Tongue Strength and Exercise in Healthy Individuals and in Head and Neck Cancer Patients

Abstract

The tongue plays a critical role in bolus propulsion through the oral cavity and pharynx. This manuscript reviews the types of lingual impairment and overall oropharyngeal swallowing impairment present after treatment for head and neck cancer; specifically, surgery and primary chemoradiotherapy. Oral tongue impairment in surgically treated patients can include reduced range of motion, reduced control, and reduced ability to manipulate, seal, and propel a bolus into the pharynx. Tongue base impairment can result in reduced bolus clearance through the pharynx, resulting in pharyngeal residue and aspiration. The biologic effects of radiotherapy are described, with tissue fibrosis being a primary contributor to development of oropharyngeal swallow disorders. In patients treated with primary chemoradiotherapy, lingual strength has been found to be reduced, as has oral and pharyngeal structural movement during the swallow. The effects of skeletal muscle strengthening programs on muscle physiology are discussed, as are the effects of tongue strengthening exercise programs on tongue strength and swallowing. Future research needs are addressed.

KEYWORDS

Tongue strength - head and neck cancer - swallowing

REFERENCES

• 1 Logemann J A. Evaluation and Treatment of Swallowing Disorders. San Diego, CA; College Hill 1983
• 2 Palmer J B. Bolus aggregation in the oropharynx does not depend on gravity.  Arch Phys Med Rehabil. 1998;  79 691-696
• 3 Cerenko D, McConnel F, Jackson R. Quantitative assessment of pharyngeal bolus driving forces.  Otolaryngol Head Neck Surg. 1989;  100 57-63
• 4 Kahrilas P J, Lin S, Logemann J A, Ergun G A, Facchini F. Deglutitive tongue action: volume accommodation and bolus propulsion.  Gastroenterology. 1993;  104 152-162
• 5 Pouderoux P, Kahrilas P J. Deglutitive tongue force modulation by volition, volume and viscosity in humans.  Gastroenterology. 1995;  108 1418-1426
• 6 McConnel F M. Analysis of pressure generation and bolus transit during pharyngeal swallowing.  Laryngoscope. 1988;  98 71-78
• 7 Fujiu M, Logemann J A, Pauloski B R. Increased postoperative posterior pharyngeal wall movement in patients with anterior oral cancer: Preliminary findings and possible implications for treatment.  Am J Speech Lang Pathol. 1995;  4 24-30
• 8 Furia C L, Carrara-de Angelis E, Martins N M, Barros A P, Carneiro B, Kowalski L P. Videofluoroscopic evaluation after glossectomy.  Arch Otolaryngol Head Neck Surg. 2000;  126 378-383
• 9 Hamlet S, Jones L, Mathog R, Bolton M, Patterson R. Bolus propulsive activity of the tongue in dysphagic cancer patients.  Dysphagia. 1988;  3 18-23
• 10 Lazarus C, Logemann J A, Gibbons P. Effects of maneuvers on swallowing function in a dysphagic oral cancer patient.  Head Neck. 1993;  15 419-424
• 11 Lazarus C L, Logemann J A, Pauloski B R et al.. Swallowing and tongue function following treatment for oral and oropharyngeal cancer.  J Speech Hear Res. 2000;  43 1011-1023
• 12 Logemann J A, Pauloski B R, Rademaker A W et al.. Speech and swallow function after tonsil/base of tongue resection with primary closure.  J Speech Hear Res. 1993;  36 918-926
• 13 Pauloski B R, Logemann J A, Fox J C, Colangelo L A. Biomechanical analysis of the pharyngeal swallow in postsurgical patients with anterior tongue and floor of mouth resection and distal flap reconstruction.  J Speech Hear Res. 1995;  38 110-123
• 14 Pauloski B R, Logemann J A, Rademaker A W et al.. Speech and swallowing function after oral and oropharyngeal resections: one-year follow-up.  Head Neck. 1994;  16 313-322
• 15 Pauloski B R, Rademaker A W, Logemann J A, Colangelo L. Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients.  Otolaryngol Head Neck Surg. 1998;  118 616-624
• 16 Mendenhall W M, Stringer S P, Amdur R J, Hinerman R W, Moore-Higgs G J, Cassisi N J. Is radiation therapy a preferred alternative to surgery for squamous cell carcinoma of the base of tongue?.  J Clin Oncol. 2000;  18 35-42
• 17 Sessions D G, Leonx J, Spector G J, Chao C, Chaudry O A. Analysis of treatment results for base of tongue cancer.  Laryngoscope. 2003;  113 1252-1261
• 18 Vokes E E, Kies M, Haraf D J et al.. Induction chemotherapy followed by concomitant chemoradiotherapy for advanced head and neck cancer: impact on the natural history of the disease.  J Clin Oncol. 1995;  13 876-883
• 19 Connor N P, Cohen S B, Kammer R E et al.. Impact of conventional radiotherapy on health-related quality of life and critical functions of the head and neck.  Int J Radiat Oncol Biol Phys. 2006;  65 1051-1062
• 20 Goguen L A, Posner M R, Norris C M et al.. Dysphagia after sequential chemoradiation therapy for advanced head and neck cancer.  Otolaryngol Head Neck Surg. 2006;  134 916-922
• 21 Hammerlid E, Mercke C, Sullivan M, Westin T. A prospective quality of life study of patients with laryngeal carcinoma by tumor stage and different radiation therapy schedules.  Laryngoscope. 1998;  108 747-759
• 22 List M A, Bilir S, Pinar E. Evaluations of quality of life and organ function.  Semin Oncol. 2004;  31 827-835
• 23 Lovell S J, Wong H B, Loh K S, Ngo R Y, Wilson J A. Impact of dysphagia on quality-of-life in nasopharyngeal carcinoma.  Head Neck. 2005;  27 864-872
• 24 Carrara-de Angelis E, Feher O, Barros A PB, Nishimoto I B, Kowalski L P. Voice and swallowing in patients enrolled in a larynx preservation trial.  Arch Otolaryngol Head Neck Surg. 2003;  129 733-738
• 25 Hughes P J, Scott P M, Kew J et al.. Dysphagia in treated nasopharyngeal cancer.  Head Neck. 2000;  22 393-397
• 26 Kendall K A, McKenzie S W, Leonard R J, Jones C. Structural mobility in deglutition after single modality treatment of head and neck carcinomas with radiotherapy.  Head Neck. 1988;  20 720-725
• 27 Koch W M, Lee D J, Eisele D W et al.. Chemoradiotherapy for organ preservation in oral and pharyngeal carcinoma.  Arch Otolaryngol Head Neck Surg. 1995;  121 974-980
• 28 Kotz T, Abraham S, Beitler J, Wadler S, Smith R V. Pharyngeal transport dysfunction consequent to an organ-sparing protocol.  Arch Otolaryngol Head Neck Surg. 1999;  125 410-413
• 29 Lazarus C, Logemann J A, Pauloski B R et al.. Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy.  Laryngoscope. 1996;  106 1157-1166
• 30 Logemann J A, Rademaker A W, Pauloski B R et al.. Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation.  Head Neck. 2006;  28 64-73
• 31 Smith R V, Kotz T, Beitler J J, Wadler S. Long-term swallowing problems after organ preservation therapy with concomitant radiation therapy and intravenous hydroxyurea.  Arch Otolaryngol Head Neck Surg. 2000;  126 384-389
• 32 Eisele D W, Koch D G, Tarazi A E, Jones B. Aspiration from delayed radiation fibrosis of the neck.  Dysphagia. 1991;  6 120-122
• 33 Eisbruch A, Schwartz M, Rasch C et al.. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT?.  Int J Radiation Oncology Biol Physics. 2004;  60 1425-1439
• 34 Ekberg O, Nylander G. Pharyngeal dysfunction after treatment for pharyngeal cancer with surgery and radiotherapy.  Gastrointest Radiol. 1983;  8 97-104
• 35 Logemann J A. Aspiration in head and neck surgical patients.  Ann Otol Rhinol Laryngol. 1985;  94 373-376
• 36 Smith C H, Logemann J A, Colangelo L, Rademaker A W, Pauloski B R. Incidence and patient characteristics associated with silent aspiration in the acute care setting.  Dysphagia. 1999;  14 1-7
• 37 Lazarus C L. Effects of radiation therapy and voluntary maneuvers on swallow function in head and neck cancer patients.  Clin Communication Disord. 1993;  3 11-20
• 38 Nguyen N P, Moltz C C, Frank C et al.. Severity and duration of chronic dysphagia following treatment for head and neck cancer.  Anticancer Res. 2005;  25 2929-2934
• 39 Law M P. Radiation-induced vascular injury and its relation to late effects in normal tissues. In: Advances in Radiation Biology.  Academic Press. 1981;  37-73
• 40 Ben-Yosef R, Kapp D S. Persistent and/or late complications of combined radiation therapy and hyperthermia.  Int J Hyperthermia. 1992;  8 733-745
• 41 Bentzen S M, Turesson I, Thames H D. Fractionation sensitivity and latency of telangiectasia after postmastectomy radiotherapy: a graded-response analysis.  Radiother Oncol. 1990;  18 95-106
• 42 Watkin K L, Diouf I, Gallagher T M, Logemann J A, Rademaker A W, Ettema S L. Ultrasonic quantification of geniohyoid cross-sectional area and tissue composition: a preliminary study of age and radiation effects.  Head Neck. 2001;  23 467-474
• 43 Gorodetsky R, Amir G, Yarom R. Effect of ionizing radiation on neuromuscular junctions in mouse tongues.  Int J Radiat Biol. 1992;  61 539-544
• 44 Kahn M Y. Radiation-induced changes in skeletal muscle.  J Neuropathol Exp Neurol. 1974;  33 42-57
• 45 Love S, Gomez S. Effects of experimental radiation-induced hypomyelinating neuropathy on motor end-plates and neuromuscular transmission.  J Neurol Sci. 1984;  65 93-109
• 46 Wilson P, Forer A. Irradiation of rabbit myofibrils with an ultraviolet microbeam. I. Effects of ultraviolet light on the myofibril components necessary for contraction.  Biochem Cell Biol. 1987;  65 363-375
• 47 Brown A P, Fixsen J A, Plowman P N. Local control of Ewing's sarcoma: an analysis of 67 patients.  Br J Radiol. 1987;  60 261-268
• 48 Stinson S F, DeLaney T F, Greenberg J et al.. Acute and long-term effects on limb function of combined modality limb sparing therapy for extremity soft tissue sarcoma.  Int J Radiat Oncol Biol Phys. 1991;  21 1493-1499
• 49 Lazarus C L. Effects of radiotherapy on tongue strength in head and neck cancer patients. Poster presented at: the annual American Speech-Language-Hearing Association meeting 2005 San Diego, CA;
• 50 Robbins J, Levine R, Wood J, Roecker E B, Luschei E. Age effects on lingual pressure generation as a risk factor for dysphagia.  J Gerontol. 1995;  50 M257-M262
• 51 Rademaker A W, Pauloski B R, Logemann J A, Shanahan T K. Oropharyngeal swallow efficiency as a representative measure of swallowing function.  J Speech Hear Res. 1994;  37 314-325
• 52 Reimers-Neils L, Logemann J A, Larson C. Viscosity effects on EMG activity in normal swallow.  Dysphagia. 1994;  9 101-106
• 53 Clark H M, Henson P A, Barber W D, Stierwalt J AG, Sherrill M. Relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments.  Am J Speech Lang Pathol. 2004;  12 40-50
• 54 Kays S A, Robbins J, Hind J A, Hewitt A, Gangnon R. Effects of lingual exercise on swallowing-related outcomes after stroke. Poster presented at: the American Speech Language Hearing Association annual convention November 18, 2004 Philadelphia, PA;
• 55 Rosenbek J, Robbins J, Roecker E B. A penetration-aspiration scale.  Dysphagia. 1996;  11 93-96
• 56 Robbins J, Coyle J, Rosenbek J, Roecker E, Wood J. Differentiation of normal and abnormal airway protection during swallowing using the penetration-aspiration scale.  Dysphagia. 1999;  14 228-232
• 57 Fiatarone M A, Marks E C, Ryan N D, Meredith C N, Lipsitz L A, Evans W J. High intensity strength training in nonagenarians: effects on skeletal muscle.  JAMA. 1990;  263 3029-3034
• 58 Frontera W R, Meredith C N, O’Reilly K P, Knuttgen H G, Evans W J. Strength conditioning in older men: skeletal muscle hypertrophy and improved function.  J Appl Physiol. 1988;  64 1038-1044
• 59 McCartney N, Hicks A L, Martin J, Webber C E. Long-term resistance training in the elderly: Effects on dynamic strength, exercise capacity, muscle and bone.  J Gerontol. 1995;  52 B97-B104
• 60 Milner-Brown H S, Miller R. Muscle strengthening through high-resistance weight training in patients with neuromuscular disorders.  Arch Phys Med Rehabil. 1988;  69 14-19
• 61 Phillips W, Hazeldene R. Strength and muscle mass changes in elderly men following maximal isokinetic training.  Gerontology. 1996;  42 114-120
• 62 Latham N K, Derrick A, Bennett D A et al.. Systematic review of progressive resistance strength training in older adults.  J Gerontol A Biol Sci Med Sci. 2004;  59 M48-M61
• 63 Ivey F M, Tracy B L, Lemmer J T et al.. Effects of strength training and detraining on muscle quality: age and gender comparisons.  J Gerontol A Biol Sci Med Sci. 2000;  55 B152-B157
• 64 LaStayo P C, Pierotti D J, Pifer J, Hoppeler H, Lindstedt S L. Eccentric ergometry: increases in locomotor muscle size and strength at low training intensities.  Am J Physiol Regul Integr Comp Physiol. 2000;  278 R1282-R1288
• 65 Jones D A, Rutherford O M. Human muscle strength training: the effects of three different regimens and the nature of the resultant changes.  J Gerontol A Biol Sci Med Sci. 2004;  59 M48-M61
• 66 Tracy B L, Ivey F M, Hurlbut D et al.. Muscle quality. II. Effects of strength training in 65- to 75-yr-old men and women.  J Appl Physiol. 1999;  86 195-201
• 67 Higbie E J, Cureton K J, Warren III G L, Prior B M. Effects of concentric and eccentric training on muscle strength, cross-sectional area, and neural activation.  J Appl Physiol. 1996;  81 2173-2181
• 68 Kauffman T L. Strength training effect in young and aged women.  Arch Phys Med Rehabil. 1985;  66 223-226
• 69 Häkkinen K, Alén M, Komi P V. Changes in isometric force- and relaxation-time, electromyographic and muscle fibre characteristics of human skeletal muscle during strength training and detraining.  Acta Physiologica Scandinavia. 1985;  125 573-585
• 70 Shepstone T N, Tang J E, Dallaire S, Schuenke M D, Staron R S, Phillips S M. Short-term high- vs. low-velocity isokinetic lengthening training results in greater hypertrophy of the elbow flexors in young men.  J Appl Physiol. 2005;  98 1768-1776
• 71 Lazarus C L, Logemann J A, Huang C H, Rademaker A W. Effects of two types of tongue strengthening exercises in young normals.  Folia Phoniatrica. 2004;  55 199-205
• 72 Robbins J, Gangnon R, Theis S, Kays S A, Hind J. The effects of lingual exercise on swallowing in older adults.  J Am Geriatr Soc. 2005;  53 1483-1489
• 73 Robin D A, Goel A, Somodi L B, Luschei E S. Tongue strength and endurance: relation to highly skilled movements.  J Speech Hear Res. 1992;  35 1239-1245
• 74 Robin D A, Somodi L B, Luschei E S. Measurement of tongue strength and endurance in normal and articulation disordered subjects. In: Moore CA, Yorkston KM, Beukelman DR Dysarthria and Apraxia of Speech: Perspectives on Management. Baltimore, MD; Paul H Brookes 1991: 173-184
• 75 Sullivan P, Hind J A, Roecker E B et al.. Lingual exercise protocol for head and neck cancer: a case study.  Dysphagia. 2001;  16 154 (Abst)
• 76 McHorney C A, Bricker E, Robbins J A, Kramer A E, Rosenbek J C, Chignell K A. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: II. Item reduction and preliminary scaling.  Dysphagia. 2000;  15 122-133