Isometric tongue endurance and incomplete laryngeal vestibule closure in Parkinson's disease

Abstract

BackgroundDysphagia is a common symptom of Parkinson's disease (PD). A delay in laryngeal vestibule closure (LVC) and a reduction in tongue pressure, may affect swallowing safety and increase the risk of pulmonary aspiration.ObjectiveTo verify the relationship between tongue pressure and airway protection in PD patients: (1) comparing tongue pressure measures and physiological events in the pharyngeal phase of swallowing between PD and controls and (2) analysing the association between tongue pressure and LVC in the PD group.MethodsTwenty‐three patients with idiopathic PD (64.9 years) and 24 healthy controls (64.1 years) participated in this study. All participants underwent the following procedures to verify tongue pressure measurements using the Iowa Oral Performance Instrument: maximum anterior and posterior pressure, isotonic and isometric tongue endurance and anterior and posterior tongue pressure during saliva swallowing. To verify swallowing safety, videofluoroscopic swallowing studies focusing on the pharyngeal phase were performed based on the MBSImP protocol.ResultsCompared to healthy controls, PD exhibited a statistically significant decline in tongue pressure tasks: posterior maximum pressure, isotonic endurance, anterior and posterior isometric endurance and tongue pressure during posterior swallowing. Patients with PD had worse pharyngeal scores, including LVC scores, than controls. PD and incomplete LVC had lower anterior isometric endurance scores when compared to those with complete LVC.ConclusionPD with incomplete LVC scored lower in the anterior isometric endurance task. We observed a potential clinical use of this task for the assessment and management of dysphagia in patients with PD.

Quantitative evaluation of swallowing function in Parkinson’s disease using tongue pressure measurement: a mini-review

“…In addition, there are few reports of studies on tongue endurance compared with tongue strength. Although there have been reports suggesting an association between decreased anterior tongue endurance and delayed laryngeal vestibular closure, the relationship between tongue endurance and swallowing function remains unclear ( 33 ). Investigating the effects of reduced muscle strength and endurance on swallowing efficiency and safety for the anterior and posterior portions of the tongue, respectively, could clarify whether tongue pressure is a clinical marker for the presence or absence of dysphagia and the pathophysiology of PD.…”

“…Solomon et al ( 30 ) investigated muscle strength and endurance in the tongue and hands of patients with PD and compared them with neurologically normal controls, and reported that the patients with PD had 8.3 kPa lower tongue strength and 8.2 s shorter endurance. Tongue strength can be measured in the anterior and posterior portions of the tongue, but studies of PD have reported declines in only the anterior portion or in both the anterior and posterior portions ( 32 , 33 ).…”

“…An analysis of the relationship between tongue pressure and swallowing function using videofluoroscopic swallowing studies reported that higher tongue strength leads to less airway penetration of thin liquids, and that low endurance in the anterior portion of the tongue delays the laryngeal vestibule closure time ( 33 , 35 ).…”

“…Tongue pressure during swallowing is a method of measuring the contact pressure between the tongue and palate during swallowing. A simple method is to place the balloon of a tongue-pressure measuring device such as the IOPI on the tongue and measure the pressure of the tongue pushing the balloon upward during swallowing ( 33 , 35 ). A detailed evaluation of tongue pressure during swallowing involves attaching a customized sensor to the palate and measuring the contact between the tongue and the palate.…”

“…Studies using IOPI bulbs have shown that tongue pressure during salivary swallowing is decreased in patients with PD compared with healthy older adults ( 11 , 35 ). Da Costa et al ( 33 ) compared tongue pressure during salivary swallowing in 23 patients with idiopathic PD (mean age, 64.9 years) and 24 healthy controls (mean age, 64.1 years) using the IOPI placed anteriorly and posteriorly. They reported that compared with the control group, patients with PD had significantly lower tongue pressure during swallowing in the posterior region.…”