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Swallow Pressures in Normal Young Adults: 

Swallow Pressures in Normal Young Adults Kerry Lenius, M.S., Florida State University Loran Clay, B.S., San Francisco State University Julie Stierwalt, Ph.D., Florida State University Elizabeth Ward, Ph.D., University of Queensland

Overview: Tongue Function: 

Overview: Tongue Function The tongue is important for both the oral and pharyngeal phases of swallowing. Formation, placement, and manipulation of the bolus Directing the bolus into the pharyngeal cavity Retraction against the pharyngeal walls to assist in bolus transfer through the pharynx Clark, Henson, Barber, Stierwalt, andamp; Sherrill, 2003; Logemann, 1998; Nicosia, Hind, Roecker, Carnes, Doyle, Dengel, andamp; Robbins, 2000; Robinovich, Hershler, andamp; Romilly, 1991; Stierwalt andamp; Clark, 2002

Overview: Dysfunction: 

Overview: Dysfunction Abnormal tongue function can lead to oral and/or pharyngeal dysphagia including: poor bolus formation abnormal bolus positioning disorganized oral transit oral residue premature spillage of the bolus into the pharynx residue in the vallecular spaces of the pharynx Logemann, 1998

Purpose: 

Purpose To examine tongue function variables during swallowing and isometric tasks. In young adults, are there differences relative to: Gender? Bolus volume? Bolus viscosity? Maximum pressure?

Methods: Participants: 

Methods: Participants 40 participants 18-40 years old. 20 men (age range 19-33; mean 23) 20 women (age range 18-33; mean 23) All in good general health Participants denied history of neurological disorders, oral surgeries, cancer, or dysphagia. Structure and function were judged to be within normal limits during an oral motor screening.

Methods: Instrumentation: 

Methods: Instrumentation Iowa Oral Performance Instrument (IOPI) Measures the amount of pressure exerted on an air-filled bulb Pressure is displayed in kilopascals (kPa)

Methods: Tasks: 

Methods: Tasks Maximum isometric pressures were obtained on the IOPI Swallowing pressures were obtained during bolus swallows of: Thin liquid 10ml and 20ml amounts Nectar 10ml and 20ml amounts Honey 10ml and 20ml amounts (Commercially pre-thickened products were used in order obtain consistent viscosity across subjects)

Methods: Swallowing Pressures: 

Methods: Swallowing Pressures Bolus volumes were drawn into a syringe (10ml andamp; 20ml) and delivered into the oral cavity via tubing.

Results: Volume (pooled): 

Results: Volume (pooled)

Results: Viscosity (pooled): 

Results: Viscosity (pooled)

Results: Maximum Pressure : 

Results: Maximum Pressure

Results: 

Results No significant gender differences were revealed across volume or viscosity. Pooled data-Volume: 10ml vs. 20ml t = -1.59; p = 0.057 Pooled data-Viscosity: Thin, Nectar, Honey F = 0.35; p = 0.70 Maximum Pressure: Gender t = 2.49; p = 0.008

Discussion: 

Discussion Swallowing pressures in young adults were equivalent across bolus volume andamp; viscosity. All participants were normal young adults with a high reserve (indicated by max pressure). This may account for their ability to adapt to variations in the bolus. No gender difference in swallowing pressure, however, there was a significant difference in maximum pressure. Perhaps men have a higher resilience.

Conclusions: 

Conclusions This data extends the normative data base on swallowing pressures (Youmans andamp; Stierwalt, in press) We did not find viscosity differences as in Youmans andamp; Stierwalt Population specific Young as opposed to high number of young and older Supports earlier findings of gender difference with maximum pressure (Youmans andamp; Stierwalt, in press; Robbins, Levine, Wood, Roecker, andamp; Luschei, 1995).

Future Directions: 

Future Directions To add normative data across the life span. Will our findings be supported across a broader age range? To further investigate the concept of a swallowing reserve. Do higher premorbid pressures result in a greater resilience for oral phase dysphagia? To extend the investigation to include individuals with dysphagia.

References: 

References Clark, H.C., Henson, P.A., Barber, W.D., Stierwalt, J.A.G., andamp; Sherrill, M. (2003). Relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments. American Journal of Speech-Language Pathology. 12, 40-50. Logemann, J.A. (1998). Evaluation and treatment of swallowing disorders (2nd ed.). Austin: Pro-ed. Nicosia, M.A., Hind, J.A., Roecker, E.B., Carnes, M., Doyle, J., Dengel, G.A., andamp; Robbins, J. (2000). Age effects on the temporal evolution of isometric and swallowing pressure. Journals of Gerontology A: Biological Sciences and Medical Sciences. 55, 634-640. Robbins, J., Levine, R., Wood, J., Roecker, E.B., andamp; Luschei, E. (1995). Age effects on lingual pressure generation as a risk factor for dysphagia. Journal of Gerontology. 50A(5), M257-M262. Robinovich, S.N., Hershler, C., andamp; Romilly, D.P. (1991). A tongue force measurement system for the assessment of oral-phase swallowing disorders. Archives of Physical Medicine and Rehabilitation. 72, 38-42. Stierwalt, J.A.G., andamp; Clark, H.M. (2002). Measures of tongue function and oral phase dysphagia. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Atlanta, GA. Youmans, S.R., Stierwalt, J.A.G. (in press). Measures of tongue function related to normal swallowing. Dysphagia.

Gratitude: 

Gratitude Our sincere thanks go to those individuals who volunteered their time to participate in our research.