Department of Communication Sciences and Disorders, University of Northern Iowa, 245 CAC University of Northern Iowa, Cedar Falls, IA, 50614, USA.
Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 400 E. Superior Street, Chicago, IL, 60611, USA.
Dysphagia. 2022 Feb;37(1):99-115. doi: 10.1007/s00455-021-10254-y. Epub 2021 Aug 17.
Measures of tongue strength and endurance using the Iowa Oral Performance Instrument (IOPI) may have diagnostic utility during clinical swallowing evaluations for persons with Parkinson's disease (PwPD). Thus, the objective was to systematically analyze the existing literature comparing IOPI values of tongue strength and endurance between age- and sex-match pairs of PwPD and healthy adults as well as across disease stages. A systematic review of 12 databases and Google Scholar identified five peer-reviewed articles published in English (1990-2019) that compared tongue strength and/or endurance between PwPD and controls. Individual-level data were published in two studies and provided by authors for three studies. Study appraisal included the NIH Quality Assessment Tool and STROBE checklists. Limited data for posterior tongue pressures restricted meta-analyses to anterior pressures. Meta-analyses of group means indicated reduced tongue strength across 106 matched pairs (p < .001, I = 0%) and a trend for reduced endurance across 41 matched pairs (p = .07, I = 54%). Participant-level analyses found reduced strength (96 pairs, p < .001) and endurance (41 pairs, p = .011) secondary to PD. Tongue strength (n = 68), but not endurance (n = 41), inversely correlated with disease stage when controlling for age (p ≤ .018). Overall, clinicians should be aware that reduced anterior tongue strength and endurance are as follows : expected in approximately one-third and one-fourth of PwPD, respectively, and reduced anterior tongue strength may manifest as early as Hoehn and Yahr stage 2 with continual decline as disease progresses. Further investigation is warranted regarding the relation among tongue strength, tongue endurance, and swallowing physiology as well as applications of tongue pressure training within dysphagia rehabilitation for PwPD.
使用爱荷华口腔表现仪器（IOPI）测量舌力和耐力的方法在帕金森病（PD）患者的临床吞咽评估中可能具有诊断效用。因此，本研究的目的是系统分析比较 PD 患者与健康成年人的年龄和性别匹配组以及疾病各阶段的 IOPI 舌力和耐力值的现有文献。通过对 12 个数据库和 Google Scholar 的系统回顾，确定了五篇发表于 1990 年至 2019 年的以英文发表的同行评议文章，比较了 PD 患者和对照组之间的舌力和/或耐力。有两项研究公布了个体水平的数据，有三项研究提供了作者的数据。研究评估包括 NIH 质量评估工具和 STROBE 清单。由于后舌压的有限数据，限制了对前舌压的 meta 分析。组均值的 meta 分析表明，在 106 对匹配对中，舌力降低（p<0.001，I=0%），在 41 对匹配对中，耐力呈降低趋势（p=0.07，I=54%）。基于个体的分析发现，在考虑到 PD 因素后，68 对患者中舌力减弱（p<0.001），41 对患者中耐力减弱（p=0.011）。当控制年龄时，舌力（n=68）而不是耐力（n=41）与疾病阶段呈负相关（p≤0.018）。总体而言，临床医生应该意识到，大约三分之一和四分之一的 PD 患者的前舌力和耐力会降低，并且舌力的降低可能早在 Hoehn 和 Yahr 分期 2 期就表现出来，随着疾病的进展持续下降。需要进一步研究舌力、舌耐力和吞咽生理学之间的关系，以及在 PD 吞咽障碍康复中应用舌压训练。
