Analysis of the suprahyoid muscles during tongue elevation: High-density surface electromyography as a novel tool for swallowing-related muscle assessment.

BACKGROUND: High-density surface electromyography (HD-sEMG) has enabled non-invasive analysis of motor unit (MU) activity and recruitment, but its application to swallowing-related muscles is limited. OBJECTIVE: We aimed to investigate the utility of HD-sEMG for quantitatively evaluating the MU recruitment characteristics of the suprahyoid muscles during tongue elevation. METHODS: We measured the sEMG activity of the suprahyoid muscles of healthy participants during tongue elevation using HD-sEMG. Maximum voluntary contraction (MVC) was measured, followed by data collection during sustained and ramp-up tasks to capture suprahyoid muscle activity. Changes in the temporal/spatial MU recruitment patterns within individual suprahyoid muscles were analysed. RESULTS: This study enrolled 16 healthy young adults (mean age: 27.8 ± 5.3 years; eight males and eight females). Increasing muscle force corresponded to a decrease in modified entropy and correlation coefficient and an increase in the coefficient of variation. No significant differences were observed between male and female participants. CONCLUSION: The results of this study, consistent with those observed in other muscles, such as the vastus lateralis muscle, suggest that HD-sEMG is a valuable and reliable tool for quantitatively evaluating MU recruitment in the suprahyoid muscles. This measurement technique holds promise for novel assessments of swallowing function.

Assessment of awake bruxism and oral mucosa indentation in adolescents.

BACKGROUND: Oral mucosa indentations can be signs of awake bruxism (AB) in adults, but this association has not yet been verified in adolescents. OBJECTIVES: To evaluate the frequency of AB in adolescents and determine whether there is an association between AB and oral mucosa indentation. METHODS: This study enrolled 66 high school students, mean age of 16.9 (±0.54) years. Clinical inspection was performed to assess the presence or absence of tongue, cheek and lip mucosa indentation. AB was assessed by the Ecological Momentary Assessment method using the WhatsApp mobile app. Messages were sent 15 times a day, 7 days, between 8:00 AM and 7:00 PM at random times to choose one of the five oral behaviours: teeth contact, teeth clenching, teeth grinding, mandible bracing and relaxed jaw muscles. The non-parametric Mann-Whitney U-test for independent samples, Friedman test for paired samples, Friedman pairwise multiple comparisons non-parametric test, Pearson's chi-squared tests, and z-test of comparisons between two proportions were performed (p < .05). RESULTS: During the week the frequency of AB behaviours was 56.20%, teeth contact was the most frequent (37.68% ± 22.26%), significantly more frequent than other AB behaviours; there was a greater frequency of cheek indentation (27.27%) and no difference between genders in oral behaviours and indentations (p > .05). A higher frequency of AB behaviours was observed in individuals with a greater frequency of cheek indentation (p < .05). CONCLUSIONS: Teeth contact and cheek indentation were the most frequent conditions among adolescents and AB behaviours are associated with this indentation.

Assessment of muscular tone of the tongue using a digital measure spoon in a healthy population: A pilot study.

The study of the muscles of the tongue forms part of a basic evaluation of upper airway function that includes swallowing, speaking and chewing. It is important because the upper airway presents a region of collapse during sleep. Through the action of the dilator muscles, mainly the genioglossus, such collapse can be prevented. In this study, we present a simple tool that can be used to measure the strength of the tongue. This tool may provide an easy way to measure tongue function and allow a simple evaluation of pathologies that affect the tone of the tongue. We have carried out 20 tongue strength measurements using the Tongue Digital Spoon (TDS) in a healthy adult population, using the Iowa Oral Performance Instrument (IOPI) as the gold standard. To validate the procedure, we performed replicate measurements on 20 individuals aged 20-70 years. We found a mean TDS measurement of 115.99 g/cm2 in young subjects, 98.47 g/cm2 in middle-aged subjects and 84.23 g/cm2 in the elderly. There was a significant difference in the measurements between young and elderly participants. There was also a significant correlation between TDS and IOPI measurements (Pearson correlation coefficient, r = 0.69, P < 0.001). We found the TDS to be a useful tool in daily clinical practice for the measurement of the strength of the tongue in the healthy population. It has potential application in oropharyngeal monitoring and rehabilitation.

Assessment of axonal sprouting and motor performance after hypoglossal-facial end-to-side nerve repair: experimental study in rats.

Hypoglossal-facial nerve anastomosis (HFA) aims to reanimate denervated mimic muscles with hypoglossal axons when the transected facial nerve is not accessible. The aim of this study was to evaluate the recovery of HFA using a "Y" tube in two variants: (1) the proximal stump of the hypoglossal nerve was entubulated to the "Y" tube (classic "Y" tube HFA) and (2) the "Y" tube was sutured to an epineurial window of a slightly damaged hypoglossal nerve (end-to-side "Y" tube HFA). A total of 48 adult female rats were divided into four groups: intact controls (group 1), sham operated (group 2), classic "Y" tube HFA (group 3) and end-to-side "Y" tube HFA (group 4). The abdominal aorta with both common iliac arteries of isogeneic male rats served as the Y-tube conduit. Animals from group 4 recovered better than those from group 3: the degree of collateral axonal branching (3 ± 1%) was significantly lower than that determined in group 3 (13 ± 1%). The mean deviation of the tongue from the midline was significantly smaller in group 4 (6 ± 4°) than that measured in animals from group 3 (41 ± 6°). In the determination of vibrissal motor function in group 3 and group 4, a decrease in amplitude was found to be - 66% and - 92%, respectively. No differences in the reinnervation pattern of the target muscles were detected. As a result, these surgical models were not determined to be able to improve vibrissal movements. It was concluded that performance of end-to-side "Y" tube HFA diminishes collateral axonal branching at the lesion site, which in turn, promotes better recovery of tongue- and vibrissal-motor performance.

Assessment of Midline Lingual Point-Pressure Somatosensation Using Von Frey Hair Monofilaments.

Detection and discrimination threshold estimates for oral point pressure are assessed using Von Frey Hair monofilaments. Consistent with previously published protocols, threshold estimates are determined using a two-interval forced choice (2-IFC) paradigm with a three down/one up approach. Detection threshold estimates determine the mean force in which a participant can identify the presence of pressure. During the detection threshold procedure, the participant is instructed to choose which of two sequentially presented observation intervals contained the tactile test stimulus. If the participant performs three correct detections in a row (i.e., 3 'hits'), the researcher decreases the stimulus to the next lower target force level. With one incorrect detection (a 'miss'), the researcher increases the force delivered to the next higher level. This threshold estimation approach is known as a 3-down/1-up adaptive staircase. Reponses are recorded on a paper ballot, and a participant's estimated threshold is defined as the geometric mean of five reversals. During the discrimination threshold procedure, the participant is asked to make a choice between two serially presented stimuli as to which is the "harder" or "stronger" pressure. The same scoring of 'hits', 'misses', and stopping points are used. Detection and discrimination testing for oral point pressure at tongue midline takes approximately 20 min to complete. Using these commercially-available clinical tools, individual touch sensation profiles for the midline tongue can be achieved in a relatively time and cost effective means.

Assessment of Tongue Position and Laryngeal Height in Two Professional Voice Populations.

Purpose To advance our current knowledge of singer physiology by using ultrasonography in combination with acoustic measures to compare physiological differences between musical theater (MT) and opera (OP) singers under controlled phonation conditions. Primary objectives addressed in this study were (a) to determine if differences in hyolaryngeal and vocal fold contact dynamics occur between two professional voice populations (MT and OP) during singing tasks and (b) to determine if differences occur between MT and OP singers in oral configuration and associated acoustic resonance during singing tasks. Method Twenty-one singers (10 MT and 11 OP) were included. All participants were currently enrolled in a music program. Experimental procedures consisted of sustained phonation on the vowels /i/ and /ɑ/ during both a low-pitch task and a high-pitch task. Measures of hyolaryngeal elevation, tongue height, and tongue advancement were assessed using ultrasonography. Vocal fold contact dynamics were measured using electroglottography. Simultaneous acoustic recordings were obtained during all ultrasonography procedures for analysis of the first two formant frequencies. Results Significant oral configuration differences, reflected by measures of tongue height and tongue advancement, were seen between groups. Measures of acoustic resonance also showed significant differences between groups during specific tasks. Both singer groups significantly raised their hyoid position when singing high-pitched vowels, but hyoid elevation was not statistically different between groups. Likewise, vocal fold contact dynamics did not significantly differentiate the two singer groups. Conclusions These findings suggest that, under controlled phonation conditions, MT singers alter their oral configuration and achieve differing resultant formants as compared with OP singers. Because singers are at a high risk of developing a voice disorder, understanding how these two groups of singers adjust their vocal tract configuration during their specific singing genre may help to identify risky vocal behavior and provide a basis for prevention of voice disorders.

Impact of Fungiform Papillae Count on Taste Perception and Different Methods of Taste Assessment and their Clinical Applications: A comprehensive review.

Fungiform papillae are raised lingual structures which contain taste buds and thus play an important role in taste perception. These structures vary in number due to their relative sensitivity to a range of systemic and local factors which affect the dorsum of the tongue. Taste sensation can be measured using both chemical and electrical methods; however, the number of fungiform papillae has a direct effect on chemogustometric and electrogustometric values during evaluation. This review provides a general overview of fungiform papillae, their quantification methods and the various factors which may affect these structures. In addition, numerous methods of recording taste sensation and their clinical applications are highlighted.

New application of dynamic magnetic resonance imaging for the assessment of deglutitive tongue movement.

BACKGROUND: Deglutitive motion of the tongue may function to maintain tooth position. However, the causation between abnormal patterns of orofacial muscle function and dental malocclusion remains unclear. To clarify the pathogenic mechanism of malocclusion, it is important to determine the relative positional relationship between the tongue tip and incisor edge or the dorsal tongue and palate during deglutition. Here, we assessed the utility of 3-T segmented cine-magnetic resonance (MR) imaging, combined with static MR images for hard tissue visualization, in assessing the relationship between the tongue and the surrounding tissues during deglutitive tongue movement. METHODS: Cine-MR images were acquired from three healthy female volunteers during deglutition who had no history of swallowing disorder or other chronic illness, normal alignment and occlusion, and a skeletal class I relationship. Three cine-MR images were taken during deglutition in accordance with an auditory cue for each volunteer. During static imaging, custom-made, contrast-medium-filled clear retainers were positioned in the mouth to allow visualization of the upper and lower incisors and hard palate boundaries. Static images were superimposed onto images of the three stages in deglutitive tongue movement, which were selected from a series of cine-MR images. These superimpositions were assessed five times by tracing cephalometric parameters to examine the reproducibility of the method. RESULTS: Traces varied little across repeated measurements, and all subjects had a similar pattern of dorsal tongue movement. Tongue-to-palate contact increased slightly during the first to second stage of swallowing and abruptly increased during the second to third stage, while the tongue tip position remained constant. CONCLUSIONS: Segmented cine-MR imaging combined with static MR images is useful for assessing soft tissue motion during deglutition. This method is particularly useful in dentistry to evaluate the relationship between tongue function and maxillofacial morphology in terms of orthodontic treatment and orofacial myofunctional therapy, and for improving tongue movement during speech therapy.

Reproducibility assessment of an instrument for measuring the axial force of the tongue. / Avaliação da reprodutibilidade de um instrumento para medição da força axial da língua.

PURPOSE: Evaluate the reproducibility of Forling, a portable instrument for measuring axial tongue force. METHODS: Axial force of the tongue was measured in 49 individuals (30 women and 19 men) aged 18-25 years using the Forling portable instrument. Measurements were performed in three days at intervals of 7±2 days. On each day, three 7-second measurements were performed with one-minute intervals between them. The coefficient of variation, Wilcoxon paired test, and intraclass correlation coefficient were used in the statistical analysis of the data. Maximum and mean tongue force values were analyzed, and comparison between them was performed using three approaches: the mean of the three values; the mean of the two highest values; the highest value of each measurement. RESULTS: In the analysis of mean tongue force, the coefficient of variation was considered desirable and the intraclass correlation coefficient was acceptable. Significant differences were observed regarding the maximum value between the second and third days, mean of the two highest values and mean of the three values between the first and second days and the second and third days. In the analysis of maximum tongue force, the coefficient of variation and the intraclass correlation coefficient were acceptable. Significant difference was found only in the comparison between the second and third days. CONCLUSION: Good reproducibility of the data obtained with the use of the Forling portable instrument was observed.

OBJETIVO: Avaliar a reprodutibilidade do Forling, instrumento portátil para medição da força axial da língua. MÉTODO: Foi realizada a medição da força axial da língua de 49 participantes, 30 mulheres e 19 homens, com idades entre 18 e 25 anos por meio do Forling portátil. As medições foram realizadas em três dias com intervalos de 7±2 dias. Em cada dia, foram realizadas três coletas com duração de 7 segundos e intervalos de 1 minuto. Na análise, empregou-se coeficiente de variação, teste pareado de Wilcoxon e coeficiente de correlação intraclasse. Foram analisados os valores de força máxima e média da língua, sendo a comparação dos valores realizada em três abordagens: utilizando-se a média dos três valores; a média dos dois maiores valores; e o maior valor de cada medição. RESULTADOS: Na análise da força média, o coeficiente de variação foi considerado desejável e o coeficiente de correlação intraclasse aceitável. Houve diferenças significativas entre o máximo valor comparando o segundo e terceiro dias, entre a média dos dois maiores valores e entre a média dos três valores comparando o primeiro e segundo dias, bem como o segundo e terceiro dias. Na análise da força máxima, o coeficiente de variação e o coeficiente de correlação intraclasse foram aceitáveis. Somente comparando o segundo e terceiro dias, foi encontrada diferença significativa. CONCLUSÃO: Observou-se boa reprodutibilidade dos dados obtidos com o uso do Forling portátil.

Objective Assessment of Lingual Nerve Microsurgical Reconstruction.

Lingual nerve (LN) injury is one of the most serious consequences of oral surgery. Prompt microsurgical reconstruction of the nerve can alleviate most of those symptoms leading to satisfactory functional recovery.Thirty-five patients with partial to complete LN injury underwent surgery in the period between January 2006 and May 2015. All patients underwent a preoperative clinical and neurological evaluation with the assessment of lingual tactile and pain sensory thresholds and masseteric inhibitory reflex.All patients underwent explorative surgery and direct microneurorrhaphy of distal and proximal stumps in case of complete lesion, while the removal of traumatic neuroma and the following microneurorrhaphy of distal and proximal stumps of the injured nerve was performed in case of incomplete lesion. Nerve grafting has always been avoided because of distal stump mobilization obtained by severing the submandibular branch of the LN.All patients but 1 exhibited good recovery of tongue sensation, never complete, both clinically and electrophysiologically: recovery of the excitability of masseteric inhibitory reflex suppression components SP1 and SP2 was observed, often with increased latencies but consistent with a functional recovery.All patients feeling pain preoperatively experienced complete relief of algic symptoms.The early microsurgical approach is the most suitable choice for the treatment of LN injuries.

The bioelectronic nose and tongue using olfactory and taste receptors: Analytical tools for food quality and safety assessment.

Food intake is the primary method for obtaining energy and component materials in the human being. Humans evaluate the quality of food by combining various facets of information, such as an item of food's appearance, smell, taste, and texture in the mouth. Recently, bioelectronic noses and tongues have been reported that use human olfactory and taste receptors as primary recognition elements, and nanoelectronics as secondary signal transducers. Bioelectronic sensors that mimic human olfaction and gustation have sensitively and selectively detected odor and taste molecules from various food samples, and have been applied to food quality assessment. The portable and multiplexed bioelectronic nose and tongue are expected to be used as next-generation analytical tools for rapid on-site monitoring of food quality. In this review, we summarize recent progress in the bioelectronic nose and tongue using olfactory and taste receptors, and discuss the potential applications and future perspectives in the food industry.

Avaliação da reprodutibilidade de um instrumento para medição da força axial da língua / Reproducibility assessment of an instrument for measuring the axial force of the tongue

RESUMO Objetivo Avaliar a reprodutibilidade do Forling, instrumento portátil para medição da força axial da língua. Método Foi realizada a medição da força axial da língua de 49 participantes, 30 mulheres e 19 homens, com idades entre 18 e 25 anos por meio do Forling portátil. As medições foram realizadas em três dias com intervalos de 7±2 dias. Em cada dia, foram realizadas três coletas com duração de 7 segundos e intervalos de 1 minuto. Na análise, empregou-se coeficiente de variação, teste pareado de Wilcoxon e coeficiente de correlação intraclasse. Foram analisados os valores de força máxima e média da língua, sendo a comparação dos valores realizada em três abordagens: utilizando-se a média dos três valores; a média dos dois maiores valores; e o maior valor de cada medição. Resultados Na análise da força média, o coeficiente de variação foi considerado desejável e o coeficiente de correlação intraclasse aceitável. Houve diferenças significativas entre o máximo valor comparando o segundo e terceiro dias, entre a média dos dois maiores valores e entre a média dos três valores comparando o primeiro e segundo dias, bem como o segundo e terceiro dias. Na análise da força máxima, o coeficiente de variação e o coeficiente de correlação intraclasse foram aceitáveis. Somente comparando o segundo e terceiro dias, foi encontrada diferença significativa. Conclusão Observou-se boa reprodutibilidade dos dados obtidos com o uso do Forling portátil.

ABSTRACT Purpose Evaluate the reproducibility of Forling, a portable instrument for measuring axial tongue force. Methods Axial force of the tongue was measured in 49 individuals (30 women and 19 men) aged 18-25 years using the Forling portable instrument. Measurements were performed in three days at intervals of 7±2 days. On each day, three 7-second measurements were performed with one-minute intervals between them. The coefficient of variation, Wilcoxon paired test, and intraclass correlation coefficient were used in the statistical analysis of the data. Maximum and mean tongue force values were analyzed, and comparison between them was performed using three approaches: the mean of the three values; the mean of the two highest values; the highest value of each measurement. Results In the analysis of mean tongue force, the coefficient of variation was considered desirable and the intraclass correlation coefficient was acceptable. Significant differences were observed regarding the maximum value between the second and third days, mean of the two highest values and mean of the three values between the first and second days and the second and third days. In the analysis of maximum tongue force, the coefficient of variation and the intraclass correlation coefficient were acceptable. Significant difference was found only in the comparison between the second and third days. Conclusion Good reproducibility of the data obtained with the use of the Forling portable instrument was observed.

Tongue-driven sonar beam steering by a lingual-echolocating fruit bat.

Animals enhance sensory acquisition from a specific direction by movements of head, ears, or eyes. As active sensing animals, echolocating bats also aim their directional sonar beam to selectively "illuminate" a confined volume of space, facilitating efficient information processing by reducing echo interference and clutter. Such sonar beam control is generally achieved by head movements or shape changes of the sound-emitting mouth or nose. However, lingual-echolocating Egyptian fruit bats, Rousettus aegyptiacus, which produce sound by clicking their tongue, can dramatically change beam direction at very short temporal intervals without visible morphological changes. The mechanism supporting this capability has remained a mystery. Here, we measured signals from free-flying Egyptian fruit bats and discovered a systematic angular sweep of beam focus across increasing frequency. This unusual signal structure has not been observed in other animals and cannot be explained by the conventional and widely-used "piston model" that describes the emission pattern of other bat species. Through modeling, we show that the observed beam features can be captured by an array of tongue-driven sound sources located along the side of the mouth, and that the sonar beam direction can be steered parsimoniously by inducing changes to the pattern of phase differences through moving tongue location. The effects are broadly similar to those found in a phased array-an engineering design widely found in human-made sonar systems that enables beam direction changes without changes in the physical transducer assembly. Our study reveals an intriguing parallel between biology and human engineering in solving problems in fundamentally similar ways.

Integrating behaviour into the pace-of-life continuum: Divergent levels of activity and information gathering in fast- and slow-living snakes.

An animal's life history, physiology, and behaviour can be shaped by selection in a manner that favours strong associations among these aspects of an integrated phenotype. Recent work combining animal personality and life-history theory proposes that animals with faster life-history strategies (i.e., fast growth, high annual reproductive rate, short lifespan) should exhibit higher general activity levels relative to those with slower life-history strategies, but empirical tests of within-species variation in these traits are lacking. In garter snakes from ecotypes which are known to differ in ecology, life-history strategy, and physiology, we tested for differences in tongue-flick rate as a measure of information gathering and movement patterns as a measure of general activity. Tongue flicks and movement were strongly positively correlated and both behaviours were repeatable across trials. Snakes from the fast-living ecotype were more active and showed evidence of habituation. The slow-living ecotype maintained low levels of activity throughout the trials. We propose that environmental factors, such as high predation, experienced by the fast-living ecotype select for both increased information-gathering and activity levels to facilitate efficient responses to repeated challenges. Thus, we offer evidence that behaviour is an important component of co-evolved suites of traits forming a general pace-of-life continuum in this system.

Comparing Manual Counting to Automated Image Analysis for the Assessment of Fungiform Papillae Density on Human Tongue.

The density of fungiform papillae (FPD) on the human tongue is currently taken as index for responsiveness to oral chemosensory stimuli. Visual analysis of digital tongue picture and manual counting by trained operators represents the most popular technique for FPD assessment. Methodological issues mainly due to operator bias are considered among factors accounting for the uncertainty about the relationships between FPD and responsiveness to chemosensory stimuli. The present study describes a novel automated method to count fungiform papillae (FP) from image analysis of tongue pictures. The method was applied to tongue pictures from 133 subjects. Taking the manual count as reference method, a partial least squares regression model was developed to predict FPD from tongue automated analysis output. FPD from manual and automated count showed the same normal distribution and comparable descriptive statistic values. Consistent subject classifications as low and high FPD were obtained according to the median values from manual and automated count. The same results on the effect of FPD variation on taste perception were obtained both using predicted and counted values. The proposed method overcomes count uncertainties due to researcher bias in manual counting and is suited for large population studies. Additional information is provided such as FP size class distribution which would help for a better understanding of the relationships between FPD variation and taste functions.

Assessment of tongue mechanical properties using different contraction tasks.

Inadequate upper airway (UA) dilator muscle function may play an important role in the pathophysiology of obstructive sleep apnea (OSA). To date, tongue mechanical properties have been assessed mainly using protrusion protocol with conflicting results. Performance during elevation tasks among patients with OSA remains unknown. This study aimed at assessing tongue muscle strength, strength stability, endurance time, fatigue indices, and total muscle work, using elevation and protrusion tasks with repetitive isometric fatiguing contractions in 12 normal plus mild, 17 moderate, and 11 severe patients with OSA, and to assess the influence of body mass index (BMI) and age. Endurance time was longer in protrusion than elevation task (P = 0.01). In both tasks, endurance time was negatively correlated with baseline value of strength coefficient of variation (P < 0.01). Compared with other groups, patients with moderate OSA had the lowest total muscle work for protrusion (P = 0.01) and shortest endurance time (P = 0.04), regardless of the type of task. Additionally, in patients with moderate-severe OSA, the total muscle work for both tasks was lower in nonobese compared with obese (P < 0.05). Total muscle work for protrusion was positively correlated with apnea hypopnea index (AHI) in obese subjects (P < 0.01). Endurance time was shorter (P < 0.01) and recovery time longer (P = 0.02) in the old compared with young subjects. In conclusion, the tongue is more prone to fatigue during the elevation task and in patients with moderate OSA. Obesity appeared to prevent alteration of tongue mechanical properties in patients with OSA. Baseline strength stability and endurance were related, illustrating the role of central neuromuscular output in tongue resistance to fatigue.NEW & NOTEWORTHY To our knowledge, this is the first study to assess and compare tongue function using both elevation and protrusion tasks with repetitive isometric fatiguing contractions in subjects with different OSA status. Tongue mechanical performance seemed to differ between protrusion and elevation tasks and depend on the severity of OSA.

Ultrasound Images of the Tongue: A Tutorial for Assessment and Remediation of Speech Sound Errors.

Diagnostic ultrasound imaging has been a common tool in medical practice for several decades. It provides a safe and effective method for imaging structures internal to the body. There has been a recent increase in the use of ultrasound technology to visualize the shape and movements of the tongue during speech, both in typical speakers and in clinical populations. Ultrasound imaging of speech has greatly expanded our understanding of how sounds articulated with the tongue (lingual sounds) are produced. Such information can be particularly valuable for speech-language pathologists. Among other advantages, ultrasound images can be used during speech therapy to provide (1) illustrative models of typical (i.e. "correct") tongue configurations for speech sounds, and (2) a source of insight into the articulatory nature of deviant productions. The images can also be used as an additional source of feedback for clinical populations learning to distinguish their better productions from their incorrect productions, en route to establishing more effective articulatory habits. Ultrasound feedback is increasingly used by scientists and clinicians as both the expertise of the users increases and as the expense of the equipment declines. In this tutorial, procedures are presented for collecting ultrasound images of the tongue in a clinical context. We illustrate these procedures in an extended example featuring one common error sound, American English /r/. Images of correct and distorted /r/ are used to demonstrate (1) how to interpret ultrasound images, (2) how to assess tongue shape during production of speech sounds, (3), how to categorize tongue shape errors, and (4), how to provide visual feedback to elicit a more appropriate and functional tongue shape. We present a sample protocol for using real-time ultrasound images of the tongue for visual feedback to remediate speech sound errors. Additionally, example data are shown to illustrate outcomes with the procedure.

Application of a barometer for assessment of oral functions: Donders space.

We developed a barometer applicable to a small space, to assess oral and pharyngeal functions. Negative oral pressure during rest and pressure changes during swallowing were measured in a space between the palate and tongue (STP). Twenty volunteers were asked to sit in a chair in a relaxed upright position. A sensor was placed on the posterior midline of hard palate. Recording commenced just before subjects closed their lips and continued. Subjects were asked to swallow saliva and keep the apposition. Finally, subjects were asked to open their mouth. Recordings were performed five times, and 5 s of continuous data in each phase was averaged. To verify the reliability of the system, the same procedure was accomplished with twin sensors. When the jaw and lips were closed, the pressure slightly decreased from atmospheric pressure (-0·17 ± 0·24-kPa). After swallowing, the pressure in STP showed more negative value (-0·50 ± 0·59-kPa). There is a significant difference between the values in open condition and after swallowing (P < 0·001) and between values after swallowing and final open condition (P < 0·05). Twin sensor showed almost the same trajectories of pressure changes for all the recordings. Obtained negative pressure might generate about 0·71-N of force and would be enough to keep the tongue in the palatal fossa at rest. The system detected large negative/positive pressure changes during swallowing. We conclude this system may be a tool to evaluate oral functions.

Relationship between clinical and instrumental assessment of the tongue in healthy young adults.

PURPOSE: To verify the association of tongue clinical evaluation aspects with quantitative evaluation of tongue force. METHODS: A cross-sectional study was conducted with 48 healthy adults, 13 men and 35 women (ages 20-44 years; mean - M=24.8 years; standard deviation - SD=5.3 years). By clinical evaluation, the following aspects were checked: tongue force, alternate movements, snap, suction and vibration of the tongue. The evaluator also checked if the floor of the mouth elevated during tasks of tongue elevation and sucking tongue on palate and the occurrence of lingual tremor. Quantitative evaluation was accomplished using the FORLING instrument. It is composed of a piston/cylinder assembly attached to a mouthguard and to a drive shaft. The force applied by the tongue to the drive shaft is hydraulically transmitted to a pressure sensor. Mann-Whitney's test was used to verify whether there were differences in average and maximum forces according to the characteristics assessed. The test was performed at a 5% level of significance. RESULTS: The aspects with the most frequent alteration were sucking tongue on palate and tongue vibration. Tremor had a higher occurrence during tongue movements. Elevation of the floor of the mouth in sucking tongue on palate was the only aspect associated with quantitative evaluation. CONCLUSION: The association between elevation of the floor of the mouth during sucking tongue on palate and quantitative evaluation can provide insight into the higher participation of the suprahyoid muscles in some participants in both tasks.

Relationship between clinical and instrumental assessment of the tongue in healthy young adults / Relação entre as avaliações clínica e instrumental da língua em adultos jovens

PURPOSE: To verify the association of tongue clinical evaluation aspects with quantitative evaluation of tongue force. METHODS: A cross-sectional study was conducted with 48 healthy adults, 13 men and 35 women (ages 20-44 years; mean - M=24.8 years; standard deviation - SD=5.3 years). By clinical evaluation, the following aspects were checked: tongue force, alternate movements, snap, suction and vibration of the tongue. The evaluator also checked if the floor of the mouth elevated during tasks of tongue elevation and sucking tongue on palate and the occurrence of lingual tremor. Quantitative evaluation was accomplished using the FORLING instrument. It is composed of a piston/cylinder assembly attached to a mouthguard and to a drive shaft. The force applied by the tongue to the drive shaft is hydraulically transmitted to a pressure sensor. Mann-Whitney's test was used to verify whether there were differences in average and maximum forces according to the characteristics assessed. The test was performed at a 5% level of significance. RESULTS: The aspects with the most frequent alteration were sucking tongue on palate and tongue vibration. Tremor had a higher occurrence during tongue movements. Elevation of the floor of the mouth in sucking tongue on palate was the only aspect associated with quantitative evaluation. CONCLUSION: The association between elevation of the floor of the mouth during sucking tongue on palate and quantitative evaluation can provide insight into the higher participation of the suprahyoid muscles in some participants in both tasks. .

OBJETIVO: Pesquisar a associação entre os aspectos da avaliação clínica da língua e avaliação quantitativa da força de protrusão da língua. Métodos: Foi realizada uma pesquisa transversal com 48 adultos saudáveis, 13 homens e 35 mulheres (idades entre 20 e 44 anos; média - M=24,8 anos; desvio padrão - DP=5,3 anos). Na avaliação clínica, os seguintes aspectos foram avaliados: força da língua, movimentos alternados, estalo, sucção e vibração da língua. O avaliador também verificou se o assoalho da boca elevava-se durante tarefas de elevação e sucção de língua no palato, bem como a ocorrência de tremor lingual. Para avaliação quantitativa da força da língua, utilizou-se o FORLING, o qual é composto por um conjunto pistão/cilindro acoplado a um bocal e a uma haste de acionamento. A força aplicada pela língua à haste é hidraulicamente transmitida a um sensor de pressão. Utilizou-se o teste de Mann-Whitney para verificar se havia diferenças nas forças médias e máximas, de acordo com as características avaliadas. Adotou-se nível de significância de 5%. RESULTADOS: Os aspectos com maior número de indivíduos alterados foram sucção de língua no palato e vibração de língua. Tremor lingual teve alta ocorrência durante tarefas de mobilidade. Elevação do assoalho da boca durante sucção de língua no palato foi o único aspecto da avaliação clínica associado à avaliação quantitativa de força. CONCLUSÃO: A associação entre elevação do assoalho da boca durante sucção de língua no palato com a avaliação quantitativa de força pode indicar uma maior participação da musculatura supra-hióidea em determinados participantes em ambas as tarefas. .