Tongue muscle strength affects posterior pharyngeal wall advancement during swallowing: A cross-sectional study of outpatients with dysphagia.

BACKGROUND: Tongue muscle strength is important for swallowing but decreases with age, in association with reduced skeletal muscle mass. However, the relationships between pharyngeal dynamics and both skeletal muscle mass and tongue muscle strength are unknown. OBJECTIVE: To investigate the effect of reductions in tongue muscle strength on pharyngeal movement during swallowing in patients with dysphagia. METHODS: Subjects were selected from male outpatients ≥65 years old who were examined for the main complaint of dysphagia. Patients with history of neurodegenerative disease affecting tongue movement, cerebrovascular disease or oral cancer were excluded. As a result, 82 men (mean age, 80.6 ± 6.8 years) participated. Skeletal muscle mass index (SMI) as physical parameters and maximum tongue pressure (MTP) as tongue muscles strength were measured. Status and dynamics of the pharyngeal organs, including change in posterior pharyngeal wall advancement (PPWA) when swallowing 3.0 mL of moderately thick liquid, were measured by analysing videofluoroscopic images. Simple bivariate correlation and multiple regression analysis were used to statistically analyse correlations between parameters. RESULTS: MTP showed a significant positive correlation with SMI (r = .43, P < .01). PPWA showed a significant negative correlation with MTP (r = -0.30, P < .01), but no association with SMI. CONCLUSIONS: While tongue muscle strength is affected by skeletal muscle mass, posterior pharyngeal wall advancement is not readily affected by decreases in skeletal muscle mass. Posterior pharyngeal wall advancement may increase to compensate for swallowing function among individuals with reduced tongue muscle strength.

Effect of dysphagia rehabilitation in patients receiving enteral nutrition at home nursing care: A retrospective cohort study.

OBJECTIVE: We considered the effect of dysphagia rehabilitation and investigated parameters associated with the resumption of oral intake in the elderly patients receiving home nursing care who were not eating by mouth. METHODS: The participants were 116 patients aged ≥65 years (66 men and 50 women, mean age 79.7 ± 8.9 years) who were receiving home nursing care and not eating by mouth because of dysphagia. All patients underwent dysphagia rehabilitation for 6 months with the objective of resuming oral intake. After 6 months of dysphagia rehabilitation, the patients' eating status was assessed using the Functional Oral Intake Scale (FOIS) and the associations of the post-intervention FOIS score with age, history of pneumonia, duration of enteral nutrition, body mass index (BMI), alertness, physical function (ability to walk) and swallowing function at the initial examination. RESULTS: Functional Oral Intake Scale scores increased significantly after 6 months rather than those at the initial evaluation (P < .001). Eighty patients (69.0%) resumed oral intake (FOIS score ≥2), thirty patients (25.9%) of whom became capable of daily oral intake (FOIS score ≥3). Swallowing function was associated with the resumption of oral intake. In addition, physical function before dysphagia rehabilitation was an important factor to resume daily oral intake. CONCLUSIONS: The results of the present study suggest that the resumption of oral intake by patients receiving enteral nutrition requires improvement in swallowing function. In addition, anyone who cannot walk may not recover daily oral intake.

Factors predicting the effects of dysphagia rehabilitation on multidimensional functional status in elder outpatients: A prospective cohort study.

OBJECTIVE: This study aimed to clarify the relationship between the oral intake function and functional status, as well as to determine the aspects of functional status potentially predicting the effects of dysphagia rehabilitation in the maintenance stage, in elder outpatients. METHODS: This study was conducted in a clinic, specialised in rehabilitation of patients with dysphagia. The participants were 93 non-tube-fed patients 65 years of age or older. The participants were scheduled to undergo the initial examination for oral intake function and functional status, and then to receive dysphagia rehabilitation for 1 year. After rehabilitation period, oral intake function was re-evaluated, and the elements of functional status potentially related to the effects of dysphagia rehabilitation were determined. RESULTS: It was found that the lower the participants' oral intake function levels, the higher the prevalence of reduced parameters of functional status. After 1-year dysphagia rehabilitation, the oral intake function was maintained or improved in 70 (75.3%) participants, but had diminished in 23 (24.7%). Our analysis revealed that participants with higher Vitality Index scores and MMSE at the time of initial examination were significantly more likely to show maintained or improved oral intake function at 1 year (odds ratio[OR], 1.76; 95% confidence interval [CI], 1.14-2.71; OR, 1.17; 95% CI, 1.06-1.28, respectively). CONCLUSIONS: It became apparent that the lower the oral intake function level at the initial examination, the higher the prevalence of reduced multidimensional functional status. Mental function was found to predict the effects of dysphagia rehabilitation in the maintenance stage.

Relationship between tongue strength and 1-year life expectancy in elderly people needing nursing care.

Tongue strength is a useful indicator of oral function and has been found to decrease with aging and reduced physical functioning. The present study aimed to assess the relationships of tongue strength with physical function, mental function, and nutritional status, and also between these factors and 1-year outcomes, to determine whether tongue strength is related to life expectancy in elderly people needing nursing care. The subjects were 140 elderly individuals requiring needing nursing care (49 men and 91 women; ≥65 years). The investigated items included sex, age, activities of daily living (ADL), comorbidity, cognitive function, nutritional status, eating function, occlusal support, and tongue strength. Furthermore, a follow-up study was conducted 1 year later, and factors related to death were identified. The mean tongue strength of the total 140 subjects was 20.3 ± 8.6 kPa. Tongue strength was assessed relative to each of the investigated items, using the t test and one-way analysis of variance. Tongue strength was significantly related to ADL, comorbidity, cognitive function, calf circumference, food intake, and occlusal support. Fifteen subjects were found to have died at the 1-year follow-up study. We assessed the relationships of 1-year outcomes with each of the factors examined, and 1-year outcomes were found to be significantly related to ADL and tongue strength.

Associations between tongue strength and skeletal muscle mass under dysphagia rehabilitation for geriatric out patients.

PURPOSE: The purpose of this study was to examine how skeletal muscle mass influences the effectiveness of dysphagia rehabilitation. METHODS: The cross-sectional study and the prospective cohort study were conducted in a clinic, specialized in rehabilitation of patients with dysphagia, located in Tokyo, Japan. Skeletal muscle mass measurement by bioelectrical impedance analysis and tongue strength measurement were performed on 178 outpatients with dysphagia. In addition, the Barthel Index, Mini Nutritional Assessment-Short Form, and Functional Oral Intake Scale values were measured. Dysphagia rehabilitation was performed, and 88 of the patients who were available for follow-up one year later were included in a follow-up study. In the cross-sectional study, the associations between tongue strength and other factors were examined. In the follow-up study, factors associated with rehabilitation effectiveness, shown by tongue strength, were examined. RESULTS: Tongue strength and skeletal muscle mass were correlated, and both decreased as eating and swallowing function level decreased. After one year of dysphagia rehabilitation, tongue strength and skeletal muscle mass increased. The factors associated with the amount of increase in tongue strength were initial tongue strength and skeletal muscle mass. CONCLUSIONS: For patients with dysphagia, maintenance of skeletal muscle mass was associated with improvement of tongue strength in rehabilitation. This indicates that prevention of sarcopenia in dysphagia patients contributes to the effect of rehabilitation.