Tongue movements in normal 2-, 3-, and 4-year-old children: a continuation study

In this study, tongue movements of normal 2-, 3-, and 4-year-old children were measured and compared. The 4-year-olds were also compared with 4-year-old children in a previous study (Schwartz J: Observation of Tongue and Jaw Movement in Normal Four- and Five-Year-Old Children, master's thesis. Washington University, School of Occupational Therapy, St. Louis, MO, 1982). Measures were taken on 56 children: 17 two-year-olds (8 females, 9 males), 19 three-year-olds (10 females, 9 males), and 20 four-year-olds (10 females, 10 males). Two different tongue positions were quantified: First, the position of the tongue as the food was presented to the child at the moment when the food was 5 cm away from the lips and second, the position of the tongue as the food was swallowed. Younger children held their tongues in a more forward position when the food was presented, although the predominant tongue position was behind the teeth in all three age groups. During swallowing there was also a progression, as age increased, from pursing the lips to puckering at the corners of the mouth. Many children kept their mouth open during swallowing. These results provide further normative data for the assessment of eating-impaired children.     

Tongue movements in normal preschool children during eating

This study describes tongue movements of normal preschool children during eating, and is the first phase in a long-term project to develop a standardized eating assessment for children. It is hoped eventually to fill the need for an objective measurement tool in pediatric occupational therapy practice. The movements were monitored in 40 children; 20 were 4 years +/- 1 month, and 20 were 5 years +/- 1 month. Each group consisted of 10 boys and 10 girls. Two different tongue positions were quantified: First, as food was presented to the child when the food was 5 cm from the lips; and second, as food was swallowed. Tongue position upon food presentation and upon swallowing was affected by age, sex, and type of food. Both responses showed maturational changes from 4 to 5 years. It is proposed that important maturational changes take place between 4 and 5 years of age, but that adult patterns of swallowing are attained later in development.     

Chewing cycles in 2- to 8-year-old normal children: a developmental profile

Chewing movements of normal 5-, 6-, 7-, and 8-year-old children were measured and compared across age, food textures, and gender. Applesauce, graham cracker, and raisins were used. Measures were taken on 98 children: eighteen 5-year-olds (9 boys, 9 girls); thirty-five 6-year-olds (16 boys, 19 girls); twenty-six 7-year-olds (13 boys, 13 girls); and nineteen 8-year-olds (10 boys, 9 girls). Comparisons were made with data of another twenty 5-year-olds (10 boys, 10 girls) from a previous study. Chewing movements were measured by time, number of cycles, and a time/cycle ratio. Food texture affected time, cycle, and the time/cycle ratio. Age affected time and cycles. Data from earlier studies are used to describe the development of chewing between the ages of 2 and 8 years. Results indicate that eating skills for different food textures mature at different rates. Skills for eating solid foods mature before skills for eating viscous and pureed foods mature. Thus, the consistent use of food textures is important when children's eating skills are evaluated. The normative data presented here may be used by clinicians evaluating children within the given age group.     

Trunk flexion in healthy children aged 3 to 7 years

I tested 80 male and 80 female subjects between the ages of 3 and 7 years on two exercises of isometric trunk flexor muscle strength (half-hold hooklying position and supine flexion position) and one exercise of isotonic trunk flexor muscle strength (hooklying sit-ups) to establish normative data for trunk flexor musculature capabilities. Measurements included the length of time the half-hold hooklying and supine flexion positions were maintained and the number of repetitions of sit-ups. I found no significant differences between the sexes in performance of the isometric tests. I did find, however, a significant difference between age groups for half-hold hooklying and supine flexion tests (p less than .0001), indicating that the ability to perform isometric trunk flexion improves with age. Height was another significant variable contributing to test results (p less than .0001). Children were able to perform sit-ups consistently at age 6 years only; the male subjects performed an average of 20 more sit-ups than the female subjects (p less than .04). I discuss in this article the possible contribution of neuromuscular maturation and physical growth to the development of normal trunk flexion. The results may be useful to clinicians to assess abnormal trunk flexion accurately in children aged 3 to 7 years.     

Effect of swallowing training on dysphagia and depression in postoperative tongue cancer patients

PurposeThe aim of the present study was to evaluate the effect of swallowing training on dysphagia and depression in postoperative tongue cancer patients.MethodFifty-eight tongue cancer patients aged 45–81 years participated in the present study. All patients were scheduled to undergo partial tongue resection and flap rehabilitation. Changes in dysphagia and depression before and after swallowing training were measured. The water swallow test (WST) and the Zung Self-Rating Depression Scale (SDS) were used to evaluate the severity of dysphagia and depression, respectively.ResultsThe WST level and SDS scores in the less than 50% tongue resection and rehabilitation group were significantly lower than those of the greater than 50% group. The WST level and SDS scores of the early tumor stage group were significantly lower than those of the advanced tumor stage group. WST levels and SDS scores before swallowing training were significantly greater than those measured after swallowing training. In all cases, lower WST levels were associated with lower SDS scores.ConclusionsPostoperative dysphagia, depression and anxiety were improved after swallowing training. Early identification and management of dysphagia can improve treatment outcomes and reduce depression.     

Application of ultrasonography in assessing oropharyngeal Dysphagia in stroke patients

This study applied submental ultrasonography (SUS) to measure changes in dysphagic stroke patients' tongue thickness and hyoid bone displacement when swallowing 5 mL of water and correlated the results with the severity of clinical dysphagia. We included 60 stroke patients (30 tube-feeding-dependent and 30 on regular oral intake) and 30 healthy controls. An additional 10 healthy people were recruited to assess the reliability of SUS. Measurements of hyoid bone displacement using videofluoroscopic swallowing study (VFSS) and SUS were compared for 12 stroke patients to assess the correlation between the two methods. Changes in tongue thickness and hyoid bone displacement were significantly less in the tube-feeding group. Those with a tongue thickness change of less than 1.0 cm and hyoid bone displacement of less than 1.5 cm were likely to be tube-feeding. SUS showed good intra-rater/inter-rater reliability and correlated well with VFSS measurement. SUS can be an adjunct assessment tool of swallowing.     

超声波检查在脑性瘫痪儿童口咽期吞咽障碍评估中的应用

目的 探讨颏下超声（SUS）检查在脑性瘫痪（简称脑瘫）儿童口咽期吞咽障碍评估中的应用价值。 方法 选取17例口咽期吞咽障碍脑瘫儿童（7例依赖鼻饲进食,10例常规经口进食）和20例吞咽功能正常儿童分别纳入观察组和正常对照组。应用SUS测量受试者吞咽5ml水时舌肌厚度变化及舌骨位移幅度,将测量结果与功能性经口摄食量表（FOIS）评估结果进行比较,初步确定应用SUS检查判断是否依赖鼻饲的界值;通过分析不同评估者应用SUS测量受试者舌肌厚度变化及舌骨位移数据,计算20例吞咽功能正常儿童的组内相关系数（ICC）,进而确定SUS检查方法的评估者间及评估者内信度。 结果 通过观察所有受试者舌肌厚度变化及舌骨位移幅度,发现鼻饲依赖组患儿上述两种指标变化幅度均明显小于非鼻饲依赖组和正常对照组（P<0.05）,初步确定舌肌厚度变化界值为1.0cm,舌骨位移幅度界值为1.5cm;计算ICC值均大于0.4,提示SUS检查具有较好的评估者间/评估者内信度。 结论 SUS检查能够辅助评估口咽期吞咽障碍脑瘫患儿的吞咽功能。     

不同头位吞咽不同黏度液体食物对健康成人舌骨上肌群表面肌电的影响

目的 探讨不同头位吞咽不同黏度液体食物对健康成人舌骨上肌群表面肌电的影响。 方法 随机选取健康受试者20例,按随机数字表法设置的顺序,依次采用3种头位吞咽5种浓度的食物,每口量均为5 ml,实时记录每次吞咽时左、右侧舌骨上肌群的表面肌电信号。对原始肌电信号进行处理后,分析不同黏度和头位对舌骨上肌群激活水平影响的主效应,再采用简单效应分析确定黏度、头位和舌骨上肌群激活水平的交互效应。 结果 不同头位或不同黏度的主效应均存在差异,差异均有统计学意义（P＜0.05）。右转头位和右侧屈头位吞咽同黏度液体食物时,左侧舌骨上肌群净振幅值均高于右侧舌骨上肌群,差异均有统计学意义（P＜0.05）。吞咽同黏度液体食物时,在中立位、右转头位、右侧屈头位,左侧舌骨上肌群的净振幅值依次增高,差异均有统计学意义（P＜0.05）。在吞咽同黏度（0～3级）的液体食物时,右转头位右侧舌骨上肌群的净振幅值低于中立位和右侧屈头位,差异均有统计学意义（P＜0.05）。在吞咽4级的液体食物时,右侧屈头位右侧舌骨上肌群的净振幅值高于中立位和右转头位,差异均有统计学意义（P＜0.05）。右转头位吞咽0级液体食物时,左侧舌骨上肌群净振幅值显著低于吞咽1～4级的液体食物,差异均有统计学意义（P＜0.05）。右侧屈头位吞咽0级液体食物时,左侧舌骨上肌群净振幅值显著低于吞咽2～4级液体食物,吞咽1级液体食物时,左侧舌骨上肌群净振幅值显著低于吞咽3～4级的液体食物,差异均有统计学意义（P＜0.05）。右侧屈头位吞咽4级的液体食物时,右侧舌骨上肌群净振幅值高于吞咽0～1级的液体食物,吞咽3级液体食物时,右侧舌骨上肌群净振幅值高于吞咽1级的液体食物,差异均有统计学意义（P＜0.05）。 结论 吞咽时采用不同的头位和黏度,可不同程度地影响舌骨上肌群的收缩。     

性别与年龄对儿童静态平衡功能影响的定量对比分析

摘要 目的：在定量分析儿童静态平衡的基础上,探讨性别、年龄对儿童静态平衡功能的影响。 方法：采用KY-1112平衡分析系统,对6—8岁254名男童和245名女童,分别在睁、闭眼状态下测试其静态平衡的各项指标。 结果：①6—8岁儿童静态平衡功能性别的比较,在睁眼状态下有3指标差异存在显著性（P<0.05）,在闭眼状态下有3项指标差异存在非常显著性（P<0.01）。②年龄比较,6—8岁儿童静态平衡在5项指标上差异存在显著性(P<0.05)。具体为在指标包络面积（睁闭眼状态下）和轨迹位置均方差（睁眼状态下）上,8岁分别和6岁7岁间存在非常显著性差异（P<0.01）,6岁和7岁之间差异无显著性;在指标轨迹长度 (睁闭眼状态下) 上,6岁、7岁、8岁相互间差异存在非常显著性（P<0.01）;这五项有差异指标的均值随着年龄的增大而减小。③指标重心曲线最小矩形长度与宽度的比值小于1。 结论：6—8岁儿童静态平衡功能在性别上差异存在显著性,女童的平衡功能好于男童;在年龄上存在显著性差异,整体趋势是静态平衡功能随着年龄的增大而增强;其重心动摇面积分布为前后大于左右。     

Age-related balance changes in hearing-impaired children

This study compared balance skills of hearing-impaired children with those of hearing children in order to determine whether a deficit in balance exists in hearing-impaired children and to ascertain whether this deficit is age-related. Twenty-eight hearing-impaired subjects were chosen as a sample of convenience from the Pennsylvania School for the Deaf and placed into one of three age groups. Ten subjects were in the 4.5 to 6.5-year-old age group, 8 in the 8- to 10-year-old age group, and 10 in the 12.5 to 14.5-year-old age group. Selection criteria included bilateral sensorineural hearing loss of greater than or equal to 65 dB and normal intelligence (IQ greater than or equal to 80). Balance was measured by the use of the Balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency. For each age group, a z test was used to compare the subjects' scores with the Balance subtest standard scores. The results showed that for each age group, the mean score for the hearing-impaired children was lower than the standard score. Both older groups had significantly higher scores than the youngest group, but the mean scores of the older groups were not significantly different. No difference between the subjects' balance scores and the Balance subtest standard scores was found among the age groups, suggesting that the balance deficit was not age-related. Gender differences were not found for balance scores.     

Comparison of chewing cycles in 2-, 3-, 4-, and 5-year-old normal children

Chewing movements of normal 2-, 3-, and 4-year-old children were measured. Chewing movements of 2- and 3-year-olds were compared with those of 4- and 5-year-olds. Measures were taken on 56 children: 17 were 2 years old (8 female, 9 male); 19 were 3 years old (10 female, 9 male); and 20 were 4 years old (10 female and 10 male). Data of twenty 5-year-olds (10 males, 10 females) were taken from a previous study (9). Chewing movements were measured by time (seconds), number of cycles, and a time/cycle ratio. A chewing cycle was defined as an upward and downward movement of the chin. Total time from the moment food was placed in the mouth until the final swallow occurred was divided by the number of cycles counted for the same period. The type of food eaten affected time, cycles, and the time/cycle ratio, but age and sex did not. A comparison of younger (2- and 3-year-olds) and older children (4- and 5-year-olds) showed significant time differences. During maturation, time was shortened. It was shown earlier that under pathologic conditions (Down's syndrome) time was prolonged. Thus, the time/cycle ratio is an excellent indicator of the developmental status of a child.     

Glutathione peroxidase activity, lipid peroxides and selenium status in blood in patients with Down's syndrome

The concentrations of selenium and lipid peroxides and the catalytic activity of glutathione peroxidase were measured in the blood of 6 children (6-16 years of age) and 8 adults (17-27 years old) with Down's syndrome (trisomy 21). The values were compared with those for a control group of age-matched normal people. The selenium concentration in whole blood, erythrocytes and plasma was significantly lower in trisomy 21 patients than in normal subjects (p less than 0.001) in both age groups. No statistically significant differences were observed in selenium concentration in whole blood, erythrocytes and plasma between children and adults in the Down's syndrome group. Glutathione peroxidase catalytic activity in erythrocytes was significantly higher in Down's syndrome children than in healthy children (p less than 0.001). Plasma glutathione peroxidase catalytic activity in both investigated age groups was statistically considerably lower in the Down's syndrome patient group. The concentration of lipid peroxides, expressed as the malondialdehyde concentration, is lower in Down's syndrome patients. No correlation between selenium concentration, glutathione peroxidase catalytic activity and amount of lipid peroxides was found in the trisomy 21 patient group.     

Chewing cycles in 4- and 5-year-old normal children: an index of eating efficacy

Eating movements in the preschool child undergo change between the ages of 2 and 5 years. There is a lack of objective clinical data from normal children against which eating movements of feeding-impaired children can be compared. In this study, chewing movements were measured to complement tongue movements described in an earlier study. The movements were monitored in 40 children: 20 were four years old and 20 were five years old. Each group had ten boys and ten girls. Chewing movements were measured by time (sec), number of cycles, and a time/cycle ratio. A chewing cycle was defined as an upward and downward movement of the chin. Total time from the moment food was placed in the mouth until the final swallow occurred was divided by the number of cycles counted for the same period. Age and sex did not affect time, cycles, or the time/cycle ratio. However, the measures were strongly affected by the type of food eaten. These findings suggest that the texture of food strongly influences both the number of chewing cycles performed and the time used for chewing. The occupational therapist administering eating evaluations to children should carefully choose the foods offered for initial evaluations and use the same food consistently during re-evaluations.     

Normal values for left anterior descending coronary artery flow velocity assessed by transthoracic doppler echocardiography in healthy children

Normal values for left anterior descending coronary artery (LAD) flow velocity were assessed from a large number of normal children. In 303 healthy children, LAD peak flow velocity was measured by Doppler echocardiography. LAD peak flow velocities were calculated considering the angle between the Doppler beam and the coronary flow direction. The flow signals of LAD were recorded in 95% (288/303). The mean angle between the Doppler beam and Doppler flow signals of LAD was 42 +/- 8 degrees. The ratio of AT to total diastolic spectral duration was 0.19 +/- 0.088 and constant with age. LAD peak flow velocity correlated significantly with age (r = -0.57, p < 0.0001) and heart rate (r = 0.63, p < 0.0001). Multiple linear regression analysis showed that LAD peak flow velocity was associated with age and heart rate (LAD peak flow velocity = 20-0.34 (age) + 0.16 (heart rate), r2 = 0.41, p < 0 .0001). Normal data obtained in the present study provide a basis of the understanding and investigation in children with congenital heart disease or acquired heart disease such as atherosclerosis, left ventricular hypertrophy, or Kawasaki's disease.     

The effects of lingual intervention in a patient with inclusion body myositis and Sjögren's syndrome: a longitudinal case study

Malandraki GA, Kaufman A, Hind J, Ennis S, Gangnon R, Waclawik A, Robbins J. The effects of lingual intervention in a patient with inclusion body myositis and Sjögren's syndrome: a longitudinal case study.ObjectiveTo report the 5-year course of a patient's swallowing disorder in the context of progressive neuromuscular disease and the effectiveness of a lingual strengthening treatment program.DesignThis is a case report that describes a lingual treatment protocol that was repeated 3 times over a 5-year period with and without maintenance periods.SettingThe study was completed in 2 settings—an outpatient swallowing clinic at an acute care hospital and the patient's home.ParticipantThe subject was a 77-year-old woman who was diagnosed with inclusion body myositis and Sjögren's syndrome.InterventionThe patient participated in an intensive 8-week lingual strengthening protocol 3 times (at years 1, 4, and 5) and a subsequent maintenance program twice (at years 4 and 5).Main Outcome MeasuresThree outcome measures were collected during the study: (1) lingual manometric pressures at the anterior and posterior tongue, measured by using a lingual manometric device, (2) airway invasion measured by using an 8-point Penetration-Aspiration Scale, and (3) clearance of the bolus measured by using a 3-point residue scale.ResultsIsometric lingual strengthening was effective in maintaining posterior tongue lingual pressure and Penetration-Aspiration Scale scores during the treatment periods. Residue scale scores did not significantly change during treatment.ConclusionsWe conclude that, in this patient, lingual strengthening slowed the progression of disease-related lingual strength loss and extended functional swallowing performance. Thus, this type of intervention may hold promise as an effective swallowing treatment option for patients with neurodegenerative inflammatory diseases such as inclusion body myositis and Sjögren's syndrome.     

Effect of swallowing training on swallowing disorders in Parkinson's disease

The purpose of the present study was to determine whether swallowing training improves swallowing function in patients with Parkinson's disease. Ten patients (5 males, 5 females) who had symptoms of dysphagia and 12 healthy volunteers were studied. The initiation time of the swallowing reflex, the "premotor time" (PMT), was calculated from an electromyogram of the submental muscles before and after swallowing training. Patients with Parkinson's disease had a significantly longer PMT (p = 0.0014) than did healthy controls. There was no correlation between PMT and the duration of the disease (r = -0.146; p = 0.6867) or the patient's age (r = 0.602; p = 0.0653). After swallowing training, the patients' PMTs decreased significantly (p = 0.0051).     

Dissociating the spatio-temporal characteristics of cortical neuronal activity associated with human volitional swallowing in the healthy adult brain

Human swallowing represents a complex highly coordinated sensorimotor function whose functional neuroanatomy remains incompletely understood. Specifically, previous studies have failed to delineate the temporo-spatial sequence of those cerebral loci active during the differing phases of swallowing. We therefore sought to define the temporal characteristics of cortical activity associated with human swallowing behaviour using a novel application of magnetoencephalography (MEG). In healthy volunteers (n = 8, aged 28-45), 151-channel whole cortex MEG was recorded during the conditions of oral water infusion, volitional wet swallowing (5 ml bolus), tongue thrust or rest. Each condition lasted for 5 s and was repeated 20 times. Synthetic aperture magnetometry (SAM) analysis was performed on each active epoch and compared to rest. Temporal sequencing of brain activations utilised time-frequency wavelet plots of regions selected using virtual electrodes. Following SAM analysis, water infusion preferentially activated the caudolateral sensorimotor cortex, whereas during volitional swallowing and tongue movement, the superior sensorimotor cortex was more strongly active. Time-frequency wavelet analysis indicated that sensory input from the tongue simultaneously activated caudolateral sensorimotor and primary gustatory cortex, which appeared to prime the superior sensory and motor cortical areas, involved in the volitional phase of swallowing. Our data support the existence of a temporal synchrony across the whole cortical swallowing network, with sensory input from the tongue being critical. Thus, the ability to non-invasively image this network, with intra-individual and high temporal resolution, provides new insights into the brain processing of human swallowing.     

Position modifies carotid artery blood flow velocity during straining

The Valsalva maneuver (VM) produces rapid shifts in cerebrovascular blood flow and is often implicated in aneurysm rupture and rebleeding. To determine whether intensity of hemodynamic shifts is affected by position, we examined effects of five body positions (chair, 70 degrees and 30 degrees upright, flat, side) on carotid artery blood flow velocity (CABFV) across the VM in 141 healthy adults (30-55 yrs.). Subjects strained at 40 mmHg pressure for 10 seconds. CABFV was measured continuously by ultrasonic Doppler technique. During straining, position significantly (F = 13.7; p less than .0001) affected CABFV. Less reduction occurred in the chair (p less than .05) position than in any of the others. The 70 degrees position produced less fall in CABFV (p less than .05) than did the 30 degrees, flat and side positions. Less increase in CABFV across the VM was recorded in the chair position (p less than .05) than in any of the others. It is concluded that the chair position can be used therapeutically to reduce severe shifts of CABFV associated with straining.     

Changes in cardiac output after acute blood loss and position change in man

Thoracic bioimpedance cardiac output (Qtbi) was measured at 1-min intervals in 27 volunteers before, during, and after withdrawing 500 ml (3.7 to 8.5 ml/kg; mean 5.8) of blood. The effects of passive leg raising (PLR) and standing on Qtbi were measured before and after blood withdrawal. Arterial oxygen saturation (SaO2), transcutaneous oxygen tension (PtcO2), mean arterial BP (MAP), and heart rate (HR) were also measured before and after blood withdrawal. Thoracic bioimpedance cardiac index (CI) decreased 18% (0.8 +/- 0.1 L/min.m2, p less than .0001) and stroke volume index (SI) decreased 22% (14.8 +/- 2.7 ml/beat.m2, p less than .0001) after blood withdrawal. HR, MAP, SaO2, and PtcO2 were not significantly different after blood withdrawal. Before blood withdrawal PLR increased CI 6.8% (0.3 +/- 0.1 L/min.m2, p less than .0001); after blood withdrawal PLR increased CI 11.1% (0.4 +/- 0.1 L/min.m2, p less than .0001). PLR can increase stroke volume and cardiac output in hypovolemic humans.