Associations between tongue strength and skeletal muscle mass under dysphagia rehabilitation for geriatric out patients

Nakazawa, Yujiro; Kikutani, Takeshi; Igarashi, Kumi; Yajima, Yuri; Tamura, Fumio

doi:10.1016/j.jpor.2019.07.004

Cited by 15 publications

(11 citation statements)

References 22 publications

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“…In accordance with previous studies in middle-aged and older adults, malnutrition risk was associated with low tongue strength [ 3 , 26 ]. To categorize low and high tongue strength, our study chose a cut-off value of 18 kPa because it gave the highest AUC value when plotting the ROC curve.…”

Section: Discussionsupporting

confidence: 92%

A simplified method for evaluating swallowing ability and estimating malnutrition risk: A pilot study in older adults

2022

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Objectives The aim of this pilot study was to develop a Thai-version of a simple swallowing questionnaire, called the T-SSQ, and to evaluate the association between malnutrition risk and swallowing ability, determined objectively by tongue strength and subjectively by the T-SSQ. Sensitivity analysis was also performed to determine which swallowing indices better estimate malnutrition in older adults. Methods This cross-sectional study comprised two phases: Phase I, development and cross-cultural translation of the T-SSQ; and Phase II, application of the T-SSQ in 60 older adults. In Phase I, content and face validity of the T-SSQ was evaluated by 10 experts and 15 older adults. In Phase II, the convergent validity of the T-SSQ was evaluated by determining its association with objective tongue strength. Nutritional status was evaluated using the Thai-version of the Mini-Nutritional Assessment. Covariates included sociodemographic characteristics, and oral and health-related status. Adjusting for covariates, the associations between the two swallowing indices and malnutrition risk were determined using multivariable regression analyses. A cut-off value for low tongue strength was determined using a receiver operating characteristic (ROC) curve, and sensitivity analysis between the swallowing indices and malnutrition risk was performed. Results The T-SSQ comprised 4-items of common signs and symptoms of a swallowing problem. Its content and face validity were verified. Older adults were considered as having a swallowing problem when at least one item was reported. Convergent validity of the subjective index was shown by significantly different tongue strength values between the participants with and without a swallowing problem (p for independent t-test = 0.014). Based on the highest area under the ROC curve, an 18-kPa cut-off value was chosen to classify low tongue strength. Having a swallowing problem and low tongue strength was significantly associated with malnutrition risk. The positive predictive value of the subjective swallowing index was 1.8-fold higher than objective tongue strength. Conclusions Self-reported swallowing problems determined by the T-SSQ can be used as a subjective index for evaluating swallowing ability in older adults. Subjective swallowing problems and objective tongue strength were associated with malnutrition risk. However, the T-SSQ estimated malnutrition risk better than the objective index.

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Section: Discussionsupporting

confidence: 92%

A simplified method for evaluating swallowing ability and estimating malnutrition risk: A pilot study in older adults

2022

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“…1,2 Reduction of muscle mass of the body induces a reduction in muscle strength, which is related to the stomatognathic function and muscle forces accordingly. 3,4 These changes have also been confirmed in oropharyngeal muscles, showing a reduction in muscle fibre density, muscle tone and contraction force of the facial, masticatory and tongue muscles. 5,6 Among these, it is known that the strength and function of the tongue are closely related to the masticatory and swallowing functions.…”

Section: Introductionmentioning

confidence: 75%

Detection of muscle fatigue caused by repeated posterior tongue lift movement from neck surface EMG: a pilot study

Furutera

Kawakami

Kodama

et al. 2021

J of Oral Rehabilitation

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Background: Fatigue is an important factor for muscle strengthening in rehabilitation medicine. Frequency analysis has been regarded as the gold standard for muscle fatigue assessment in surface electromyography (EMG). However, there are no experiments quantifying fatigue with grouped discharge (GD), which is one of the historical phenomena observed in patients having fatigue, by using high sampling rate recording of EMG.Objective: To investigate the effect of fatigue, which is induced by repeated posterior tongue lift movement (TLM), on the occurrence of GD peaks, thus, to provide possible basis as a parameter for future fatigue evaluation.Methods: Nineteen healthy adults (9 men and 10 women) participated in this study.The muscle fatigue protocol consisted of repetitive posterior TLM and maximum voluntary contractions (MVC). Bilateral N-EMG (Neck surface EMG for measuring the muscle activity of the posterior tongue) was recorded. Results:Subjective tongue fatigue at the end of the protocol was significantly higher than at beginning throughout the muscle fatigue protocol (p < .01). The frequency of occurrence of GD peaks was 0.9 ± 1.2 (per second) at the baseline in 33 of 38 subject sides, and significantly increased depending on fatigue progression (p < .01). Conclusion:It was shown that fatigue due to repetitive posterior tongue lifting resulted in significant increase in the frequency of occurrence of GD peaks. Especially, the nature of GD, showing very few occurrences at non-fatigue condition, might work as an advantageous property for its use in future absolute evaluation of fatigue phenomena.

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“…This suggests that nutrition support may prevent sarcopenia in COPD patients. In fact, a recent study showed that maintaining skeletal muscle mass had a positive impact on tongue strength gained through dysphagia rehabilitation [ 35 ]. Having a social network involving neighbors and taking part in leisure activities were associated with higher tongue pressures [ 36 ].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Decreased Tongue Strength is Related to Skeletal Muscle Mass in COPD Patients

et al. 2021

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Dysphagia is frequently observed in patients with chronic obstructive pulmonary disease (COPD). Decreased tongue strength is one of the causes of dysphagia, and it is often observed in patients with sarcopenia. Sarcopenia is also frequently observed in COPD patients. We hypothesized that tongue strength is lower in COPD patients compared to normal subjects. This was a single-center, observational, cross-sectional study. Maximum tongue pressure (MTP) was measured in 27 patients with COPD and 24 age-matched control subjects. We also evaluated handgrip strength, gait speed, and appendicular skeletal muscle mass to define subjects as having sarcopenia. We used bioelectrical impedance analysis to assess body composition. The eating assessment test-10 was used to diagnose dysphagia. MTP was significantly lower in COPD patients than in control subjects (33.8 ± 8.4 vs 38.0 ± 5.3; p = 0.032). All measures of muscle and fat free body mass, handgrip strength, and gait speed were also significantly lower in COPD patients compared to control subjects ( p < 0.01). The prevalence of sarcopenia in COPD patients was higher than that in control subjects (6/27 versus 0/24; p = 0.007), but the prevalence of dysphagia was not different between groups (COPD: 5/27, versus control: 1/24; p = 0.112). MTP was moderately correlated with skeletal muscle mass index ( r = 0.56, p = 0.003) and handgrip strength ( r = 0.43, p = 0.027) in COPD patients. Tongue strength was lower in COPD patients compared to normal subjects, and decreased tongue strength may be correlated with sarcopenia in COPD patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00455-021-10314-3.

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Associations between tongue strength and skeletal muscle mass under dysphagia rehabilitation for geriatric out patients

Cited by 15 publications

References 22 publications

A simplified method for evaluating swallowing ability and estimating malnutrition risk: A pilot study in older adults

A simplified method for evaluating swallowing ability and estimating malnutrition risk: A pilot study in older adults

Detection of muscle fatigue caused by repeated posterior tongue lift movement from neck surface EMG: a pilot study

Decreased Tongue Strength is Related to Skeletal Muscle Mass in COPD Patients

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