated concerning postoperative functional outcomes at different time points (6 months and 1 year). Swallowing was studied by videonasal endoscopic evaluation (VEES) and videofluoroscopy (VFS), testing various food consistencies and grading the results with the Donzelli scale. Speech articulation, lingual strength, and endurance were studied by phone call and Iowa Oral Performance Instrument (IOPI). Subjective tests (EORTC H&N35 and UWQOL) were administered. After 1 year, VEES showed a Donzelli scale of 67% level 1, 23% level 2, and 10% level 3. Vallecular pouch was present in 81% of patients. VFS showed levels 1, 2, and 3 in 42%, 25%, and 33%, respectively, with liquids (L); 48%, 19%, and 33%, with semi-liquids (SL); and 54%, 33%, and 13%, with semi-solids (SS). Vallecular pouch residue was present in 69% with L, 73% with SL, and 87% with SS. The mean number of words recognized at phone call was 56 of 75 (range, 27-74). IOPI showed a mean tongue strength of 19.2 kPa (range, 0-40), and a mean endurance of 16.2 seconds (range, 0-60). CTS does not significantly affect speech. Sub-clinical food aspiration and vallecular pouch are present in a significant proportion of patients, especially when adjuvant treatments are administered. Residual tongue strength is not affected when proper reconstruction is performed. 4 Laryngoscope, 131:E176-E183, 2021.

The influence of training variables on lingual strength and swallowing in adults with and without dysphagia

AbstractBackgroundSwallowing disorders (dysphagia) occur in a large proportion of individuals over the age of 60. The improvement of tongue strength by resistance exercise is postulated to be directly related to lingual‐palatal pressure generation and bolus propulsion into the pharynx during swallowing. To the best of our knowledge, however, there is no evidence‐based discussion evaluating the strength training variables of the tongue for improving tongue strength maximally.MethodsTo solve this problem, we reviewed the relationships between different resistance training variables (i.e. training period, intensity, duration of muscle contraction, volume, and frequency) and the change in muscle strength in the lingual muscle.ResultsOur findings show that tongue strength training may improve anterior and posterior tongue strength in both healthy adults and patients with dysphagia. Anterior and posterior tongue strength gradually increased and did not reach a plateau after at least 8 weeks of training. Data for other variables were insufficient to draw clear conclusions. Available data suggest that a training intensity of 60–100% of maximum tongue strength, a contraction time of 2–3 s, a total number of 90–120 repetitions per day, and a training frequency of three times per week appears to result in an improvement in maximal isometric tongue elevation strength in adults with and without dysphagia.ConclusionsFuture studies are warranted to better determine if there are dose–response relationships in tongue strength training in healthy adults and patients with dysphagia.

Language, speech, and oromotor function in children with Pompe disease

Advances in the treatment of Pompe disease have improved life expectancy and quality of life, but speech and oromotor function remain significantly affected. The purpose of this study was to expand on existing data and present new findings of speech acoustic and physiologic outcomes in Pompe disease. A retrospective analysis was carried out on results of speech, language and oromotor tests carried out in 14 children diagnosed with Pompe disease. The assessment battery included standardized tests of language, picture naming, maximum performance tests, and oromotor resistance tasks. Speech production was scored with respect to intelligibility, hypernasality, and articulatory accuracy. Language delays ranged from mild to severe in 1/3 of the children. Reduced speech intelligibility, disordered articulation, and hypernasality were present in at least 2/3 of the children. Maximum performance tests all fell at least 1 SD below normative means. Significant correlations were identified between maximum phonation time and articulation and between the S/Z ratio and intelligibility. Positive correlations were also found between tongue strength and articulation. Results confirm previous reports of speech and language function in Pompe disease. Clinical acoustic measures provide important insights into the speech deficits in this group of children and suggest possible treatment strategies.

The influence of tongue strength on children's performance in computer games reliant on lingual force generation.

Oral motor exercises, for recovering tongue strength, can be integrated with computer games to increase motivation, especially for treatments in children. The aim of this study was to investigate the influence of tongue strength on motor performance in computer games reliant on lingual force generation. An observational study was carried out at a speech-language pathology outpatient university clinic. Twenty participants (10 with normal tongue strength and 10 with reduced tongue strength) aged 8-13years used an intra-oral joystick controlled by the tongue to play six computer games during which they had to reach targets that appeared on the screen. Motor performance was measured by the number of attempts to score and the time during which the target force was maintained. Tongue motor performance was compared between groups and across directions of tongue movement, resistance force levels, order of target appearance, continuous force application time on the target, age and sex. Children with normal tongue strength had a lower number of attempts to score (P=.014) and maintained the target force for longer periods (P=.002) than those with reduced tongue strength. The performance was better for both groups (a) in the downward direction compared with the performance in other directions, (b) in games with the lowest resistive force level (0.5N) compared to those with other levels of resistive force and (c) in the second and third rounds compared with the first round. There were no gender-related differences in performance. Older participants performed better than younger participants. Tongue strength, direction of movement, force to reach the target, time of continuous force application, order of target appearance and age influenced tongue motor performance.

Decreased Tongue Volume Post Radiation.

To evaluate volume changes within the tongue post chemoradiation therapy (CRT). Retrospective review. Academic Medical Center. Subjects included 19 patients that received CRT as the primary treatment for tonsillar or hypopharynx squamous cell carcinoma. Tongue volumes were calculated by three raters from thin slice computed tomography images collected before treatment and up to 29 months post-CRT. Body mass index (BMI) was also collected at each time point. Inter-rater reliability was high with an ICC of 0.849 (95% CI = 0.773, 0.905). Linear mixed effects modeling showed a mean decrease of 0.45 cm3 (standard error of the mean [SEM] = 0.11) in tongue volume per month post-CRT (P < .001). However, the addition of BMI to the model was significant (χ2 (4) = 25.0, P < .001), indicating that BMI was a strong predictor of tongue volume, with a mean decrease of 1.75 cm3 (SEM = 0.49) in tongue volume per unit decrease in BMI (P < .001) and reducing the post-CRT effect on tongue volume decrease per month to 0.23 cm3 (P = .02). BMI significantly (P < .001) decreased by 0.11 units (SEM = 0.02) per month post radiation. Tongue dysfunction and decreased tongue strength are significant contributors to the dysphagia that patients experience after receiving CRT. In this study, both tongue volume and BMI decreased post-CRT; therefore, BMI could potentially be used as a predictor of tongue volume post-CRT.

Effect of tongue-strengtheningtraining combined with a tablet personal computer game in healthy adults.

Game-based training has been shown to improve behavioural motor learning in various medical fields including rehabilitation. This study aimed to investigate the effects of a tablet PC (personal computer) game-based tongue training on tongue strength, thickness and compliance in healthy adults. This study recruited 30 healthy volunteers. Subjects were randomly assigned to two groups (n=15/group). Group 1 performed game-based tongue training, and group 2 performed tongue resistance training using the Iowa Oral Performance Instrument. Both groups performed the same tongue exercises as follows: frequency (isotonic=30 times×3, isometric=20seconds×3), intensity (70% of 1-repeated maximum contraction) and intervention period (5days for 6weeks). The primary outcomes were tongue muscle strength and thickness. Secondary outcomes were assessed using a 0-to-10 numerical rating self-report scale that included motivation, interest/fun, physical effort and muscle fatigue/pain. Both groups showed significant improvement in tongue strength and thickness, but there were no significant differences between the groups after the intervention. The self-report scale numerical rating revealed that group 1 had significantly higher motivation and interest/fun after the exercise than group 2. Group 1 had expended a significantly lower physical effort than group 2. No significant differences were noted between the 2 groups for muscle fatigue/pain. This study showed that both exercises had similar effects on tongue strength and thickness increase in healthy adults, but game-based tongue training was more fun and physically less demanding.

Influence of sex and resistance training status on orofacial muscle strength and morphology in healthy adults between the ages of 18 and 40: A cross-sectional study.

To compare the orofacial muscle strength and facial muscle thickness between resistance-trained and non-resistance trained men and women. Resistance-trained (25 men and 22 women) and non-resistance trained (21 men and 30 women) adults (18-40 years) had standard measurements of orofacial muscle strength (ie, anterior tongue elevation, cheek compression, and lip compression) and ultrasound measurements of facial muscle thickness. Body composition (percent fat, etc.) was estimated using ultrasound prediction Equations. A Bayesian analysis of variance (ANOVA) with between subject factors of training status (yes/no) and sex (man/woman) were used to determine differences in muscle size and strength. Body mass, height, and percent fat were similar between resistance-trained and non-resistance trained individuals, while appendicular lean mass was higher in resistance-trained. There were no differences in orofacial muscle strength between resistance-trained and non-resistance trained. However, men had greater strength in every task except for anterior tongue strength which was similar between sexes (men: 66 vs women: 64 kPa). Handgrip strength was greater in men and in those who were resistance-trained. The frontalis muscle was greater in women than in men and in those who were non-resistance-trained than those resistance-trained. None of the other muscles differed by training status, however, all were greater in men. Results from our cross-sectional study would suggest that exercise-stimulation to the facial muscles during resistance training of the limbs and trunk did not reach a level where orofacial muscle strength could be changed. Sex differences in facial muscle thickness are very unique, although the reasons are unclear.

Tongue-Strengthening Exercises in Healthy Older Adults: Effect of Exercise Frequency – A Randomized Trial

Introduction: Positive effects from tongue-strengthening exercises (TSE) are widely described, but dose-dependent studies concerning exercise frequency have not yet been reported. This study aimed to determine the training and detraining effects of TSE with exercise frequencies of respectively 3 and 5 times per week on maximum isometric anterior and posterior tongue pressures (MIP_A and MIP_P) and on anterior and posterior tongue strength during an effortful saliva swallow (Pswal_A and Pswal_P). Method: Twenty healthy adults were randomly assigned to two exercise groups, training 3 (EX3, n = 10) or 5 (EX5, n = 10) times per week with the Iowa Oral Performance Instrument. MIP_A, MIP_P, Pswal_A, and Pswal_P were measured at baseline, after 4 and 8 weeks of training and 4 and 8 weeks after the last training session to document detraining effects. Descriptive statistics, linear mixed model effects, and post hoc analyses were calculated. Results: Significant increases in MIP_A, MIP_P, Pswal_A, and Pswal_P were measured for training both 3 and 5 times per week. No significant differences on any parameter were found between EX3 and EX5 groups. No significant detraining effects were found after 4 or 8 weeks in any treatment arm either for MIPs or for effortful swallow pressures. Conclusion: This randomized study demonstrated a positive effect of TSE on MIP and Pswal in healthy older adults, without detraining effects. No superiority of exercise frequency was identified based on significance testing, although some trends are discussed.

Multi-dimensional electrical impedance myography of the tongue as a potential biomarker for amyotrophic lateral sclerosis

ObjectiveIn amyotrophic lateral sclerosis (ALS) bulbar disease biomarkers are lacking. We evaluated a novel tongue electrical impedance myography (EIM) system, utilising both 2D and 3D electrode configurations for detection of tongue pathology. MethodsLongitudinal multi-frequency phase angle spectra were recorded from 41 patients with ALS (baseline, 3 and 6 months) and 30 healthy volunteers (baseline and 6 months). ALS functional rating scale-revised (ALSFRS-R) data and quantitative tongue strength measurements were collected. EIM data were analysed for reliability (intra-class correlation coefficient; ICC) and differences between patients and volunteers ascertained using both univariate (Mann-Whitney U test) and multivariate techniques (feature selection and L2 norm). ResultsThe device produced highly reliable data (pooled ICC: 0.836). Significant EIM differences were apparent between ALS patients and healthy volunteers (P < 0.001). EIM data demonstrated a significant relationship to tongue strength and bulbar ALSFRS-R scores (P < 0.015). The EIM recordings revealed a group level longitudinal change over 6 months and consistently identified patients in whom symptoms or tongue strength changed. ConclusionsThe novel EIM tongue system produces reliable data and can differentiate between healthy muscle and ALS-related disease. SignificanceTongue EIM utilising multiple frequencies and electrode configurations has potential as a bulbar disease biomarker in ALS.

Frequent Karaoke Training Improves Frontal Executive Cognitive Skills, Tongue Pressure, and Respiratory Function in Elderly People: Pilot Study from a Randomized Controlled Trial.

We tested whether karaoke training improves cognitive skills and reduces the risk of physical function impairments. We conducted a single-blinded randomized controlled trial in 26 elderly participants at residential care facilities, who were generally healthy or required the lowest level of care. Participants were near the threshold for mild cognitive impairment with the Montreal Cognitive Assessment (MoCA) and close to the sarcopenia cut-off with the skeletal muscle mass index. Pulmonary function as measured with spirometry and tongue strength were used as markers for physical functions affected by sarcopenia. Karaoke training occurred once a week for two hours, with an hour of homework assigned weekly. Karaoke training significantly improved the Frontal Assessment Battery at bedside (FAB) compared with an active control group receiving scratch art training (F = 8.04, permutation p-value = 0.013). Subscore improved with inhibitory control (F = 7.63, permutation p-value = 0.015) and sensitivity to interference (F = 11.98, permutation p-value = 0.001). We observed improved tongue pressure (F = 4.49, permutation p-value = 0.040) and pulmonary function by a greater increase in FIV1 (F = 5.22, permutation p-value = 0.047). Engaging elderly people, especially those in care homes, with karaoke training exercises that are moderately physically challenging may be a key to slowing cognitive decline and preventing dysphagia by sarcopenia.

Hypoglossal nerve stimulation therapy does not alter tongue protrusion strength and fatigability in obstructive sleep apnea.

Hypoglossal nerve stimulation (HNS) is an effective surgical alternative for patients with obstructive sleep apnea (OSA). HNS therapy relies on the stimulation of the hypoglossal nerve to open the upper airways. This stimulation could lead to alterations in tongue strength and fatigability, which could alter treatment outcome over time. The aim of the study was to investigate whether HNS alters tongue strength and fatigability. Tongue protrusion strength (peak pressure in kPa) and fatigability (time to task failure during 50% of peak pressure contraction) were measured with a pressure transducer at least 2 months after HNS implantation (n = 30). These results were compared to a group of patients with OSA (n = 38) and a non-OSA control group (n = 35). Median tongue protrusion strength was lower (54.7 [43.8, 63.0] versus 60.7 [53.7, 66.0] kPa, P = .013) and fatigue occurred more quickly (21.3 [17.4, 26.3] versus 26.0 [19.3, 31.3] seconds, P = .017) in the patients with OSA compared to the non-OSA control group. In multiple regression analysis, age was a significant factor for tongue strength and diagnosis of OSA for tongue fatigability. Tongue strength and fatigability did not differ between patients with OSA with conservative therapy or observation versus after HNS implantation (51.8 [41.3, 63.4] versus 56.3 [45.0, 62.3] kPa, P = .502; 20.8 [16.3, 26.2] versus 21.8 [18.3, 26.8] seconds, P = .418). Tongue strength decreases with age. Tongue fatigability is more pronounced in people with OSA. However, approximately 1.5 years of HNS therapy on average does not alter tongue strength or fatigability compared to an OSA control group. Registry: ClinicalTrials.gov; Title: Change in Tongue Strength and Fatigue After Upper Airway Stimulation Therapy; Identifier: NCT03980158.

Devices used for measuring tongue force: A review

Over many decades, medical representatives, researchers, etc., are making an attempt to quantify the force/pressure put by the tongue within the oral cavity. Evaluation of the abovementioned may be done by qualitative or quantitative methods. The aim of this study was to assemble a review of literature regarding the devices to measure tongue strength used by different researchers over a period of time from everywhere the globe. A critical analysis regarding the devices custom-made or used to quantify tongue force was meted out in different words such as “tongue pressure,” “role of tongue,” and “malocclusion” in varied search engines using the Internet. The articles considered were over a period of 60 years approximately, i.e., 1956 dated up to March 2018. In addition, searches were also made within the references of the chosen articles. Every custom-made device has drawbacks in its own. In an overall view, most of the devices measure pressure in just one direction. However, tongue activity throughout the features entails a combination of dynamic and static forces because the tongue is oriented in a diffusion of various positions. The employment of quantitative ways to measure tongue force helps the skilled in the evaluation of orofacial physiology, making the diagnosis of tongue force more reliable, particularly in those subjects with a small strength deficit which are difficult to be noted by clinical evaluation.

The Effects of Orofacial Myofunctional Training on the Changes of Lip and Tongue Strength in Elderly People

The Effects of Orofacial Myofunctional Training on the Changes of Lip and Tongue Strength in Elderly People

Tongue Force Training Induces Plasticity of the Lingual Motor Cortex in Young Adult and Aged Rats.

Tongue exercise programs are used clinically for dysphagia in aged individuals and have been shown to improve lingual strength. However, the neural mechanisms of age-related decline in swallowing function and its association with lingual strength are not well understood. Using an established rat model of aging and tongue exercise, we hypothesized that the motor cortex of aged rats would have a smaller lingual motor map area than young adult rats and would increase in size as a function of tongue exercise. Over 8 weeks, rats either underwent a progressive resistance tongue exercise program (TE), learned the task but did not exercise (trained controls, TC), or were naïve untrained controls (UC). Cortical motor map areas for tongue and jaw were determined using intracortical microstimulation (ICMS). Rats in the TE and TC groups had a significantly larger motor cortex region for the tongue than the UC group. Lingual cortical motor area was not correlated with protrusive tongue force gains and did not differ significantly with age. These results suggest that learning a novel tongue force skill was sufficient to induce plasticity of the lingual motor cortex yet increasing tongue strength with progressive resistance exercise did not significantly expand the lingual motor area beyond the gains that occurred through the skilled learning component.

Comparison of three exercises on increasing tongue strength in healthy young adults

ObjectivesTo compare three different exercises for dysphagia to see if they had effects on tongue strength. DesignThirty-one healthy volunteers were randomly divided into three groups. One group (G1, n = 10) performed 24 sets of five repetitions with 30 s rest with the target level set at 80 % of one repetition maximum using Iowa Oral Performance Instrument (IOPI) per day. Another group (G2, n = 10) performed exercise which was consisted of forceful swallow of 5 mL of water in a neutral posture every 10 s for 20 min per day. The other group (G3, n = 11) performed 5 mL of water swallowing exercise in chin-down posture every 10 s for 20 min per day. A total of 12 sessions in four weeks were performed in all groups. Blinded lingual strength measures (maximal isometric pressure) were obtained using IOPI before training and at four weeks after training for the three groups. ResultsAfter four weeks of training, measures of tongue strength were increased significantly in all groups. However, there was no significant difference in strength increment among groups [average increase in strength ± standard deviation (% of initial value): G1, 10.3 ± 10.4 %; G2, 8.7 ± 9.45 %; G3, 9.9 ± 12.6 %, p = 0.825]. ConclusionsRegardless of the type, tongue strengthening exercises had good effects in improving the swallowing function with equal superiority.

Functionally navigated transcranial magnetic stimulation to evoke lingual pressure in stroke survivors with dysphagia and healthy adults: a proof of concept trial

ABSTRACTBackground: Post-stroke dysphagia is characterized by reduced corticolingual excitability and lingual pressure; however, it remains unknown if transcranial magnetic stimulation (TMS) directly facilitates lingual pressure generation.Objectives: To explore optimal procedures for single pulse TMS using neuronavigation to evoke lingual pressure in intact and disrupted neural networks.Methods: Using co-registered functional magnetic resonance imaging, stimulation sites were determined for five healthy adults (Mage = 67) and four stroke survivors with dysphagia and reduced tongue strength (Mage = 66). Evoked lingual pressures were sampled across 45-65% of maximum stimulator output. Healthy participants repeated TMS with a bite block to isolate lingual pressure from off-target stimulation of mandibular elevators.Results: Only one functionally-guided stimulation site fell within previously reported optimal lateral (8-11cm) and anterior (2–4.25cm) coordinates. Lingual pressure was stable prior to pulse and increased linearly with intensity for both groups (p = .005). Post-stroke active motor thresholds were elevated compared to healthy adults (p = .025). Lingual pressure latency remained stable across intensities (p > .05). Jaw stabilization via bite block reduced the mean magnitude of evoked lingual pressure by approximately 16%.Conclusions: Single pulse TMS directly evokes higher lingual pressure and can define motor thresholds in intact and disordered corticolingual pathways. Stimulation sites using neuronavigation in healthy adults and stroke survivors largely differed from external coordinates in the literature that were predominantly established in young adults. Procedures to investigate motor thresholds for lingual pressure generation are proposed. The therapeutic role of TMS to address post-stroke deficits in lingual pressure and corticolingual excitability warrants continued investigation.

Effects of mental and physical orofacial training on pressure pain sensitivity and tongue strength: A single-blind randomized controlled trial

ObjectivesThe main objective of this study was to analyze differences on pain pressure thresholds, tongue strength and perceived effort between various orofacial motor exercise training dosages of mental representation training through motor imagery (MI) and action observation (AO), first in isolation and then in combination with real exercise performance. MethodsA single-blind randomized controlled trial was designed. 48 asymptomatic individuals were randomized into two groups: Intensive training group (IG) and Moderate training group (MG). Both groups performed a first session of MI and AO of orofacial exercises training and a second session of actual orofacial exercises combined with mental representation training, but with different dosage in terms of series and repetitions. Pain pressure thresholds (PPTs) in the masseter and temporal muscles and tongue muscle strength were the main variables. ResultsRegarding the PPT, ANOVA revealed significant between-group differences, where MG showed a significantly higher PPT than IG at post-day2, with a medium effect size. Both groups showed with-in group differences between pre and post intervention measures in the first session, but only the IG showed differences in the second. Regarding tongue muscle strength, ANOVA revealed significant within-group differences only in MG between the pre-day and post-day first intervention. ConclusionThe results of the present study suggest that movement representation training performed in isolation may have a positive effect on PPTs and tongue muscle strength. In addition, the combination with the actual execution of the exercises could be considered effective, but it is necessary to take into account the training dosage to avoid fatigue responses.