Biofeedback and Exercise Load Affect Accuracy of Tongue Strength Exercise Performance.

Rehabilitative exercises require precise movement coordination and target accuracy for optimal effectiveness. This paper explores the impact of tongue strength exercises (TSE) performance accuracy on exercise outcomes, adherence, and participant confidence and motivation. An 8-week randomized clinical trial included 84 typically aging participants divided into four groups defined by access to biofeedback (present/absent) and TSE intensity dosing (maximal/submaximal) during a home exercise program (HEP). Retention, training, and HEP accuracy were tracked at biweekly visits and during HEP for participants with access to a biofeedback device. Associations with tongue strength outcomes, participant factors, biofeedback, and intensity dosing were analyzed. Exercise accuracy measures did not contribute to tongue strength outcomes at the end of 8 weeks. Increased training accuracy (less practice required to achieve competency) was associated with higher participant confidence and better adherence to the HEP. The presence of biofeedback was associated with reduced adherence but better retention accuracy, while maximal intensity was associated with improvements in all accuracy measures compared to submaximal intensity exercise. These findings in typically aging participants suggest the need for tailored approaches in swallowing-related exercise programs, given the effects of biofeedback and exercise intensity on motor learning and exercise retention. Accuracy performance and its effect on clinical outcomes warrants study in clinical populations with dysphagia and with various rehabilitative approaches.Trial Registration Clincialtrials.gov: NCT04809558.

Evaluating palatability in young children: a mini-review of relevant physiology and assessment techniques.

The palatability of pediatric pharmaceutical products plays a crucial role of influencing medication compliance. Rejection of unpalatable medications can potentially lead to treatment failure which can have immediate and delayed consequences. With advances in both the food and pharmaceutical industries, the systematic assessment of palatability has gained importance. Various methods such as visual analogue scales, facial hedonic scales, and facial recognition software, have been employed to assess palatability. While proven to be useful, these methods have significant limitations and may not be workable for young children. Despite these advancements, a universally accepted "gold standard" for assessing pediatric mediation palatability, recognized by drug regulatory agencies, is yet to be established.

A Comparison of Lingual Pressure Generation Measures Using Two Devices in Community-Dwelling, Typically Aging Adults: An Important Clinical Implication.

DESIGN: A multisite, prospective, and randomized within-subject design study. SETTING: Five university settings in varied geographical areas in the United States. PURPOSE: The purpose of this study was to compare lingual pressure generation using the Tongueometer (TO) and the Iowa Oral Performance Instrument (IOPI) in typically aging, community-dwelling adults during three measurement tasks: maximum isometric pressure (MIP), regular effort saliva swallow (RESS) pressure, and effortful saliva swallow pressure (ESP). PARTICIPANTS: Eighty-seven typically aging, community-dwelling adults (aged 55 years and over) with no self-reported history of swallowing or neurological disorders were recruited to complete this study. RESULTS: Strong positive associations were found between the lingual pressure generation measures from the TO and IOPI in all tasks in typically aging adults, with Pearson correlations ranging from r = .780 to .874, p < .001. Agreement between the devices (Lin's concordance correlation coefficient) ranged from moderate for the MIP (ρc = .78) and ESP (ρc = .61) tasks to weak agreement for the RESS task (ρc = .47). MIP, RESS pressure, and ESP were lower when measured by the TO compared with the IOPI, p < .001. CONCLUSIONS: The TO measures lingual pressure generation similarly to the IOPI but pressures register lower when using the TO than the IOPI in typically aging persons. This supports the need for developing normative values specific to the TO device or development of a valid and reliable conversion formula from TO to IOPI normative values. At this time, the clinical use of reference values from the TO should not be generalized to IOPI normative values.

Flexibility for Intensity Dosing in Lingual Resistance Exercises: A Large Randomized Clinical Trial in Typically Aging Adults as Proof of Principle.

OBJECTIVE: The objective of this study was to determine the effect of intensity dosing during tongue exercise on tongue pressure generation, adherence, and perceived effort. DESIGN: This was a five-site, prospective, randomized clinical trial. Outcome measures were obtained across multiple baselines, biweekly during exercise, and 4-weeks post-intervention. SETTING: The general community at each study site. PARTICIPANTS: Typically aging adults between 55-82 years of age with no history of neurological or swallowing disorders. Eighty-four volunteers completed the study. INTERVENTIONS: Participants were randomly assigned to one of four exercise groups: (a) maximum intensity/no biofeedback, (b) progressive intensity/no biofeedback, (c) maximum intensity/biofeedback, and (d) progressive intensity/biofeedback. Half of the participants completed a maintenance exercise program. OUTCOME MEASURES: Maximum isometric pressure (MIP), regular effort saliva swallow pressure, adherence, and the Borg Rating of Perceived Exertion Scale. RESULTS: All exercise protocols were efficacious for gains in MIP (large effect sizes; Cohen's d). Group 3 made gains in regular effort saliva swallow pressure (medium effect size). There was a significant change in perceived exertion for regular effort saliva swallow pressure at 8 weeks. Tongue pressure gains were maintained at 1 month, regardless of maintenance group status. Mean adherence across groups was high. CONCLUSIONS: All groups improved pressure generation. Intensity dosing differences did not affect strength gains, adherence, or detraining. Regular effort saliva swallow pressure may be most responsive to maximum intensity with biofeedback. The findings suggest flexibility in approach to tongue exercise protocols. Tongue muscles may differ from limb muscles in terms of dose response and neuroplasticity principles.

Dysphagia Presentation, Airway Invasion, and Gender Differences in a Clinically Based Sample of People with Parkinson's Disease.

Dysphagia in People with Parkinson's Disease (PWPD) is expected to occur in most individuals. The manifestation of dysphagia and its salient swallow dysfunction characteristics leading to decreased airway safety are not well understood. The aim of this study was to quantify dysphagia presentation and severity, examine contributors to airway invasion, and explore gender differences in dysphagia manifestation in PWPD. 60 PWPD in clinical, healthcare settings underwent a Videofluoroscopic Swallow Study (VFSS) after referral for complaints of dysphagia. VFSS records and videos were analyzed to obtain dysphagia diagnosis, Videofluoroscopic Dysphagia Scale (VDS) scores, laryngeal vestibule kinematic timings, and Penetration-Aspiration Scale scores. Frequencies of VDS component and PAS scores were examined. MANOVA and logistic regression analyses were used to identify predictors of penetration and aspiration. Pharyngeal stage dysphagia was prevalent throughout PWPD and presented more frequently than oral stage dysphagia. Pharyngeal residue was a significant predictor for aspiration events. Laryngeal vestibule closure reaction time (LVCrt) and duration time (LVCd) were significant predictors of airway invasion, as were bolus consistency and volume. LVCrt, LVCd, and pharyngeal stage VDS scores were significantly altered in men compared to women in PWPD. A broad clinical sample of PWPD displayed atypical frequencies of airway invasion and frequent atypical scores of oral and pharyngeal stage physiologies. Thicker and smaller bolus consistencies significantly reduced the odds of airway invasion. Men and women presented with significantly different swallow physiology including prolonged LVCrt, LVCd, and more frequent atypical scores of pharyngeal residue and laryngeal elevation.Journal instruction requires a country for affiliations; however, these are missing in affiliation [1, 2]. Please verify if the provided country are correct and amend if necessary.Yes, USA is correct as the provided country.

Clinical Practice Patterns of Speech-Language Pathologists Delivering Dysphagia Services to Persons with COPD: Analysis of Survey Outcomes.

Swallowing impairments co-occur with chronic obstructive pulmonary disease (COPD) leading to aspiration, disease exacerbations, and malnutrition. This pilot survey study aimed to identify current clinical practice patterns for swallowing evaluation and treatment in persons with COPD. A 35-question Qualtrics survey was deployed to medical speech-language pathology (SLP) social media sites and professional boards; flyers were distributed at a professional conference. Forty-eight SLPs completed the study. SLPs routinely include a clinical swallow examination (96%), videofluoroscopic swallowing study (79%), adjunctive respiratory measures (respiratory rate [83%], and pulse oximetry [67%], respiratory-swallow pattern [77%]) but less frequently include fiberoptic endoscopic evaluation of swallowing (23%). Self-reported advanced clinical experience and expert respiratory analysis skills were associated with adjunctive respiratory measure (respiratory rate, pulse oximetry) inclusion during assessment. Compensatory strategy training (77%) is a preferred treatment for dysphagia in COPD; however, respiratory-swallow pattern training and expiratory muscle strength training are increasing in use. SLPs self-report a comprehensive, individualized patient-centered care approach with inclusion of adjunctive respiratory-focused methods in dysphagia evaluation and treatment practice in persons with COPD. Advances in the identification of the integral role of respiratory function in swallowing integrity may be translating to clinical practice methods for dysphagia management in persons with COPD.

An Exploration of Lung Volume Effects on Swallowing in Chronic Obstructive Pulmonary Disease.

Purpose Chronic obstructive pulmonary disease (COPD) limits respiration, which may negatively impact airway safety during swallowing. It is unknown how differences in lung volume in COPD may alter swallowing physiology. This exploratory study aimed to determine how changes in lung volume impact swallow duration and coordination in persons with stable state COPD compared with older healthy volunteers (OHVs). Method Volunteers ≥ 45 years with COPD (VwCOPDs; n = 9) and OHVs (n = 10) were prospectively recruited. Group and within-participant differences were examined when swallowing at different respiratory volumes: resting expiratory level (REL), tidal volume (TV), and total lung capacity (TLC). Participants swallowed self-administered 20-ml water boluses by medicine cup. Noncued (NC) water swallows were followed by randomly ordered block swallowing trials at three lung volumes. Estimated lung volume (ELV) and respiratory-swallow patterning were quantified using spirometry and respiratory inductive plethysmography. Manometry measured pharyngeal swallow duration from onset of base of tongue pressure increase to offset of negative pressure in the pharyngoesophageal segment. Results During NC swallows, the VwCOPDs swallowed at lower lung volumes than OHVs (p = .011) and VwCOPDs tended to inspire after swallows more often than OHVs. Pharyngeal swallow duration did not differ between groups; however, swallow duration significantly decreased as the ELV increased in VwCOPDs (p = .003). During ELV manipulation, the COPD group inspired after swallowing more frequently at REL than at TLC (p = .001) and at TV (p = .002). In conclusion, increasing respiratory lung volume in COPD should improve safety by reducing the frequency of inspiration after a swallow.

A Randomized Controlled Trial Comparing Physical and Mental Lingual Exercise for Healthy Older Adults.

Mental practice using motor imagery (MP-MI) has been shown to improve motor outcomes of upper and lower extremities especially when combined with physical exercise. Here, we studied community-dwelling, healthy older adults to determine the effects of including an MP-MI component with lingual strengthening exercise. In this pilot study, twenty-nine typically aging participants were assigned to an intervention group: physical lingual exercise (n = 7), physical and MP-MI lingual exercise (n = 8), MPMI lingual exercise (n = 7), or a control group (placebo exercise) (n = 7). All participants completed the assigned exercise regimen with three sessions per day, three days a week, for 6 consecutive weeks. Maximum isometric pressure (MIP) and regular effort saliva swallowing (RESS) pressure were collected at baseline and weeks 2, 4, and 6. A post hoc Bonferroni corrected treatment effect from baseline to week 6 was shown for only participants in the MP-MI/Physical exercise group for MIP (p = 0.003 MPMI/ Physical group; p = 0.11 Control group; p = 0.32 Physical only group; p = 0.14 MP-MI only group) and RESS (p = 0.009 MP-MI/Physical group; p = 0.14 Control group; p = 0.10 Physical only group; p = 0.04 MP-MI only group). Findings also indicate spontaneous carryover of significantly increased swallowing pressure when mental and physical exercise are combined. In conclusion, the potential effect of including an MPMI lingual exercise component in preventative and rehabilitative frameworks with older persons to possibly enhance functional swallowing improvement is promising and should be investigated.

Consensus-Based Attributes for Identifying Patients With Spasmodic Dysphonia and Other Voice Disorders.

Importance: A roadblock for research on adductor spasmodic dysphonia (ADSD), abductor SD (ABSD), voice tremor (VT), and muscular tension dysphonia (MTD) is the lack of criteria for selecting patients with these disorders. Objective: To determine the agreement among experts not using standard guidelines to classify patients with ABSD, ADSD, VT, and MTD, and develop expert consensus attributes for classifying patients for research. Design, Setting and Participants: From 2011 to 2016, a multicenter observational study examined agreement among blinded experts when classifying patients with ADSD, ABSD, VT or MTD (first study). Subsequently, a 4-stage Delphi method study used reiterative stages of review by an expert panel and 46 community experts to develop consensus on attributes to be used for classifying patients with the 4 disorders (second study). The study used a convenience sample of 178 patients clinically diagnosed with ADSD, ABSD, VT MTD, vocal fold paresis/paralysis, psychogenic voice disorders, or hypophonia secondary to Parkinson disease. Participants were aged 18 years or older, without laryngeal structural disease or surgery for ADSD and underwent speech and nasolaryngoscopy video recordings following a standard protocol. Exposures: Speech and nasolaryngoscopy video recordings following a standard protocol. Main Outcomes and Measures: Specialists at 4 sites classified 178 patients into 11 categories. Four international experts independently classified 75 patients using the same categories without guidelines after viewing speech and nasolaryngoscopy video recordings. Each member from the 4 sites also classified 50 patients from other sites after viewing video clips of voice/laryngeal tasks. Interrater κ less than 0.40 indicated poor classification agreement among rater pairs and across recruiting sites. Consequently, a Delphi panel of 13 experts identified and ranked speech and laryngeal movement attributes for classifying ADSD, ABSD, VT, and MTD, which were reviewed by 46 community specialists. Based on the median attribute rankings, a final attribute list was created for each disorder. Results: When classifying patients without guidelines, raters differed in their classification distributions (likelihood ratio, χ2 = 107.66), had poor interrater agreement, and poor agreement with site categories. For 11 categories, the highest agreement was 34%, with no κ values greater than 0.26. In external rater pairs, the highest κ was 0.23 and the highest agreement was 38.5%. Using 6 categories, the highest percent agreement was 73.3% and the highest κ was 0.40. The Delphi method yielded 18 attributes for classifying disorders from speech and nasolaryngoscopic examinations. Conclusions and Relevance: Specialists without guidelines had poor agreement when classifying patients for research, leading to a Delphi-based development of the Spasmodic Dysphonia Attributes Inventory for classifying patients with ADSD, ABSD, VT, and MTD for research.

Relative Efficacy of Swallowing versus Non-swallowing Tasks in Dysphagia Rehabilitation: Current Evidence and Future Directions.

Clinical trials published in 2012 and the first six months of 2013 were reviewed. These involved either traditional dysphagia therapy, indirect methods not involving dysphagia therapy or a combination of direct and indirect methods. Of 27 studies, 7 were RCTs, 5 were controlled clinical trials and the remainder were uncontrolled case series. Sixteen studies combined an indirect treatment with traditional dysphagia therapy; only one study examined one technique for direct swallowing therapy. Effect sizes were computed and contrasted for each trial. Traditional dysphagia therapy had small to moderate effect sizes (between 0.3 and 0.6) while spontaneous recovery in acute stroke had effect sizes of 1.2. Placebo effects on patient ratings of degree of improvement on swallowing were estimated as small to moderate. To improve effect sizes, adaptive research designs are needed to develop the optimal methods and dosages of therapy before future clinical trials.