Evaluation of tongue pressure and lip closing force in bimaxillary orthognathic surgery: A retrospective study.

The purpose of this study was to quantitatively compare changes in tongue pressure and lip closing force among skeletal Class II and Class III patients, who had undergone orthognathic surgery, and a control group. Maximum tongue pressure and lip closing forces were measured preoperatively and at 6 and 12 months postoperatively. Time-course changes were analyzed and compared among the groups. The control group involved 40 skeletal Class I occlusion volunteers (20 male and 20 female), the Class II group involved 20 female patients, and the skeletal Class III group involved 40 patients, who were subdivided by sex into two groups comprising 20 males and 20 females, respectively. Time-course changes in tongue pressure were not significantly different between and within groups. However, postoperative lip closing forces became gradually higher in the Class III group female and male subjects compared with the control group, although this was not observed in the Class II group. There were significant correlations between tongue pressure and lip closing force before and after surgery (p = 0.001), and these correlations increased over time. Although there was no significant increase in maximum tongue pressure after orthognathic surgery, there was an associated increase in perioral muscle strength. This suggests that an increase in perioral muscle strength may contribute more to the stability of postoperative jaw morphology.

Measuring Articulatory Patterns in Amyotrophic Lateral Sclerosis Using a Data-Driven Articulatory Consonant Distinctiveness Space Approach.

PURPOSE: The aim of this study was to leverage data-driven approaches, including a novel articulatory consonant distinctiveness space (ACDS) approach, to better understand speech motor control in amyotrophic lateral sclerosis (ALS). METHOD: Electromagnetic articulography was used to record tongue and lip movement data during the production of 10 consonants from healthy controls (n = 15) and individuals with ALS (n = 47). To assess phoneme distinctness, speech data were analyzed using two classification algorithms, Procrustes matching (PM) and support vector machine (SVM), and the area/volume of the ACDS. Pearson's correlation coefficient was used to examine the relationship between bulbar impairment and the ACDS. Analysis of variance was used to examine the effects of bulbar impairment on consonant distinctiveness and consonant classification accuracies in clinical subgroups. RESULTS: There was a significant relationship between the ACDS and intelligible speaking rate (area, p = .003; volume, p = .010), and the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) bulbar subscore (area, p = .009; volume, p = .027). Consonant classification performance followed a consistent pattern with bulbar severity, where consonants produced by speakers with more severe ALS were classified less accurately (SVM = 75.27%; PM = 74.54%) than the healthy, asymptomatic, and mild-moderate groups. In severe ALS, area of the ACDS was significantly condensed compared to both asymptomatic (p = .004) and mild-moderate (p = .013) groups. There was no statistically significant difference in area between the severe ALS group and healthy speakers (p = .292). CONCLUSIONS: Our comprehensive approach is sensitive to early oromotor changes in response due to disease progression. The preserved articulatory consonant space may capture the use of compensatory adaptations to counteract influences of neurodegeneration. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22044320.

Vocal Tract Resonance Detection at Low Frequencies: Improving Physical and Transducer Configurations.

Broadband excitation introduced at the speaker's lips and the evaluation of its corresponding relative acoustic impedance spectrum allow for fast, accurate and non-invasive estimations of vocal tract resonances during speech and singing. However, due to radiation impedance interactions at the lips at low frequencies, it is challenging to make reliable measurements of resonances lower than 500 Hz due to poor signal to noise ratios, limiting investigations of the first vocal tract resonance using such a method. In this paper, various physical configurations which may optimize the acoustic coupling between transducers and the vocal tract are investigated and the practical arrangement which yields the optimal vocal tract resonance detection sensitivity at low frequencies is identified. To support the investigation, two quantitative analysis methods are proposed to facilitate comparison of the sensitivity and quality of resonances identified. Accordingly, the optimal configuration identified has better acoustic coupling and low-frequency response compared with existing arrangements and is shown to reliably detect resonances down to 350 Hz (and possibly lower), thereby allowing the first resonance of a wide range of vowel articulations to be estimated with confidence.

Electromyographic activities of the jaw and facial muscles in subjects with different vertical skeletal patterns and breathing modes.

BACKGROUND: Mouth breathing (MB) can affect morphological changes in the craniofacial structures, electromyography is widely used for quantitative analysis of muscle function. OBJECTIVE: The aim was to evaluate the electromyographic (EMG) activities of the anterior temporalis (TA), masseter muscle (MM), orbicularis oris superior (OOS) and mentalis muscle (MT) in children with different vertical skeletal patterns and breathing modes during rest and various functional mandibular movements. METHODS: BioEMG III was used to measure the variations in EMG activities of TA, MM, OOS, and MT in 185 subjects aged 6-12 years during continuous clenching, rest, maximal intercuspation, lips closed lightly and swallowing. RESULTS: The results of logistic regression analysis showed that the model with vertical skeletal patterns as the dependent variable was ineffective (p = .106), while the model with breathing modes as the dependent variable was effective (p = .000). When considering both vertical skeletal patterns and breathing modes, the following significant differences were found. (1) In the normal-angle group, the EMG ratio in OOS with lips closed lightly of MB was significantly higher than NB (p = .005). (2) In the low-angle group, EMG ratios in TA and MM during the swallowing of MB were significantly lower than NB (p = .020, p = .040, respectively). (3) In the high-angle group, EMG ratios of MB were significantly higher in MT during continuous clenching, rest, lips closed lightly and swallowing (p = .038, p = .036, p = .005, p = .028, respectively), and OOS with lips closed lightly compared to NB (p = .005). CONCLUSION: Breathing modes and vertical skeletal patterns interacted to alter maxillofacial EMG activities, with breathing modes having a greater effect.

Magnetoencephalographic evaluation of repaired lip sensation in patients with cleft lip.

BACKGROUND: Cleft lip is the most common congenital anomaly worldwide. Nevertheless, lip somatosensory characteristics of patients with cleft lip after cheiloplasty have not yet been determined. The present study used magnetoencephalography to objectively evaluate the lip sensation in patients with unilateral cleft lip to establish a new objective evaluation method. METHODS: Participants were 15 patients with unilateral cleft lip after cheiloplasty (UCL group), and 30 healthy young subjects (control group). Five points of the upper and lower lips were stimulated electrically to measure somatosensory evoked magnetic fields (SEFs). The sources of the magnetic fields were modeled as single equivalent current dipoles (ECDs). ECDs located on the central sulcus by superimposition on magnetic resonance images were analyzed. Latency and intensity at 50-75 ms (cP60m) observed in the UCL group were compared with those in the control group. Thresholds of tactile stimuli in both groups were obtained using Semmes-Weinstein monofilaments for subjective sensory evaluation. RESULTS: No significant difference was found in the intensity of the cP60m or subjective evaluation between the groups. However, the latency of the cP60m was significantly longer in the upper lip of the UCL group than in the control group. CONCLUSIONS: SEFs showed a difference in lip sensation between the UCL group and the control group, suggesting that longer latency might be caused by the effects of surgical scarring on the neurotransmission pathway. These results suggest SEFs as useful for the objective evaluation of lip sensations. This study might improve future surgical procedures and lip functions of patients with cleft lip.

Comparing the Tongue and Lip Strength and Endurance of Children with Down Syndrome with Their Typical Peers Using IOPI.

Muscular hypotonia is a feature of Down syndrome (DS), and it affects the tongue and lips. A study on oral dysfunction in children with DS concluded that most of them did not have the tongue strength for completing the oral phase of swallowing. Recognizing the weakness of the oral muscles and improving its motor function positively affects mastication and swallowing, and prevents complications. This cross-sectional study aimed to measure the lip and tongue strength and endurance of children with DS and their typical peers, and compare these two groups with each other using Iowa Oral Performance Instrument (IOPI). Eight children with DS and 33 typical children aged 8-13 years were enrolled in this study. To examine the effect of age on the tongue strength and endurance, we divided the children into three groups of 8-9, 10-11, and 12-13 years old. The results showed that both anterior and posterior tongue strength were significantly lower in children with DS (p = 0.004 and 0.003). But, it was not the case with tongue endurance. Also, in 10-11 years old age group, the mean posterior tongue strength and in 12-13 years old age group the lip endurance was significantly lower in children with DS (p = 0.05 for both). Lips strength and endurance were both remarkably lower in children with DS (p = 0.004 and 0.02). In this study, tongue, and lip strength and endurance in both children with DS and typical ones were measured with IOPI for the first time. Moreover, it provided quantitative data on the strength and endurance of the muscles of the tongue and lips, which can contribute to future studies.

Lip-closing strength in children is enhanced by lip and facial muscle training.

OBJECTIVES: Weakening of lip-closing strength (LCS) associated with an incompetent lip seal (ILS) may affect the oral balance between the lip and tongue pressures. The purpose of this study was to evaluate the effects of lip-closing training in children with lower LCS and/or abnormal habits across different age groups and to compare its effects on increasing LCS in children with malocclusion and/or oral habits. MATERIAL AND METHODS: Lip-closing training was performed by 154 Japanese children aged 3-12 years using a specialized training device at home for 3 months. Children with oral habits and/or exhibiting less than standard LCS were included. LCS was measured using a digital strain force gauge at a dental clinic at the beginning (T0) and after each month (after 3 months: T3). RESULTS: Children had higher LCS responses after lip-closing training. The first month of lip-closing training was more effective than the subsequent months. With lip-closing training, the LCS increased from an average of 6.2 N (T0) to 11.4 N (T3) in Group I, 7.9 N (T0) to 12.8 N (T3) in Group II, and 6.8 N to 11.4 N in Group III. Anterior cross bite, including reverse bite, open bite, and tongue thrusting, significantly reduced training effects. CONCLUSION: Our findings showed that lower LCS in children with ILS resulted in greater responses to lip-closing training in a short period, but oral dysfunction, such as abnormal habits, inhibited the positive effects of training. Our results suggest that less detrimental effects of malocclusion and abnormal oral habits lip-closing training enhances LCS in younger children.

Do congruent lip movements facilitate speech processing in a dynamic audiovisual multi-talker scenario? An ERP study with older and younger adults.

In natural conversations, visible mouth and lip movements play an important role in speech comprehension. There is evidence that visual speech information improves speech comprehension, especially for older adults and under difficult listening conditions. However, the neurocognitive basis is still poorly understood. The present EEG experiment investigated the benefits of audiovisual speech in a dynamic cocktail-party scenario with 22 (aged 20-34 years) younger and 20 (aged 55-74 years) older participants. We presented three simultaneously talking faces with a varying amount of visual speech input (still faces, visually unspecific and audiovisually congruent). In a two-alternative forced-choice task, participants had to discriminate target words ("yes" or "no") among two distractors (one-digit number words). In half of the experimental blocks, the target was always presented from a central position, in the other half, occasional switches to a lateral position could occur. We investigated behavioral and electrophysiological modulations due to age, location switches and the content of visual information, analyzing response times and accuracy as well as the P1, N1, P2, N2 event-related potentials (ERPs) and the contingent negative variation (CNV) in the EEG. We found that audiovisually congruent speech information improved performance and modulated ERP amplitudes in both age groups, suggesting enhanced preparation and integration of the subsequent auditory input. In the older group, larger amplitude measures were found in early phases of processing (P1-N1). Here, amplitude measures were reduced in response to audiovisually congruent stimuli. In later processing phases (P2-N2) we found decreased amplitude measures in the older group, while an amplitude reduction for audiovisually congruent compared to visually unspecific stimuli was still observable. However, these benefits were only observed as long as no location switches occurred, leading to enhanced amplitude measures in later processing phases (P2-N2). To conclude, meaningful visual information in a multi-talker setting, when presented from the expected location, is shown to be beneficial for both younger and older adults.

Effects of adding a commercial capsaicin fertilizer on the feeding behavior of sika deer (Cervus nippon).

We investigated the inhibitory effect of capsaicin fertilizer on feeding in deer. We tested four captive adult female deer. In Experiment 1, in addition to the treatment (intact) containing only a solid feed (HC), we mixed the fertilizer not containing capsaicin (F) or the capsaicin fertilizer (CF) in the solid feed. In addition, the solid feed was put on a wire net that capsaicin fertilizer was placed 5 cm below (SCF). We investigated their feeding behavior response. In Experiment 2, we changed the amount of substance (fertilizer and capsaicin fertilizer) mixed in the HC. We mixed different amounts (0, 50, 100, and 200 g) of the treatments other than the intact with HC and presented them to the deer, and investigated their feeding behavior response. In Experiment 1, intake in the F and CF decreased (p < .05). In Experiment 2, HC intake was significantly lower in the 100 and 200 g CF (p < .05). However, HC intake relatively increased by the last day in the CF 200 g too. The capsaicin fertilizer decreased the feeding behavior of deer by directly touching the mucous membranes of the deer nose and lips. However, the effects were decreased over time.

Cortical reorganization following auditory deprivation predicts cochlear implant performance in postlingually deaf adults.

Long-term hearing loss in postlingually deaf (PD) adults may lead to brain structural changes that affect the outcomes of cochlear implantation. We studied 94 PD patients who underwent cochlear implantation and 37 patients who were MRI-scanned within 2 weeks after the onset of sudden hearing loss and expected with minimal brain structural changes in relation to deafness. Compared with those with sudden hearing loss, we found lower gray matter (GM) probabilities in bilateral thalami, superior, middle, inferior temporal cortices as well as the central cortical regions corresponding to the movement and sensation of the lips, tongue, and larynx in the PD group. Among these brain areas, the GM in the middle temporal cortex showed negative correlation with disease duration, whereas the other areas displayed positive correlations. Left superior, middle temporal cortical, and bilateral thalamic GMs were the most accurate predictors of post-cochlear implantation word recognition scores (mean absolute error [MAE] = 10.1, r = .82), which was superior to clinical variables used (MAE: 12.1, p < .05). Using the combined brain morphological and clinical features, we achieved the best prediction of the outcome (MAE: 8.51, r = .90). Our findings suggest that the cross-modal plasticity allowing the superior temporal cortex and thalamus to process other modal sensory inputs reverses the initially lower volume when deafness becomes persistent. The middle temporal cortex processing higher-level language comprehension shows persistent negative correlations with disease duration, suggesting this area's association with degraded speech comprehensions due to long-term deafness. Morphological features combined with clinical variables might play a key role in predicting outcomes of cochlear implantation.

Morphological and functional variability in central and subcentral motor cortex of the human brain.

There is a long-established link between anatomy and function in the somatomotor system in the mammalian cerebral cortex. The morphology of the central sulcus is predictive of the location of functional activation peaks relating to movement of different effectors in individuals. By contrast, morphological variation in the subcentral region and its relationship to function is, as yet, unknown. Investigating the subcentral region is particularly important in the context of speech, since control of the larynx during human speech production is related to activity in this region. Here, we examined the relationship between morphology in the central and subcentral region and the location of functional activity during movement of the hand, lips, tongue, and larynx at the individual participant level. We provide a systematic description of the sulcal patterns of the subcentral and adjacent opercular cortex, including the inter-individual variability in sulcal morphology. We show that, in the majority of participants, the anterior subcentral sulcus is not continuous, but consists of two distinct segments. A robust relationship between morphology of the central and subcentral sulcal segments and movement of different effectors is demonstrated. Inter-individual variability of underlying anatomy might thus explain previous inconsistent findings, in particular regarding the ventral larynx area in subcentral cortex. A surface registration based on sulcal labels indicated that such anatomical information can improve the alignment of functional data for group studies.

Analysis of Labial and Lingual Strength among Healthy Chinese Adults in Taiwan.

This study collected 11 parameters regarding the labial and lingual strength for maximum isometric and swallowing tasks among 150 healthy Chinese adults in Taiwan. Measurements were performed using the Iowa Oral Performance Instrument (IOPI). All of the labial and lingual strength parameters were measured three times. The maximal value of three trials represents the pressure of every parameter. The overall mean (±standard deviation) and maximum isometric pressures of the lips, anterior tongue, and posterior tongue were 24.81 ± 5.64, 55.95 ± 14.13, and 53.23 ± 12.24 kPa, respectively. The mean value of posterior tongue strength was less than that of the anterior tongue by approximately 5%. The percentages of maximum isometric tongue pressure during the swallowing of saliva and water were 85% and 80% for the anterior tongue and 90% and 81% for the posterior tongue, respectively. The average endurances for the anterior tongue and posterior tongue were 13.86 ± 7.08 and 10.06 ± 5.40 s, respectively. The maximum isometric pressures were greater than both the saliva and water swallowing pressures, and the saliva swallowing pressures were greater than the water swallowing pressures. A value of 33 kPa in maximum isometric pressure could serve as a demarcation of weak tongue strength for healthy Chinese adults. As for the repeated trials of labial and lingual strength, there were no statistically significant differences for any of the pressures obtained from the 11 labial and lingual strength parameters. The normative data can be used for the objective assessment of labial and lingual strength in healthy Chinese adults.

Vision perceptually restores auditory spectral dynamics in speech.

Visual speech facilitates auditory speech perception, but the visual cues responsible for these benefits and the information they provide remain unclear. Low-level models emphasize basic temporal cues provided by mouth movements, but these impoverished signals may not fully account for the richness of auditory information provided by visual speech. High-level models posit interactions among abstract categorical (i.e., phonemes/visemes) or amodal (e.g., articulatory) speech representations, but require lossy remapping of speech signals onto abstracted representations. Because visible articulators shape the spectral content of speech, we hypothesized that the perceptual system might exploit natural correlations between midlevel visual (oral deformations) and auditory speech features (frequency modulations) to extract detailed spectrotemporal information from visual speech without employing high-level abstractions. Consistent with this hypothesis, we found that the time-frequency dynamics of oral resonances (formants) could be predicted with unexpectedly high precision from the changing shape of the mouth during speech. When isolated from other speech cues, speech-based shape deformations improved perceptual sensitivity for corresponding frequency modulations, suggesting that listeners could exploit this cross-modal correspondence to facilitate perception. To test whether this type of correspondence could improve speech comprehension, we selectively degraded the spectral or temporal dimensions of auditory sentence spectrograms to assess how well visual speech facilitated comprehension under each degradation condition. Visual speech produced drastically larger enhancements during spectral degradation, suggesting a condition-specific facilitation effect driven by cross-modal recovery of auditory speech spectra. The perceptual system may therefore use audiovisual correlations rooted in oral acoustics to extract detailed spectrotemporal information from visual speech.

Quantal biomechanical effects in speech postures of the lips.

The unique biomechanical and functional constraints on human speech make it a promising area for research investigating modular control of movement. The present article illustrates how a modular control approach to speech can provide insights relevant to understanding both motor control and observed variation across languages. We specifically explore the robust typological finding that languages produce different degrees of labial constriction using distinct muscle groupings and concomitantly distinct lip postures. Research has suggested that these lip postures exploit biomechanical regions of nonlinearity between neural activation and movement, also known as quantal regions, to allow movement goals to be realized despite variable activation signals. We present two sets of computer simulations showing that these labial postures can be generated under the assumption of modular control and that the corresponding modules are biomechanically robust: first to variation in the activation levels of participating muscles, and second to interference from surrounding muscles. These results provide support for the hypothesis that biomechanical robustness is an important factor in selecting the muscle groupings used for speech movements and provide insight into the neurological control of speech movements and how biomechanical and functional constraints govern the emergence of speech motor modules. We anticipate that future experimental work guided by biomechanical simulation results will provide new insights into the neural organization of speech movements.NEW & NOTEWORTHY This article provides additional evidence that speech motor control is organized in a modular fashion and that biomechanics constrain the kinds of motor modules that may emerge. It also suggests that speech can be a fruitful domain for the study of modularity and that a better understanding of speech motor modules will be useful for speech research. Finally, it suggests that biomechanical modeling can serve as a useful complement to experimental work when studying modularity.

Training lip force by oral screens. Part 3: Outcome for patients with stroke and peripheral facial palsy.

The aim of this study was to investigate whether training with an oral screen can improve oral motor function in patients with stroke and peripheral palsy. The participants in the study were eight patients with orofacial dysfunction after stroke, included 7-14 months after onset, and seven patients with peripheral palsy, included 14-28 months after onset. A customized oral screen in acrylic was made for each participant. The screen had a tube around the handle to allow air to pass when measurements were made of the perioral muscle force. When measuring the ability to suck, the hole was sealed with wax. The participants trained with the oral screen two times daily for 5 min. Measurements were made at baseline, after 1 month and thereafter every third month until no further improvement was achieved. Measurements were made with two different instructions, to squeeze and to suck. In the stroke group, muscles around the mouth improved when pouting and smiling; these participants also achieved statistically significant changes when sucking. For the peripheral palsy group, little improvement could be seen when pouting and smiling. However, these patients reported less or no drooling, and the measurements for sucking increased significantly for six of the seven patients. The first recorded significant change was seen in the stroke group after 4 weeks training and in the group with peripheral palsy after 6 weeks. Training with a custom-made oral screen can significantly improve perioral muscle force and the ability to create negative intraoral pressure. The patients reported less leakage in saliva, drink, and food as well as fewer bite injuries and less food accumulation.

Dentofacial mini- and microesthetics as perceived by dental students: A cross-sectional multi-site study.

BACKGROUND: How dental education influences students' dental and dentofacial esthetic perception has been studied for some time, given the importance of esthetics in dentistry. However, no study before has studied this question in a large sample of students from all grades of dental school. This study sought to fill that gap. The aim was to assess if students' dentofacial esthetic autoperception and heteroperception are associated with their actual stage of studies (grade) and if autoperception has any effect on heteroperception. METHODS: Between October 2018 and August 2019, a questionnaire was distributed to 919 dental students of all 5 grades of dental school at all four dental schools in Hungary. The questionnaire consisted of the following parts (see also the supplementary material): 1. Demographic data (3 items), Self-Esthetics I (11 multiple- choice items regarding the respondents' perception of their own dentofacial esthetics), Self-Esthetics II (6 Likert-type items regarding the respondents' perception of their own dentofacial esthetics), and Image rating (10 items, 5 images each, of which the respondents have to choose the one they find the most attractive). Both the self-esthetics and the photo rating items were aimed at the assessment of mini- and microesthetic features. RESULTS: The response rate was 93.7% (861 students). The self-perception of the respondents was highly favorable, regardless of grade or gender. Grade and heteroperception were significantly associated regarding maxillary midline shift (p < 0.01) and the relative visibility of the arches behind the lips (p < 0.01). Detailed analysis showed a characteristic pattern of preference changes across grades for both esthetic aspects. The third year of studies appeared to be a dividing line in both cases, after which a real preference order was established. Association between autoperception and heteroperception could not be verified for statistical reasons. CONCLUSION: Our findings corroborate the results of most previous studies regarding the effect of dental education on the dentofacial esthetic perception of students. We have shown that the effect can be demonstrated on the grade level, which we attribute to the specific curricular contents. We found no gender effect, which, in the light of the literature, suggests that the gender effect in dentofacial esthetic perception is highly culture dependent. The results allow no conclusion regarding the relation between autoperception and heteroperception.

The structural and motivational role of the unique lip-flip movement in the gelada (Theropithecus gelada) facial display repertoire.

OBJECTIVES: Human language represents an extreme form of communicative complexity. Primate facial display complexity, which depends upon facial mobility, can be used as a model for the study of the evolution of communicative complexity. The gelada (Theropithecus gelada) is the only primate that can produce a lip-flip eversion. This study investigates the role of the lip-flip relative to the bared-teeth display to understand its role in generating communicative complexity. MATERIALS AND METHODS: We reviewed videos of gelada social interactions. We utilized the facial action coding system (FACS) to define structural component action units (AUs) of each display. We inferred display motivation from the behaviors of the display sender. RESULTS: The lip-flip was used only in combination with the essential AUs of the bared-teeth display, serving as an optional structural element added to produce a structural variant. Both the bared-teeth display with and without a lip-flip occurred most frequently with nonaggressive, submissive behaviors. The lip-flip was more frequently preceded by approach than the bared-teeth display, especially in males. The lip-flip was also present in the majority of structurally blended facial displays though the motivation of the non-lip-flip parent display often dominated. DISCUSSION: The lip-flip may potentially function as an indicator of benign intent after an approach or as an intensifying component of nonaggressive intent. Adaptations to increase facial mobility in geladas via facilitating the lip-flip may promote increased communicative complexity through increased conspicuousness and motivational signaling specification or intensification.

Wireless Sensing of Lower Lip and Thumb-Index Finger 'Ramp-and-Hold' Isometric Force Dynamics in a Small Cohort of Unilateral MCA Stroke: Discussion of Preliminary Findings.

Automated wireless sensing of force dynamics during a visuomotor control task was used to rapidly assess residual motor function during finger pinch (right and left hand) and lower lip compression in a cohort of seven adult males with chronic, unilateral middle cerebral artery (MCA) stroke with infarct confirmed by anatomic magnetic resonance imaging (MRI). A matched cohort of 25 neurotypical adult males served as controls. Dependent variables were extracted from digitized records of 'ramp-and-hold' isometric contractions to target levels (0.25, 0.5, 1, and 2 Newtons) presented in a randomized block design; and included force reaction time, peak force, and dF/dtmax associated with force recruitment, and end-point accuracy and variability metrics during the contraction hold-phase (mean, SD, criterion percentage 'on-target'). Maximum voluntary contraction force (MVCF) was also assessed to establish the force operating range. Results based on linear mixed modeling (LMM, adjusted for age and handedness) revealed significant patterns of dissolution in fine force regulation among MCA stroke participants, especially for the contralesional thumb-index finger followed by the ipsilesional digits, and the lower lip. For example, the contralesional thumb-index finger manifest increased reaction time, and greater overshoot in peak force during recruitment compared to controls. Impaired force regulation among MCA stroke participants during the contraction hold-phase was associated with significant increases in force SD, and dramatic reduction in the ability to regulate force output within prescribed target force window (±5% of target). Impaired force regulation during contraction hold-phase was greatest in the contralesional hand muscle group, followed by significant dissolution in ipsilateral digits, with smaller effects found for lower lip. These changes in fine force dynamics were accompanied by large reductions in the MVCF with the LMM marginal means for contralesional and ipsilesional pinch forces at just 34.77% (15.93 N vs. 45.82 N) and 66.45% (27.23 N vs. 40.98 N) of control performance, respectively. Biomechanical measures of fine force and MVCF performance in adult stroke survivors provide valuable information on the profile of residual motor function which can help inform clinical treatment strategies and quantitatively monitor the efficacy of rehabilitation or neuroprotection strategies.

Customized lip enhancement for clinical different lip features: An observational study.

BACKGROUND: The request for lip improvement treatments with injectable hyaluronic acid (HA) is increasing. However, as the patient's needs can be extremely different, it is unconceivable to use the same technique/product for clinical different lips to grant customized results. AIMS: To provide a specific treatment approach for clinically different lips based on the Author's clinical experience. PATIENTS/METHODS: Patients belonged to four clinical groups: young lips requiring volume enhancement or a reshaping intervention, and senescent lips requiring rejuvenation or a rebuild intervention. At first visit T0, subjects underwent a pretreatment evaluation and the investigator performed an individual treatment based upon patient's esthetic goals and lip's baseline features. Lip fullness was assessed by the investigator using a Medicis Lip Fullness Scale (MLFS) at first visit (T0) and at 2 weeks (T1). Subjects and investigator answered to the Global Aesthetic Improvement Scale (GAIS) at 2 weeks T1 and at 12 weeks (T2). A photographic evaluation was undertaken at T0 and T2. RESULTS: Only, in the two groups requiring volumization there was 1 grade of improvement in the MLFS (young lips-volume and senescent lips-rebuild). Nonetheless, the performed combination of techniques/products was overall very satisfactory: 80% of the subjects reported a much improved/very much improved outcome in the GAIS, and the same was reported by the investigator in 90% of the subjects. A weak positive correlation was found between MLFS responses and subject's GAIS at T1 in all groups. CONCLUSIONS: This customized treatment approach, consisting in choosing the right gel technology injected in minimum quantities with the right technique, ensures a harmonic result avoiding aberrations and standardizations.