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A Pilot Study of the Tongue Pull-Back Exercise for Improving Tongue-Base Retraction and Two Novel Methods to Add Resistance to the Tongue Pull-Back

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Abstract

This pilot study investigated the tongue pull-back (TPB) exercise to improve tongue-base retraction as well as two methods to add resistance to the TPB. Surface electromyography (sEMG) to the submental triangle was used as an indication of tongue-base activity on 13 healthy adults during: (1) saliva swallow, (2) 15 mL water swallow, (3) effortful swallow, (4) unassisted TPB, (5) TPB with added resistance by holding the tongue with gauze (finger-resisted TPB), and (6) TPB with the tongue clipped to a spring-loaded tension resistance device (device-resisted TPB). Order of the exercises was randomized. The exercises fell into two groups—weak and intense. Weak exercises included saliva swallow, water swallow, and unassisted TPB (mean sEMG = 19.07 μV, p = .593). Intense exercises included effortful swallow, finger-resisted TPB, and device-resisted TPB (mean sEMG = 36.44 μV, p = .315). Each intense exercise resulted in significantly higher mean sEMG peak amplitude than each weak exercise (p < .05), with one exception; the effortful swallow was not significantly different than the unassisted TPB (p = .171). This study provides preliminary evidence that the unassisted TPB may not be any more helpful for improving tongue-base retraction than normal swallowing. Adding resistance to the TPB by holding the tongue with gauze may be an effective alternative. This study also demonstrates proof-of-concept for creating a device to attach to the tongue and provide tension resistance during the TPB exercise. Further research with a more sophisticated design is needed before such a device can be fully developed and implemented clinically.

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Notes

  1. sEMG activity output to a computer was not purchased with the sEMG unit and so was not available for this pilot study.

  2. Clinical experience indicated that individuals tend to curl the tip of the tongue when asked to pull the tongue back, rather than bunching the back of the tongue up in the back of the mouth, which is the proper way to do the TPB.

References

  1. Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. Am J Rehabil. 1990;154:963.

    Google Scholar 

  2. Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing—normal and abnormal. Phys Med Rehabil Clin N Am. 2008;19(4):691–707.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kahrilas P, Logemann J, Lin S, Ergun G. Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study. Gastroenterology. 1992;103(1):128–36.

    CAS  PubMed  Google Scholar 

  4. Donner M, Bosma J, Robertson D. Anatomy and physiology of the pharynx. Gastrointest Radiol. 1985;10:196–212.

    CAS  PubMed  Google Scholar 

  5. McConnel FM. Analysis of pressure generation and bolus transit during pharyngeal swallowing. Laryngoscope. 1988;98(1):78.

    Article  Google Scholar 

  6. Kahrilas P. Pharyngeal structure and function. Dysphagia. 1993;8:303–7.

    Article  CAS  PubMed  Google Scholar 

  7. Pouderoux P, Kahrilas P. Deglutitive tongue force modulation by volition, volume, and viscosity in humans. Gastroenterology. 1995;108(5):1418–26.

    Article  CAS  PubMed  Google Scholar 

  8. Lazarus C. Management of swallowing disorders in head and neck cancer patients: optimal patterns of care. Semin Speech Lang. 2000;21(4):309.

    Article  Google Scholar 

  9. Dejaeger E, Pelemans W, Ponette E, Joosten E. Mechanisms involved in postdeglutition retention in the elderly. Dysphagia. 1997;12(2):63–7.

    Article  CAS  PubMed  Google Scholar 

  10. Cola MG, Daniels SK, Corey DM, Lemen LC, Romero M, Foundas AL. Relevance of subcortical stroke in dysphagia. Stroke. 2010;41(3):486.

    Article  Google Scholar 

  11. Eisbruch A, Lyden T, Bradford CR, Dawson LA, Haxer MJ, Miller AE, et al. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol. 2002;53(1):28.

    Google Scholar 

  12. Logemann J. Evaluation and treatment of swallowing disorders, chapter 3. Anatomy and physiology of normal deglutition. 3rd ed. Austin: Pro-Ed; 1998. p. 33.

    Google Scholar 

  13. Miller A. Neurophysiological basis of swallowing. Dysphagia. 1986;1:91–100.

    Article  Google Scholar 

  14. Corbin-Lewis K, Liss J, Sciortino K. Clinical anatomy and physiology of the swallow mechanism, chapter 2. Examination of the pharyngeal swallow component. Clifton Park: Thomas Delmar Learning; 2004. p. 60.

    Google Scholar 

  15. Seikel J, King W, Drumright D. Anatomy & physiology for speech, language, and hearing, chapter 8. Physiology of mastication and deglutition. 4th ed. Clifton Park: Cengage Learning; 2010. p. 414.

    Google Scholar 

  16. Napadow V, Chen Q, Wedeen V, Gilbert R. Biomechanical basis for lingual muscular deformation during swallowing. Am J Physiol Gastrointest Liver Physiol. 1999;277(3):G701.

    Google Scholar 

  17. Groher M, Crary M. Dysphagia: Clinical management in adults and children, Chapter 2. Normal swallowing in adults. Maryland Heights: Mosby, Inc; 2010. p. 27.

    Google Scholar 

  18. Palmer P, Luschei E, Jaffe D, McCulloch T. Contributions of individual muscles to the submental surface electromyogram during swallowing. JSLHR. 1999;42(6):1378–91.

    CAS  PubMed  Google Scholar 

  19. Lazarus C, Logemann J, Wook Song C, Rademaker A, Kahrilas P. Effects of voluntary maneuvers on tongue base function for swallowing. Folia Phoniatr Logop. 2002;54(4):171–6.

    Article  PubMed  Google Scholar 

  20. Hind JA, Nicosia MA, Roecker EB, Carnes ML, Robbins J. Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. Arch Phys Med Rehabil. 2001;82(12):1661–5.

    Article  CAS  PubMed  Google Scholar 

  21. Huckabee M, Steele CM. An analysis of lingual contribution to submental surface electromyographic measures and pharyngeal pressure during effortful swallow. Arch Phys Med Rehabil. 2006;87(8):1067–72.

    Article  PubMed  Google Scholar 

  22. Huckabee M, Butler SG, Barclay M, Jit S. Submental surface electromyographic measurement and pharyngeal pressures during normal and effortful swallowing. Arch Phys Med Rehabil. 2005;86(11):2144–9.

    Article  PubMed  Google Scholar 

  23. Veis S, Logemann JA, Colangelo L. Effects of three techniques on maximum posterior movement of the tongue base. Dysphagia. 2000;15(3):142–5.

    Article  CAS  PubMed  Google Scholar 

  24. Johnson D, Herring H, Daniels S. Dysphagia management in stroke rehabilitation. Curr Phys Med Rehabil Rep. 2014;2(4):218.

    Article  Google Scholar 

  25. Murry T, Carrau R. Clinical management of swallowing disorders. 2nd ed. San Diego: Plural Publishing; 2006.

    Google Scholar 

  26. Steele CM, Huckabee ML. The influence of orolingual pressure on the timing of pharyngeal pressure events. Dysphagia. 2007;22(1):36.

    Article  Google Scholar 

  27. Park J, Oh J, Park S, Yoon T, Kwon B. Effortful swallowing training coupled with electrical stimulation leads to an increase in hyoid elevation during swallowing. Dyshpagia. 2009;24:296–301.

    Google Scholar 

  28. Park J, Kim Y, Oh J, Lee H. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study. Dysphagia. 2012;27:521–7.

    Article  PubMed  Google Scholar 

  29. Clark MC, Shelton N. Training effects of the effortful swallow under three exercise conditions. Dysphagia. 2014;29:553–63.

    Article  PubMed  Google Scholar 

  30. Robbins J, Butler SG, Daniels S, Gross RD, Langmore S, Lazarus C. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. JSLHR. 2008;51(1):300.

    Google Scholar 

  31. Burkhead LM, Sapienza CM, Rosenbek JC. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia. 2007;22(3):251–65.

    Article  PubMed  Google Scholar 

  32. Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51(1):225–39.

    Article  Google Scholar 

  33. Hamdy S, Aziz Q, Rothwell JC, Power M, Singh KD, Nicholson DA, et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology. 1998;115(5):1112.

    Article  Google Scholar 

  34. Kim J, Sapienza C. Implications of expiratory muscle strength training for rehabilitation of the elderly: tutorial. J Rehabil Res Dev. 2005;42(2):211–24.

    Article  PubMed  Google Scholar 

  35. Troche M, Okun M, Rosenbek J, Musson N, Fernandez H, Rodriguez R, et al. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST. Neurology. 2010;75(21):1912–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Miller J, Watkin K. The influence of bolus volume and viscosity on anterior lingual force during the oral stage of swallowing. Dysphagia. 1996;11(2):117–24.

    Article  CAS  PubMed  Google Scholar 

  37. Huckabee M, Low IS, McAuliffe MJ. Variability in clinical surface electromyography recording of submental muscle activity in swallowing of healthy participants. Asia Pac J Speech Lang Hear. 2012;15(3):186.

    Google Scholar 

  38. Crary M, Groher M. Basic concepts of surface electromyographic biofeedback in the treatment of dysphagia: a tutorial. Am J Speech Lang Pathol. 2000;9(2):125.

    Article  Google Scholar 

  39. Bryant M. Biofeedback in the treatment of a selected dysphagic patient. Dysphagia. 1991;6(3):140–4.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Communicative Sciences and Disorders, The University of Montana, 32 Campus Drive, Missoula, MT, 59812-9968, USA

    Laurie Slovarp, Lauren King & Catherine Off

  2. Speech and Hearing Science, Arizona State University, 975 S. Myrtle Ave, P.O. Box 870102, Tempe, AZ, 85287-0102, USA

    Julie Liss

Authors
  1. Laurie Slovarp
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  2. Lauren King
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  3. Catherine Off
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  4. Julie Liss
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Correspondence to Laurie Slovarp.

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Slovarp, L., King, L., Off, C. et al. A Pilot Study of the Tongue Pull-Back Exercise for Improving Tongue-Base Retraction and Two Novel Methods to Add Resistance to the Tongue Pull-Back. Dysphagia 31, 416–423 (2016). https://doi.org/10.1007/s00455-016-9693-y

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  • DOI: https://doi.org/10.1007/s00455-016-9693-y

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