Tongue-Strengthening Exercises in Healthy Older Adults: Effect of Exercise Frequency - A Randomized Trial.

INTRODUCTION: Positive effects from tongue-strengthening exercises (TSE) are widely described, but dose-dependent studies concerning exercise frequency have not yet been reported. This study aimed to determine the training and detraining effects of TSE with exercise frequencies of respectively 3 and 5 times per week on maximum isometric anterior and posterior tongue pressures (MIPA and MIPP) and on anterior and posterior tongue strength during an effortful saliva swallow (PswalA and PswalP). METHOD: Twenty healthy adults were randomly assigned to two exercise groups, training 3 (EX3, n = 10) or 5 (EX5, n = 10) times per week with the Iowa Oral Performance Instrument. MIPA, MIPP, PswalA, and PswalP were measured at baseline, after 4 and 8 weeks of training and 4 and 8 weeks after the last training session to document detraining effects. Descriptive statistics, linear mixed model effects, and post hoc analyses were calculated. RESULTS: Significant increases in MIPA, MIPP, PswalA, and PswalP were measured for training both 3 and 5 times per week. No significant differences on any parameter were found between EX3 and EX5 groups. No significant detraining effects were found after 4 or 8 weeks in any treatment arm either for MIPs or for effortful swallow pressures. CONCLUSION: This randomized study demonstrated a positive effect of TSE on MIP and Pswal in healthy older adults, without detraining effects. No superiority of exercise frequency was identified based on significance testing, although some trends are discussed.

Tongue-Strengthening Exercises in Healthy Older Adults: Does Exercise Load Matter? A Randomized Controlled Trial.

Tongue-strengthening exercises (TSE) are based on the principles of exercise and motor learning, including intensity. Intensity is manipulated by gradually adjusting the resistive load. This randomized controlled trial (RCT) investigates the effect of three different values resistive load during TSE in healthy older adults. Sixty subjects completed 8 weeks of TSE while exercising with Iowa Oral Performance Instrument (IOPI). They were randomly distributed to 4 different treatment arms: 3 exercise groups (EG1: n = 15; EG2: n = 16, EG3: n = 16) and 1 control group performing lip-strengthening exercises (CG: n = 13). Values of resistive load for EG1, EG2, and EG3 were 100, 80, and 60% 1RM, respectively. Anterior and posterior maximal isometric pressures (MIPA, MIPP) were measured at baseline, after 4 and 8 weeks of training and 4 weeks post-training. MIPA and MIPP in the EG were significantly higher than in the CG at all time points, except baseline. No significant differences between EG were found, but some trends were observable. Anteriorly, the higher the resistive load, the higher the increase in MIP. Posteriorly, 100% 1RM caused the highest values, followed by 60% and 80% 1RM. No detraining effects were measured. The degree of exercise load had a significant negative effect on the registered success rate. This RCT confirms the efficacy of TSE in healthy older adults. For MIPA and MIPP, TSE at a resistive load of 100% 1RM are the most efficient choice in this population, while lowering the resistive load will lead to an increased success rate. No detraining effects were registered.

Study protocol for a randomized controlled trial: tongue strengthening exercises in head and neck cancer patients, does exercise load matter?

BACKGROUND: Reduced tongue strength is an important factor contributing to early and late dysphagia in head and neck cancer patients previously treated with chemoradiotherapy. The evidence is growing that tongue strengthening exercises can improve tongue strength and swallowing function in both healthy and dysphagic subjects. However, little is known about the impact of specific features of an exercise protocol for tongue strength on the actual outcome (strength or swallowing function). Previous research originating in the fields of sports medicine and physical rehabilitation shows that the degree of exercise load is an influential factor for increasing muscle strength in the limb skeletal muscles. Since the tongue is considered a muscular hydrostat, it remains to be proven whether the same concepts will apply. METHODS/DESIGN: This ongoing randomized controlled trial in chemoradiotherapy-treated patients with head and neck cancer investigates the effect of three tongue strengthening exercise protocols, with different degrees of exercise load, on tongue strength and swallowing. At enrollment, 51 patients whose dysphagia is primarily related to reduced tongue strength are randomly assigned to a training schedule of 60, 80, or 100% of their maximal tongue strength. Patients are treated three times a week for 8 weeks, executing 120 repetitions of the assigned exercise once per training day. Exercise load is progressively adjusted every 2 weeks. Patients are evaluated before, during and after treatment by means of tongue strength measurements, fiber-optic endoscopic evaluation of swallowing and quality-of-life questionnaires. DISCUSSION: This randomized controlled trial is the first to systematically investigate the effect of different exercise loads in tongue strengthening exercise protocols. The results will allow the development of more efficacious protocols. TRIAL REGISTRATION: Current Controlled Trials ISRCTN14447678.

The influence of age, sex, bulb position, visual feedback, and the order of testing on maximum anterior and posterior tongue strength and endurance in healthy belgian adults.

This study collected data on the maximum anterior and posterior tongue strength and endurance in 420 healthy Belgians across the adult life span to explore the influence of age, sex, bulb position, visual feedback, and order of testing. Measures were obtained using the Iowa Oral Performance Instrument (IOPI). Older participants (more than 70 years old) demonstrated significantly lower strength than younger persons at the anterior and the posterior tongue. Endurance remains stable throughout the major part of life. Gender influence remains significant but minor throughout life, with males showing higher pressures and longer endurance. The anterior part of the tongue has both higher strength and longer endurance than the posterior part. Mean maximum tongue pressures in this European population seem to be lower than American values and are closer to Asian results. The normative data can be used for objective assessment of tongue weakness and subsequent therapy planning of dysphagic patients.

Reliability and clinical relevance of segmental analysis based on intelligibility assessment.

OBJECTIVE: In persons with a speech pathology, improved intelligibility is the fundamental goal of treatment. Identification of specific phonetic features that affect intelligibility, contributes to selecting intervention targets. The main purpose of this study was to investigate whether a segmental analysis based on a perceptual phoneme intelligibility assessment is reliable and can be used for target selection. Secondly, the hypothesis that the degree of agreement for phoneme identification may depend on the intelligibility of the speaker is addressed. PATIENTS AND METHODS: 30 patients with pathological speech (11 dysarthric, 10 hearing impaired, 9 laryngectomees) were assessed by means of a standardized phoneme intelligibility assessment. The samples were judged twice by 9 experienced listeners. The inter- and intra-rater reliability for each test item were examined. RESULTS: The inter-rater reliability per patient for phoneme identification varied between fair and almost perfect (k: 0.24-0.89). The higher the patient's intelligibility, the higher the level of agreement (p < 0.001). The intra-rater reliability for phoneme identification across all patients was good (k: 0.603-0.787). CONCLUSION: A segmental analysis based on a phoneme intelligibility assessment is only reliable and clinically relevant in patients with a slightly to moderately decreased overall intelligibility level.