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Oh JC. Effect of Visual Biofeedback Obtained Using the Iowa Oral Performance Instrument on the Suprahyoid Muscle Activation Level During Effortful Swallowing Maneuver. Dysphagia 2024; 39:433-443. [PMID: 37936019 DOI: 10.1007/s00455-023-10627-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/08/2023] [Indexed: 11/09/2023]
Abstract
Effortful swallowing (ES) is a maneuver prescribed for patients who experience pharyngeal residues after swallowing owing to weakness of the tongue and pharyngeal constrictor muscles. ES can increase the pharyngeal contraction force by intentionally increasing the degree of effort during swallowing. However, the effect is limited as the nature of swallowing makes it difficult to maintain a constant high-effort level. The aim of this study was to assess the effect of visual feedback, delivered by the Iowa Oral Performance Instrument (IOPI), a tongue pressure measurement device on ES maneuver effort. Overall, 34 healthy adults performed five sets of ten ES, once every 10 s. The ES maneuver was conducted under two conditions, ES with and without IOPI biofeedback in a crossover design. IOPI biofeedback was provided at 80% of the maximum posterior oral tongue pressure. The suprahyoid muscle activation level was assessed using surface electromyography during the ES maneuver. The mean suprahyoid muscle activation levels in all sets for which IOPI biofeedback was provided were significantly higher than those during ES maneuver without biofeedback (p < 0.05). IOPI biofeedback can help maintain the ES maneuver target effort, utilizing a constantly high swallowing pressure potentially promoting better pharyngeal pressures and muscle strength.
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Affiliation(s)
- Jong-Chi Oh
- Department of Occupational Therapy, Cheongju University, 298 Daesung-ro, Cheongwon-gu, Cheongju, Chungcheongbuk-do, 28503, Republic of Korea.
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Ihara Y, Kato H, Sunakawa A, Murakami K, Minoura A, Hirano K, Watanabe Y, Yoshida M, Kokaze A, Ito Y. Comparison of Two Types of Electrodes for Measuring Submental Muscle Activity During Swallowing. Cureus 2024; 16:e59726. [PMID: 38841025 PMCID: PMC11151711 DOI: 10.7759/cureus.59726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE This study aimed to investigate the potential of a newly developed small electrode to accurately record muscle activity during swallowing. MATERIAL AND METHODS This study included 31 healthy participants. The participants underwent swallowing trials with three types of material. The recordings involved the following conditions: 1) swallowing saliva, 2) swallowing 3 mL water, and 3) swallowing 5 mL water. Two types of electrodes, a conventional electrode (CE) and a newly developed small electrode (NE), were symmetrically positioned on the skin over the suprahyoid muscle group, starting from the center. From the surface electromyography data, the swallowing duration (s), peak amplitude, and rising time (duration from swallowing onset to peak amplitude: s) were measured. Additionally, the equivalence of characteristics of the waveform of muscle activities was calculated by using the variance in both the upper and lower confidence limits in duration and rising time. RESULTS No significant differences in baseline, swallowing duration or rising time between the CE and NE were observed for any swallowing material. The peak amplitude was significantly higher for the NE than for the CE for all swallowing materials. The CE and NE displayed no significant difference in the equivalence of characteristics of the waveform of muscle activities for any swallowing material. CONCLUSIONS The gold-plated small electrodes utilized in this study indicated the ability to record the same characteristics of muscle activity as conventional electrodes. Moreover, it was able to capture the muscle activity of each muscle group with improved sensitivity in a narrow area, such as under the submandibular region, with more precision than that of conventional electrodes.
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Affiliation(s)
- Yoshiaki Ihara
- Department of Oral Health Management, Division of Oral Functional Rehabilitation Medicine, Showa University School of Dentistry, Tokyo, JPN
| | - Hirotaka Kato
- Department of Oral Rehabilitation Medicine, Showa University Graduate School of Dentistry, Tokyo, JPN
| | - Atsumi Sunakawa
- Department of Oral Rehabilitation Medicine, Showa University Graduate School of Dentistry, Tokyo, JPN
| | - Kouzou Murakami
- Department of Radiology, Division of Radiation Oncology, Showa University School of Medicine, Tokyo, JPN
| | - Akira Minoura
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Tokyo, JPN
| | - Kojiro Hirano
- Department of Otorhinolaryngology Head and Neck Surgery, Showa University School of Medicine, Tokyo, JPN
| | - Yoshio Watanabe
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, JPN
| | - Masaki Yoshida
- Faculty of Health Sciences, Osaka Electro-Communication University, Osaka, JPN
| | - Akatsuki Kokaze
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Tokyo, JPN
| | - Yoshinori Ito
- Department of Radiology, Division of Radiation Oncology, Showa University School of Medicine, Tokyo, JPN
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Glass TJ, Russell JA, Fisher EH, Ostadi M, Aori N, Yu YE, Connor NP. Altered tongue muscle contractile properties coincide with altered swallow function in the adult Ts65Dn mouse model of down syndrome. Front Neurol 2024; 15:1384572. [PMID: 38585362 PMCID: PMC10995394 DOI: 10.3389/fneur.2024.1384572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Down syndrome (DS) is a developmental disability associated with difficulties in deglutition. The adult Ts65Dn mouse model of DS has been previously shown to have differences in measures of swallowing compared with euploid controls. However, the putative mechanisms of these differences in swallowing function are unclear. This study tested the hypothesis that the Ts65Dn genotype is associated with atypical measures of tongue muscle contractile properties, coinciding with atypical swallow function. Methods Adult (5-month-old) Ts65Dn (n = 15 female, 14 male) and euploid sibling controls (n = 16 female, 14 male) were evaluated through videofluoroscopy swallow studies (VFSS) to quantify measures of swallowing performance including swallow rate and inter-swallow interval (ISI). After VFSS, retrusive tongue muscle contractile properties, including measures of muscle fatigue, were determined using bilateral hypoglossal nerve stimulation. Results The Ts65Dn group had significantly slower swallow rates, significantly greater ISI times, significantly slower rates of tongue force development, and significantly greater levels of tongue muscle fatigue, with lower retrusive tongue forces than controls in fatigue conditions. Conclusion Tongue muscle contractile properties are altered in adult Ts65Dn and coincide with altered swallow function.
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Affiliation(s)
- Tiffany J. Glass
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
| | - John A. Russell
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
| | - Erin H. Fisher
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
| | - Marziyeh Ostadi
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, United States
| | - Nanyumuzi Aori
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
| | - Y. Eugene Yu
- The Children’s Guild Foundation Down Syndrome Research Program, Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- Genetics, Genomics and Bioinformatics Program, State University of New York at Buffalo, Buffalo, NY, United States
| | - Nadine P. Connor
- Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, United States
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, United States
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Oh JC. Changes in the Activation Level of the Floor of the Mouth Muscles during Pressing and Swallowing Tasks According to the Degree of Tongue Pressure. Dysphagia 2024:10.1007/s00455-024-10691-5. [PMID: 38466426 DOI: 10.1007/s00455-024-10691-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/26/2024] [Indexed: 03/13/2024]
Abstract
The suprahyoid muscles play an important role in protecting the airway by elevating both the hyoid bone and larynx superior-anteriorly during swallowing. However, providing systematic external resistance when performing exercises to improve suprahyoid muscle strength is practically difficult. This study attempted to confirm whether systematic resistance can be provided to the suprahyoid muscles using the Iowa Oral Performance Instrument (IOPI)-a representative tongue pressure measurement device. Thirty-one healthy adults participated in this study (20.6 ± 0.96 y, 19 females). The participants performed 16 exercise tasks using the IOPI three times each in random order (Anterior/posterior tongue × pressing/swallowing task × 40/60/80/100% maximum tongue pressure). Furthermore, the floor of the mouth (FOM) muscle activity during exercise was simultaneously measured using surface electromyography. During the pressing task, there were significant differences in FOM maximal muscle activity among the four exercise intensities for both the anterior and posterior oral tongue. For the swallowing task, a significant difference was found in FOM muscle activity among the four exercise intensities for the anterior tongue. For the posterior tongue, significant differences were identified among all conditions except for the comparison between 80% and 100% maximum tongue pressure. Significant correlations between the degree of tongue pressure and maximal FOM muscle activity were found in both the pressing and swallowing tasks at the anterior and posterior oral tongue. Overall, these results indicate that objective and systematic external resistance can be applied using the IOPI-a standard tongue pressure measurement device-during the program to improve suprahyoid muscle function.
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Affiliation(s)
- Jong-Chi Oh
- Department of Occupational Therapy, Cheongju University, 298 Daesung-ro, Cheongwon-gu, Cheongju, Chungcheongbuk-do, 28503, Republic of Korea.
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Barikroo A, Zinser A. Impact of Varying Transcutaneous Electrical Stimulation Pulse Frequency on Swallow Timing Measures in Healthy Adults. Dysphagia 2024; 39:140-149. [PMID: 37436448 DOI: 10.1007/s00455-023-10601-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/21/2023] [Indexed: 07/13/2023]
Abstract
The impaired swallow timing subsequent to dysphagia or aging can potentially endanger swallowing safety and efficiency. Preliminary evidence has suggested that transcutaneous electrical stimulation (TES) may have the potential to affect swallow timing. However, limited knowledge exists regarding which TES parameters can optimize swallow timing. Pulse frequency is one of the primary TES parameters that can affect the quality of muscle contraction. Yet, no clear information exists regarding how changing pulse frequency impacts the timing of swallowing events. This study aimed to investigate the varying effects of submental TES pulse frequency on swallowing events during and post-15-min TES administration. Twenty-six healthy individuals between the ages of 20 and 54 participated in this study and were assigned to high pulse frequency (HPF) (80 Hz) or low pulse frequency (LPF) (30 Hz) groups. Videofluoroscopic swallowing study (VFSS) was used to record swallowing. Three trials of 10 mL pureed mixed with barium sulfate were presented under three different conditions, including pre-TES, during TES, and post-TES, in which measures were taken following 15 min of TES delivery. The swallow timing events that were measured in each condition were time to maximum hyoid elevation, time to maximum laryngeal elevation, laryngeal vestibule closure reaction time (LVCrt), laryngeal vestibule closure duration (LVCd), time to maximum pharyngeal constriction, and pharyngoesophageal segment (PES) opening duration. No significant pulse frequency effect was found on any swallow timing measures during or after 15 min of TES. Both protocols decreased the duration of some swallowing events during TES including time to maximum hyoid elevation [p < 0.017, ηp2 = 0.185], LVCrt [p < 0.032, ηp2 = 0.158], and time to maximum pharyngeal constriction [p < 0.034, ηp2 = 0.155]. None of the significant TES effects were continued when TES ceased after 15 min. Overall, both protocols have comparable immediate effects on shortening the duration of some swallowing events during TES. Future clinical trials should examine whether these physiologic timing changes can lead to safer and more efficient swallows in patients with dysphagia.
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Affiliation(s)
- Ali Barikroo
- Swallowing Physiology & Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, School of Health Sciences, Kent State University, PO Box 5190, Kent, OH, 44242-0001, USA.
| | - Alyssa Zinser
- Swallowing Physiology & Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, School of Health Sciences, Kent State University, PO Box 5190, Kent, OH, 44242-0001, USA
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Ohta M, Ryu M, Ogami K, Ueda T. Oral Function for Diagnosing Oral Hypofunction in Healthy Young Adults: A Comparison with the Literature. THE BULLETIN OF TOKYO DENTAL COLLEGE 2023; 64:105-111. [PMID: 37599090 DOI: 10.2209/tdcpublication.2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
This study investigated decline in oral function in healthy young adults and compared it with that observed in an earlier studies employing older adults. The participants comprised 130 young healthy adults (mean age 24.1±2.9 yr), all with complete dentition. All participants underwent the oral hypofunction test established by the Japanese Society of Gerodontology, which evaluates oral hygiene, oral dryness, occlusal force, tongue-lip motor function (oral diadochokinetic rate; ODK), tongue pressure, and masticatory and swallowing function. The average value for and rate of hypofunction of each parameter were calculated. In healthy young adults, the scores were 28.9±17.1% for oral hygiene; 28.8±2.2 for oral dryness; 959.9±499.8 N for occlusal force; 7.0±0.8 times/sec for ODK /pa/, 7.6±0.8 times/sec for /ta/, and 6.9±0.9 times/sec for /ka/; 41.8±8.4 kPa for tongue pressure; 249.8±94.1 mg/dl for masticatory function; and 0.2±0.7 for swallowing function. No sign or symptom of change in oral function was observed at a high rate in young adults. Occlusal force, tongue-lip motor function, and tongue pressure showed a large difference in the rate of hypofunction between younger and older adults, however.
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Affiliation(s)
- Midori Ohta
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College
| | - Masahiro Ryu
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College
| | - Koichiro Ogami
- Division of General Dentistry, Chiba Dental Center, Tokyo Dental College
| | - Takayuki Ueda
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College
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Burruss CP, Pappal RB, Witt MA, Harryman C, Ali SZ, Bush ML, Fritz MA. Healthcare disparities for the development of airway stenosis from the medical intensive care unit. Laryngoscope Investig Otolaryngol 2022; 7:1078-1086. [PMID: 36000059 PMCID: PMC9392386 DOI: 10.1002/lio2.865] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives/hypothesis To identify sociodemographic factors associated with the development of airway stenosis (AS) among intubated medical intensive care unit (MICU) patients. Study design Retrospective cohort study. Methods A retrospective review of adult MICU intubated patients from 2013 to 2019 at a single academic institution was performed. Univariate and multivariate analysis with logistic regression examined associations between the development of AS and subsite abnormalities such as posterior glottic stenosis (PGS), subglottic stenosis (SGS), tracheal stenosis (TS), vocal fold immobility (VFI), and posterior glottic granuloma (PGG) with age, body mass index (BMI), height, weight, race, ethnicity, sex, rurality, Appalachian status, length of admission, distance to hospital, and median household income. Results Of an overall sample of 6603 MICU patients, 449 intubated patients were included in the study, and 204 patients were found to have AS. AS was statistically associated with decreased driving distance to the hospital and increases in BMI. PGS was statistically associated with increases in age. TS was statistically associated with increases in admission duration and not having residence status in Appalachia. VFI was statistically associated with decreases in driving distance to the hospital and not having residence status in Appalachia. Additionally, black patients had a higher odds of developing VFI compared to Caucasian patients. Conclusion AS is associated with sociodemographic factors such as age, BMI, shorter distance to hospital, admission duration, and no Appalachian status. These data demonstrate the need to further investigate the impact of social determinants of health on airway pathology and outcomes. Level of evidence 4.
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Affiliation(s)
| | - Robin B. Pappal
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of KentuckyLexingtonKentuckyUSA
| | - Michael A. Witt
- College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
| | | | - Syed Z. Ali
- Department of AnesthesiologyUniversity of KentuckyLexingtonKentuckyUSA
| | - Matthew L. Bush
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of KentuckyLexingtonKentuckyUSA
| | - Mark A. Fritz
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of KentuckyLexingtonKentuckyUSA
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Ogino Y, Suzuki H, Ayukawa Y, Ueno Y, Jinnouchi A, Koyano K. Masticatory performance and other oral functions in community-dwelling elderly patients without posterior occlusal support by natural teeth. J Oral Sci 2021; 63:330-333. [PMID: 34470988 DOI: 10.2334/josnusd.21-0265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate masticatory performance (MP), maximum occlusal force (MOF), maximum tongue pressure (MTP) and oral diadochokinesis (ODK) among community-dwelling elderly patients without posterior occlusal support. METHODS This study enrolled community-dwelling elderly patients (≥65 years old) who belonged to Eichner A, B4, C1, C2, and C3. Each oral function was statistically compared among groups. Correlations between MP and other variables were examined in Eichner B4 and C patients. RESULTS MP and MOF values in Eichner B4 and C patients were significantly lower than in Eichner A patients. There were significant differences in MTP values between Eichner "A and C2, C3", and "B4 and C2, C3". ODK in Eichner C patients showed significantly lower values compared to Eichner A patients in general. Although there were statistically significant correlations of MP with age, the number of remaining teeth and all oral functions were identified, and multiple regression analysis indicated that MOF and MTP were independently related to MP. CONCLUSION Oral functions in Eichner B4 and C patients were lower compared to Eichner A patients. MP was significantly correlated with MOF and MTP in elderly patients without posterior occlusal support, suggesting the importance of rehabilitation of MOF and MTP in MP.
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Affiliation(s)
- Yoichiro Ogino
- Section of Fixed Prosthodontics, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Hiroki Suzuki
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University.,Department of Dentistry, Inouekai Medical Corporation Sasaguri Hospital
| | - Yasunori Ayukawa
- Section of Fixed Prosthodontics, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University.,Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Yoko Ueno
- Department of Dentistry, Inouekai Medical Corporation Sasaguri Hospital
| | - Akio Jinnouchi
- Department of Dentistry, Inouekai Medical Corporation Sasaguri Hospital
| | - Kiyoshi Koyano
- Division of Advanced Dental Devices and Therapeutics, Faculty of Dental Science, Kyushu University
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Weimers MJ, Pillay M. Pathogenic oral bacteria in hospitalised patients with dysphagia: The silent epidemic. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2021; 68:e1-e7. [PMID: 34342488 PMCID: PMC8335773 DOI: 10.4102/sajcd.v68i1.798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Background Aspiration pneumonia is a serious and fatal complication of dysphagia, secondary to the ingestion of bacteria-laden secretions. However, no studies have documented the oral hygiene features present in patients who present with dysphagia. Objectives The purpose of this study was to describe the oral hygiene problems of adults admitted to a sub-acute rehabilitation hospital and who presented with dysphagia. Methods A descriptive, cross-sectional survey was conducted, during which 40 participants – 57.5% (n = 23) male and 42.5% (n = 17) female – underwent a clinical swallow evaluation using the Mann Assessment of Swallowing Ability (MASA) augmented with cervical auscultation (CA) and pulse oximetry (PO), an oral hygiene assessment using an adapted version of the Oral Health Assessment Tool (OHAT), followed by microbiology laboratory analysis of buccal swab samples to detect bacteria not considered part of the normal oral flora. Results Results indicated that poor oral hygiene status was a common feature amongst all participants who presented with dysphagia. The most prevalent oral hygiene issues were related to abnormalities concerning saliva (60%), oral cleanliness (82.5%), the tongue (80%) and the use of dentures (71.4%). A high prevalence, 62.5% (n = 25), of opportunistic bacteria was found. The most commonly occurring bacteria groups were: (1) Candida albicans (47.5%) and (2) respiratory pathogens (37.5%) such as Klebsiella pneumoniae and Staphylococcus aureus. Conclusion Persons with dysphagia have poor oral hygiene which creates favourable environments for bacteria to flourish and increases the prevalence of pathogenic oral bacteria associated with the development of aspiration pneumonia. The management of oral health issues for persons with dysphagia should receive greater attention during hospitalisation.
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Affiliation(s)
- Merryl J Weimers
- Department of Speech Pathology and Audiology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
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Liu HY, Chen JH, Hsu KJ, Yao CT, Chen PH, Hsiao SY, Lin CL. Decreased Tongue Pressure Associated with Aging, Chewing and Swallowing Difficulties of Community-Dwelling Older Adults in Taiwan. J Pers Med 2021; 11:jpm11070653. [PMID: 34357120 PMCID: PMC8303908 DOI: 10.3390/jpm11070653] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/20/2022] Open
Abstract
Personalized tongue pressure (TP) training focuses on improving swallowing. This study aims to establish the TP values of different age levels and compare changes between different swallowing status among community-dwelling elders. In this cross-sectional study, 1000 participants, aged 60 years old and above, were recruited from community care centers. All participants were classified into non chewing and/or swallowing difficulties (NCSD) and with chewing and/or swallowing difficulties (CSD) groups and their diseases and dieting status were recorded using a structured questionnaire. A disposable oral probe was used to measure TP by asking participants to compress it against the hard palate with maximum voluntary effort. Among 1000 elders, 63.10% had CSD and their TP (from 31.76 to 18.20 kPa) was lower than the NCSD group (from 33.56 to 24.51 kPa). Both groups showed the same tendency for TP decline with increasing age. Decline of TP makes CSD elderly have a poor appetite, eat a soft or liquid diet, and take longer to eat a meal (all p < 0.050). The secondary risk factor dominating TP decline for NCSD and CSD elders is having an education level less than primary school and an abnormal eating assessment, respectively. Our results demonstrated that TP decline has a significant relationship with age changes. Education level and an abnormal eating assessment score are closely associated with TP decline. A series of TP values can be used as a reference indicator of personalized medicine during the aging process among community-dwelling older adults.
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Affiliation(s)
- Hsiu-Yueh Liu
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Jen-Hao Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (J.-H.C.); (K.-J.H.); (P.-H.C.); (S.-Y.H.)
- Division of Prosthodontics, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Kun-Jung Hsu
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (J.-H.C.); (K.-J.H.); (P.-H.C.); (S.-Y.H.)
- Department of Family Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Dentistry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan
| | - Ching-Teng Yao
- Master Program of Long-Term Care in Aging, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Ping-Ho Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (J.-H.C.); (K.-J.H.); (P.-H.C.); (S.-Y.H.)
- Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Szu-Yu Hsiao
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (J.-H.C.); (K.-J.H.); (P.-H.C.); (S.-Y.H.)
- Division of Pediatric Dentistry and Special Needs Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan
| | - Chun-Li Lin
- Department of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Hsinchu 30010, Taiwan
- Correspondence:
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Kim S, Doh RM, Yoo L, Jeong SA, Jung BY. Assessment of Age-Related Changes on Masticatory Function in a Population with Normal Dentition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136899. [PMID: 34199065 PMCID: PMC8296882 DOI: 10.3390/ijerph18136899] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to investigate the influence of changes in age-related physiological muscular and dental factors on masticatory function. This study was conducted in 211 healthy participants divided into four different age groups: 20–45 years (Gr1); 45–60 years (Gr2); 61–70 years (Gr3); and ≥71 years (Gr4). For objective evaluation of masticatory function, the masticatory performance, bite force, posterior bite area (PBA), functional tooth units (FTUs), the number of remaining teeth, tongue pressure, masseter muscle thickness (MMT), and handgrip strength were examined. Food intake ability (FIA) and the Oral Health Impact Profile-14 score were assessed subjectively using questionnaires. A significant decrease in the number of remaining teeth, FTUs, handgrip strength, and FIA was found in Gr4, and a significant decrease in the tongue pressure, PBA, and bite force was found in those aged ≥61 years. In groups 1 and 3, an association of the PBA with masticatory performance was observed. However, there was no significant decreasing trend in the MMT with respect to masticatory performance with aging. With sufficient FTUs and posterior tooth support, although age-dependent decreases in the bite force, tongue pressure and handgrip strength were observed, masticatory performance was maintained. Establishing the PBA by improving occlusion through dental treatment is thought to be important for masticatory function.
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Affiliation(s)
- Seonhui Kim
- Department of Dentistry, The Graduate School, Yonsei University, Seoul 03722, Korea;
| | - Re-Mee Doh
- Department of Advanced General Dentistry, College of Dentistry, Dankook University, Cheonan 31116, Korea;
| | - Leegang Yoo
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul 03722, Korea; (L.Y.); (S.-A.J.)
| | - Sol-Ah Jeong
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul 03722, Korea; (L.Y.); (S.-A.J.)
| | - Bock-Young Jung
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul 03722, Korea; (L.Y.); (S.-A.J.)
- Correspondence: ; Tel.: +82-2-2228-8980
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Oh JC. Effects of Effortful Swallowing Exercise with Progressive Anterior Tongue Press Using Iowa Oral Performance Instrument (IOPI) on the Strength of Swallowing-Related Muscles in the Elderly: A Preliminary Study. Dysphagia 2021; 37:158-167. [PMID: 33566219 DOI: 10.1007/s00455-021-10259-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/27/2021] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to confirm the effect of effortful swallowing (ES) exercise programs applied to increase the swallowing-related muscle strength in the elderly. In this study, 20 healthy elderly people (76.65 ± 5.87 years; 10 women and 10 men) participated and exercised for 7 weeks. The experimental group performed ES exercise combined with external resistance using Iowa Oral Performance Instrument (IOPI), and the control group performed pure ES without external resistance. The exercises were performed for 20 min a day, 2 days a week for 7 weeks in both groups. ES was repeated 60 times in weeks 1 and 2, 80 times in week 3 and 4, and 120 times in weeks 5-7. In the experimental group, the isometric and swallowing tongue pressures at week 8 were significantly improved compared to baseline. At week 8, the anterior and swallowing tongue pressures and anterior tongue endurance were significantly higher than those of the control group. In the control group, no significant change in tongue pressure-related variables was observed after 7 weeks of exercise. ES exercise combined with IOPI resistance for 7 weeks tended to increase the suprahyoid muscle activation level without statistical significance. For clinical application of this exercise protocol, further studies including more elderly people and patients with dysphagia are required.
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Affiliation(s)
- Jong-Chi Oh
- Department of Occupational Therapy, Cheongju University, 298 Daesung-ro, Cheongwon-gu, Cheongju, Chungcheongbuk-do, 28503, Republic of Korea.
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Brates D, Molfenter S. The Influence of Age, Eating a Meal, and Systematic Fatigue on Swallowing and Mealtime Parameters. Dysphagia 2021; 36:1096-1109. [PMID: 33479862 DOI: 10.1007/s00455-020-10242-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
Fatigue is widely accepted as a clinically relevant factor in the diagnosis, treatment, and management of dysphagia. Despite the relative importance that is placed on swallowing-related fatigue, the occurrence and effects of fatigue during swallowing is unclear. The goal of this study was to explore effects of eating a meal on measures of tongue strength, endurance, and other parameters of swallowing function under normal conditions compared to when the tongue is intentionally fatigued. Thirty healthy females, 15 "Young" (18-35 years old), and 15 "Old" (70 + years old) were seen for two data collection sessions one week apart. On both days, pre-meal measures were collected, then participants consumed a standardized meal based on a previously published protocol (half a bagel with peanut butter and 8 baby carrots) followed by post-meal measures. An additional pre-meal fatigue task was included on one of the test days (counterbalanced), involving maximal tongue presses until participants could not achieve 40% of baseline maximum pressure. Pre- and post-meal measures included anterior and posterior maximum tongue pressures, saliva swallow pressure, tongue endurance, surface electromyography (sEMG), the modified Borg scale, and the Test of Mastication and Swallowing of Solids (TOMASS). Linear mixed effects regressions compared pre- and post-meal outcome measures (1) on the non-fatigue day and (2) between fatigue and non-fatigue days while controlling for participant and age. The fatigue task caused significant reductions in maximum anterior and posterior tongue pressure. After a normal meal (i.e., without fatigue), we found decreased anterior pressures in the older group only. Older participants also had decreased saliva swallow pressures after the meal compared to pre-meal, while this measure increased post-mean in the young participants. When compared to the non-fatigue meal, eating a meal after tongue fatigue resulted in significantly lower post-meal posterior pressures, regardless of age group. The same pattern was observed with posterior functional reserve. Our results demonstrate that a systematic, participant-specific tongue fatigue task induced measurable changes in maximum tongue pressure. A meal by itself was observed to reduce anterior tongue strength and saliva swallow pressures only in older participants. Overall, it appears that older adults may be more vulnerable to fatigue-induced changes in tongue strength, though the relationship between these measures and changes to functional swallowing remains unknown.
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Affiliation(s)
- Danielle Brates
- Department of Communicative Sciences and Disorders, NYU Steinhardt, 665 Broadway, 9th Floor, New York, NY, 10012, USA.
| | - Sonja Molfenter
- Department of Communicative Sciences and Disorders, NYU Steinhardt, 665 Broadway, 9th Floor, New York, NY, 10012, USA
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Effects of rehabilitation with complete dentures on bite force and electromyography of jaw and neck muscles and the correlation with occlusal vertical dimension. Clin Oral Investig 2021; 25:4691-4698. [PMID: 33442778 DOI: 10.1007/s00784-021-03783-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the effects of oral rehabilitation with complete dentures on bite force and electromyography of the suprahyoid and sternocleidomastoid muscles, and their correlation with occlusal vertical dimension (OVD). The research questions were "What are the effects of rehabilitation with complete dentures on bite force and electromyography of suprahyoid and sternocleidomastoid muscles, and how are they correlated with OVD?" MATERIALS AND METHODS Patients who are wearers of unsatisfactory removable complete dentures were attended in three sessions (T0, T1, and T2). At T0, while the patients still wore the old dentures, they were submitted to bite force and surface electromyographic exams of the suprahyoid and sternocleidomastoid muscles. These exams were repeated, and the OVD was measured while the patients wore their old and new prostheses, 30 days after insertion of the new prosthesis (T1). The exams were repeated 100 days after the insertion of the new prosthesis (T2). The data were submitted to the Shapiro-Wilk normality test, analysis of variance (ANOVA), and Pearson correlation and linear regression, all with 5% significance. RESULTS Fifteen patients participated in the study. No statistically significant difference was observed for bite force or electromyography in T0, T1, or T2. However, the correlation and regression tests showed important interactions between the OVD and maximum voluntary occlusal bite force, as well as the OVD and electromyography during deglutition for the suprahyoid muscles. CONCLUSION Rehabilitation did not impact bite force nor the activity of the assessed muscles (electromyography). On the other hand, OVD was shown to be an important factor for bite force, and deglutition of water after rehabilitation. CLINICAL RELEVANCE This study shows what are the influences of rehabilitation on oral functions and reinforces the importance of corrected reestablishment of OVD because it has been found to be an important factor for bite force and electromyography during deglutition.
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Haresaku S, Nakashima F, Hara Y, Kuroki M, Aoki H, Kubota K, Naito T. Associations of Oral Health-Related Quality of Life with age, oral status, and oral function among psychiatric inpatients in Japan: a cross-sectional study. BMC Oral Health 2020; 20:361. [PMID: 33317511 PMCID: PMC7737280 DOI: 10.1186/s12903-020-01355-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/08/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND As the general population of Japan ages, the population of hospitalized psychiatric patients is also ageing. The purpose of this study was to investigate the associations of oral health-related quality of life (OHRQoL) with age and oral health, including oral and swallowing function, among psychiatric inpatients. METHODS The subjects included 165 psychiatric inpatients in psychiatric hospitals in Japan. The General Oral Health Assessment Index (GOHAI) and the Eating Assessment Tool (EAT-10) were included in the questionnaire survey for the measurement of OHRQoL and the screening of dysphagia. A score ≥ 3 on the EAT-10 was defined as suspected dysphagia. Oral examinations and oral diadochokinesis (ODK) measurements for the tongue-lip motor function evaluation were conducted. The inpatients with acute psychiatric symptoms, moderate and severe dementia, and cognitive impairment that affected their ability to communicate and relate their feelings were excluded. A chi-squared test, the Mann-Whitney U test, and linear regression analysis were used for the analysis. The data were analysed at the 5% significance level. RESULTS A total of 100 (64.5%) psychiatric inpatients (mean age, 67.3 [SD, 14.5] years, 49% males, and 51% females) participated in this study. The means ± SDs for the decayed missing filled teeth (DMFT) index and GOHAI score were 20.6 ± 6 and 49.7 ± 7.9, respectively. The GOHAI score in the older age group (≥ 65 years) was significantly lower than that in the younger age group (< 65 years). The mean ODK scores were less than 3 times/s for all syllables. The percentage of the participants with suspected dysphagia was 45.0%. Tooth loss and suspected dysphagia were significantly associated with low GOHAI scores. The EAT-10 score was significantly correlated with the GOHAI score only after adjusting for age and sex (β = - 0.725, 95% CI - 0.97, - 0.64). CONCLUSIONS In hospitalized psychiatric patients, impaired oral health in the older subjects was more pronounced compared with that among general adults. Tooth loss and swallowing function were associated with OHRQoL. Therefore, oral care for the recovery of occlusal and swallowing functions may be needed to improve OHRQoL among psychiatric patients.
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Affiliation(s)
- Satoru Haresaku
- Department of Nursing, Fukuoka Nursing College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan.
| | - Fuyuko Nakashima
- Department of Nursing, Fukuoka Nursing College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
| | - Yayoi Hara
- Department of Nursing, Fukuoka Nursing College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
| | - Madoka Kuroki
- Department of Dental Hygiene, Fukuoka College of Health Sciences, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
| | - Hisae Aoki
- Department of Nursing, Fukuoka Nursing College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
| | - Keiko Kubota
- Department of Nursing, Fukuoka Nursing College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
| | - Toru Naito
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
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Kosaka S, Ohara Y, Naito S, Iimori S, Kado H, Hatta T, Yanishi M, Uchida S, Tanaka M. Association among kidney function, frailty, and oral function in patients with chronic kidney disease: a cross-sectional study. BMC Nephrol 2020; 21:357. [PMID: 32819288 PMCID: PMC7441609 DOI: 10.1186/s12882-020-02019-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/13/2020] [Indexed: 12/19/2022] Open
Abstract
Background Chronic kidney disease (CKD) involves many factors that can cause frailty and oral hypofunction. We aimed to investigate the prevalence of frailty and oral hypofunction and to examine the associations among kidney function, frailty, and oral function in adults with CKD in Japan. Methods This cross-sectional study was conducted at two institutions. The participants included 109 patients with CKD stages 3–5 who visited outpatient clinics or were admitted for inpatient treatment. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study frailty criteria. Oral function was evaluated by assessing oral motor skills [oral diadochokinesis (ODK) rate], masticatory ability, and the repetitive saliva swallowing test. The estimated glomerular filtration rate (eGFR) was used to indicate kidney function. We examined the associations among kidney function, frailty, and oral function using binomial logistic regression analysis. Results In total, 31 participants (28.4%) were classified as being frail. Univariate analysis showed that age, body mass index, eGFR, and haemoglobin level were significantly associated with frailty. ODK and swallowing function were significantly associated with frailty. Multivariate analysis revealed that frailty was significantly associated with eGFR [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92–1.00, p = 0.048] and ODK rate (OR 0.68, CI 0.47–0.98, p = 0.038). However, no significant association was found between CKD severity and masticatory or swallowing function. Conclusion We found a high prevalence of frailty in patients with CKD and a significant association between frailty and oral motor skills, affecting the swallowing function of patients with nondialysis CKD. The high prevalence of frailty among patients with CKD suggests that routine assessment of frailty is necessary to prevent the development of severe complications. In addition, oral and kidney function should be carefully evaluated, and oral health education and interventions should be performed for patients with CKD.
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Affiliation(s)
- Shiho Kosaka
- Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Shotaro Naito
- Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Soichiro Iimori
- Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hiroshi Kado
- Omihachiman Community Medical Center, 1379 Tuchida-cho, Omihachiman-city, Shiga, 523-0082, Japan
| | - Tsuguru Hatta
- Omihachiman Community Medical Center, 1379 Tuchida-cho, Omihachiman-city, Shiga, 523-0082, Japan
| | - Masaaki Yanishi
- Kansai Medical University, 2-3-1 Shinmachi, Hirakata-city, Osaka, 573-1191, Japan
| | - Shinichi Uchida
- Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Makoto Tanaka
- Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Oh JC. Systematic Effortful Swallowing Exercise Without External Resistance Does Not Increase Swallowing-Related Muscle Strength in the Elderly. Dysphagia 2020; 36:465-473. [PMID: 32720053 DOI: 10.1007/s00455-020-10163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
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 65 years and over. In total, 30 healthy older adults participated in this study (16 women and 14 men, aged 67-90 years). The subjects participated in the exercise program for 20 min a day, twice a week, for 7 weeks. 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.
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Affiliation(s)
- Jong-Chi Oh
- Department of Occupational Therapy, Cheongju University, 298 Daesung-ro, Cheongwon-gu, Cheongju, Chungcheongbuk-do, Cheongju city, 28503, Republic of Korea.
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Abstract
(1) Background: Increasing tongue and lip strength may help improve various speech and swallowing disorders, but it is unclear if instrumentalists who use these muscle groups for long periods of time have greater strength and endurance compared to controls. It is also unclear if instrumentalists can more accurately estimate various exercise intensities. The purpose of this study was to determine differences in lip and tongue strength and endurance between instrumentalists and non-instrumentalists (controls). A secondary purpose was to assess differences in ability to estimate various exercise intensities between the two groups. (2) Methods: Instrumentalists and controls’ maximum strength and endurance were measured using the IOPI Pro medical device. In addition, 40%, 60% and 80% of maximum strength were estimated in a randomized order. (3) Results: No significant differences were found between instrumentalists and controls in strength or endurance or the ability to estimate various intensities. Overall, participants were better at estimating tongue strength at moderate intensities and lip strength at higher intensities. (4) Conclusion: Tongue and lip strength and endurance and the ability to estimate exercise intensities are not impacted by years of instrumentalist training compared to healthy controls.
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Umay EK, Yilmaz V, Gundogdu I, Ozturk E, Gurcay E, Karaahmet O, Saylam G, Ceylan T, Cakci A. What Happens to Swallowing Muscles after Stroke?: A Prospective Randomized Controlled Electrophysiological Study. Neurol India 2020; 67:1459-1466. [PMID: 31857535 DOI: 10.4103/0028-3886.273645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Stroke is the most frequent reason of neurological dysphagia Electrophysiological studies can be used to evaluate oral, pharyngeal and initial phase of esophageal phase. Aims This study aims to noninvasively evaluate mastication, mimic, and tongue muscles of stroke patients, which play an important role in the oral phase of swallowing process and compare them with healthy individuals. Setting and Design This study was conducted at the Physical Medicine and Rehabilitation Clinic of our hospital between January 2014 and December 2016. Materials and Methods Fifty-one patients who were admitted to our clinic with stroke and 51 healthy individuals were evaluated for the study. Demographic features of individuals were recorded. The swallowing intervals and motor action potentials (MAPs) of trigeminal, facial and hypoglossal nerves were measured. After four weeks of treatment schedule, patients were re-evaluated. Statistical Analysis The Wilcoxon Signed Rank test, the Mann-Whitney U test and Fisher exact test were used in this study. Results The all swallowing intervals were found prolonged compared to the healthy controls (P < 0.05). The MAPs of the masseter, orbicularis oculi, and intrinsic tongue muscles were significantly lower in patient group (P < 0.05). After treatment, we found significant improvement for all parameters in patient group, but the swallowing intervals were still significantly prolonged, and MAPs of these muscles were still lower (P < 0.05). Conclusion Although swallowing is examined as different phases, the process is complicated and should be evaluated totally. In post-stroke dysphagia, oral phase of swallowing process is as important as phayngeal phase and perioral, mastication, and tongue muscles are influenced even in an early period as a month.
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Affiliation(s)
- Ebru Karaca Umay
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Volkan Yilmaz
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Ibrahim Gundogdu
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Erhan Ozturk
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Eda Gurcay
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Ozgur Karaahmet
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Guleser Saylam
- Otolaryngology-Head and Neck Surgery Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Tijen Ceylan
- Otolaryngology-Head and Neck Surgery Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Aytul Cakci
- Physical Medicine and Rehabilitation Department, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
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Changes in etiology and severity of dysphagia with aging. Eur Geriatr Med 2019; 11:139-145. [DOI: 10.1007/s41999-019-00259-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/30/2019] [Indexed: 12/20/2022]
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Association of feeding behavior with jaw bone metabolism and tongue pressure. JAPANESE DENTAL SCIENCE REVIEW 2018; 54:174-182. [PMID: 30302136 PMCID: PMC6175966 DOI: 10.1016/j.jdsr.2018.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/12/2018] [Accepted: 05/23/2018] [Indexed: 12/26/2022] Open
Abstract
In recent decades, the eating habits of children and adolescents have undergone many changes due to the diversification of lifestyles worldwide. Reduced masticatory function in growing animals results in changes in the mandible, including a decrease in bone mass. However, the influence of different eating behaviors on jaw bone metabolism (e.g., the palatal palate) during the growth period is not fully understood. In addition, recent clinical studies reported that masticatory performance is positively related to tongue pressure in adults, but no consensus has been reached regarding whether tongue pressure is related to masticatory performance in children. This review summarizes current findings related to these issues, focusing on the influence of different feeding behaviors on jaw bone metabolism, including the development of tongue pressure. Consumption of a soft diet had a negative impact on jaw bone metabolism in the maxilla and mandible of rats; however, mastication of a hard diet recovered the collapsed equilibrium of bone turnover caused by a soft diet during growth. Tongue pressure is closely associated with an increase in masticatory performance in children. Peak maximum tongue pressure is reached earlier in women than in men. Before reaching adulthood, women require intervention to increase their peak tongue pressure.
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Swallowing Changes in Community-Dwelling Older Adults. Dysphagia 2018; 33:848-856. [PMID: 29948259 DOI: 10.1007/s00455-018-9911-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 05/29/2018] [Indexed: 12/24/2022]
Abstract
Older adults may evidence changes in swallowing physiology. Our goals were to identify dysphagia risk in community-dwelling older adults with no history of dysphagia, and to compare swallowing physiology and safety between older and younger adults. Thirty-two older adults with no history of dysphagia were prospectively recruited and completed the Dysphagia Handicap Index (DHI), two trials of a 3 oz. swallow screen, and videofluoroscopy (VFSS). Self-ratings of swallowing function were compared to published norms by paired t tests, and multivariate logistic regression models were generated to determine whether these ratings and VFSS analysis of swallowing function were associated with failure of one or both swallow screen trials. Archived VFSS of 33 younger adults were compared to older adults with Wilcoxon rank-sum tests. The DHI scores of older adults were higher than published non-dysphagic adults but lower than dysphagic adults. Older participants with greater Oral Residue scores were more likely to fail both swallow screen trials. Older adults received higher median MBSImP™© scores for select pharyngeal components than younger adults. The two age groups did not differ on Penetration-Aspiration Scale scores, and no aspiration was observed. Measures of swallowing in older individuals may reflect age-related sensory and motor changes in the context of functional swallowing and adequate airway protection.
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Fujita Y, Ichikawa M, Hamaguchi A, Maki K. Comparison of masticatory performance and tongue pressure between children and young adults. Clin Exp Dent Res 2018; 4:52-58. [PMID: 29744216 PMCID: PMC5893476 DOI: 10.1002/cre2.104] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 01/24/2018] [Accepted: 01/29/2018] [Indexed: 12/20/2022] Open
Abstract
The aims of the present study were to evaluate whether there are significant differences in masticatory performance by gender and dental stage. We also determined the factors directly associated with the masticatory performance in children, and those directly associated with masticatory performance in young adults. The study included 180 subjects, ranging in age from 6 to 12 years or 20 to 33 years. The subjects were divided into three groups according to the Hellman developmental stage (III A, III B, or VA); the groups were the subdivided according to gender. The body mass index (BMI), maximum tongue pressure, and sum of decayed, missing, and filled teeth (DMFT) were determined in all subjects. To investigate masticatory performance, the total number and maximum projected area of chewed particles of the jelly materials were measured. Masticatory performance had the highest values at Stage VA in both males and females. Regarding the maximum tongue pressure in females, Stage III B had the highest value of all stages. Multiple regression analysis showed that masticatory performance was associated with DMFT index, maximum tongue pressure, and BMI in children. Among young adults, masticatory performance was associated with DMFT index and maximum tongue pressure. Better masticatory performance is directly associated with better dental status, a higher BMI, and tongue pressure in schoolchildren. Additionally, masticatory performance was well-correlated with tongue pressure in young adults, although maximum tongue pressure reached its peak before Stage VA in females. We suggest that females need training with respect to tongue pressure, by the mixed dentition stage.
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Affiliation(s)
- Yuko Fujita
- Division of Developmental Stomatognathic Function Science, Department of Health Promotion Kyushu Dental University Japan
| | - Maika Ichikawa
- Division of Developmental Stomatognathic Function Science, Department of Health Promotion Kyushu Dental University Japan
| | - Ayako Hamaguchi
- Division of Developmental Stomatognathic Function Science, Department of Health Promotion Kyushu Dental University Japan
| | - Kenshi Maki
- Division of Developmental Stomatognathic Function Science, Department of Health Promotion Kyushu Dental University Japan
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Maeda K, Koga T, Akagi J. Interferential current sensory stimulation, through the neck skin, improves airway defense and oral nutrition intake in patients with dysphagia: a double-blind randomized controlled trial. Clin Interv Aging 2017; 12:1879-1886. [PMID: 29158670 PMCID: PMC5683771 DOI: 10.2147/cia.s140746] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Neuromuscular electrical stimulation with muscle contraction, administered through the skin of the neck, improves a patient’s swallowing ability. However, the beneficial effects of transcutaneous electrical sensory stimulation (TESS), without muscle contraction, are controversial. We investigated the effect of TESS, using interferential current, in patients undergoing dysphagia rehabilitation. Methods This double-blind, randomized controlled trial involved 43 patients who were prescribed in-hospital dysphagia rehabilitation for ≥3 weeks. Patients were randomly assigned to the sensory stimulation (SS) or sham groups; all received usual rehabilitative care plus 2 weeks of SS or sham intervention. Outcome measures included cough latency times against a 1% citric acid mist, functional oral intake scale (FOIS) scores, and oral nutritional intake – each determined after the second and third week following treatment initiation. Results Mean patient age was 84.3±7.5 years; 58% were women. The SS and sham groups had similar baseline characteristics. Changes in cough latency time at 2 weeks (−14.1±14.0 vs −5.2±14.2 s, p=0.047) and oral nutrition intake at 3 weeks (437±575 vs 138±315 kcal/day, p=0.042) improved more in the SS group than in the sham group. Changes in cough frequency and FOIS scores indicated better outcomes in the SS group, based on substantial effect sizes. Conclusion TESS, using interferential current through the neck, improved airway defense and nutrition in patients suffering from dysphagia. Further large-scale studies are needed to confirm the technique’s effect on swallowing ability.
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Affiliation(s)
- Keisuke Maeda
- Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Kumamoto.,Palliative Care Center, Aichi Medical University, Nagakute
| | | | - Junji Akagi
- Department of Surgery, Tamana Regional Health Medical Center, Tamana, Tamana City, Kumamoto, Japan
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Sakai K, Nakayama E, Tohara H, Kodama K, Takehisa T, Takehisa Y, Ueda K. Relationship between tongue strength, lip strength, and nutrition-related sarcopenia in older rehabilitation inpatients: a cross-sectional study. Clin Interv Aging 2017; 12:1207-1214. [PMID: 28814847 PMCID: PMC5546916 DOI: 10.2147/cia.s141148] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study was to clarify the relationship between tongue strength, lip strength, and nutrition-related sarcopenia (NRS). Patients and methods A total of 201 older inpatients aged ≥65 years (70 men, median age: 84 years, interquartile range: 79–89 years) consecutively admitted for rehabilitation were included in this cross-sectional study. The main factors evaluated were the presence of NRS diagnosed by malnutrition using the Mini-Nutrition Assessment – Short Form, sarcopenia based on the criteria of the Asian Working Group for Sarcopenia, tongue strength, and lip strength. Other factors such as age, sex, comorbidity, physical function, cognitive function, and oral intake level were also assessed. Results In all, 78 (38.8%) patients were allocated to the NRS group, and 123 (61.2%) patients were allocated to the non-NRS group. The median tongue strength and lip strength (interquartile range) were significantly lower in the NRS group (tongue: 22.9 kPa [17.7–27.7 kPa] and lip: 7.2 N [5.6–9.8 N]) compared with the non-NRS group (tongue: 29.7 kPa [24.8–35.1 kPa] and lip: 9.9 N [8.4–12.3 N], P<0.001 for both). Multivariable logistic regression analysis showed that NRS was independently associated with tongue strength (odds ratio [OR] =0.93, 95% confidence interval [CI] 0.87–0.98, P=0.012) and lip strength (OR =0.76, 95% CI 0.66–0.88, P<0.001), even after adjusting for age, sex, comorbidity, physical function, cognitive function, and oral intake level. Conclusion The likelihood of occurrence of NRS decreased when tongue strength or lip strength increased. Tongue strength and lip strength may be important factors for preventing and improving NRS, regardless of the presence of low oral intake level in older rehabilitation inpatients.
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Affiliation(s)
- Kotomi Sakai
- Department of Rehabilitation Medicine, Setagaya Memorial Hospital.,Department of Dysphagia Rehabilitation, Nihon University School of Dentistry
| | - Enri Nakayama
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry
| | - Haruka Tohara
- Gerodontology and Oral Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | | | - Takahiro Takehisa
- Department of Orthopaedic Surgery, Setagaya Memorial Hospital, Tokyo
| | - Yozo Takehisa
- Department of Internal Medicine, Hakuai Memorial Hospital, Tokushima, Japan
| | - Koichiro Ueda
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry
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Cullins MJ, Connor NP. Alterations of intrinsic tongue muscle properties with aging. Muscle Nerve 2017; 56:E119-E125. [PMID: 28181263 DOI: 10.1002/mus.25605] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/27/2017] [Accepted: 02/03/2017] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Age-related decline in the intrinsic lingual musculature could contribute to swallowing disorders, yet the effects of age on these muscles is unknown. We hypothesized there is reduced muscle fiber size and shifts to slower myosin heavy chain (MyHC) fiber types with age. METHODS Intrinsic lingual muscles were sampled from 8 young adult (9 months) and 8 old (32 months) Fischer 344/Brown Norway rats. Fiber size and MyHC were determined by fluorescent immunohistochemistry. RESULTS Age was associated with a reduced number of rapidly contracting muscle fibers, and more slowly contracting fibers. Decreased fiber size was found only in the transverse and verticalis muscles. DISCUSSION Shifts in muscle composition from faster to slower MyHC fiber types may contribute to age-related changes in swallowing duration. Decreasing muscle fiber size in the protrusive transverse and verticalis muscles may contribute to reductions in maximum isometric tongue pressure found with age. Differences among regions and muscles may be associated with different functional demands. Muscle Nerve 56: E119-E125, 2017.
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Affiliation(s)
- Miranda J Cullins
- Department of Surgery, University of Wisconsin-Madison, 1300 University Avenue, Madison, Wisconsin, 53706, USA
| | - Nadine P Connor
- Department of Surgery, University of Wisconsin-Madison, 1300 University Avenue, Madison, Wisconsin, 53706, USA
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Johnson KN, Botros DB, Groban L, Bryan YF. Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management. Clin Interv Aging 2015; 10:1925-34. [PMID: 26673904 PMCID: PMC4675650 DOI: 10.2147/cia.s93796] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
There are many anatomical, physiopathological, and cognitive changes that occur in the elderly that affect different components of airway management: intubation, ventilation, oxygenation, and risk of aspiration. Anatomical changes occur in different areas of the airway from the oral cavity to the larynx. Common changes to the airway include tooth decay, oropharyngeal tumors, and significant decreases in neck range of motion. These changes may make intubation challenging by making it difficult to visualize the vocal cords and/or place the endotracheal tube. Also, some of these changes, including but not limited to, atrophy of the muscles around the lips and an edentulous mouth, affect bag mask ventilation due to a difficult face-mask seal. Physiopathologic changes may impact airway management as well. Common pulmonary issues in the elderly (eg, obstructive sleep apnea and COPD) increase the risk of an oxygen desaturation event, while gastrointestinal issues (eg, achalasia and gastroesophageal reflux disease) increase the risk of aspiration. Finally, cognitive changes (eg, dementia) not often seen as related to airway management may affect patient cooperation, especially if an awake intubation is required. Overall, degradation of the airway along with other physiopathologic and cognitive changes makes the elderly population more prone to complications related to airway management. When deciding which airway devices and techniques to use for intubation, the clinician should also consider the difficulty associated with ventilating the patient, the patient's risk of oxygen desaturation, and/or aspiration. For patients who may be difficult to bag mask ventilate or who have a risk of aspiration, a specialized supralaryngeal device may be preferable over bag mask for ventilation. Patients with tumors or decreased neck range of motion may require a device with more finesse and maneuverability, such as a flexible fiberoptic broncho-scope. Overall, geriatric-focused airway management is necessary to decrease complications in this patient population.
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Affiliation(s)
- Kathleen N Johnson
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Daniel B Botros
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leanne Groban
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA ; Section on Molecular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA ; Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, USA ; Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Yvon F Bryan
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Goda H, Hatta T, Kishigami H, Suzuki A, Ikeda T. Does a Novel-Developed Product of Wheelchair Incorporating Pelvic Support Prevent Forward Head Posture during Prolonged Sitting? PLoS One 2015; 10:e0142617. [PMID: 26581089 PMCID: PMC4651560 DOI: 10.1371/journal.pone.0142617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 10/23/2015] [Indexed: 11/18/2022] Open
Abstract
Disabled elderly individuals with kyphosis or loss of muscle strength often display forward head posture (FHP). This study aimed to determine the utility of a wheelchair incorporating pelvic support in preventing FHP in disabled elderly individuals. In this study, 14 disabled elderly individuals (87.1 ± 8.1 years) were selected. A wheelchair incorporating pelvic support (RX_ABS Lo) and a basic wheelchair (RX-1) were used. Each individual sat on both wheelchairs for 30 minutes. RX_ABS Lo has two belts to support the pelvic and thorax. Postures were recorded in the sagittal plane using a video camera. Cervical and trunk angles from horizontal were measured every 5 minutes. Simultaneously, contact areas and total pressures applied to the wheelchair seats and back supports were measured every 5 minutes. Comparisons of area under the curve values between the wheelchairs were performed using the paired t-test. Comparisons of time-dependent parameters for each wheelchair were performed using repeated one-way ANOVA. Cervical angles were greater when using RX_ABS Lo than RX-1. Although cervical angles were unchanged during 30 minutes when using RX_ABS Lo, the angles were significantly decreased after 30 minutes of using RX-1. Back support pressures and contact areas were greater for RX_ABS Lo than for RX-1. No significant difference in back support pressure distributions was observed during 30 minutes in the wheelchairs. The RX_ABS Lo may have utility in improving FHP by increasing cervical angles and improving stability with a back support to the upper thorax, lower thorax, and pelvis during prolonged sitting.
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Affiliation(s)
- Hiroshi Goda
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
- Japan Health Care College, Eniwa, Japan
- Nihon Welfare Rehabilitation School, Eniwa, Japan
| | - Tatsuo Hatta
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
- * E-mail:
| | | | - Ayaka Suzuki
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
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