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

Lee, Jae Hong; Choi, Seong-Youl

doi:10.23736/s1973-9087.20.06180-8

Cited by 7 publications

(6 citation statements)

References 45 publications

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“…An increase of 5% and 18% in the tongue thickness and tongue-palate pressure, respectively have been reported in older adults with dysphagia following TSE 20) . Improved tongue muscle strength, increased saliva secretion, increased thickness of the suprahyoid and tongue muscles, and a decrease in the VDS scores have been reported following tongue rehabilitation training [21][22][23][24][25][26] . These positive outcomes have been reported…”

Section: Key Results and Comparison With Previous Studiesmentioning

confidence: 96%

Comparison of the Tongue-Palate Pressure Patterns According to the Tongue Pressure in Community-Dwelling Older Adults

Jo,

Kim,

Park

et al. 2023

J Dent Hyg Sci

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Background: Oral frailty has garnered considerable interest following its identification as a risk factor for physical frailty. The Korean oral frailty diagnosis criteria have emphasized the need for extensive research on oral frailty diagnostic items and interventions.Our study performed an in-depth analysis of the tongue-palate pressure patterns in healthy community-dwelling older adults. Methods: Of the 217 older adults aged ≥60 years who visited a senior center in Wonju, 205 participants who completed tongue pressure measurement were included in the final analysis. Pressure changes over time were recorded by instructing the participants to press their tongue against the hard palate with for 7 seconds per cycle. The participants were divided into the normal and abnormal tongue pressure (NTP and ATP, respectively) groups based on whether they achieved the target tongue pressure at least once; tongue pressure patterns were compared between the groups. Furthermore, the average time taken to achieve the standard tongue pressure value was calculated for the participants in the NTP group and used to evaluate the decrease in tongue pressure in the ATP group. Results: Among the 205 participants, 40.5% had ATP. The tongue pressure graph revealed a gentle and consistent incline that was maintained even after achieving standard tongue pressure in the NTP group. The graph was more extreme in the ATP group, and the changes in the pressure type varied across individuals; the tongue pressure was only 48.4%, 40.7%, 31.9%, and 22.6% of the NTP in the participants in their 60s, 70s, 80s, and ≥90s, respectively (p＜0.05). Conclusion: Tongue pressure weakness was observed in 40.5% of the healthy community-dwelling older adults. Furthermore, ATP graphs were observed in the patients with tongue pressure weakness. Thus, activities improving the oral function in community-dwelling older adults and systematic oral rehabilitation programs should be devised to promote normal swallowing.

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Section: Key Results and Comparison With Previous Studiesmentioning

confidence: 96%

Comparison of the Tongue-Palate Pressure Patterns According to the Tongue Pressure in Community-Dwelling Older Adults

Jo,

Kim,

Park

et al. 2023

J Dent Hyg Sci

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“…Oliveira et al (2017) found that stroke patients with dysphagia had lower tongue strength than those without. Beyond that, Lee and Choi (2020) claim that tongue strength has similar predictive abilities to bedside tests screening aspiration and penetration in stroke patients and even call it a new screening test to reduce the risk of pneumonia. From this point of view, the maximum anterior tongue elevation strength measurement can be an effective additional tool for neurogenic dysphagia evaluation, especially in poststroke patients in clinical application.…”

Section: Review Of Literaturementioning

confidence: 99%

Aspiration Risk Screening With Tongue Pressure Measurement in Acute Stroke: A Diagnostic Accuracy Study Using STARD Guidelines

Szabó,

Műhelyi,

Halász

et al. 2023

SAGE Open Nursing

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Introduction Dysphagia can affect more than 50% of stroke patients in the acute phase. Aspiration pneumonia is a serious complication that can be prevented with dysphagia screening and assessment. Measurement of tongue elevation pressure is suggested to be a useful tool in aspiration risk screening. Objective This study aimed to assess the diagnostic accuracy of maximum anterior tongue elevation strength (Pmax) in acute stroke care. Method In this prospective study, data were collected in a neurology department (stroke center) where patients formed a consecutive case series. The sample consisted of thirty stroke patients who failed an initial dysphagia screening. Patients underwent anterior tongue elevation strength measurement (index test) during bedside dysphagia assessment by a speech-language pathologist and flexible endoscopic evaluation of swallowing (reference test) by an otorhinolaryngologist on the same day. Outcome variables (index values in kPa, reference values interpreted on the penetration-aspiration scale) were used for estimating measures of diagnostic accuracy in aspiration risk screening. Results Ten patients aspirated on instrumental evaluation. At the cut-off point of ≤ 34 kPa the analysis showed 90% sensitivity, 35% specificity, 41% positive predictive value, and 88% negative predictive value. The area under the curve (AUC) for Pmax was AUC = 0.700 (95% CI [0.500–0.900]). Conclusion Although individuals with low anterior tongue elevation strength tend to have a higher risk of aspiration, this variable alone is not capable of screening aspiration in acute stroke. In combination with a thorough noninstrumental bedside examination, it might have the potential to reduce the number of false positive cases. Further studies in this area would be worthwhile.

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“…Maximum isometric posterior tongue pressure is measured by placing the bulb 10 mm anterior to the most posterior circumvallate papilla ( Figure 1 c) [ 21 ]. To obtain the maximum tongue pressure (pMax), subjects are then asked to push the tongue towards the hard palate as hard as possible [ 22 ]. Tongue endurance is measured by placing the bulb in the desired location (anterior or posterior) and capturing the number of seconds (s) a subject can maintain tongue pressure at 50% of pMax.…”

Section: Introductionmentioning

confidence: 99%

Quantitative Measurement of Swallowing Performance Using Iowa Oral Performance Instrument: A Systematic Review and Meta-Analysis

et al. 2022

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Swallowing is a complex but stereotyped motor activity aimed at serving two vital purposes: alimentary function and the protection of upper airways. Therefore, any impairment of the swallowing act can represent a significant clinical and personal problem that needs an accurate diagnosis by means of reliable and non-invasive techniques. Thus, a systematic review and meta-analysis was performed to investigate the reliability of the Iowa Oral Pressure Instrument (IOPI) in distinguishing healthy controls (HC) from patients affected by swallowing disorders or pathologies and conditions that imply dysphagia. A comprehensive search was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and using PubMed, Scopus, Web of Science, Cochrane, and Lilacs databases. Overall, 271 articles were identified and, after a three-step screening, 33 case-control and interventional studies reporting IOPI measurements were included. The methodological quality of the retrieved studies resulted in being at a low risk of bias. The meta-analysis on case-control studies showed that maximum tongue pressure (MIP) values were always higher in HC than in patients, with an overall effect of the MIP difference of 18.2 KPa (17.7–18.7 KPa CI). This result was also confirmed when the sample was split into adults and children, although the MIP difference between HC and patients was greater in children than in adults (21.0 vs. 15.4 KPa in the MIP mean difference overall effect, respectively). Tongue endurance (TE) showed conflicting results among studies, with an overall effect among studies near zero (0.7 s, 0.2–1.1 s CI) and a slight tendency toward higher TE values in HC than in patients. Among the intervention studies, MIP values were higher after treatment than before, with a better outcome after the experimental tongue training exercise than traditional treatments (the MIP mean difference overall effect was 10.8 and 2.3 KPa, respectively). In conclusion, MIP values can be considered as a reliable measure of swallowing function in adults and in children, with a more marked MIP difference between HC and patients for the children population. MIP measures in patients are also able to detect the best outcome on the tongue function after the training exercise compared to traditional training.

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

Cited by 7 publications

References 45 publications

Comparison of the Tongue-Palate Pressure Patterns According to the Tongue Pressure in Community-Dwelling Older Adults

Comparison of the Tongue-Palate Pressure Patterns According to the Tongue Pressure in Community-Dwelling Older Adults

Aspiration Risk Screening With Tongue Pressure Measurement in Acute Stroke: A Diagnostic Accuracy Study Using STARD Guidelines

Quantitative Measurement of Swallowing Performance Using Iowa Oral Performance Instrument: A Systematic Review and Meta-Analysis

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