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      Assessment of muscular tone of the tongue using a digital measure spoon in a healthy population: A pilot study

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          Abstract

          The study of the muscles of the tongue forms part of a basic evaluation of upper airway function that includes swallowing, speaking and chewing. It is important because the upper airway presents a region of collapse during sleep. Through the action of the dilator muscles, mainly the genioglossus, such collapse can be prevented. In this study, we present a simple tool that can be used to measure the strength of the tongue. This tool may provide an easy way to measure tongue function and allow a simple evaluation of pathologies that affect the tone of the tongue. We have carried out 20 tongue strength measurements using the Tongue Digital Spoon (TDS) in a healthy adult population, using the Iowa Oral Performance Instrument (IOPI) as the gold standard. To validate the procedure, we performed replicate measurements on 20 individuals aged 20–70 years. We found a mean TDS measurement of 115.99 g/cm 2 in young subjects, 98.47 g/cm 2 in middle-aged subjects and 84.23 g/cm 2 in the elderly. There was a significant difference in the measurements between young and elderly participants. There was also a significant correlation between TDS and IOPI measurements (Pearson correlation coefficient, r = 0.69, P < 0.001). We found the TDS to be a useful tool in daily clinical practice for the measurement of the strength of the tongue in the healthy population. It has potential application in oropharyngeal monitoring and rehabilitation.

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          Most cited references24

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          Age effects on the temporal evolution of isometric and swallowing pressure.

          The tongue plays a key role in bolus propulsion through the oropharyngeal chamber. In this study, possible age effects on the magnitude and timing of lingual pressure generation were analyzed. Oral pressure was measured during isometric and swallowing tasks for 10 elderly (mean age = 81 years) and 10 young (mean age = 51 years) subjects. Three trials each of the isometric task and swallows of three different boluses (3 ml semisolid, 3 ml liquid, and 10 ml liquid) were performed by each subject. The timing and magnitude of isometric and swallowing pressure generation along with the pattern of the swallowing pressure waveform were analyzed. Whereas maximum lingual isometric pressures decreased with age (p < .001). no significant age difference was found for swallowing pressure. Time taken to reach peak pressure also was reduced with age in both the isometric task and swallows of liquid boluses (p < .05), while no significant age effect was found for semisolid swallows. Finally, only elderly subjects showed a pattern of liquid swallowing pressure generation in which multiple lingual gestures were required to reach peak pressure (termed "pressure building"), a pattern demonstrated by both young and elderly groups for semisolids. Decreased lingual strength with age combined with unchanging swallowing pressure leads to a decreased "pressure reserve," perhaps leaving older individuals more at risk for dysphagia resulting from insults directly or indirectly to the swallowing system. Additionally, swallowing is generally "slowed" with age, apparently due to both central and peripheral factors, and this change may have an impact on bolus flow outcomes.
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            A systematic review and meta-analysis of measurements of tongue and hand strength and endurance using the Iowa Oral Performance Instrument (IOPI).

            The purpose of this systematic review was to examine the evidence for the use of the Iowa Oral Performance Instrument (IOPI) to measure strength and endurance of the tongue and hand in healthy populations and those with medical conditions. A systematic search of the scientific literature published since 1991 yielded 38 studies that addressed this purpose. The IOPI was used primarily for tongue strength (38 studies) and endurance (15 studies) measurement; relatively few studies measured hand strength (9 studies) or endurance (6 studies). The majority of the studies identified used the IOPI as an evaluation tool, although four used it as an intervention tool. Half the studies were conducted in healthy people, primarily adults. Most of the other participants had disorders with dysphagia, primarily Parkinson's disease or head or neck cancer. Age and gender, as well as a number of medical conditions, influence the values of tongue and hand strength. There is sufficient evidence to support the use of the IOPI as a suitable tool for measuring tongue strength and endurance and as an assessment tool for intervention studies, and there is growing support for its use to assess hand strength and endurance in healthy and clinical populations.
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              Tongue measures in individuals with normal and impaired swallowing.

              This investigation sought to add to the extant literature on measures of normal tongue function, to provide information on measures of tongue function in a group of individuals with oral phase dysphagia, and to provide a comparison of these 2 groups matched for age and gender. The Iowa Oral Performance Instrument was utilized to measure tongue function (strength and endurance) in a group of individuals with normal (N=200) and impaired (N=50) swallowing. The peak measure of 3 encouraged trials was recorded as participants' strength, and 50% of their peak was sustained as long as possible for endurance. Results for the control group supported previous investigations wherein greater tongue strength was found in males than in females and in the youngest versus oldest groups. The experimental group demonstrated a similar trend in strength for gender. When matched for age and gender, the experimental group demonstrated significantly lower strength. Significant differences were not revealed on measures of tongue endurance. We were able to extend the normative database on tongue function and document reduced tongue strength in a group of individuals with dysphagia. The findings provide evidence that in this group, tongue weakness coincided with signs of dysphagia, adding justification for tongue-strengthening protocols.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – original draft
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 February 2021
                2021
                : 16
                : 2
                : e0245901
                Affiliations
                [1 ] Department of Otorhinolaryngology, Hospital Universitario Clínico San Cecilio, Granada, Spain
                [2 ] Department of Otorhinolaryngology, Hospital Quirón Marbella, Marbella, Spain
                [3 ] Department of Otorhinolaryngology, Hospital Quirón Campo de Gibraltar, Marbella, Spain
                [4 ] Department of Otorhinolaryngology, Hospital Universitario Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
                [5 ] Department of Otorhinolaryngology, Hospital Sanitas La Zarzuela, Madrid, Spain
                AUSL della Romagna, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0001-6409-4921
                Article
                PONE-D-20-39215
                10.1371/journal.pone.0245901
                7891707
                33600465
                c2157c9c-a7a3-45c5-a05d-e626758850a7
                © 2021 Rodríguez-Alcalá et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 December 2020
                : 3 January 2021
                Page count
                Figures: 5, Tables: 4, Pages: 10
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Biology and Life Sciences
                Anatomy
                Digestive System
                Mouth
                Tongue
                Medicine and Health Sciences
                Anatomy
                Digestive System
                Mouth
                Tongue
                Engineering and Technology
                Measurement
                People and Places
                Population Groupings
                Age Groups
                Adults
                Elderly
                Medicine and Health Sciences
                Health Care
                Geriatric Care
                Medicine and Health Sciences
                Otorhinolaryngology
                Laryngology
                Speech-Language Pathology
                Speech Therapy
                Medicine and Health Sciences
                Otorhinolaryngology
                Laryngology
                Dysphagia
                Engineering and Technology
                Equipment
                Measurement Equipment
                Biology and Life Sciences
                Molecular Biology
                Molecular Biology Techniques
                Cell Labeling
                Nucleic Acid Labeling
                Nick Translation
                Research and Analysis Methods
                Molecular Biology Techniques
                Cell Labeling
                Nucleic Acid Labeling
                Nick Translation
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

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                Uncategorized

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