The Relationship Between Tongue Pressure and Oral Dysphagia in Stroke Patients

Jong Ha Lee, Hee-Sang Kim, Dong Hwan Yun, Jinmann Chon, Yoo Jin Han, Seung Don Yoo, Dong Hwan Kim, Seung Ah Lee, Hye In Joo, Ji-Su Park, Jin Chul Kim, Yunsoo Soh, Jong Ha Lee, Hee-Sang Kim, Dong Hwan Yun, Jinmann Chon, Yoo Jin Han, Seung Don Yoo, Dong Hwan Kim, Seung Ah Lee, Hye In Joo, Ji-Su Park, Jin Chul Kim, Yunsoo Soh

Abstract

Objective: To evaluate the relationships between tongue pressure and different aspects of the oral-phase swallowing function.

Methods: We included 96 stroke patients with dysphagia, ranging in age from 40 to 88 years (mean, 63.7 years). Measurements of tongue pressure were obtained with the Iowa Oral Performance Instrument, a device with established normative data. Three trials of maximum performance were performed for lip closure pressure (LP), anterior hard palate-to-tongue pressure (AP), and posterior hard palate-to-tongue pressure (PP); buccal-to-tongue pressures on both sides were also recorded (buccal-to-tongue pressure, on the weak side [BW]; buccal-to-tongue pressure, on the healthy side [BH]). The average pressure in each result was compared between the groups. Clinical evaluation of the swallowing function was performed with a videofluoroscopic swallowing study.

Results: The average maximum AP and PP values in the intact LC group were significantly higher than those in the inadequate lip closure group (AP, p=0.003; PP, p<0.001). AP and PP showed significant relationships with bolus formation (BF), mastication, premature bolus loss (PBL), tongue to palate contact (TP), and oral transit time (OTT). Furthermore, LP, BW, and BH values were significantly higher in the groups with intact mastication, without PBL and intact TP.

Conclusion: These findings indicate that the tongue pressure appears to be closely related to the oral-phase swallowing function in post-stroke patients, especially BF, mastication, PBL, TP and OTT.

Keywords: Dysphagia; Iowa Oral Performance Instrument; Stroke; Tongue pressure; VFSS.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1. Positioning of the air-filled lingual…
Fig. 1. Positioning of the air-filled lingual pressure sensor of the Iowa Oral Performance Instrument between the tongue and an oral structure.
Fig. 2. Correlation between premature bolus loss…
Fig. 2. Correlation between premature bolus loss (PBL) and mean tongue pressure. A larger amount of PBL was associated with a lower maximal tongue pressure (Jonckheere– Terpstra rank correlation test, p

References

    1. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–2763.
    1. Smithard DG, O'Neill PA, Parks C, Morris J. Complications and outcome after acute stroke. Does dysphagia matter? Stroke. 1996;27:1200–1204.
    1. Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154:953–963.
    1. Daniels SK, Brailey K, Foundas AL. Lingual discoordination and dysphagia following acute stroke: analyses of lesion localization. Dysphagia. 1999;14:85–92.
    1. Logemann JA. Evaluation and treatment of swallowing disorders. 2nd ed. Austin: Pro-Ed; 1998.
    1. Konaka K, Kondo J, Hirota N, Tamine K, Hori K, Ono T, et al. Relationship between tongue pressure and dysphagia in stroke patients. Eur Neurol. 2010;64:101–107.
    1. Ku DN, Ma PP, McConnel FM, Cerenko D. A kinematic study of the oropharyngeal swallowing of a liquid. Ann Biomed Eng. 1990;18:655–669.
    1. Clark HM, Henson PA, Barber WD, Stierwalt JA, Sherrill M. Relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments. Am J Speech Lang Pathol. 2003;12:40–50.
    1. Horner J, Massey EW. Silent aspiration following stroke. Neurology. 1988;38:317–319.
    1. Roth EJ. Medical complications encountered in stroke rehabilitation. Phys Med Rehabil Clin North Am. 1991;2:563–577.
    1. DePippo KL, Holas MA, Reding MJ, Mandel FS, Lesser ML. Dysphagia therapy following stroke: a controlled trial. Neurology. 1994;44:1655–1660.
    1. Falsetti P, Acciai C, Palilla R, Bosi M, Carpinteri F, Zingarelli A, et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis. 2009;18:329–335.
    1. Han TR, Paik NJ, Park JW. Quantifying swallowing function after stroke: a functional dysphagia scale based on videofluoroscopic studies. Arch Phys Med Rehabil. 2001;82:677–682.
    1. Logemann JA. Manual for the videofluorographic study of swallowing. 2nd ed. Austin: Pro-Ed; 1993.
    1. Han TR, Paik NJ, Park JW, Kwon BS. The prediction of persistent dysphagia beyond six months after stroke. Dysphagia. 2008;23:59–64.
    1. Robbins J, Levine R, Wood J, Roecker EB, Luschei E. Age effects on lingual pressure generation as a risk factor for dysphagia. J Gerontol A Biol Sci Med Sci. 1995;50:M257–M262.
    1. Park JS, You SJ, Kim JY, Yeo SG, Lee JH. Differences in orofacial muscle strength according to age and sex in East Asian healthy adults. Am J Phys Med Rehabil. 2015;94:677–686.
    1. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol. 1989;42:703–709.
    1. Kang Y, Na DL, Hahn S. A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc. 1997;15:300–308.
    1. Pouderoux P, Kahrilas PJ. Deglutitive tongue force modulation by volition, volume, and viscosity in humans. Gastroenterology. 1995;108:1418–1426.
    1. Robbins J, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;53:1483–1489.
    1. Hagg M, Anniko M. Influence of lip force on swallowing capacity in stroke patients and in healthy subjects. Acta Otolaryngol. 2010;130:1204–1208.
    1. Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am. 2008;19:691–707.
    1. Moon HI, Pyun SB, Kwon HK. Correlation between location of brain lesion and cognitive function and findings of videofluoroscopic swallowing study. Ann Rehabil Med. 2012;36:347–355.
    1. Kim DH, Choi KH, Kim HM, Koo JH, Kim BR, Kim TW, et al. Inter-rater reliability of videofluoroscopic dysphagia scale. Ann Rehabil Med. 2012;36:791–796.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren