Search Results (30)

Introduction: Myotonia is a rare neuromuscular condition characterized by impaired muscle relaxation. In this study, we provide normative values for clinical tests related to myotonia in the Hungarian population and compare them to patients with myotonic dystrophy type 1 (DM1). Methods: Relaxation tests (10 eye openings, tongue extension, and palm openings), handgrip strength, and the nine-hole peg test were conducted on 139 healthy individuals and 31 patients with DM1. Results: We observed non-significant declines in handgrip strength and relaxation tests with age (p < 0.05). Significant differences were found between controls (n:139) and patients with DM1 (n = 31) in all tests (p < 0.05). Sex differences were noted in the healthy population: men (n:68/139) had stronger handgrip (mean of men 42.45 ± 1.15 vs. women 24.3 ± 0.9) and slower relaxation tests (mean of eye openings in men 3.6 ± 0.2 vs. in women 4.2 ± 0.2, tongue extensions in men 3.7 ± 0.2 vs. in women 4.2 ± 0.2, palm openings in men 4 ± 0.2 vs. in women 4.9 ± 0.2 However, these differences were not present among patients with DM1. Discussion: Normal values for relaxation tests across different age groups were established. These results might be useful for further clinical investigations. Our study supports the usage of averages of healthy population instead of age groups of relaxation tests and their clinical relevance in the evaluation of patients with myotonia. Full article

Background: Myofunctional therapy has emerged as a treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) enables objective measurement of lingual and orofacial muscle strength, although it was originally designed for evaluating dysphagia. OSA is frequently associated with a hypotonic phenotype characterized by reduced strength in upper airway muscles, but its identification remains unclear. Objective: We evaluated the usefulness of IOPI measurements in identifying hypotonic phenotypes among patients with obstructive sleep apnea (OSA). Methods: We carried out a cross-sectional study analyzing the relationship between IOPI scores, sleep polygraphy metrics—such as the apnea–hypopnea index (AHI)—and findings from physical examination. In addition to the standard IOPI protocol, we introduced novel maneuvers aimed at providing a more comprehensive assessment of oropharyngeal muscle function. Results: Although IOPI conventional maneuvers showed no clear association with AHI or ODI, the inferior tongue maneuver showed higher awake tongue strength, with a statistically significant correlation to both AHI (r = 0.2873; p = 0.008) and ODI (r = 0.2495; p = 0.032). Performing each exercise three times yielded highly consistent results across trials (r > 0.94), but did not significantly alter the overall outcome. Interestingly, lower tongue strength values were observed in patients with a high-arched palate (p < 0.05), whereas no relevant associations were found with the presence of a restricted lingual frenulum or CPAP use. Conclusions: Incorporating specific IOPI maneuvers, especially the inferior tongue exercise, may provide additional insight into muscle function in OSA. Selective repetition is advisable for borderline values. Full article

Background and Objectives: Sufficient evidence supports the Iowa Oral Performance Instrument (IOPI) as a reliable tool for measuring tongue strength and endurance as well as an effective assessment instrument for intervention studies. This study aimed to investigate the impact of a tongue training device, the HEAL, on tongue muscle strength in patients with obstructive sleep apnea (OSA) following modified uvulopalatopharyngoplasty (UPPP), utilizing the IOPI for evaluation. Materials and Methods: We introduced a tongue strengthener, the HEAL, made from medical-grade silicone, designed to improve tongue strength. Each patient was provided with the HEAL and instructed to begin using it one month after undergoing modified UPPP for OSA. The tongue strength of OSA patients was measured using the IOPI both before using the HEAL and approximately 6 weeks later. Results: A total of 66 participants with OSA underwent modified UPPP and were included in the final analysis. The mean age was 39.15 ± 8.84 years, and the mean BMI was 27.41 ± 4.03 kg/m². The duration between the pre- and post-assessment of tongue strength using the HEAL was 42.95 ± 17.97 days. The mean tongue strength pressure before and after using the HEAL was 32.16 ± 16.00 kilopascals (kPa) and 42.95 ± 17.97 kPa, respectively. Tongue strength increased by an average of approximately 52.8% after using the HEAL for an approximate duration of 6 weeks. Conclusions: In the current study, participants with OSA who had undergone modified UPPP and subsequently used the HEAL demonstrated an average improvement of 10.79 kPa in tongue strength—an increase of over 50%—as measured by the IOPI. The interval between the pre- and post-assessment of tongue strength was approximately six weeks. Further studies are needed to validate these findings. Full article

Background: Swallowing dysfunction is a prevalent but often overlooked problem in long-term care facilities. This study investigated the relationships between nutritional deficits, frailty, oral health, and swallowing dysfunction. Additionally, we explored the associations between oral muscle weakness, frailty markers, and swallowing dysfunction. Methods: We recruited 373 participants from seven long-term care facilities across Taiwan. Swallowing function, frailty, nutrition status, and oral health were assessed by research staff. Oral muscle function was evaluated through tongue strength measurements, cheek bulging function tests, the Repetitive Saliva Swallowing Test (RSST), and a diadochokinetic task. Frailty was assessed through grip strength as well as mid-upper arm and calf circumference measurements. Results: The Functional Oral Intake Scale revealed that 97 participants (26%) had swallowing dysfunction. Participants with swallowing dysfunction had poorer nutritional status, higher frailty levels, and worsened oral health. Frailty was the factor most strongly associated with swallowing dysfunction. Participants with swallowing dysfunction also exhibited lower tongue pressure, decreased cheek-bulging ability, fewer repetitions in the diadochokinetic task, lower scores on the RSST, lower calf circumferences, and lower grip strength. Logistic regression demonstrated that cheek bulging was most strongly associated with swallowing dysfunction. Furthermore, lower grip strength was significantly associated with swallowing dysfunction. Conclusions: Frailty was most strongly associated with swallowing dysfunction, followed by poorer nutritional status and worsened oral health. These factors should be thoroughly assessed in long-term care residents. Participants with swallowing dysfunction also experienced oral muscle weakness, particularly in cheek bulging. Grip strength, which represents frailty, was directly associated with swallowing dysfunction and could serve as a crucial indicator of swallowing dysfunction. Full article

Most previous studies on orofacial muscle strength have focused on older adults with conditions associated with sensorimotor deficits, such as stroke. However, the modifiable oral health factors that directly impact orofacial muscle strength and swallowing ability in healthy older adults remain unexplored. This pilot study explored the potential factors associated with orofacial muscle strength, particularly oral health conditions, in 70 healthy adults aged ≥65 years living independently without any diseases that cause dysphagia or sensorimotor deficits. The Iowa Oral Performance Instrument (IOPI) was used to assess orofacial muscle strength (tongue elevation, and cheek and lip compression). Statistical analyses were conducted using an independent t-test, one-way ANOVA, and multivariate linear regression. In the final regression models after adjustment, older age and fewer remaining teeth were significantly associated with reduced tongue and cheek strengths (p < 0.05). Socio-demographic factors, such as age, and oral health conditions, such as discomfort in pronunciation or mastication due to oral problems, poor self-rated oral health, and reduced salivary flow, were associated with tongue, cheek, and lip muscle strengths (p < 0.05). Early active oral health interventions can help prevent a decline in orofacial muscle strength in healthy older adults. Full article

Background: The chin-tuck maneuver has been suggested to increase suprahyoid muscle activation, but a method to measure the strength of the chin-tuck maneuver has not been established. We developed a method to measure the strength of the chin-tuck maneuver (chin-tuck strength) and examined the reliability and validity of chin-tuck-strength measurement in community-dwelling older adults. Participants and Methods: The participants were 233 older adults aged ≥65 years without dysphagia or physical disability. Chin-tuck strength was measured twice consecutively using the developed device, and reproducibility was analyzed using intraclass correlation coefficients (ICCs). In addition, maximum tongue pressure, oral diadochokinesis, grip strength, knee extension strength, and the timed up and go test (TUGT) were measured as indices of swallowing-related muscle function and appendicular muscle function. The associations of chin-tuck strength with swallowing-related muscle function and appendicular muscle function were analyzed statistically. Results: The ICCs for chin-tuck strength were 0.82 (95% confidence interval [CI]: 0.73–0.88) in males and 0.87 (95% CI: 0.70–0.93) in females. Chin-tuck strength was significantly associated with maximum tongue pressure, grip strength, knee extension strength, and TUGT. Conclusions: This study suggests that chin-tuck strength is a reliable and valid assessment of swallowing-related muscle strength. Full article

Most previous studies addressing dysphagia examined individuals who already had diseases causing dysphagia and did not pay much attention to oral health conditions as a risk factor. This pilot study investigated 62 healthy adults aged 65 years or older who were living independently in the community, performed basic activities of daily living independently, and had no history of a causative disease of dysphagia to identify the factors associated with dysphagia risk, especially oral health. The Dysphagia Risk Assessment Scale was used to screen the patients for dysphagia. Hyposalivation was diagnosed by evaluating the unstimulated salivary flow rate, and orofacial muscle strength (anterior tongue elevation, buccinator muscle, and lip strength) was quantitatively measured using the Iowa Oral Performance Instrument. To analyze the factors associated with dysphagia risk, the Mann–Whitney test, Kruskal–Wallis test, and multiple logistic regression analyses were conducted. In the final regression model adjusted for sociodemographic characteristics, the oral health-related factors independently associated with dysphagia risk were buccinator muscle strength, hyposalivation, and subjective masticatory discomfort (p < 0.05). Therefore, our findings suggest that weak buccinator muscle strength, hyposalivation, and subjective masticatory discomfort are valuable indicators for the early detection of dysphagia in older, healthy, independent, community-dwelling adults. Full article

Background and Objectives: Muscle strength evaluation using high-density surface electromyography (HD-sEMG) was recently developed for the detailed analysis of the motor unit (MU). Detection of the spatial distribution of sEMG can detect changes in MU recruitment patterns resulting from muscle-strengthening exercises. We conducted a prospective study in 2022 to evaluate the safety and feasibility of transcutaneous electrical sensory stimulation (TESS) therapy using an interferential current device (IFCD) in patients with head and neck squamous cell carcinoma (HNSCC) undergoing chemoradiotherapy (CRT), and reported the safety and feasibility of TESS. We evaluated the efficacy of swallowing exercises in patients with HNSCC undergoing CRT and determined the significance of sEMG in evaluating swallowing function. Materials and Methods: In this supplementary study, the patients performed muscle-strengthening exercises five days a week. The association of the effects of the exercises with body mass index, skeletal muscle mass index, HD-sEMG, tongue muscle strength, and tongue pressure were evaluated. Results: We found significant correlations between the rate of weight loss and skeletal muscle mass index reduction and the rate of change in the recruitment of the MU of the suprahyoid muscle group measured using HD-sEMG. Conclusions: We believe that nutritional supplementation is necessary in addition to muscle strengthening during CRT. Full article

Physical performance shows approximately 30% diurnal variation; however, diurnal variation in oral function remains unclear. This study aimed to determine the diurnal variation in oral and swallowing function in older adults requiring long-term care. The participants included 13 adults aged >60 years (3 men and 10 women, mean age: 77.2 ± 6.3 years, age range: 62–90 years) requiring long-term care. Tongue strength (TS) and oral mucosal moisture were measured as indices of oral and swallowing function, while hand grip strength was measured as an index of general muscle strength. The patients were asked to participate in a “test” after breakfast, lunch, and dinner on the same day. Multilevel linear regression analysis was used to examine diurnal differences in each item. Multilevel linear regression analysis with adjustment for age and sex revealed that TS was significantly higher at noon (p = 0.001) than in the morning. Therefore, caregivers who provide support during meals to older people requiring long-term care should consider the possibility of swallowing function differing according to the time of the day. In conclusion, it may be beneficial to establish a nutritional therapy that accounts for the diurnal variation in TS. Full article

Background: Measurements of tongue force are important in clinical practice during both the diagnostic process and rehabilitation progress. It has been shown that patients with chronic temporomandibular disorders have less tongue strength than asymptomatic subjects. Currently, there are few devices to measure tongue force on the market, with different limitations. That is why a new device has been developed to overcome them. The objectives of the study were to determine the intra- and inter-rater reliability and the responsiveness of a new low-cost device to evaluate tongue force in an asymptomatic population. Materials and Methods: Two examiners assessed the maximal tongue force in 26 asymptomatic subjects using a developed prototype of an Arduino device. Each examiner performed a total of eight measurements of tongue force in each subject. Each tongue direction was measured twice (elevation, depression, right lateralization, and left lateralization) in order to test the intrarater reliability. Results: The intrarater reliability using the new device was excellent for the measurements of the tongue force for up (ICC > 0.94), down (ICC > 0.93) and right (ICC > 0.92) movements, and good for the left movement (ICC > 0.82). The SEM and MDC values were below 0.98 and 2.30, respectively, for the intrarater reliability analysis. Regarding the inter-rater reliability, the ICC was excellent for measuring the tongue up movements (ICC = 0.94), and good for all the others (down ICC = 0.83; right ICC = 0.87; and left ICC = 0.81). The SEM and MDC values were below 1.29 and 3.01, respectively, for the inter-rater reliability. Conclusions: This study showed a good-to-excellent intra- and inter-reliability and good responsiveness in the new device to measure different directions of tongue force in an asymptomatic population. This could be a new, more accessible tool to consider and add to the assessment and treatment of different clinical conditions in which a deficit in tongue force could be found. Full article

Introduction: The purpose of the present study was to clarify the relationships between the risk of malnutrition as a preliminary stage of malnutrition and overall and oral measurements for sarcopenia in older Japanese adults. Methods: Forty-five participants (79.7 ± 6.1 years) were included in the analysis. The nutrition status of the participants was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) and classified into two groups: normal and at risk of malnutrition. Overall measurements for sarcopenia in the present study were the skeletal muscle mass index, grip strength, and walking speed, while oral measurements were the cross-sectional area of the geniohyoid muscle, tongue pressure (TP), and oral diadochokinesis. Results: MNA-SF correlated with TP (r = 0.347, p = 0.019). We observed decreases of 5.7 kPa in TP and 3.9 kg/cm² in BMI in the at risk of malnutrition group. A multiple regression analysis of parameters contributing to the risk of malnutrition identified TP as an independent variable (β = 0.913, p = 0.042). Conclusions: The present results demonstrate that the risk of malnutrition is associated with TP as an oral measurement for sarcopenia, but not overall measurements for sarcopenia. Therefore, low TP may be related with the risk of malnutrition. Full article

Myofunctional therapy (MT) is a recent treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) is a useful but expensive tool for measuring tongue strength in patients with OSA. We validated the Tongue Digital Spoon (TDS) to monitor tongue hypotonia in patients with OSA. Measurements with the IOPI and TDS were compared in patients with OSA before and after MT for tongue hypotonia. Baseline mean tongue strength measured with the IOPI in patients with moderate and severe OSA were 35.36 ± 9.05 and 33.83 ± 12.05, respectively, and that with the TDS were 168.55 ± 42.8 and 129.61 ± 53.7, respectively. After MT, mean tongue strength significantly improved: measured with the IOPI in patients with moderate and severe OSA were 53.85 ± 10.09 and 55.50 ± 9.64 (p = 0.8), and that with the TDS were 402.36 ± 52.92 and 380.28 ± 100.75 (p = 0.01), respectively. The correlation between the IOPI and TDS was high (r = 0.74; p = 0.01 pre-treatment, and r = 0.25; p = 0.05 post-treatment). The TDS is a useful tool for monitoring the efficacy of MT in patients with short-term OSA. Future randomized studies will determine the effectiveness of MT for the treatment of OSA. Full article

We aimed to investigate the effects of an integrative cognitive function improvement program that combined existing cognitive, emotional, and physical therapies on cognitive function, oral health, and mental health in elder participants. Participants were classified into one of the following groups: cognitively normal (CN; n = 18), mild cognitive impairment (MCI; n = 17), and control (n = 17). An integrative cognitive function improvement program was administered to the CN and MCI groups for six weeks. To measure cognitive function, electroencephalogram (EEG) and cerebral blood flow (CBF) were evaluated, and to measure oral health, the O’Leary index, Löe & Silness index, tongue coating, unstimulated saliva flow rate, and oral muscle strength were measured. To measure mental health status, mental health, happiness and social support were measured. The CN and MCI groups showed a significant change in EEG-based indices for awareness level and physical stress. Regarding oral health, the O’Leary and the Löe & Silness index score decreased significantly in the CN and MCI groups. Saliva flow rate increased significantly in the CN and MCI groups. In regards to mental health, the happiness score increased post-intervention in the CN and MCI groups. In conclusion, the integrative cognitive function improvement program was effective in improving cognitive function, oral health, and mental health of elder people. Full article

Tongue pressure (TP) is used to assess tongue muscle strength and is related to function and frailty. While performing TP, it is necessary to elevate the tongue and oral floor by contracting the suprahyoid muscles. However, the association between TP and suprahyoid muscle strength remains unclear. Accordingly, this study investigated the relationship between TP and jaw-opening force (JOF), an indicator of suprahyoid muscle strength. This cross-sectional study included 88 independent community-dwelling participants aged ≥65 years. Age, sex, and the number of remaining teeth were recorded. Ultrasonography was used to evaluate the cross-sectional area of the tongue and geniohyoid muscle, as representatives of the suprahyoid muscles. Sarcopenia was diagnosed based on appendicular skeletal muscle mass index, handgrip strength, and gait speed. Multiple regression analysis was performed with TP as the dependent variable. TP was significantly associated with JOF (β = 0.371, p = 0.003). This study revealed that decreased TP was associated with a decline in JOF and suprahyoid muscle mass in older adults. Thus, low TP may be associated with decreased JOF. Prevention of the weakness of the suprahyoid muscles and maintaining TP may also contribute to the prevention of frailty associated with TP. Full article

Recently, many manufacturers have been developing or producing imitation crab sticks (ICSs) that are highly similar to real snow crab leg meat (RC). This study evaluated the similarities between commercial ICSs and RC based on the analysis of physicochemical and sensory properties. Normal ICS (NS) and premium ICSs either with real crab leg meat (PS-RC) or without it (PS) were compared with RC. The sensory evaluation results showed that PS and NS had the highest and lowest levels of similarity to RC, respectively. The carbohydrate contents of ICSs (10–23%) were higher than that of RC (0.5%). Among ICSs, PS showed more similarity with RC than NS and PS-RC in terms of gel strength and texture profiles. PS-RC and PS showed a microstructural pattern that slightly imitated the muscle fiber arrangement of RC. The electric tongue analysis of taste compounds, such as sugars, free amino acids, and nucleotides, showed that the taste profile of ICSs is distinctly different from that of RC. The electronic nose analysis identified 32 volatile compounds, while the principal component analysis using electronic nose data successfully distinguished three clusters: PS-RC and PS, RC, and NS. Our results could provide useful information for the development of ICSs with higher similarity to RC. Full article