Relationship between tongue strength, lip strength, and nutrition-related sarcopenia in older rehabilitation inpatients: a cross-sectional study

Kotomi Sakai,1,2 Enri Nakayama,2 Haruka Tohara,3 Keiji Kodama,4 Takahiro Takehisa,5 Yozo Takehisa,6 Koichiro Ueda2 1Department of Rehabilitation Medicine, Setagaya Memorial Hospital, 2Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, 3Gerodontology and Oral Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 4Department of Internal Medicine, 5Department of Orthopaedic Surgery, Setagaya Memorial Hospital, Tokyo, 6Department of Internal Medicine, Hakuai Memorial Hospital, Tokushima, Japan Objective: The objective of this study was to clarify the relationship between tongue strength, lip strength, and nutrition-related sarcopenia (NRS).Patients and methods: A total of 201 older inpatients aged ≥65 years (70 men, median age: 84 years, interquartile range: 79–89 years) consecutively admitted for rehabilitation were included in this cross-sectional study. The main factors evaluated were the presence of NRS diagnosed by malnutrition using the Mini-Nutrition Assessment – Short Form, sarcopenia based on the criteria of the Asian Working Group for Sarcopenia, tongue strength, and lip strength. Other factors such as age, sex, comorbidity, physical function, cognitive function, and oral intake level were also assessed.Results: In all, 78 (38.8%) patients were allocated to the NRS group, and 123 (61.2%) patients were allocated to the non-NRS group. The median tongue strength and lip strength (interquartile range) were significantly lower in the NRS group (tongue: 22.9 kPa [17.7–27.7 kPa] and lip: 7.2 N [5.6–9.8 N]) compared with the non-NRS group (tongue: 29.7 kPa [24.8–35.1 kPa] and lip: 9.9 N [8.4–12.3 N], P<0.001 for both). Multivariable logistic regression analysis showed that NRS was independently associated with tongue strength (odds ratio [OR] =0.93, 95% confidence interval [CI] 0.87–0.98, P=0.012) and lip strength (OR =0.76, 95% CI 0.66–0.88, P<0.001), even after adjusting for age, sex, comorbidity, physical function, cognitive function, and oral intake level.Conclusion: The likelihood of occurrence of NRS decreased when tongue strength or lip strength increased. Tongue strength and lip strength may be important factors for preventing and improving NRS, regardless of the presence of low oral intake level in older rehabilitation inpatients. Keywords: sarcopenia, rehabilitation, tongue, lip, malnutritio

Excessive anterior cervical muscle tone affects hyoid bone kinetics during swallowing in healthy individuals

Yasuhiro Yamazaki, Haruka Tohara, Koji Hara, Ayako Nakane, Yoko Wakasugi, Kohei Yamaguchi, Shunsuke Minakuchi Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan Purpose: This study aimed to determine whether excessive neck muscle tone affects hyoid bone kinetics during swallowing using videofluorography (VF) in an unnatural posture in healthy individuals. Subjects and methods: Subjects were 28 healthy adults (12 men, 16 women; mean age, 39.75±9.50 years) without any history or present complaints of swallowing disorders. We first established the participant’s posture a reclining wheelchair that was adjusted to a 30-degree angle with the headrest (without excessive neck muscle tone) or without headrest (with excessive neck muscle tone), used an electromyogram above the mylohyoid muscle to represent the suprahyoid muscles and above the sternohyoid muscle to represent the infrahyoid muscles to confirm neck muscle tone, and then conducted VF of swallowing measurements. Videofluorographic images were obtained when 5 mL of 50% (w/v) barium sulfate was being swallowed, and hyoid bone coordinate (the resting position and the elevated position), extent of horizontal and vertical hyoid bone elevation, as well as duration and velocity of hyoid bone elevation were evaluated (x-axis and y-axis coordinates for the resting position of hyoid bone are referred to as Xr and Yr, respectively; those for the elevated hyoid bone position induced during swallowing are referred to as Xs and Ys, respectively). Results: In the resting position of the hyoid bone, the Yr coordinates in those with excessive neck muscle tone were significantly lower than in those without excessive neck muscle tone. Vertical hyoid bone elevation and hyoid bone elevation velocity were significantly higher with excessive neck muscle tone than without excessive neck muscle tone, whereas horizontal elevation showed no significant differences. Conclusion: Our findings suggest that the generation of neck muscle tone due to inappropriate posture may encourage hyoid depression and increase the extent of hyoid bone elevation, thereby increasing the risk of aspiration. Keywords: dysphagia, swallow, muscle tone, hyoid bone, infrahyoid muscles, suprahyoid muscle

A Dentist-Led Oral Care System Can Prevent Stroke-Associated Pneumonia: The Effects of Early Intervention by Dental Team

Kenichiro Ozaki,1,2 Haruka Tohara,2 Mikoto Baba,1 Satoshi Teranaka,1,3 Yosuke Kawai,1,3 Satoru Komatsumoto4,5 1Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; 2Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan; 3Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan; 4Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; 5Fujita Health University, Toyoake, Aichi, JapanCorrespondence: Kenichiro Ozaki, Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, 284-1, Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan, Tel +81-284-21-0121, Fax +81-284-21-6810, Email [email protected]: Our facility’s dental team consists of a full-time dentists and dental hygienists who work exclusively in the wards to implement best practices in oral healthcare. We executed the dental care system (DCS) that includes lectures and practical training for nurses conducted by dentists and dental hygienists, the introduction to oral assessment, standardization of oral care procedures, a process for nurses to request the dental team, and early bedside oral screening conducted by the dental team. This study investigated the DCS’s effects on the incidence of stroke-associated pneumonia (SAP).Methods: This single-center retrospective cohort study included 2,771 acute stroke patients who were newly hospitalized between April 1, 2012, and March 31, 2020. The 8-year period was divided into four phases at two-year intervals as follows: Pre (N=632), Post-1 (N=642), Post-2 (N=716), and Post-3 (N=781). Pre was prior to DCS practice. Post-1 was an early introduction to DCS. Post-2 simplified dental team requests from nurses, and Post-3 added bedside oral screening within 72 hours of admission by the dental team. Statistical analysis was performed using the Cochran-Armitage trend test, followed by multivariate logistic regression.Results: A decrease in SAP rates was observed across the four groups (P< 0.0001). Logistic regression analysis revealed a significant difference for respiratory disease (odds ratio 7.74, 95% confidence interval 5.49– 10.90), hypertension (2.28, 1.39– 3.73), cardiac failure (1.72, 1.04– 2.85), and diabetes (1.59, 1.11– 2.26), 3-digit code on the Japan coma scale (3.57, 2.53– 5.05 [reference ≤ 2-digit code]), age ≥ 90 years (2.34, 1.15– 4.77 [reference 18– 59 years]), male (1.86, 1.31– 2.67), and the Post-1 (0.49, 0.31– 0.76 [reference Pre]), Post-2 (0.38, 0.25– 0.61 [reference Pre]), and Post-3 (0.24, 0.15– 0.40 [reference Pre]) periods.Conclusion: The suppression of SAP is effectively achieved through early intervention and education of nurses by dental professionals.Plain Language Summary: Pneumonia is a dangerous disease that kills millions of individuals around the world every year. Stroke patients are susceptible to developing pneumonia because their swallowing reflex is sometimes impaired. This risk may be reduced by maintaining oral hygiene through advanced oral care involving dentists and dental hygienists. For this reason, our acute care hospital has a dental team consisting of a full-time dentists and dental hygienists dedicated to the ward. In 2014, the dental team launched a program for nurses on how to provide oral care to inpatients. Additionally, we have introduced a system that enables nurses to contact the dental team immediately if oral care becomes difficult for nurses due to problems in the patient’s mouth. Furthermore, the dental team began evaluating the oral health of all stroke patients within 72 hours after hospitalization. We studied the changes in the frequency of pneumonia in stroke patients at our hospital before the application of this approach and 6 years after its introduction. The rate of pneumonia decreased steadily during this period. Overall, the pneumonia rates in stroke patients at our hospital reduced by approximately 60%, suggesting that this system is an effective way to prevent pneumonia.Keywords: hospital dental services, hospital dentistry, special care dentistry, oral health management, oral care, acute stroke, stroke-associated pneumonia, team approac

Excessive anterior cervical muscle tone affects hyoid bone kinetics during swallowing in healthy individuals [Corrigendum]

Yamazaki Y, Tohara H, Hara K, Nakane A, Wakasugi Y, Yamaguchi K, Minakuchi S. Clin Interv Aging. 2017;12: 1903&ndash;1910.Page 1903, the title, &ldquo;Excessive anterior cervical muscle tone affects hyoid bone kinetics during swallowing in healthy individuals&rdquo; should read &ldquo;Excessive anterior cervical muscle tone affects hyoid bone kinetics during swallowing in adults&rdquo;.Page 1903, Abstract, Purpose, line 3, &ldquo;healthy individuals&rdquo; should read &ldquo;adults&rdquo;.Page 1903, Abstract, Subjects and methods, &ldquo;28 healthy adults (12 men, 16 women; mean age, 39.75&plusmn;9.50 years) without any history or present complaints of swallowing disorders&rdquo; should read &ldquo;28 adults (12 men, 16 women; mean age, 39.75&plusmn;9.50 years) who were suspected to have some symptom of swallowing disorders but did not have swallowing dysfunctional from the result of videofluorography&rdquo;.Page 1904, right column, line 10, &ldquo;healthy individuals&rdquo; should read &ldquo;adults&rdquo;.Page 1904, Methods, Study participants, &ldquo;The present study evaluated 28 healthy adults (12 men, 16 women; mean age, 39.75&plusmn;9.50 years) without any history or present complaints of swallowing disorders&rdquo; should read &ldquo;The present study evaluated 28 adults (12 men, 16 women; mean age, 39.75&plusmn;9.50 years) who were suspected to have some symptom of swallowing disorders but did not have swallowing dysfunctional from the result of videofluorography&rdquo;.Read the original articl

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

Chizuru Namiki,1 Koji Hara,1 Haruka Tohara,1 Kenichiro Kobayashi,2 Ariya Chantaramanee,1 Kazuharu Nakagawa,1 Takayuki Saitou,2 Kohei Yamaguchi,1 Kanako Yoshimi,1 Ayako Nakane,1 Shunsuke Minakuchi1 1Department of Gerodontology, Division of Gerontology and Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan; 2Kobayashi Dental Clinic, Tokyo, Japan Purpose: Producing tongue pressure (TP) by pushing the tongue against the palate consists of lifting the tongue muscles and elevating the floor of the mouth via suprahyoid muscle contraction. Though studies have shown that tongue-pressure resistance training (TPRT) increases tongue function, none have focused on suprahyoid muscle function enhancements. Our study aimed to verify whether TPRT improves both tongue function and hyoid movement during swallowing.Materials and methods: Eighteen patients (mean age: 76.8&plusmn;6.2 years) with presbyphagia presenting with symptoms such as coughing and choking were enrolled. All patients performed daily living activities independently. None of the participants had diseases causing dysphagia or previous oral or pharyngeal surgery. Participants were instructed to push their tongues against the palate as hard as possible with their mouths closed for 10 seconds, and then resting for 10 seconds. A set consisted of five consecutive exercise and resting periods; two sets per day were performed for a month. TP and the oral diadochokinetic rate (ODKR), measured by repetitions of the syllables /ta/ and /ka/, assessed tongue function. The extent of anterior and superior hyoid movement and parameters related to swallowing, including the penetration aspiration scale (PAS) and the normalized residue ratio scale (NRRS) in the valleculae (NRRSv) and piriform sinus (NRRSp), were evaluated based on videofluoroscopic data.Results: The anterior (P=0.031) and superior hyoid movement (P=0.012), TP (P=0.002), ODKR/ta/ (P=0.034), ODKR/ka/ (P=0.009), and the width of the upper esophageal sphincter (P=0.001) were larger at follow-up than at baseline. NRRSp (P=0.022), PAS (P=0.016), and pharyngeal transit times (P=0.004) were smaller at follow-up than at baseline.Conclusion: TPRT improved tongue strength, dexterity, both anterior and superior hyoid elevation, and swallowing functions. Therefore, TPRT could improve tongue function and suprahyoid muscle function simultaneously and contribute to prevention of sarcopenic dysphagia. Keywords: sarcopenic dysphagia, swallowing muscle, tongue function, suprahyoid muscl