Tongue and Lip Comparisons between Healthy and Nondysphagic Poststroke Individuals

Abstract

<b><i>Background:</i></b> The lips and tongue play a substantial role in efficient clearance of food from the mouth and pharynx into the esophagus. No study has compared oral pressures between healthy individuals and poststoke individuals who report functional swallow abilities. <b><i>Aim:</i></b> The current study aimed to investigate the presence of differences in oral pressures between healthy individuals and poststroke individuals who report functional swallowing abilities. <b><i>Design:</i></b> This is a controlled matched pair study. <b><i>Population:</i></b> Eighteen control participants (CG) and 18 nondysphagic poststroke participants (NDSG) were enrolled into this study. <b><i>Methods:</i></b> The Iowa Oral Performance Instrument (IOPI) was used to measure and compare tongue strength, endurance, and functional lingual and labial pressures between sex and age-matched pairs. <b><i>Results:</i></b> Six paired, two-tailed <i>t</i> tests revealed that tongue and lip pressures were different between the 2 groups. Maximum anterior tongue pressures and posterior tongue pressures were also different, i.e., <i>t</i>(17) = –2.89 (<i>p</i> = 0.010) and <i>t</i>(17) = –2.85 (<i>p</i> = 0.011), with the CG presenting higher pressures. Right lip pressures were significantly lower in the NDSG compared to the CG, i.e., <i>t</i>(17) = 2.45 (<i>p</i> = 0.0001). Left lip pressures were significantly lower in the NDSG compared to the CG, i.e., <i>t</i>(17) = –5.43 (<i>p</i> = 0.0001). Tongue endurance, i.e., <i>t</i>(17) = 0.092 (<i>p</i> = 0.928) and saliva swallow pressures, i.e., <i>t</i>(17) = –0.490 (<i>p</i> = 0.63) were not different. <b><i>Conclusion:</i></b> Although poststroke participants reported functional swallowing abilities, there were differences in tongue and lip pressures but not in endurance or saliva swallow pressures. <b><i>Clinical Rehabilitation Impact:</i></b> Poststroke individuals without complaints of dysphagia who are not assessed may experience subclinical dysphagia that could negatively impact their nutrition and quality of life.

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

“…Differently from MIP values, TE showed contrasting results among studies ( Figure 5 ). Indeed, in three studies (9.09%) [ 71 , 72 , 74 ], TE values were lower in HC than in patients, in three other studies (9.09%) [ 50 , 54 , 77 ], TE values were similar for the two groups, and in the remaining three studies [ 59 , 73 , 76 ] (9.09%), TE values were higher in HC than in patients. The overall effect was near zero (0.7 s, 0.2–1.1 s), showing a slight prevalence of studies showing higher TE values in HC than in patients.…”

“…An initial screening of the titles and abstracts identified 47 studies. After reading the full texts, 33 studies [ 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ] were included, thus eliminating 14 studies [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 78 ] that did not meet the inclusion/exclusion criteria. The summary of the search strategy is depicted in Figure 2 .…”

“…Impaired swallowing performance was associated to many pathologies and conditions. In particular, among the 19 studies [ 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ] with a case-control design, participants included patients with head and neck cancer in 3 studies (21.4%) [ 71 , 72 , 76 ], with muscular dystrophies in 4 studies (28.5%) [ 70 , 73 , 74 , 75 ], and dysphagic [ 77 ], post-extubated [ 49 ], unilateral cleft-lip-palate [ 50 ], Parkinson’s disease [ 51 ], chronic temporo-mandibular disorders (TMD) [ 52 ], sleep breathing disorders [ 53 ], and post-stroke [ 54 ] subjects in 1 study (7.1%), respectively. Among the 5 case-control studies with a cross-sectional design, older adults [ 55 ], patients with mouth breathing behavior [ 56 ], motor speech disorders and sound disorders [ 57 ], Sjogren syndrome [ 58 ], and Down syndrome [ 59 ] were included in only 1 study (20%).…”

“…Among case control studies, a low risk of bias was found in eight studies [ 49 , 50 , 54 , 71 , 72 , 75 , 76 , 77 ]. Six studies instead [ 51 , 52 , 53 , 70 , 73 , 74 ] resulted in being at an intermediate risk of bias because of inadequate information about “Selection”, “Comparability”, and “Exposure” domains, according to the Newcastle–Ottawa quality assessment scale.…”

“…For the case-control analyses, 21 [ 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 65 , 67 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ] studies (63.64%) reported at least one of the outcome variables in the HC and patients’ groups. Specifically, 19 studies [ 49 , 50 , 51 , 53 , 54 , 55 , 56 , 57 , 59 , 65 , 67 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ] (57.57%) reported MIP values, 4 studies [ 51 , 52 , 54 , 74 ] (12.12%) reported LSP values, 9 studies [ 36 , 40 , 45 , 61 , 62 ,…”