Developmental Changes in Tongue Strength, Swallow Pressures, and Tongue Endurance
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ORIGINAL ARTICLE
Developmental Changes in Tongue Strength, Swallow Pressures, and Tongue Endurance Nancy L. Potter1 · Anmol Bajwa1 · Elizabeth H. Wilson1 · Mark VanDam1 Received: 26 May 2020 / Accepted: 19 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Maximum tongue strength, mean swallow pressures, and tongue endurance were measured in 324 children ages 6–12 years. The purpose of this study was to measure saliva swallow pressures in absolute terms (i.e., kilopascals) and as a percentage of maximum tongue strength to determine functional reserve in across ages in children and to examine factors that may influence tongue strength and swallow pressures including age, tongue endurance, and tongue-tie. The study results showed that maximum tongue strength and swallow pressures increased with age, while tongue endurance did not. Swallow pressures averaged 44% of maximum tongue strength across ages, indicating that children typically have a functional reserve of 56%. Tongue strength and swallow pressures were not decreased in the 20 children with tongue-tie. A sample clinical case is discussed. Keywords Tongue strength · Swallow pressure · Tongue endurance · Pediatric · Children · Tongue-tie · Ankyloglossia
Introduction The tongue plays a primary role during the oral phase in swallowing. Adequate tongue function is important for bolus preparation, bolus transport, bolus hold, and elimination of oral residue [1]. Tongue function can be assessed with three different objective measures: tongue strength (also known as maximal isometric pressure or MIP), swallow pressures, and tongue endurance. These three measures are indicative of dysphagia in adults and are associated with increased risk of oropharyngeal dysphagia, including penetration and aspiration [1–4]. In the pediatric population, tongue strength and endurance, but not swallow pressure measurements, have been reported across age in relatively large (n > 100) studies [5–7]. The Iowa Oral Performance Instrument (IOPI; IOPI; Model 2.1, IOPI Medical LLC, Woodinville, WA, USA) is a commercially available instrument specifically designed to assess tongue function using an air-filled silicone bulb that, when depressed between the tongue and hard palate, * Nancy L. Potter [email protected] 1
Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University Spokane, PO Box 1495, Spokane, WA 99210‑1495, USA
measures the displaced air in kilopascals. Two bulb placements, anterior with the bulb placed on the alveolar ridge just posterior to the central incisors, and posterior with the bulb placed mid-palate, have been used with the adult populations [8]. Tongue strength is typically greater and tongue endurance longer in anterior placement compared to posterior placement [9]. In the pediatric population, there is not a significant difference between anterior and posterior tongue strength [7]. In typically developing children, tongue strength has been shown to increase rapidly across 3
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