Tongue-pressure resistance training improves tongue and suprahyoid muscle functions simultaneously

Figures & data

Figure 1 Tongue-pressure resistance training.

Notes: The straight line is the palate, the dashed line is the tongue surface, and the white circles represent the hyoid bone. The left panel shows the resting position. The right panel shows the elevated hyoid with the tongue pushing against the palate as hard as possible.

Figure 2 Lateral radiogram demonstrating the x- and y-axes.

Notes: A coordinate system was established with the y-axis forming a straight line connecting the lower edges of the second (white triangle) and fourth cervical vertebrae (black triangle) and x-axis forming a straight line drawn perpendicular from the lower end of the fourth cervical vertebra. The white circle indicates the hyoid bone. The distances between the maximum anterior-superior hyoid elevation and the hyoid position at the onset of elevation were defined as anterior and superior movement along the x- and y-axes, respectively. The extent of hyoid movement was normalized by dividing by the length of a straight line connecting the lower ends of the second and fourth cervical vertebrae on the y-axis.

Figure 3 Example of pixel-based measurement of pharyngeal residue in the piriform sinus.

Notes: The black line is the spatial housing area, the white area is residue area, and the dashed line is the length from C2 to C4. For example, the normalized residue ratio scale in the piriform sinus (NRRSp) was calculated as follows: NRRSp = (residue area/housing area) × (residue area/[the length C2 to C4]²×10).

Table 3 Correlations between PAS scores and NRRS and the other variables

Baseline	Anterior hyoid	Superior hyoid	TP	ODKR/ta/	ODKR/ka/	PTT	UES
PAS	0.045	−0.411	−0.475*	−0.249	−0.455	−0.097	0.675*
NRRSv	0.188	−0.158	−0.063	−0.516*	−0.449*	0.044	0.043
NRRSp	−0.249	0.440	0.280	−0.200	−0.094	0.221	−0.183
Follow-up	Anterior hyoid	Superior hyoid	TP	ODKR/ta/	ODKR/ka/	PTT	UES
PAS	0.216	−0.324	−0.084	−0.365	−0.342	0.425	−0.216
NRRSv	0.126	0.053	−0.251	−0.448	−0.530*	0.060	0.045
NRRSp	0.449	−0.113	0.327	−0.144	−0.194	−0.229	−0.497*

Note:

* P<0.05.

Abbreviations: anterior hyoid, anterior movement of the hyoid bone; NRRS, normalized residue ratio scale; NRRSv, NRRS in valleculae; NRRSp, NRRS in the piriform sinus; ODKR, oral diadochokinetic rate; PAS, penetration aspiration scale; PTT, pharyngeal transit time; superior hyoid, superior movement of the hyoid bone; TP, tongue pressure; UES, upper esophageal sphincter opening width.

Table 2 Pre- and post-exercise swallowing function comparison

Measurements (n=18)	Baseline	Follow-up	P-value	ES
Pharyngeal transition time (s)	0.98 (0.81–1.20)	0.80 (0.74–0.82)	0.004	r=0.68
UES opening width	11.3 (8.6–14.8)	12.3 (11.2–17.6)	0.001	r=0.82
Penetration and aspiration scale	2 (1–2.25)	1 (1–1)	0.016	r=0.57
NRRSv	0.08 (0.01–0.11)	0.04 (0.02–0.05)	0.093	r=0.4
NRRSp	0.02 (0.03–0.05)	0 (0–0.01)	0.022	r=0.54

Notes: Results are expressed as mean (IQR) for the Wilcoxon signed-rank test. ES was defined as large for r>0.5, medium for 0.3<r<0.5, small for 0.1<r<0.3, and no effect for r<0.1.

Abbreviations: ES, effect size; NRRS, normalized residue ratio scale; NRRSp, post-residue in the piriform sinus; NRRSv, post-residue in valleculae; UES, upper esophageal sphincter.

Table 1 Pre- and post-exercise comparison of hyoid bone kinematics

Measurements (n=18)	Baseline (%)	Follow-up (%)	P-value	ES
Superior movement of the hyoid bone	44.6±30.3	56.9±33.6	0.012	r=0.65
Anterior movement of the hyoid bone	27 (11.4–33.8)	33.2 (13.9–50.9)	0.031	r=0.51
TP (k/Pa)	31.5±8.9	34.3±8.4	0.002	r=0.65
ODKR/ta/ (t/s)	5.6±1.3	6.0±0.9	0.034	r=0.49
ODKR/ka/ (t/s)	5.2 (4.7–5.8)	5.6 (5.2–6.0)	0.009	r=0.61

Notes: Results are expressed as mean ± SD for the paired t-test and median (IQR) for the Wilcoxon signed-rank test. ES was defined as large for r>0.5, medium for 0.3<r<0.5, small for 0.1<r<0.3, and no effect for r<0.1.

Abbreviations: ES, effect size; ODKR, oral diadokokinetic rate (for syllables /ta/ and /ka/); TP, tongue pressure; t/s, time per second.

OgawaNMoriTFujishimaIUltrasonography to measure swallowing muscle mass and quality in older patients with sarcopenic dysphagiaJ Am Med Dir Assoc201819651652229287693

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