Effects of Tongue-Strengthening Exercise on Tongue Strength and Effortful Swallowing Pressure in Young Healthy Adults: A Pilot Study.

PURPOSE: The purpose of this study was to investigate the effects of tongue-strengthening exercise (TSE) on tongue strength and effortful swallowing pressure in young healthy adults. METHOD: Thirteen young healthy volunteers (six men, seven women; M age = 20.5 ± 0.5 years) performed 8 weeks of isometric TSE 3 days per week. A tongue pressure measurement device was used to measure maximum isometric tongue pressure (MITP) and conduct the TSE, and a tactile sensor system attached to the hard palate was used to measure effortful swallowing pressure. MITP and effortful swallowing pressure were measured at baseline, after 4 and 8 weeks of training, and at 4 and 8 weeks after the last training session to examine the detraining effects. RESULTS: The results indicated that both MITP and effortful swallowing pressure increased significantly from baseline to 8 weeks after training. Although the improved MITP significantly decreased at 4 and 8 weeks after training cessation, no detraining effect was observed for effortful swallowing pressure. CONCLUSIONS: TSE is an effective method for increasing tongue pressure in wide tongue-palate contact areas during effortful swallow. The effortful swallowing pressure gained with TSE appears to be maintained for at least eight nontraining weeks.

[Labial closure force, activities of daily living, and cognitive function in frail elderly persons].

AIM: Few studies have reported the influence of declining labial closure force on ADL among frail elderly persons. We therefore investigated to elucidate the relationships among labial closure force, ADL and cognitive function in frail elderly persons. METHODS: The subjects were 92 frail elderly persons. Labial closure forces were examined using "Lip De Cum". The ADL and cognitive status of the subjects were evaluated using the ADL20 scale and HDS-R respectively. Furthermore, the symptoms related to dysphagia and salivation were evaluated by a patient-reported outcome. RESULTS: The labial closure force was significantly related to total score and each sub-score of the ADL20 scale, and it was also related to HDS-R score. Furthermore, the labial closure force was significantly associated with salivation and 5 symptoms related to dysphagia as follows: weight loss, episodes of pyrexia, difficulties in swallowing, food falling from the mouth, sensation of food being stuck in the esophagus. CONCLUSION: Labial closure force among frail elderly persons correlated with ADL and cognitive function. These findings suggest that declining labial closure force is closely related with decreasing comprehensive physical and mental activities.

[Effect of size of tablets on easiness of swallowing and handling among the frail elderly].

AIM: The purpose of the present study was to examine the effect of the size of tablets on the status of swallowing and handling during taking medicine among frail elderly persons. METHODS: The subjects of the present study were 73 frail elderly persons. After they conducted simulation taking medicine, they determined the desirable size of tablets using subjective evaluation. Their behavior and the time required for the simulation were examined. We also evaluated their activities of daily living using the ADL20, and swallowing ability using the repetitive saliva swallowing test (RSST). RESULTS: There was a significant difference in behavior during taking medicine between the frail elderly with low swallowing ability and other subjects with normal swallowing ability, that is, the elderly persons with low swallowing ability tend to swallow three tablets after several trials (p<0.05). Also, the required time for simulation taking medicine was related significantly to the size of tablets (p<0.01). CONCLUSION: The most desirable size based upon easiness of swallowing and handling is 7-8mm. These results suggest that medicine taking behavior was influenced greatly by the decline of swallowing ability and ADL, and the prescriptions for the frail elderly are needed to meet their swallowing ability.

Relationship between general health status and the change in chewing ability: a longitudinal study of the frail elderly in Japan over a 3-year period.

OBJECTIVES: The aim of the present study was to identify the onset predictors of a change in chewing ability over a 3-year period in the frail elderly. METHODS: The subjects were frail elderly people living in southern Japan. Data were collected at baseline (n = 92) and 3 years later (n = 60). The dependent variable was a change in self-rated chewing ability. The independent variables were age, gender, number of present teeth, dentition, maximum bite force (evaluated using a pressure-sensitive foil), basic activities of daily living, self-rated general health status, higher level of competence (evaluated using Tokyo Metropolitan Institute of Gerontology index), cognitive status (evaluated by revised Hasegawa Dementia Rating scale), and quality of life (evaluated using Philadelphia Geriatric Center morale scale) at baseline. To identify the most reliable predictors, bivariate analysis and multiple logistic regression analysis were performed, with the change of chewing ability as the dependent variable. RESULTS: Bivariate analysis showed the change in chewing ability was significantly associated with general health status (p < 0.01), number of present teeth (p < 0.05) and maximum bite force (p < 0.01). Backward logistic regression analysis revealed that the most reliable predictor of a change in chewing ability at 3 years was general health status (odds ratio = 6.35, 95% CI = 1.69-23.88). CONCLUSION: The present findings suggest that general health status at baseline produces a change in chewing ability.

[Care assessment related to dysphagia in the frail elderly].

The purpose of the present study was to investigate some symptoms related to dysphagia, comprehensive health status, and oral care in the frail elderly. The subjects were 92 elderly individuals (30 men, 62 women) above 65 years in a nursing home. The risk factors of dysphagia were evaluated by 15 items of self-assessment and 18 items of assessment by their caregivers. Both assessments contained 12 identical items. Basic ADL, cognitive status, and QOL were evaluated by the Barthel index, HDS-R, and PGC morale scale respectively. The status of oral care was evaluated by the frequency of tooth cleaning a day and the number of total anaerobic bacteria or streptococci in the dental plaque. "Chewing difficulty with hard food" was frequently found (21.74%) in the self-assessment, while "fever" was frequently found in the caregiver's assessment (20.65%). Also, in the duplicate items in both assessments, "anamnesis of pneumonia" showed a high agreement (k = 0.85), while "decline of appetite" had a low agreement (k = 0.27). These results suggest that dual assessment is effective to detect dysphagia. We also investigated the relationship among dysphagia, comprehensive health status, and oral hygiene. The status of dysphagia was related only to the Barthel index (p < 0.01). These results suggest that subjects with decreased basic ADL tend to have some risk factors related to dysphagia, and that subjects with dysphagia risk factors need to improve oral care to prevent aspiration pneumonia.