Tongue strength and endurance: relation to highly skilled movements.

Tongue strength and endurance (fatigue) were examined in subjects who have acquired high skill levels with their tongues (supranormal) and in subjects who use the tongue normally. The supranormal groups were trumpet players and high school debaters who were able to speak intelligibly at rates much faster than normal. Hand strength and fatigue were also assessed. Maximal strength was measured by recording how much pressure an individual could exert on an air-filled bulb. Endurance was measured by determining how long subjects could sustain 50% of their maximal pressure. Results showed that maximal strength of the tongue and hand did not differentiate the supranormal subjects from the normal subjects. Hand endurance did not differentiate the subjects either. However, the supranormal groups had significantly longer tongue endurance times than did the normal subjects.     

Changes in normal speech after fatiguing the tongue.

Detrimental effects of tongue fatigue on speech have been assumed to exist based on neuromotor speech disorders. However, to address whether fatigue is a contributing cause to impaired speech requires an experimental protocol with an uncomplicated population. This study induced tongue fatigue in eight neurologically normal persons and examined changes in speech perceptually and acoustically. The fatigue task consisted of repeated cycles of 6 s of sustained maximum voluntary contraction and 4 s of rest until 50% of maximum strength could not be achieved for three consecutive cycles. Participants then produced speech that was weighted heavily with lingual-palatal consonants. Perceptual analyses of the speech revealed a statistically significant deleterious effect of induced tongue fatigue on speech precision and an incomplete reversal of this effect after a recovery period. Acoustically, the first and third spectral moments (mean and skewness) of the spectral energy for /see text/, /see text/, and /see text/ differed significantly after fatigue but in directions opposite to a priori predictions. Tendencies were found for decreased stop-closure duration and increased voice onset time for /see text/ after fatigue. Supplemental analyses revealed decreased second formant (F2) frequency for /see text/ and /see text/ and flattened F2 transition for the diphthong /see text/ after fatigue. These results indicate disruption of tongue positioning and transitioning for lingual-palatal consonants during speech after prolonged strenuous tongue exercises.     

The effect of jaw position on measures of tongue strength and endurance.

Assessment of tongue strength and endurance is common in research and clinical contexts. It is unclear whether the results reveal discrete function by the tongue or combined abilities of the tongue and jaw. One way to isolate the movement of the tongue is to constrain the jaw kinematically by using a bite block. In this study, 10 neurologically normal young adults performed tongue strength and endurance tasks without a bite block ("jaw-free") and with bite blocks of various heights (2, 5, 10, and 15 mm for strength; 5 mm for endurance). Data signals included tongue pressure exerted on an air-filled bulb, surface electromyography (SEMG) from the superior tongue blade, and SEMG from 1 masseter. On average, tongue strength (pressure in kPa) was greatest with no bite block and generally decreased as bite blocks increased in height. Pairwise analyses revealed statistically significant differences for all but 3 comparisons (jaw-free to 2 mm, 2 to 5 mm, and 5 to 10 mm). After removing outlying data from 1 participant, tongue endurance at 50% of tongue strength was significantly greater without a bite block than with one. SEMG data did not differ significantly for the strength task across bite block conditions, but inspection of the individual data revealed a tendency for masseter activity to be lower when the jaw was unconstrained. These results suggest that maximal tongue strength and endurance are best assessed with an unconstrained mandible or with a very small bite block.     

Oral strength in subjects with a unilateral cleft lip and palate

Purpose

Facial appearance and speech outcome may affect psychosocial functioning in girls and boys. Several studies reported dissatisfaction with facial appearance and more specifically the lip and mouth profile in children with cleft lip and palate (CLP). The purpose of this controlled study was to measure the tongue and lip strength and endurance in boys and girls with CLP.

Methods

Twenty-five subjects (mean age: 10.6 years) with a unilateral CLP and a gender- and age- matched control group were selected. All subjects with an unilateral CLP consulted the same craniofacial team and had undergone an identical surgical procedure. Surgical procedure of the lip was performed using a modified Millard technique without primary nose correction at an average age of 5.5 months. The Iowa Oral Performance instrument was used to measure lip and tongue strength and tongue endurance.

Results

The results of the Iowa Oral Performance measurement showed no significant differences between the subjects with an unilateral cleft lip and palate and the age and gender matched control group without a cleft lip and palate.

Conclusion

There is no significant differences regarding oral strength more specifically the lip and tongue strength and endurance between subjects with and without an unilateral cleft lip and palate. ENT specialists and speech pathologists must be aware of this aspect of the normal lip and tongue functions.     

Swallowing and tongue function following treatment for oral and oropharyngeal cancer.

This study examined tongue function and its relation to swallowing in 13 subjects with oral or oropharyngeal cancer treated with primary radiotherapy +/- chemotherapy and 13 age- and sex-matched control subjects. Measures of swallowing and tongue function were obtained using videofluoroscopy, pretreatment and 2 months posttreatment. Maximum isometric strength and endurance at 50% of maximum strength were obtained with the Iowa Oral Performance Instrument (IOPI). Control subjects were tested once. All subjects with head and neck cancer were evaluated pretreatment and 2 months posttreatment. No significant differences were found for the tongue function measures pre- and 2 months posttreatment in the group with head and neck cancer. Significantly higher tongue strength was observed in the control than in the group with head and neck cancer both pre- and posttreatment. No significant differences were found for the 2 groups for tongue endurance measures. Significant correlations of tongue strength and endurance and some swallow measures were found pre- and posttreatment for the group with head and neck cancer and for the control group. These correlations included oral and pharyngeal temporal swallow measures and oropharyngeal swallow efficiency. Pretreatment differences between the 2 groups in tongue strength were likely related to tumor bulk, pain, and soreness. Two-month posttreatment differences were likely related to radiation +/- chemotherapy changes to the oral and pharyngeal mucosa. This study provides support for the hypothesis that tongue strength plays a role in oropharyngeal swallowing, particularly related to the oral phase of the swallow.     

Interarticulator coordination in dysarthria: an X-ray microbeam study.

Articulatory discoordination is often said to be an important feature of the speech production disorder in dysarthria, but little experimental work has been done to identify and specify the coordination difficulties. The present study evaluated the coordination of labial and lingual gestures for /u/ production in persons with Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and in control participants. Both tongue backing/raising and reduction of the area enclosed by the lips can produce the characteristic low F2 of /u/. The timing of these articulatory gestures with respect to the acoustic target of a low F2 was inferred from X-ray microbeam data. Pellet motions of the tongue dorsum and lips revealed the timing of the lingual and labial gestures to be strongly linked together (synchronized), predictive of the temporal location of the lowest F2 within the vocalic nucleus, and scaled proportionately to the overall vowel duration in control participants. Somewhat surprisingly, essentially the same findings were obtained in the speakers with dysarthria. These relationships were noisier among the speakers with dysarthria, but the global synchronization patterns applied to all 3 groups. Further analyses revealed the synchronization to be less well defined and more variable across speakers with ALS, as compared to speakers with PD and the controls. Results are discussed relative to concepts of coordination in dysarthria.     

Tongue strength: Part II: In artificial alaryngeal speech

Tongue strength does not appear to be reduced in proficient esophageal speakers. However, no data exist on tongue strength for laryngectomized subjects who have not developed esophageal speech. Anterior and lateral tongue strength measures were obtained from 13 laryngectomized subjects who used an artificial larynx and 15 normal subjects by means of a pressure transducer and recording device. The results indicated that laryngectomized subjects had significantly weaker tongues in two of three directions measured. It was concluded that laryngectomy may affect tongue strength, but that the method of alaryngeal speech utilized postoperatively influences the return to normal.     

Radiation dose to the tongue and velopharynx predicts acoustic-articulatory changes after chemo-IMRT treatment for advanced head and neck cancer

The aim of this study was to investigate to what extent changes in speech after C-IMRT treatment are related to mean doses to the tongue and velopharynx (VP). In 34 patients with advanced hypopharyngeal, nasopharyngeal, or oropharyngeal cancer, changes in speech from pretreatment to 10 weeks and 1 year posttreatment were correlated with mean doses to the base of tongue (BOT), oral cavity (OC) and tonsillar fossa/soft palate (VP). Differences in anteroposterior tongue position, dorsoventral degree of tongue to palate or pharynx constriction, grooving, strength, nasality, and laryngeal rise, were assessed by acoustic changes in three speech sounds that depend on a (post-) alveolar closure or narrowing (/t/, /s/, /z/), three with a tongue to palate/pharyngeal narrowing (/l/, /r/, /u/), and in vowel /a/ at comfortable and highest pitch. Acoustically assessed changes in tongue positioning, shape, velopharyngeal constriction, and laryngeal elevation were significantly related to mean doses to the tongue and velopharynx. The mean dose to BOT predicted changes in anteroposterior tongue positioning from pre- to 10-weeks posttreatment. From pretreatment to 1-year, mean doses to BOT, OC, and VP were related to changes in grooving, strength, laryngeal height, nasality, palatalization, and degree of pharyngeal constriction. Changes in speech are related to mean doses to the base of tongue and velopharynx. The outcome indicates that strength, motility, and the balance between agonist and antagonist muscle forces change significantly after radiotherapy.     

Effects of neurosurgical management of Parkinson's disease on speech characteristics and oromotor function.

The present study examined the effects of neurosurgical management of Parkinson's disease (PD), including the procedures of pallidotomy, thalamotomy, and deep-brain stimulation (DBS) on perceptual speech characteristics, speech intelligibility, and oromotor function in a group of 22 participants with PD. The surgical participant group was compared with a group of 25 non-neurologically impaired individuals matched for age and sex. In addition, the study investigated 16 participants with PD who did not undergo neurosurgical management to control for disease progression. Results revealed that neurosurgical intervention did not significantly change the surgical participants' perceptual speech dimensions or oromotor function despite significant postoperative improvements in ratings of general motor function and disease severity. Reasons why neurosurgical intervention resulted in dissimilar outcomes with respect to participants' perceptual speech dimensions and general motor function are proposed.     

Sustaining a constant effort by the tongue and hand: effects of acute fatigue.

A constant-effort task was used previously as a potential assessment technique for fatigue. Participants sustained submaximal target effort levels with the tongue and hand against soft air-filled bulbs. For 80% of all trials, pressure decreased exponentially to a positive asymptote. In addition, pressure decreased faster when the muscles were fatigued than when they were rested. This study attempted to replicate the previous findings with new participants and to extend the findings to include surface electromyographic (EMG) data. Pressure and surface EMG signals were collected simultaneously while 10 neurologically normal young adults performed the constant-effort task at 50% of maximum pressure with the tongue and the hand. Eighty-one percent of the pressure data were modeled by a negative exponential equation with a nonzero asymptote. Seventy-three percent of the corresponding EMG data also fit this mathematical model. The pressure signals decayed more slowly than the corresponding EMG signals, particularly for the hand. After participants fatigued the tongue and hand with repeated brief maximal voluntary contractions, the time constants were reduced (rate of decay increased) for the tongue but not the hand. These results corroborate the previous finding that the time constant, determined from an exponential curve-fitting procedure, is a replicable measure. Furthermore, the reduction in the time constant after inducing acute fatigue in the tongue was replicated, although this same relationship was not replicated for the hand. The EMG data suggest that decreases in neuromuscular drive, including increased early adaptation, motor unit derecruitment, and motor unit desynchronization, contributed to the decrease in pressure during the constant-effort task, especially after acute fatigue was induced. These observations support the hypothesis that the task reflects, at least in part, central fatigue processes.     

Tongue strength: Part I: Following total laryngectomy

Surgical repositioning of the genioglossus muscle, as in total laryngectomy, may have an adverse effect on the protrusive strength of the tongue. To test this premise, anterior and lateral tongue strength measures were obtaind from 10 laryngectomized and 15 normal subjects by means of a pressure transducer and recording device. The results indicated no significant difference between laryngectomized and normal subjects on tongue strength measures. Further, all laryngectomized subjects were judged to have good to excellent esophageal speech. It was concluded that laryngectomy does not adversely affect the major musculature concerned with protrusive tongue strength for proficient esophageal speakers.     

Articulatory movements during vowels in speakers with dysarthria and healthy controls.

PURPOSE: This study compared movement characteristics of markers attached to the jaw, lower lip, tongue blade, and dorsum during production of selected English vowels by normal speakers and speakers with dysarthria due to amyotrophic lateral sclerosis (ALS) or Parkinson disease (PD). The study asked the following questions: (a) Are movement measures different for healthy controls and speakers with ALS or PD, and (b) Are articulatory profiles comparable for speakers with ALS and speakers with PD? METHOD: Nineteen healthy controls and 15 speakers with dysarthria participated in this study. The severity of dysarthria varied across individuals and between the 2 disorder groups. The stimuli were 10 words (i.e., seed, feed, big, dish, too, shoo, bad, cat, box, and dog) embedded into sentences read at a comfortable reading rate. Movement data were collected using the X-ray microbeam. Movement measures included distances, durations, and average speeds of vowel-related movement strokes. RESULTS: Differences were found (a) between speakers with ALS and healthy controls and (b) between speakers with ALS and PD, particularly in movement speed. Tongue movements in PD and ALS were more consistently different from healthy controls than jaw and lower lip movements. This study showed that the effects of neurologic disease on vowel production are often articulator-, vowel-, and context-specific. CONCLUSIONS: Differences in severity between the speakers with PD and ALS may have accounted for some of the differences in movement characteristics between the groups. These factors need to be carefully considered when describing the nature of speech disorder and developing empirically based evaluation and treatment strategies for dysarthria.     

Vocal fatigue perceived in remote working by teachers of different school grades during COVID-19 pandemic

ObjectiveTeachers have an increased prevalence of voice disorders. The present study aimed to investigate the impact of remote teaching on perceived voice fatigue among Italian teachers of all grades during the lockdown due to the COVID-19 pandemic.Methods The participants were 195 female teachers (M_age=48.77; SD_age=9.61) in primary, secondary, and high schools. They completed the Vocal Fatigue Index (VFI) through an online survey. The tool includes 19 items grouped into three dimensions: tiredness of voice and avoidance of voice use (TA); physical discomfort (PD); and improvement of symptoms with rest (IS). The participants reported their perceived voice fatigue during remote teaching. They were also asked to provide data about voice fatigue as perceived in previous classroom teaching. The data were analyzed through two sets of independent one-way ANOVAs, with voice fatigue subscales as criterion variables and school grade as a between-subjects factor.ResultsThe teachers involved in the study reported higher voice fatigue scores than vocally healthy adults from the general population. Primary school teachers showed higher voice fatigue during remote teaching than both secondary and high school teachers, specifically for the TA and PD dimensions, whereas no difference emerged for IS. The VFI scores of primary school teachers were similar to those of dysphonic individuals.ConclusionThe results of the study confirm that primary school teachers are more vulnerable to developing voice disorders and suggest the need for specific vocal health interventions in case of prolonged remote work.     

Anticipatory coarticulation in the speech of adults and young children: acoustic, perceptual, and video data.

Three experiments investigated anticipatory lingual and labial coarticulation in the [sV] productions of children and adults. Acoustic, perceptual, and video data were used to trace the development of intrasyllabic coarticulation in the speech of adults and children (ages 3, 5, and 8 years). Although children show greater variability in their articulatory patterns than adults, the data do not support claims that young children produce a greater degree of intrasyllabic coarticulation than older children or adults. Rather, the acoustic and video data suggest that young children and adults produce similar patterns of anticipatory coarticulation, and the perceptual data indicate that coarticulatory cues in the speech of 3-year-old children are less perceptible than those of the other age groups.     

Relationships between the perception of nasalization and speech movements in speakers with cleft palate

The purpose of this study was to examine the relationships between several temporal measures of speech movements and perceived nasalization in speakers with cleft palate. Four adult subjects with repaired cleft palate were filmed using high-speed (100 frames/s) cinefluorography as they produced target syllables embedded in a carrier phrase. Perceived nasalization of each extracted acoustic target syllable was rated by 18 trained judges. Movements of the tongue tip, tongue dorsum, jaw, velar knee, velar tip, and posterior pharyngeal wall were plotted over time. Time of movement onsets and movement offsets was identified from the plots. Voice onset and offset times were identified from the synchronized acoustic recordings. The findings indicate that normally expected velopharyngeal movements occurred near the time of jaw-lowering onset during nasalized CVC and CVN productions in two subjects who were judged to exhibit high levels of nasalization. The other two subjects showed no velopharyngeal movements during the CVC production. It is speculated that velopharyngeal movements normally expected in CVC utterances may be avoided by some speakers with cleft palate in order to minimize perceptible nasalization.     

Force transducers for the evaluation of labial, lingual, and mandibular motor impairments

Three transducers were developed for evaluating lip, tongue, and jaw muscle force control in individuals with motor speech disorders. The rationale for the development of these transducers was based upon the hypothesized need for clinical assessment of the individual motor subsystems of the speech production mechanism. To provide an indication of the utility of these devices, exemplary force control data from adults with Parkinson's disease and spastic cerebral palsy are provided. Observations of differential force control impairment in the labial, lingual, and mandibular subsystems of these dysarthric individuals supported the rationale for this development. Observations were made also concerning the utility of these nonspeech measures for predicting speech motor dysfunction.     

顶舌法联合刮舌法对舌系带过短患儿术后舌尖音训练效果的分析

目的：探讨顶舌法联合刮舌法对舌系带过短患儿术后舌尖音训练效果的影响。方法采用随机对照研究设计,将50例舌系带过短术后仅有舌尖音发音障碍的患儿（4～8岁）随机分为实验组25例,对照组25例。实验组在常规语音训练的基础上配合顶舌刮舌法训练,对照组采用常规语音训练,分别测试两组患儿在语音治疗前和治疗3个疗程后的语音清晰度,比较两组结果。结果实验组及对照组患儿治疗前的语音清晰度分别约为37．91％、37．69％,治疗后分别为87．69％、72．99％,两组患儿治疗前语音清晰度差异无统计学意义（t＝0．726,P ＞0．05）,治疗后两组患儿语音清晰度均较治疗前明显提高,差异有统计学意义（P ＜0．001）,且实验组患儿语音清晰度显著高于对照组。结论顶舌法联合刮舌法可以促进舌系带过短患儿术后仅有舌尖音发音障碍患儿语音清晰度的提高。     

Analysis of high-frequency electroencephalographic-electromyographic coherence elicited by speech and oral nonspeech tasks in Parkinson's disease.

PURPOSE: Corticomuscular electroencephalographic-electromyographic (EEG-EMG) coherence elicited by speech and nonspeech oromotor tasks in healthy participants and those with Parkinson's disease (PD) was examined. Hypotheses were the following: (a) corticomuscular coherence is demonstrable between orbicularis oris (OO) muscles' EMG and scalp EEG recording; (b) the presence, location, and magnitude of coherence is task specific; (c) differences in corticomuscular coherence patterns exist between healthy and PD participants; and (d) differences will manifest as either increased or decreased coherence values in certain frequency bands, with EEG localization at primary sensorimotor cortex and/or supplementary motor area (SMA). METHOD: Simultaneous EEG, EMG (OO), and speech samples were recorded on 20 healthy and 20 PD participants during speech and nonspeech tasks. Fast Fourier transform and coherence analysis was performed with Neuroscan software on 1,000 randomly generated epochs per task per group. Corticomuscular coherence was analyzed between each EEG electrode and right and left superior and inferior OO muscles up to 200 Hz. Significant coherence peaks exceeded 95% confidence limits (.003). RESULTS: Corticomuscular coherence existed for both groups and for all tasks, but to varying degrees in primary sensorimotor cortex and SMA. CONCLUSIONS: Results support task specificity for both groups and, in PD, a diminished modulation flexibility linked to the sensorimotor area and reduced corticomuscular coherence at the SMA.     

Acoustic and perceptual correlates of stress in nonwords produced by children with suspected developmental apraxia of speech and children with phonological disorder.

Previous research (L. Shriberg, D. Aram, & J. Kwiatkowski, 1997b, 1997c) has suggested that accuracy in producing linguistic stress reliably distinguishes between children with suspected developmental apraxia of speech (sDAS) and children with phonological disorder (PD). The current investigation tested this hypothesis by examining acoustic correlates of stress in trochaic (strong-weak) and iambic (weak-strong) nonwords produced by 5 children in each of these 2 groups. Four measures relating to stress production were examined: vowel duration, fundamental frequency (f0) at vowel midpoint, timing of the f0 peak relative to vowel onset, and intensity at vowel midpoint. In addition, perceptual judgments of accuracy of stress production were obtained. No group differences in the production of stress were found; however, listeners judged that the nonword repetitions of children with sDAS matched the target stress contour less often than did the repetitions of children with PD. Multiple regression analyses found that mean vowel duration, as well as the relative duration and relative f0 of stressed and stressless syllables, predicted listeners judgments of stress, although these variables only accounted for a small proportion of variance (21.8%). Thus, children with sDAS were able to produce acoustic differences between stressed tently perceptible to listeners.