Improvements in tongue strength and pressure-generation precision following a tongue-pressure training protocol in older individuals with dysphagia: Three case reports

Dysphagia, or difficulty swallowing, often occurs secondary to conditions such as stroke, head injury or progressive disease, many of which increase in frequency with advancing age. Sarcopenia, the gradual loss of muscle bulk and strength, can place older individuals at greater risk for dysphagia. Data are reported for three older participants in a pilot trial of a tongue-pressure training therapy. During the experimental therapy protocol, participants performed isometric strength exercises for the tongue as well as tongue pressure accuracy tasks. Biofeedback was provided using the Iowa Oral Performance Instrument (IOPI), an instrument that measures tongue pressure. Treatment outcome measures show increased isometric tongue strength, improved tongue pressure generation accuracy, improved bolus control on videofluoroscopy, and improved functional dietary intake by mouth. These preliminary results indicate that, for these three adults with dysphagia, tongue-pressure training was beneficial for improving both instrumental and functional aspects of swallowing. The experimental treatment protocol holds promise as a rehabilitative tool for various dysphagia populations

Linking Symptom Inventories using Semantic Textual Similarity

An extensive library of symptom inventories has been developed over time to measure clinical symptoms, but this variety has led to several long standing issues. Most notably, results drawn from different settings and studies are not comparable, which limits reproducibility. Here, we present an artificial intelligence (AI) approach using semantic textual similarity (STS) to link symptoms and scores across previously incongruous symptom inventories. We tested the ability of four pre-trained STS models to screen thousands of symptom description pairs for related content - a challenging task typically requiring expert panels. Models were tasked to predict symptom severity across four different inventories for 6,607 participants drawn from 16 international data sources. The STS approach achieved 74.8% accuracy across five tasks, outperforming other models tested. This work suggests that incorporating contextual, semantic information can assist expert decision-making processes, yielding gains for both general and disease-specific clinical assessment

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29

Tongue pressure and submental surface electromyography measures during non-effortful and effortful saliva swallows in healthy women

Purpose The effortful swallow, a compensatory technique frequently employed by speech-language pathologists for their patients with dysphagia, is still not fully understood in terms of how it modifies the swallow. In particular, although age-related changes are known to reduce maximum isometric tongue-pressure, it is not known whether age affects people’s ability to perform the effortful swallow. In this study, differences were explored between younger and older healthy women in execution of the effortful swallowing maneuver through a comparative analysis of effortful and non-effortful swallows. Methods Eighty healthy women (40 aged 18-35 years; 40 aged 60 years and older) participated. Peak amplitude measures and the timing of signal onset to peak were measured using concurrent tongue-pressure and submental surface electromyography. Results Statistically significant main effects of age-group were not observed in the amplitude data, but older participants showed slower rise-times to peak anterior tongue-palate pressure. Conclusions Despite the general age-related deterioration of the swallowing musculature due to the phenomenon of sarcopenia, older women can still produce non-effortful and effortful swallows with similar lingual pressure and submental EMG amplitudes to younger women

Decreasing the knowledge-to-action gap through research-clinical partnerships in speech-language pathology

A partnership between a Swallowing Rehabilitation Research Laboratory (SRRL) team and four clinical speech-language pathologists (S-LPs) was created to address an identifi ed knowledge-toaction(KTA) gap with respect to the use of a novel treatment technique for dysphagia. Clinicians who had previously been educated in the use of surface electromyography(sEMG) biofeedback in swallowing rehabilitation, but who had not adopted this technique in their clinical practice, received hands-on mentorship to facilitate utilization of the treatment technique in question. An action plan was devised following the framework of the KTA process outlined by Graham et al. (2006). Analysis of post-training interview data indicated that the clinicians valued their experience working with the SRRL team. Clinicians reported that support from the SRRL team helped them overcome various barriers, including therapeutic time constraints, difficulty maintaining knowledge of current research literature, and lack of confi dence in implementing new techniques. Overall, a successful KTA process was achieved, benefiting clinicians, patients, and researchers

Rationale for strength and skill goals in tongue resistance training: A review

Recent evidence in the dysphagia literature shows that tongue resistance training can be used to improve tongue strength. In this review article, we summarize what is known about the tongue and its role in swallowing. We review the literature on tongue pressure generation capacity (strength) and response to tongue resistance exercises. Tongue skill is introduced as a possible alternate goal in tongue resistance training, based on consideration of related literature regarding neural adaptation and improvements in motor performance resulting from treatment approaches in which goal-oriented practice and performance-specific feedback are provided

Pressure profile similarities between tongue resistance training tasks and liquid swallows

Tongue-pressure resistance training is known to increase tongue strength in seniors and individuals with stroke-related dysphagia. However, evidence of associated functional improvements in swallowing is equivocal. We investigated similarities in pressure waveform profiles between swallowing and several of tongue-palate pressure tasks to identify tasks that may be best-suited for inclusion in tongue-pressure resistance training protocols for patients who are unable to safely perform real bolus swallows in treatment. Tongue-palate pressures were recorded in twenty healthy, young adults. Participants performed water and nectar-thick juice swallows, effortful and non-effortful saliva swallows, and “half-maximum” tongue-palate partial-pressure tasks emphasizing either anterior or posterior tongue-palate contact at different speeds. Pressure slopes (amplitude change over time) during the pressure application (rise) and withdrawal (release) phases were analyzed. A subset of four tasks with the greatest similarity in slope characteristics to those seen in bolus swallows was identified: anterior half-maximum tongue-presses; posterior maximum tongue-presses; posterior half-maximum slow tongue presses; and effortful saliva swallows. We propose that future research should explore the degree to which swallowing improvements are obtained from treatment protocols that emphasize these tasks.Canadian Institutes of Health Research (Grants 69521, 82668, 84534 and 83888). Toronto Rehabilitation Institute and an Ontario Ministry of 10 Research and Innovation Early Researcher Award to the first autho