Evaluating the Tongue-Hold Maneuver Using High-Resolution Manometry and Electromyography

Abstract

The tongue-hold maneuver is a widely used clinical technique designed to increase posterior pharyngeal wall movement in individuals with dysphagia. It is hypothesized that the tongue-hold maneuver results in increased contraction of the superior pharyngeal constrictor. However, an electromyographic study of the pharynx and tongue during the tongue-hold is still needed to understand whether and how swallow muscle activity and pressure may change with this maneuver. We tested eight healthy young participants using simultaneous intramuscular electromyography with high-resolution manometry during three task conditions including (a) saliva swallow without maneuver, (b) saliva swallow with the tongue tip at the lip, and (c) saliva swallow during the tongue-hold maneuver. We tested the hypothesis that tongue and pharyngeal muscle activity would increase during the experimental tasks, but that pharyngeal pressure would remain relatively unchanged. We found that the pre-swallow magnitude of tongue, pharyngeal constrictor, and cricopharyngeus muscle activity increased. During the swallow, the magnitude and duration of tongue and pharyngeal constrictor muscle activity each increased. However, manometric pressures and durations remained unchanged. These results suggest that increased superior pharyngeal constrictor activity may serve to maintain relatively stable pharyngeal pressures in the absence of posterior tongue movement. Thus, the tongue-hold maneuver may be a relatively simple but robust example of how the medullary swallow center is equipped to dynamically coordinate actions between tongue and pharynx. Our findings emphasize the need for combined modality swallow assessment to include high-resolution manometry and intramuscular electromyography to evaluate the potential benefit of the tongue-hold maneuver for clinical populations.

Expanding Instrumental Options for Dysphagia Diagnosis and Research: Ultrasound and Manometry

“…Pharyngeal HRM is limited by a seldom-reported measurement error in the ManoScan™ system, used widely in research [52,73,81,82,88,92,93,94,95]. A pressure drift has been found to refute the manufacturer's report that pressure uniformity remains within 2 mm Hg for 4 h or less of recording [93,96].…”

“…Research applications of HRM rely heavily on software such as MATLAB to analyse pharyngeal swallowing with custom algorithms outside of commercial HRM devices [78,79,80,81,82,83,91], and reliability of pharyngeal HRM is limited to one study investigating a custom MATLAB programme. The reliability of a custom-designed software programme was evaluated after provision of a 20-min training session to 20 raters with varying experience (e.g., expert and novice speech-language pathologists) [91].…”

“…Pharyngeal HRM has been used to evaluate normal swallowing [18] and swallowing using various manoeuvres, including tongue hold [81], effortful swallowing [18,82], the Mendelsohn manoeuvre [82], head turn and chin tuck [63,64]. Differences in bolus sizes and textures have additionally been evaluated [83,84].…”

Mudança funcional no padrão de deglutição por meio da realização de exercícios orofaciais

“…The disuse of swallowing mechanism can reduce its cortical representation and corresponds to a threat to functional recovery at long term (26) . Studies (1,8) already describe that exercises in specific muscle groups, which view at swallowing, can have a significant contribution for the function rehabilitation. The significant reduction of clinic signs presence after performing the exercises reflects the functional improvement at feeding.…”

“…Besides using adaptations at the moment of oral intake, it has been suggested a variety of exercise protocols to improve the swallowing capacity aiming at larger range of movement (3) , increase at the swallowing effort (4)(5)(6) and sensorial system impulse (7) . Among them are tongue-hold (8,9) , Shaker exercise (10) , counter-resistance exercise with head lowered (11) , tongue exercises (12) , Iowa Oral Performance Instrument -IOPI (13) , etc. Some studies (14)(15)(16) have shown a motor reorganization map as a feedback for therapeutic stimulation.…”