Objective: To investigate tongue strength in patients with Parkinson’s disease and the relation with speech and swallowing.

Background: Motor disorders in Parkinson’s disease (PD) are characterized by hypokinesie and rigidity, not by weakness. However, there is an ongoing debate whether tongue strength may become reduced in patients with PD, the extent to which tongue weakness relates to reduction of speech intelligibility and swallowing efficiency (1) and whether tongue strengthening exercises may lead to improvement of dysarthria or dysphagia.

Methods: We used the Iowa Oral Performance Instrument (IOPI) to assess tongue strength in 33 community-dwelling patients with PD (27 men), recruited via a speech pathologists network. The anterior and posterior tongue strength (maximum isometric pressure in kiloPascal) and endurance (in seconds) were measured following the protocol that was used to collect normal values in Belgium (2). In addition from all patients length, weight, disease duration and Hoehn & Yahr stage were collected, as well as the maximum swallowing speed (ml/s) and the severity of patients’ complaints about speech, swallowing and drooling with the Radboud Oral Motor inventory for Parkinson’s disease (ROMP).

Results: Mean age was 71.1 years and mean disease duration 7.4 years. The mean outcomes versus normal values were for anterior strength 41.8 kPa vs. 38.6 kPa (p = 0.23), posterior strength 35.5 kPa vs. 36.6 kPa (p = 0.69), anterior endurance 14.6 s vs. 25.1 s (p = 0.00) and posterior endurance 10.0 s vs. 16.5 s (p = 0.00). When comparing by age group, strength was equal in all groups, but higher in group 71-80 and endurance proved only lower in group 61-70 y. Tongue strength and endurance remained stable with H&Y stage and did not correlate with swallowing speed or ROMP score for speech or ROMP score for swallowing, but strength (r = 0.52 with p <0.01; r = 0.43 with p < 0.05) and anterior endurance (r = 0.39 with p <0.05) correlated with the ROMP score for drooling. However, swallowing speed was significantly dependent from age and H&Y stage (p = 0.042) and the total ROMP score from H&Y stage (p = 0.000).

Conclusions: Tongue strength does not seem to be diminished in patients with PD and endurance in some, when compared with Belgian normal values, while speech and swallowing decrease with age and disease severity as expected. However, a larger study group is required for more robust conclusions.

References: (1) Solomon, N. P., et al. (2000). “Strength, endurance, and stability of the tongue and hand in Parkinson disease.” J Speech Lang Hear Res 43(1): 256-267.

(2) Vanderwegen, J., et al. (2013). “The influence of age, sex, bulb position, visual feedback, and the order of testing on maximum anterior and posterior tongue strength and endurance in healthy belgian adults.” Dysphagia 28(2): 159-166.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/tongue-strength-in-parkinsons-disease/