It is clinically important to evaluate tongue function in terms of rehabilitation of swallowing and eating ability. We have developed a disposable tongue pressure measurement device designed for clinical use. In this study we used this device to determine standard values of maximum tongue pressure in adult Japanese. Eight hundred fifty-three subjects (408 male, 445 female; 20-79 years) were selected for this study. All participants had no history of dysphagia and maintained occlusal contact in the premolar and molar regions with their own teeth. A balloon-type disposable oral probe was used to measure tongue pressure by asking subjects to compress it onto the palate for 7 s with maximum voluntary effort. Values were recorded three times for each subject, and the mean values were defined as maximum tongue pressure. Although maximum tongue pressure was higher for males than for females in the 20-49-year age groups, there was no significant difference between males and females in the 50-79-year age groups. The maximum tongue pressure of the seventies age group was significantly lower than that of the twenties to fifties age groups. It may be concluded that maximum tongue pressures were reduced with primary aging. Males may become weaker with age at a faster rate than females; however, further decreases in strength were in parallel for male and female subjects.

Standard values of maximum tongue pressure taken using newly developed disposable tongue pressure measurement device.

The tongue plays a key role in oropharyngeal swallowing. It has been reported that maximum isometric tongue pressure decreases with age. The risk for dysphagia resulting from low tongue strength remains unclear. This study was designed to reveal the relationship between tongue pressure and clinical signs of dysphagic tongue movement and cough and to demonstrate the clinical value of tongue pressure measurement in the evaluation of swallowing function. One hundred forty-five institutionalized elderly in five nursing homes participated. Evaluation of physical activity with self-standing up capability and mental condition with Mini Mental Status Examination (MMSE) were recorded. Maximum tongue pressure was determined using a newly developed tongue pressure measurement device. Voluntary tongue movement and signs of dysphagic cough at mealtime were inspected and evaluated by one clinically experienced dentist and speech therapist. The relationship between level of tongue pressure and incidence of cough was evaluated using logistic regression analysis with physical and mental conditions as covariates. Tongue pressure as measured by the newly developed device was significantly related to the voluntary tongue movement and incidence of cough (p < 0.05). The results of this study suggest that tongue pressure measurement reflects clinical signs of dysphagic tongue movement and cough and that measurement of tongue pressure is useful for the bedside evaluation of swallowing.

Decreased Tongue Pressure Reflects Symptom of Dysphagia

Newly developed sensor sheet for measuring tongue pressure during swallowing.

Objectives: The tongue plays an important role in swallowing by contacting the palate. The aim of the present study was to investigate the characteristics of tongue pressure production during swallowing in post-stroke patients using a newly developed sensor sheet.



Materials and methods:  Ten post-stroke inpatients with hemiplegia and five healthy volunteers participated in this study. Magnitude of tongue pressure during a dry swallow was measured using a newly developed sensor sheet comprising five sensors applied directly to the palate or to the palatal surface of a maxillary denture using denture adhesive. Swallowing ability was evaluated by measuring the time taken to swallow 30 ml of water. The magnitude of tongue pressure was compared between the post-stroke patients and healthy subjects as well as between each measuring point in both groups. The relationship between tongue pressure and swallowing ability and that between tongue pressure and state of occlusal support were also examined.



Results:  The magnitude of tongue pressure in the post-stroke patients was smaller than that of the healthy subjects at the measuring points along the median line (Welch test, p < 0.05), larger in the non-paralysed side than in the paralysed side (two-way anova, p < 0.05), and was influenced by swallowing ability and occlusal support (Welch test, p < 0.05).



Conclusions:  Measurement of the magnitude of tongue pressure shows promise as a simple, non-invasive and quantitative method by which tongue activity in post-stroke patients, in whom swallowing ability is a concern, could be evaluated.

Tongue pressure against hard palate during swallowing in post-stroke patients.

A new tongue pressure device consisting of a simple and safe disposable probe and manometer has been developed. This report describes a study that examined the validity of the new device, comparing it to a widely used tongue pressure manometer, the Iowa Oral Performance Instrument (IOPI), and to the stable adhered three air-filled bulbs manometry system. The first test compared maximum tongue pressure measured with the new device and the IOPI (13 male, 9 female, 25.0 years). The second test compared maximum tongue pressure and swallowing tongue pressure measured with the new device and the three-bulb device (13 male, 9 female, 31.0 years). Significant correlations of maximum tongue pressure were found between the new device and the IOPI in the first test (p < 0.05). In the second test, significant correlations of maximum tongue pressure were found between the new device at the anterior and middle sensors (p < 0.05) but not at the posterior sensor of the three-bulb device. Significant correlations of swallowing tongue pressure between the new device and the three-bulb device were found (p < 0.05). These findings demonstrate that the measurements by the new simple tongue pressure device are closely equivalent to those of the IOPI and three-bulb devices, demonstrating that the new device is capable of accurately measuring the pressure generated by the whole tongue.

Comparison of three types of tongue pressure measurement devices.

We examined the influence on temporal aspects of three consonants, /k/, /c/ and /s/, of alterations in the oral environment produced by either palatal augmentation or by an increase in the vertical dimension of occlusion Voice onset time (VOT) for /k/ and /c/ was influenced more than aspiration time by the palatal augmentation Consonant duration for /s/ was also influenced by palatal augmentation Significant influence of an increase in vertical dimension on the timing was not recognized Speech disorder caused by the malformation of palate seems to be more frequent than that caused by vertical dimension Adaptation to prostheses would seem to be definitely concerned with orosensory feedback

Influence of alterations in the oral environment on speech production

Purpose : The purpose of the present study was to examine the relationship of tongue pressure and changes in occlusal vertical dimension to swallowing.Materials and Methods : The volunteer subjects were four young male dentulous adults and eight elderly complete denture wearers. The tongue pressure to the palate was simultaneously recorded with electromyography (EMG) measurements of the suprahyoid muscles as the occlusal vertical dimension changed. The subjects were instructed to perform two actions : swallowing without any liquid or food (dry swallowing) and swallowing of 2 ml water (wet swallowing).Results : During dry swallowing, the maximum pressure decreased significantly as the vertical dimension increased in the young subjects. In the elderly, the maximum tongue pressure decreased monotonically as the vertical occlusion increased. The same results were clearly found for wet swallowing. Overall data suggested that the tongue pressure of the elderly group was lower and the duration of tongue pressure in wet swallowing was longer than that of the younger group.Conclusion : An increase of the vertical dimension decreased the tongue pressure to the palate, whereas a decrease of the vertical dimension affected the tongue pressure less. Tongue pressure is an important factor for the evaluation of tongue function, especially swallowing.

Influence of Changes in Occlusal Vertical Dimension on Tongue Pressure to Palate during Swallowing

Mastication and swallowing are closely related to tongue function. In the elderly, decrease of tongue function is suspected to cause oral malfunction. The purpose of the present study was to clarify the aging of swallowing by observing tongue pressure on the palate during swallowing. The subjects used were three young dentate persons and eight elderly complete denture wearers. Five pressure transducers were placed in either the artificial palatal plate or the duplicated upper denture. Tongue pressure and electromyography (EMG) of the suprahyoid muscle were recorded.The results were as follows:1. Maximum tongue pressure of the elderly denture wearers was significantly lower than that of young dentate persons.2. Upon swallowing saliva, both the duration from the EMG onset of suprahyoid muscle movement to the onset of tongue pressure and from the EMG onset to the time of maximum tongue pressure of the elderly were longer than those of the young dentate persons.3. In young dentate persons, the duration from the onset of tongue pressure to the time of maximum tongue pressure in swallowing saliva was shorter than that for swallowing 2 ml water, while that of elderly denture wearers was longer.

Observation of Tongue Pressure to Palate at Swallowing. Comparison between Young Dentitions and Elderly Complete Denture Wearers.

The purpose of this study was to investigate the influence of the vertical dimension on pronunciation.Tongue pressures, mandibular movements and speech sounds were simultaneously recorded and analyzed for the following sounds:/asa/, /asi/, /ahi/, /aci/, /aki/, /ake/ and /ari/ when the vertical dimension was normal and increased by 4mm, 8mm and 12mm beyond the normal vertical dimension at the incisor.The results were as follows:1. The maximum tongue pressures tended to be smaller on for /asa/ than other sounds and be greater in more posterior palate in the normal vertical dimension.2. The maximum tongue pressures changed differently among subjects, sounds and measuring sites, but tended to decrease in anterior palate for any sounds and increase in posterior palate with increases in vertical dimensions.3. Tongue contacts usually started from posterior palate to anterior palate before the end of the preceding vowel, and tongue pressures usually came up to maximum between the end of the preceding vowel and the start of the following vowel. But the timings between sounds and tongue pressures were not evidently influenced with increasing vertical dimensions.4. It was found that changes in maximum tongue pressures with increasing vertical dimensions were related to those of simultaneous mandibular movements.

Junji Komoda

Papers

Influence of alterations in the oral environment on speech production

Influence of Changes in Occlusal Vertical Dimension on Tongue Pressure to Palate during Swallowing

Observation of Tongue Pressure to Palate at Swallowing. Comparison between Young Dentitions and Elderly Complete Denture Wearers.

Influences of the vertical dimension of articulatory movements of the tongue and mandible.

Establishment of speech test using a speech recognition unit. Part 1. The utility of the speech recognition unit.