Abstract
Clinical tongue-strengthening therapy programs are generally based on the principles of exercise and motor learning, including the specificity paradigm. The aim of this study was to investigate the specific effect of anterior and posterior tongue-strengthening exercises (TSE) on tongue strength (TS) in healthy older adults and to measure possible detraining effects. Sixteen healthy elderly completed 8 weeks of TSE by means of the Iowa Oral Performance Instrument (IOPI). They were distributed in two different treatment arms and performed either exclusively anterior or posterior TSE (ATSE, n = 9 or PTSE, n = 7) depending on the treatment arm. Anterior and posterior maximal isometric pressures (MIPA, MIPP) were measured at baseline, halfway, and after completion of the training sessions. Detraining was measured by repeating MIPA and MIPP measures 4 weeks after the last session of TSE. MIPA and MIPP increased significantly in both treatment arms. MIPA was significantly higher in the ATSE group compared to the PTSE group across all measures in time. No significant differences were observed in MIPP between the ATSE and PTSE groups. Regardless of treatment arm, there was no significant detraining effect measured 4 weeks after the last TSE session. This study suggests that TSE show partial specificity concerning bulb position. We conclude that especially anterior training results in higher anterior TS in comparison with posterior exercises. Furthermore, we found no detraining effects, independent of bulb location.
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De Bodt M, Guns C, D’Hondt M, Vanderwegen J, Van Nuffelen G. Dysfagie. Handboek voor de klinische praktijk. Antwerp: Garant; 2015.
Butler SG, Stuart A, Leng X, Wilhelm E, Rees C, Williamson J, Kritchevsky SB. The relationship of aspiration status with tongue and handgrip strength in healthy older adults. J Gerontol Ser A. 2011;66:452–8.
Ono T, Kumakura I, Arimoto M, Hori K, Dong J, Iwata H, Nokubi T, Tsuga K, Akagawa Y. Influence of bite force and tongue pressure on oro-pharyngeal residue in the elderly. Gerontology. 2007;24:143–50.
Burkhead LM, Sapienza CM, Rosenbek JC. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia. 2007;22:251–65. doi:10.1007/s00455-006-9074-z.
Sanders I, Mu L. A 3-dimensional atlas of the human tongue muscles. Anat Rec. 2013;296:1102–14. doi:10.1002/ar.22711.
Gilbert RJ, Napadow VJ, Gaige TA, Wedeen VJ. Anatomical basis of lingual hydrostatic deformation. J Exp Biol. 2007;210:4069–82.
Kier WM, Smith KK. Tongues, tentacles and trunks: the biomechanics of movement in muscular-hydrostats. Zool J Linn Soc. 1985;83:307–24.
Felton SM, Gaige TA, Reese TG, Wedeen VJ, Gilbert RJ. Mechanical basis for lingual deformation during the propulsive phase of swallowing as determined by phase contrast magnetic resonance imaging. J Appl Physiol. 2007;103:255–65.
Sale D. Specificity of training of training. Can J Sports Sci. 1992;17:71.
Van Nuffelen G, Van den Steen L, Vanderveken O, Specenier P, Van Laer C, Van Rompaey D, Guns C, Mariën S, Peeters M, Van de Heyning P, Vanderwegen J, De Bodt M. Study protocol for a randomized controlled trial: tongue strengthening exercises in head and neck cancer patients, does exercise load matter? Trials. 2015;16:395. doi:10.1186/s13063-015-0889-5.
Kletzien H, Russell JA, Leverson GE, Connor NP. Differential effects of targeted tongue exercise and treadmill running on aging tongue muscle structure and contractile properties. J Appl Physiol. 2013;114:472–81. doi:10.1152/japplphysiol.01370.2012.
Lazarus C, Logemann JA, Huang CF, Rademaker W. Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatr Logop. 2003;55:199–205.
Clark HM. Specificity of training in the lingual musculature. J Speech Lang Hear Res. 2012;55:657–76. doi:10.1044/1092-4388(2011/11-0045).
Hori K, Taniguchi H, Hayashi H, Magara J, Minagi Y, Li Q, Ono T, Inoue M. Role of tongue pressure production in oropharyngeal swallow biomechanics. Physiol Rep. 2013;. doi:10.1002/phy2.167.
Steele CM, Van Lieshout P. Tongue movements during water swallowing in healthy young and older adults. J Speech Lang Hear Res. 2009;52:1255–67. doi:10.1044/1092-4388(2009/08-0131).
Napadow VJ, Chen Q, Wedeen VJ, Gilbert RJ. Intramural mechanics of the human tongue in association with physiological deformations. J Biomech. 1999;32:1–12.
Chi-Fishman G, Stone M, Mc Call GN. Lingual action in normal sequential swallowing. J Speech Lang Hear Res. 1998;41:771–85. doi:10.1044/jslhr.4104.771.
Tasko SM, Kent RD, Westbury JR. Variability in tongue movement kinematics during normal liquid swallowing. Dysphagia. 2002;17:126–38. doi:10.1007/s00455-001-0112-6.
Wilson EM, Green JR. Coordinative organization of lingual propulsion during the normal adult swallow. Dysphagia. 2006;21:226–36. doi:10.1007/s00455-006-9053-4.
Stierwalt JA, Youmans SR. Tongue measures in individuals with normal and impaired swallowing. Am J Speech Lang Pathol. 2007;16(2):144–56.
Clark HM, Henson PA, Barber WD, Stierwalt JA, Sherrill M. Relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments. Am J Speech Lang Pathol. 2003;12:40–50. doi:10.1044/1058-0360(2003/051).
Robbins J, Levine R, Wood J, Roecker EB, Luschei E. Age effects on lingual pressure generation as a risk factor for dysphagia. J Gerontol A Biol Sci Med Sci. 1995;50(5):257–62.
Yoshida M, Kikutani T, Tsuga K, Utanohara Y, Hayashi R, Akagawa Y. Decreased tongue pressure reflects symptom of dysphagia. Dysphagia. 2006;21:61–5.
Palmer PM, Jaffe DM, McCulloch TM, Finnegan EM, Van Daele DJ, Luschei ES. Quantitative contributions of the muscles of the tongue, floor-of-mouth, jaw, and velum to tongue-to-palate pressure generation. J Speech Lang Hear Res. 2008;51:828–35. doi:10.1044/1092-4388(2008/060).
Clark HM, O’Brien K, Calleja A, Corrie SN. Effects of directional exercise on lingual strength. J Speech Lang Hear Re. 2009;52:1034–47. doi:10.1044/1092-4388(2009/08-0062).
Robbins J, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;53:1483–9. doi:10.1111/j.1532-5415.2005.53467.x.
Robbins J, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, Taylor AJ. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007;88:150–8. doi:10.1016/j.apmr.2006.11.002.
Yeates EM, Molfenter SM, Steele CM. Improvements in tongue strength and pressure-generation precision following a tongue-pressure training protocol in older individuals with dysphagia: three case reports. Clin Interv Aging. 2008;3:735–47.
Lazarus CL, Husaini H, Falciglia D, DeLacure M, Branski RC, Kraus D, Lee N, Ho M, Ganz C, Smith B, Sanfilippo N. Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy. Int J Oral Maxillofac Surg. 2014;43:523–30. doi:10.1016/j.ijom.2013.10.023.
Steele CM, Bailey GL, Polacco RE, Hori SF, Molfenter SM, Oshalla M, Yeates EM. Outcomes of tongue-pressure strength and accuracy training for dysphagia following acquired brain injury. Int J Speech Lang Patholog. 2013;15:492–502. doi:10.3109/17549507.2012.752864.
Oh JC. Effects of tongue strength training and detraining on tongue pressures in healthy adults. Dysphagia. 2015;30:315–20. doi:10.1007/s00455-015-9601-x.
Park JS, Kim HJ, Oh DJ. Effect of tongue strength training using the Iowa Oral Performance Instrument in stroke patients with dysphagia. J Phys Ther Sci. 2015;27:3631–2. doi:10.1589/jpts.27.3631.
Steele CM, Bayley MT, Peladeau-Pigeon M, Nagy A, Namasivayam AM, Stokely SL, Wolkin T. A randomized trial comparing two tongue pressure resistance training protocols for post-stroke dysphagia. Dysphagia. 2016;31:452–61. doi:10.1007/s00455-016-9699-5.
Rogus-Pulia N, Rusche N, Hind JA, Zielinski J, Gangnon R, Safdar N, Robbins J. Effects of device-facilitated isometric progressive resistance oropharyngeal therapy on swallowing and health-related outcomes in older adults with dysphagia. J Am Geriatr Soc. 2016;64:417–24. doi:10.1111/jgs.13933.
Folstein MF, Folstein SE, McHugh PR. “Mini mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.
Vanderwegen J, Guns C, Van Nuffelen G, Elen R, De Bodt M. 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. Dysphagia. 2013;28:159–66. doi:10.1007/s00455-012-9425-x.
Suiter DM, Sloggy J, Leder SB. Validation of the Yale Swallow Protocol: a prospective double-blinded videofluoroscopic study. Dysphagia. 2014;29:199–203. doi:10.1007/s00455-013-9488-3.
Hiraoka A, Yoshikawa M, Nakamori M, Hosomi N, Nagasaki T, Mori T, Oda M, Maruyama H, Yoshida M, Izumi Y, Matsumoto M, Tsuga K. Maximum tongue pressure is associated with swallowing dysfunction in ALS patients. Dysphagia. 2017;. doi:10.1007/s00455-017-9797-z.
O’Day C, Frank E, Montgomery A, Nichols M, McDade H. Repeated tongue and hand strength measurements in normal adults and individuals with Parkinson’s disease. Int J Orofac Myol. 2005;31:15–25.
Murdoch BE, Spencer TJ, Theodoros DG, Thompson EC. Lip and tongue function in multiple sclerosis: a physiological analysis. Mot Control. 1998;2(2):148–60.
Lazarus CL, Husaini H, Hu K, Culliney B, Li Z, Urken M, Jacobson A, Persky M, Tran T, Concert C, Palacios D, Metcalfe-Klax R, Kumar M, Bennett B, Harrison L. Functional outcomes and quality of life after chemoradiotherapy: baseline and 3 and 6 months post-treatment. Dysphagia. 2014;29(3):365–75. doi:10.1007/s00455-014-9519-8.
Schoenfeld BJ, Ratamess NA, Peterson MD, Contreras B, Tiryaki-Sonmez G. Influence of resistance training frequency on muscular adaptations in well-trained men. J Strength Cond Res. 2015;29(7):1821–9. doi:10.1519/JSC.0000000000000970.
Fernández-Lezaun E, Schumann M, Mäkinen T, Kyröläinen H, Walker S. Effects of resistance training frequency on cardiorespiratory fitness in older men and women during intervention and follow-up. Exp Gerontol. 2017;95:44–53. doi:10.1016/j.exger.2017.05.012.
Van den Steen L, Vanderveken O, Vanderwegen J, Van Gestel D, Daisne JF, Allouche J, Delacroix L, Van Rompaey D, Beauvois S, Cvilic S, Mariën S, Desuter G, Vermorken JB, Van den Weyngaert D, Specenier P, Van Laer C, Peeters M, Van de Heyning P, Chantrain G, Lawson G, Lazarus C, De Bodt M, Van Nuffelen G. Feasibility of tongue strength measurements during (chemo)radiotherapy in head and neck cancer patients. Support Care Cancer. 2017;. doi:10.1007/s00520-017-3761-1.
Langmore SE, Pisegna JM. Efficacy of exercises to rehabilitate dysphagia: a critique of the literature. Int J Speech Lang Pathol. 2015;17:222–9. doi:10.3109/17549507.2015.1024171.
Ivey FM, Tracy BL, Lemmer JT, NessAiver M, Metter J, Fozard JL, Hurley BF. Effects of strength training and detraining on muscle quality: age and gender comparison. J Gerontol. 2000;55:152–9.
Toraman NF. Short term and long term detraining: is there any difference between young-old and old people? Br J Sports Med. 2005;39:561–4.
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This study was approved by the Ethical Committee of the Antwerp University Hospital (B300201421549). All subjects agreed voluntarily to participate in this study and signed an informed consent.
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Van den Steen, L., Schellen, C., Verstraelen, K. et al. Tongue-Strengthening Exercises in Healthy Older Adults: Specificity of Bulb Position and Detraining Effects. Dysphagia 33, 337–344 (2018). https://doi.org/10.1007/s00455-017-9858-3
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DOI: https://doi.org/10.1007/s00455-017-9858-3