Prevalence of Self-Reported Swallowing Difficulties and Swallowing-Related Quality of Life Among Community-Dwelling Older Adults in India.

Self-reported swallowing difficulties are highly prevalent but underreported among older adults. The aging population in India is increasing, yet there is a lack of empirical data on self-reported swallowing difficulties in older adults. In the present study, we aimed to estimate the prevalence of self-reported swallowing difficulties and assess the swallowing-related quality of life (QOL) among community-dwelling older adults in India. We recruited 361 older adults (60-91 years) from the community. Participants completed the Eating Assessment Tool-10 (EAT-10) to assess self-reported swallowing difficulties and the Dysphagia Handicap Index (DHI) to assess swallowing-related QOL. Participants rated the EAT-10 from 0 for 'no problem' to 4 for 'severe problem'. The DHI rating included 0 for 'never', 2 for 'sometimes', and 4 for 'always'. The total scores of EAT-10 and DHI were summarised using descriptive statistics. Statistically significant differences between pass-fail groups of EAT-10 and DHI were evaluated using an independent t-test and multivariate analysis of variance test, respectively. The overall mean score for EAT-10 was 3.34, and 7.56 for DHI, with higher scores observed among females. 36.6% of older adults self-reported experiencing swallowing difficulties, while 47.4% self-reported having poor swallowing-related QOL at p < 0.05. A strong positive correlation (r = 0.86) was found between EAT-10 and total DHI scores at p < 0.001. The present study sheds light on the widespread yet underreported issue of self-reported swallowing difficulties and the impact on swallowing-related QOL among older adults in India. These findings emphasize the urgent need for early swallowing screening programs among older adults.

Test of mastication and swallowing solids in healthy individuals aged 6 to 20 years: A normative study in an Indian context.

BACKGROUND: The Test of Mastication and Swallowing Solids (TOMASS) is a reliable tool for assessing chewing and swallowing in healthy adults, using commercially available crackers. TOMASS-Children (TOMASS-C) is the paediatric version of TOMASS. OBJECTIVE: The present study aimed to establish normative data for TOMASS-C using a validated regional commercial cracker among healthy individuals aged between 6-20 years of India. METHODS: 327 healthy individuals between 6-20 years were recruited in a cross-sectional study design following a convenient sampling procedure. Participants consumed one validated regional cracker and the procedure was video recorded. Data were stratified according to age groups (6-7, 8-9, 10-13, 14-17 and 18-20 years) and sex (boys and girls). Two Speech Language Pathologists independently analysed the video recordings to derive discrete bites, masticatory cycles, swallows and total swallow time indices. Using them, time/swallow, masticatory cycles/bite, swallows/bite and time/bite were calculated. RESULTS: All parameters of TOMASS-C had moderate to good (0.6-0.85) test-retest reliability and moderate to excellent (0.69-0.99) inter-rater reliability at p > .000. Younger participants took more bites, chewed more times and swallowed more frequently with longer chewing and swallowing time. Boys exhibited a lower number of swallows, shorter swallow time and reduced total masticatory time at p > .05. Additionally, girls demonstrated fewer bites and chewing cycles compared to boys at p > .05. CONCLUSION: TOMASS-C using a validated regional cracker was feasible and reliable. Normative data established for healthy boys and girls between 6-20 years offers much-needed quantitative data to objectively delineate individuals with and without chewing and swallowing solid food difficulties.

Occurrence, presence and severity of bruxism and its association with altered state of consciousness in individuals with severe acquired brain injury.

BACKGROUND: Excessive jaw muscle activity is a frequent complication after acquired brain injury (ABI). OBJECTIVE: The study aimed to identify the occurrence and severity of jaw muscle activity and its association with altered state of consciousness in patients with ABI. METHODS: A total of 14 severe ABI patients with varied altered state of consciousness were recruited. A single-channel electromyographic (EMG) device was used to assess the jaw muscle activity for three consecutive nights during Week 1 and Week 4 following admission. Differences in number of EMG episodes/h between Week 1 and 4 were analysed using non-parametric tests and association between the EMG activity and altered state of consciousness were analysed using Spearman's correlation test. RESULTS: Nine of fourteen (64%) patients showed indications of bruxism (cutoff: >15 EMG episodes/h). The average EMG episodes/h at admission were 44.5 ± 13.6 with no significant changes after Week 4 of admission (43 ± 12.9; p = .917). The EMG episodes/h ranged from 2 to 184 during Week 1 and 4-154 during Week 4. There were no significant correlations between the number of EMG episodes/h during the three nights and the individuals altered state of consciousness during Week 1 and Week 4. CONCLUSION: Patients with ABI had a conspicuously high but variable level of jaw muscle activity at admission and it tend to remain high after 4 week of hospitalisation which could potentially lead to adverse effects such as excessive tooth wear, headaches and pain in jaw muscles. The lack of associations between individuals altered level of consciousness and EMG activity could be due to low sample size and further studies are clearly warranted in this patient group with special needs. Single-channel EMG devices can record jaw muscle activity early in the hospitalisation period and might be a helpful tools for early detection of bruxism in ABI patients.

Impact of oral motor task training on corticomotor pathways and diadochokinetic rates in young healthy participants.

BACKGROUND: Studies addressing the training-induced neuroplasticity and interrelationships of the lip, masseter, and tongue motor representations in the human motor cortex using single syllable repetition are lacking. OBJECTIVE: This study investigated the impact of a repeated training in a novel PaTaKa diadochokinetic (DDK) orofacial motor task (OMT) on corticomotor control of the lips, masseter, and tongue muscles in young healthy participants. METHODS: A total of 22 young healthy volunteers performed 3 consecutive days of training in an OMT. Transcranial magnetic stimulation was applied to elicit motor evoked potentials (MEPs) from the lip, masseter, tongue, and first dorsal interosseous (FDI, internal control) muscles. MEPs were assessed by stimulus-response curves and corticomotor mapping at baseline and after OMT. The DDK rate from PaTaKa single syllable repetition and numeric rating scale (NRS) scores were also obtained at baseline and immediately after each OMT. Repeated-measures analysis of variance was used to detect differences at a significance level of 5%. RESULTS: There was a significant effect of OMT and stimulus intensity on the lips, masseter, and tongue MEPs compared to baseline (p < .001), but not FDI MEPs (p > .05). OMT increased corticomotor topographic maps area (p < .001), and DDK rates (p < .01). CONCLUSION: Our findings suggest that 3 consecutive days of a repeated PaTaKa training in an OMT can induce neuroplastic changes in the corticomotor pathways of orofacial muscles, and it may be related to mechanisms underlying the improvement of orofacial fine motor skills due to short-term training. The clinical utility should now be investigated.

Internal structure and validity of the bedside oral examination tool in patients with brain injury at neurorehabilitation setting.

OBJECTIVES: To assess the internal structure and validity of the 'bedside oral examination' (BOE) instrument in individuals with acquired brain injury (ABI). METHODS: Ninety ABI individuals were examined using BOE in their first week of neurorehabilitation. BOE measures oral health within eight categories including: swallow, tongue, odour, teeth, lips, saliva, mucosa and gingiva. To assess the validity of BOE, full-mouth clinical examination (gold standard) was performed. The internal structure of BOE was assessed using exploratory and confirmatory factor analyses. To measure the validity, the BOE scores were dichotomised into excellent oral health and altered oral health. Sensitivity, specificity and area under the receiver operating characteristic (ROC) curve of the six/eight BOE items were compared with their related clinical oral examination tool. RESULTS: Overall, the patients had poor oral health irrespective of the oral examination tool used. Factor analyses indicated two factors within BOE: 'oral hygiene' (teeth, gingiva and mucosa) and 'orofacial health' (lips, swallow and saliva). BOE tongue and odour items loaded in neither factor. BOE items showed low validity since the highest area under the ROC curve was 0.60. Findings on the sensitivity value ranged from 35.0 to 74.2, while specificity from 44.4 to 83.3, depending on the item evaluated. CONCLUSION: Bedside oral examination does not seem to be an ideal 'single' outcome tool in a neurorehabilitation setting as it lacks validity. BOE evaluates oral health as two independent but correlated components and treat them separately indicating precision treatment depending on their oral health dysfunction. It is advisable to use BOE as a screening tool. However, it should be complimented by proper clinical examination before establishing a treatment plan for oral health in patients with ABI.

Assessment and rehabilitation interventions for central facial palsy in patients with acquired brain injury: a systematic review.

Objectives: To do a systematic review covering assessments and interventions for central facial palsy (CFP) in patients with acquired brain injury.Methods: PubMed, Embase, Cinahl, PsycInfo, and Web of Science were screened until April 2019. Assessments were defined as clinical- and instrumental tools and rating scales. Interventions were defined as rehabilitation interventions alleviating CFP.Results: 690 articles were screened based on the title and abstract. Interrater agreement was 98.12%. Sixteen articles were included: six clinical trials and 10 observational studies. Assessment: Commonest scale for assessing CFP was the House-Brackmann facial nerve Grading System. Strain gauges for measuring lip and cheek strength were applied in five studies and neurophysiological methods of assessing motor neuron pathways were applied in three studies. Interventions: An oral screen for improving lip strength was reported in three studies. Other interventions reported were neuromuscular electrical stimulation, Castillo Morales therapy, mirror therapy, exercises with electromyography feedback, and acupuncture.Conclusions: Scales for assessing peripheral facial palsy were applied for assessing CFP. Based on neurophysiological differences in the manifestation of peripheral facial palsy and CFP, these scales should be validated in patients with CFP. More studies on interventions for CFP are required before conclusions may be drawn about their effectiveness.

Periodontitis and orofacial health-related systemic impairment in patients with brain injury: a factor analysis approach.

Aim: To investigate the association of periodontitis to orofacial health-related systemic impairment in patients with acquired brain injury (ABI).Methods: Ninety individuals with ABI were included. Full mouth periodontal examination was performed. Orofacial health-related 'motor' and 'cognitive' scores, dysphagia and feeding status, onset of pneumonia were retrieved from e-journal. Factor analysis dubbed periodontal data as 'moderate' and 'severe' periodontitis while orofacial health-related brain injury scores were dubbed into 'motor' and 'cognitive' domains. Association between periodontal findings and systemic impairments were analyzed using multivariable linear regression models.Results: Higher scores of 'moderate' periodontitis were significantly associated with lower scores of motor impairment (ß = -0.2), feeding tube dependency (ß = 0.2) and dysphagia (ß = 1.21), whereas higher scores of 'severe' periodontitis were associated with lower scores of cognition (ß = -0.2) and reduced dental visits (ß = -0.2). Both periodontal domains were significantly associated with aging (ß = 0.02) and onset of pneumonia (ß = 0.5-0.7).Conclusions: Robust association between 'moderate' periodontitis and motor impairment, feeding problems and dysphagia, reflects an acute clinical condition, demanding cross-disciplinary intervention. Periodontal examination can be an early indicator tool for systemic chronic conditions, as ABI and periodontitis share a common environmental, social and biological background. Periodontitis majorly affects ageing population and are prone to pneumonia, compromising rehabilitation plan.

Changes in oral health related quality of life and its associated factors in individuals with brain injury.

Purpose: To evaluate changes in oral health-related quality of life (OHRQoL) and associated factors in individuals with acquired brain injury (ABI) during hospitalization.Methods: Forty-six individuals with ABI were examined at week 1 and 5 of hospitalization. OHRQoL was recorded through Oral Health Impact Profile-14 (OHIP-14), clinical oral examinations were conducted, while orofacial health-related 'motor' and 'cognitive' scores were retrieved from patients' e-journal. Association between variables were investigated using factor analysis and multilevel regression modeling.Results: There were no significant differences in the OHIP-14 scores between week 1 and 5. Factors analysis revealed two OHIP-14 domains, 'psychosocial' and 'physica'. Individuals who improved their cognitive skills over study period and those with 'severe' periodontitis at baseline had increased scores of OHIP-14 'psychosocial' domain. Individuals who improved orofacial health-related 'motor' skills over study period had decreased 'physical' domain scores. Increased cognition over study period, current smoking and dental calculus were associated with increased 'physical' domain.Conclusions: The OHRQoL was poor both at week 1 and 5. Individual's cognitive and motor skills as well as their oral health status influenced their OHRQoL. Thus, individual's awareness and involvement in addition to oral care seem to be imperative in improving the OHRQoL in neurorehabilitation setting.

Construct and content validity of the Functional Oral Intake Scale; Analyses from a cohort of patients with acquired brain injury.

OBJECTIVE: To investigate the construct validity of the Functional Oral Intake Scale (FOIS) as a proxy measure for dysphagia, through associations with swallowing prerequisites, orofacial functions, age, and diagnosis; and to investigate content validity through distributions of FOIS ratings. METHODS: A cohort of 1,876 patients with severe acquired brain injury. Early Functional Abilities items were applied as measures of swallowing prerequisites and orofacial functions. Clustered logistic regression model with 6,052 cross-sectional observations. RESULTS: Disturbance in swallowing 10.55 OR (95%CI:7.90;14.09), oro-facial stimulation 3.04 OR (95%CI:2.41;3.83), and head control 2.86 OR (95%CI:2.25;3.62) were robustly associated with tube feeding (FOIS 1-3). Disturbance in trunk control, wakefulness, tongue movement/chewing, older age, and a non-stroke diagnosis were also associated with tube feeding. BMI did not attenuate associations in sensitivity analyses. FOIS ratings had greatest density in FOIS level 1 and level 7, with 25% and 40% of registrations, respectively. Level 4 was rated in only 1% of 6,052 registrations. CONCLUSIONS: The FOIS was robustly associated with indicators of dysphagia. However, associations with postural control, wakefulness, age and diagnosis highlights that tube feeding may be attributed to other issues than dysphagia. It should be further investigated whether FOIS level 4 is meaningful in neurorehabilitation.

Oral health: something to worry about in individuals with acquired brain injury?

OBJECTIVES: To investigate the oral health status in patients with acquired brain injury (ABI) admitted at neurorehabilitation setting. METHODS: 132 individuals with ABI were examined within their first week of admission. Individuals' socio-behavioral history, length of stay in acute care etc. were recorded. Comprehensive clinical oral examination consisting of acute conditions [dental plaque, bleeding on probing (BOP)] and chronic conditions [periodontal status, tooth loss] were recorded. RESULTS: The average length of stay in acute care was 41 days before admission at neurorehabilitation. It was observed that 42% and 50% of the patients with ABI had visible plaque and active BOP in >60% of all examined sites respectively. All patients suffered from periodontitis and 74% had severe periodontitis (Stage III), indicating a chronic inflammatory destruction of the supporting tissues. Each participant had at least two decayed teeth, five filled and five extracted teeth. CONCLUSIONS: Presence of dental plaque and BOP, an acute condition, speculates that poor oral health worsened while patients were at acute care setting. Majority of individuals had severe periodontitis indicating chronic poor oral health. Thus, indicating the need of not only planning treatment strategies while hospitalization but also uplifting the prevention of oral diseases much earlier in life.

Combination of jaw and tongue movement training influences neuroplasticity of corticomotor pathways in humans.

Since humans in daily life perform multiple motor behaviors that often involve the simultaneous activation of both jaw and tongue muscles, it is essential to understand the effects of combined orofacial sensorimotor tasks on plasticity in corticomotor pathways. Moreover, to establish novel rehabilitation programs for patients, it is important to clarify the possible interrelationships in corticomotor excitability between jaw and tongue motor control. The aim of this study was to examine the effect of a combination of a repetitive tooth bite task (TBT) and a repetitive tongue lift task (TLT) on corticomotor excitability of the tongue and jaw muscles as assessed by transcranial magnetic stimulation (TMS). Sixteen healthy individuals participated in three kinds of training tasks consisting of 41-min TBT, 41-min TLT, and 82-min TBT + TLT. Motor-evoked potentials (MEPs) from the tongue muscle, masseter muscle, and first dorsal interosseous muscle were measured before and after the training tasks. The amplitude of tongue MEPs after training with TLT and TLT + TBT, and masseter MEPs after training with TBT and TLT + TBT, were significantly higher than before training (P < 0.05). Tongue MEPs and masseter MEPs were significantly higher after TLT + TBT than after TBT or TLT (P < 0.05). The present results suggest that a task combining both jaw and tongue movement training is associated with a greater degree of neuroplasticity in the corticomotor control of jaw and tongue muscles than either task alone.

Survey of oral nursing care attitudes, knowledge and practices in a neurorehabilitation setting.

The provision of oral care is an important fundamental nursing activity. The purpose of the study was to gain knowledge on nursing care professionals´ attitude, belief, knowledge and practice towards oral care in a neurorehabilitation setting. Nursing care professionals (n = 260, response rate: 60%) at neurorehabilitation hospital took part in cross-sectional web-based 59-items survey. Attitudes were cross-tabulated and compared using Fisher's exact test. Oral care product frequencies were compared between patients with/without eating difficulties using McNemar's test. Most professionals agreed that oral health impacts general health (93%) and poor oral health can cause pneumonia (85%). 41% professionals found it difficult to clean the oral cavity and 12% found it unpleasant. 40% indicated that time allocated for oral hygiene was insufficient, 27% indicated a need for broader range of oral care supplies and >80% would like continuing oral care education. Manual toothbrush and toothpaste were used more than once per shift by >75% in all patients. Swabs, premixed mouth rinse, carbonated water and lip moisturiser were more frequently used in patients with eating difficulties compared to with no eating difficulties. Oral care is perceived as an essential component of care in neurorehabilitation. However, professionals indicated lack of time, need for better supplies and oral care training. The differentiated use of oral care products shows that professionals were aware that patients with eating difficulties have different requirements; however, some oral care practices were inappropriate. The results should be considered while designing oral care guidelines and training.

Prevalence and association of oral candidiasis with dysphagia in individuals with acquired brain injury.

OBJECTIVE: To describe the prevalence of oral candidiasis (OC) in individuals with acquired brain injury (ABI) and to evaluate the association of OC with improvement in dysphagia. DESIGN: Longitudinal observational study. METHODS: Individuals with ABI admitted to rehabilitation were recruited over a one-year period (n = 206 (59% with dysphagia)). OC-data were collected by clinical examinations and verified by cultivation/microscopy in every 3 weeks during first 10 weeks of admission. Dysphagia improvement was defined by: 1) first positive change in food consistency, 2) initiation of at least soft food consistency. Individuals with/without OC were compared using multivariable Cox proportional hazards regression. RESULTS: The overall OC prevalence in all individuals, in individuals with dysphagia and in individuals not treated with antifungal agents were 32.5%, 43.4% and 29.7%, respectively. The OC prevalence was 24.8% at one week after admission and reduced to 10.1% ten weeks after admission. Adjusted hazard ratios for improvement in dysphagia were 0.64-0.77 in OC compared to without OC, though not statistically significant. CONCLUSION: Prevalence of OC was high at admission but reduced during rehabilitation. Though non-significant, the negative trend between OC and improvement in dysphagia suggest that OC may delay rehabilitation of dysphagia.

Can short-term oral fine motor training affect precision of task performance and induce cortical plasticity of the jaw muscles?

The aim was to test the hypothesis that short-term oral sensorimotor training of the jaw muscles would increase the precision of task performance and induce neuroplastic changes in the corticomotor pathways, related to the masseter muscle. Fifteen healthy volunteers performed six series with ten trials of an oral sensorimotor task. The task was to manipulate and position a spherical chocolate candy in between the anterior teeth and split it into two equal halves. The precision of the task performance was evaluated by comparing the ratio between the two split halves. A series of "hold-and-split" tasks was also performed before and after the training. The hold force and split force along with the electromyographic (EMG) activity of jaw muscles were recorded. Motor-evoked potentials and cortical motor maps of the right masseter muscle were evoked by transcranial magnetic stimulation. There was a significant effect of series on the precision of the task performance during the short-term oral sensorimotor training (P < 0.002). The hold force during the "hold-and-split" task was significantly lower after training than before the short-term training (P = 0.011). However, there was no change in the split force and the EMG activity of the jaw muscles before and after the training. Further, there was a significant increase in the amplitude of the motor-evoked potentials (P < 0.016) and in the motor cortex map areas (P = 0.033), after the short-term oral sensorimotor training. Therefore, short-term oral sensorimotor task training increased the precision of task performance and induced signs of neuroplastic changes in the corticomotor pathways, related to the masseter muscle.

Influence of visual observational conditions on tongue motor learning.

The aim of this study was to investigate the impact of visual observational conditions on performance during a standardized tongue-protrusion training (TPT) task and to evaluate subject-based reports of helpfulness, disturbance, pain, and fatigue, due to the observational conditions on 0-10 numerical rating scales. Forty-eight healthy participants performed a 1-h standard TPT task. Participants were randomly assigned to one of the following three groups with different observational conditions: group 1, model observation (participants watched a prerecorded video showing standard TPT before optimal TPT being performed); group 2, self-observation (participants watched live video feedback of their own TPT performance); and group 3, control group (participants performed the TPT with no conditioning). There was no overall difference between groups but TPT performance increased over time. A significant group×time interaction indicated that the self-observation group performed significantly better than the model-observation group in the last 20 min of TPT. The subject-based reports of video helpfulness showed that the model-observation group rated the prerecorded video as more helpful for TPT performance compared with the other groups but there was no significant difference between groups regarding the level of disturbance, pain, or fatigue. Self-observation of tongue-training facilitated behavioral aspects of tongue motor learning compared with model observation but not compared with control.

Comprehensive oral-health assessment of individuals with acquired brain-injury in neuro-rehabilitation setting.

PRIMARY OBJECTIVE: To perform a detailed clinical oral health assessment and oral-health-related social and behavioural aspect assessment in individuals with acquired brain injury (ABI). RESEARCH DESIGN: Prospective observational study. METHODS AND PROCEDURES: Thirteen individuals with ABI were recruited. Individual's social and behavioural history, bed-side oral examination score (BOE), tooth condition and periodontal status (bleeding, plaque and clinical attachment loss) were thoroughly examined. The entire examination took up to 60 minutes, using proper dental armamentarium. MAIN OUTCOMES AND RESULTS: All evaluated individuals were diagnosed with chronic generalized periodontitis. A relationship between active periodontal disease and severe BOE score was observed (p = 0.01). Significant interaction between severe BOE scores (≥ 15 or ≥ 14) and periodontal disease severity of ≥ 2 mm (p = 0.01) was observed. The same interaction was seen between severe BOE scores and the combination of 75% extent and 2 mm severity (p = 0.01). Severity and activity of periodontitis showed dependence on individual brushing frequency (p = 0.03 and p = 0.05, respectively). CONCLUSIONS: Individuals with ABI had a poor status across a range of oral-, dental- and periodontal-related parameters. Further structured studies are required to define evidence-based assessment approaches for such clinical reality.

Tongue-controlled computer game: a new approach for rehabilitation of tongue motor function.

OBJECTIVE: To investigate the influence of tongue disability, age, and sex on motor performance for a tongue-training paradigm involving playing a computer game using the Tongue Drive System (TDS). DESIGN: Two controlled observational studies. SETTING: A neurorehabilitation center and a dental school. PARTICIPANTS: In study 1, tongue-disabled patients with symptoms of dysphagia and dysarthria (n=11) and age- and sex-matched controls (n=11) participated in tongue training. In study 2, healthy elderly persons (n=16) and healthy young persons (n=16) volunteered. INTERVENTION: In study 1 and study 2, the tongue training lasted 30 and 40 minutes, respectively. Participants were instructed to play a computer game with the tongue using TDS. MAIN OUTCOME MEASURES: Motor performance was compared between groups in both studies. Correlation analyses were performed between age and relative improvement in performance. Subject-based reports of motivation, fun, pain, and fatigue evaluated on 0-to-10 numeric rating scales were compared between groups. RESULTS: In study 1, tongue-disabled patients performed poorer than healthy controls (P=.005) and with a trend of a sex difference (P=.046). In study 2, healthy young participants performed better than healthy elderly participants (P<.001), but there was no effect of sex (P=.140). There was a significant negative correlation between age and relative improvement in performance (δ=-.450; P=.009). There were no significant differences in subject-based reports of motivation, fun, pain, and fatigue between groups in any of the studies (P>.094). CONCLUSIONS: The present study provides evidence that tongue disability and age can influence behavioral measures of tongue motor performance. TDS may be a new adjunctive neurorehabilitation regimen in treating tongue-disabled patients.

Motivational conditions influence tongue motor performance.

Motivation plays an important role in the outcome of motor learning but has not received attention in tongue-training-induced plasticity of the corticomotor pathways. The present study investigated the influence of two different motivational conditions and gender on performance during a complex tongue-training paradigm using the tongue drive system (TDS). In addition, subject-based reports of motivation, fun, pain, and fatigue were compared between groups and genders. Sixteen subjects were randomized into three groups and were asked to use the TDS for 40 min. A motivational condition (monetary reward or self-controlled practice) was introduced in two groups and the third group served as the control. The subjects were instructed to play a computer game using the TDS, having control of the computer cursor through a magnet attached to the tongue, and performance was compared among groups. Performance improved in all groups and in both genders. The monetary reward group tended towards higher performance scores compared with the control group, whereas the self-controlled practice group performed significantly better compared with the control group. There was no significant difference between groups and genders in the subject-based report for level of motivation, fun, pain, or fatigue. In conclusion, introduction of motivational conditions influenced tongue motor performance.

A Survey of Speech-Language Pathologists' Applications of Motor Learning Principles in Dysphagia Therapy in Adults in India.

PURPOSE: In the study, we investigated whether speech-language pathologists (SLPs) in India use practice and feedback conditions of motor learning principles (MLPs), including biofeedback, in dysphagia therapy in adults using a problem-solution approach. METHOD: Based on a literature review and clinical experience, we developed and validated a hypothetical case involving an adult with dysphagia (representing the problem) and a purpose-built 22-item questionnaire (representing the solution). We distributed the questionnaire electronically by sending an e-mail to 2,069 SLPs and also published a flyer on the dysphagia special interest group of India. RESULTS: A total of 107 SLPs anonymously submitted their responses. In practice conditions, most of the SLPs reported following massed over distributed, small over large, blocked over random, whole over part, variable over constant, and internal over external practice strategies. In feedback conditions, most of the participants reported using knowledge of results over performance, high over low, immediate over delayed, and self over therapist feedback strategies. Lastly, more than two thirds of SLPs did not use biofeedback devices for dysphagia therapy. CONCLUSION: The findings from our study indicate that SLPs in India do not adhere uniformly to the recommended practices of MLPs for dysphagia therapy in adults.

Force and complexity of tongue task training influences behavioral measures of motor learning.

Relearning of motor skills is important in neurorehabilitation. We investigated the improvement of training success during simple tongue protrusion (two force levels) and a more complex tongue-training paradigm using the Tongue Drive System (TDS). We also compared subject-based reports of fun, pain, fatigue, and motivation between paradigms. Three randomized sessions and one control experiment were performed. Sixteen healthy subjects completed two different 1-h sessions of simple tongue training with 1 N and 3 N, respectively, and one TDS session. After 1 wk, six out of 16 subjects participated as experienced subjects with six naive subjects in a control experiment with 2 × 5-min TDS training separated by a 30-min rest. Performance improved during training in all sessions. The mean ± SEM relative increase in success was 80 ± 12% (1 N), 52 ± 11% (3 N), and 285 ± 45% (TDS). In the control experiment the experienced group performed equal to the last 5 min of their first TDS session and neither group improved during rest. Training with the TDS was rated as more fun, less painful, less fatiguing, and more motivating compared with simple tongue training. In conclusion, force level and complexity of tongue training influences behavioral aspects of tongue motor learning.