Evaluating the Tongue-Hold Maneuver Using High-Resolution Manometry and Electromyography
Evaluating the Tongue-Hold Maneuver Using High-Resolution Manometry and Electromyography
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DOI：
10.1007/s00455-014-9545-6
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发表时间：
2014-10-01
期刊：
影响因子：
2.6
通讯作者：
McCulloch, Timothy M.
中科院分区：
文献类型：
--
作者：
Hammer, Michael J.;Jones, Corrine A.;McCulloch, Timothy M.
握舌手法是一种广泛使用的临床技术，旨在增加吞咽困难患者的咽后壁运动。据推测，按住舌头的动作会导致咽上缩肌收缩增加。然而，仍然需要对舌头保持舌头时的咽部和舌头进行肌电研究，以了解吞咽肌肉的活动和压力是否以及如何随着这种动作的变化而变化。我们测试了8名健康的年轻受试者，在三种任务条件下，包括(A)不动吞咽唾液，(B)舌尖在嘴唇处吞咽唾液，(C)在舌头保持动作时吞咽唾液，同时使用高分辨率测压技术对8名年轻受试者进行肌内肌电测试。我们测试了一种假设，即在实验任务期间，舌头和咽部肌肉的活动会增加，但咽部压力相对保持不变。我们发现吞咽前的舌肌、咽缩肌和环咽肌的活动增加。在吞咽过程中，舌肌和咽缩肌的活动幅度和持续时间都增加。然而，压力和持续时间保持不变。这些结果表明，在没有舌后运动的情况下，咽上缩肌活动的增加可能有助于维持相对稳定的咽压。因此，舌头保持动作可能是一个相对简单但健壮的例子，说明延髓吞咽中心是如何配备来动态协调舌头和咽部之间的动作的。我们的研究结果强调了综合评估吞咽功能的必要性，包括高分辨率测压和肌内肌电描记，以评估临床人群舌头保持动作的潜在益处。
The tongue-hold maneuver is a widely used clinical technique designed to increase posterior pharyngeal wall movement in individuals with dysphagia. It is hypothesized that the tongue-hold maneuver results in increased contraction of the superior pharyngeal constrictor. However, an electromyographic study of the pharynx and tongue during the tongue-hold is still needed to understand whether and how swallow muscle activity and pressure may change with this maneuver. We tested eight healthy young participants using simultaneous intramuscular electromyography with high-resolution manometry during three task conditions including (a) saliva swallow without maneuver, (b) saliva swallow with the tongue tip at the lip, and (c) saliva swallow during the tongue-hold maneuver. We tested the hypothesis that tongue and pharyngeal muscle activity would increase during the experimental tasks, but that pharyngeal pressure would remain relatively unchanged. We found that the pre-swallow magnitude of tongue, pharyngeal constrictor, and cricopharyngeus muscle activity increased. During the swallow, the magnitude and duration of tongue and pharyngeal constrictor muscle activity each increased. However, manometric pressures and durations remained unchanged. These results suggest that increased superior pharyngeal constrictor activity may serve to maintain relatively stable pharyngeal pressures in the absence of posterior tongue movement. Thus, the tongue-hold maneuver may be a relatively simple but robust example of how the medullary swallow center is equipped to dynamically coordinate actions between tongue and pharynx. Our findings emphasize the need for combined modality swallow assessment to include high-resolution manometry and intramuscular electromyography to evaluate the potential benefit of the tongue-hold maneuver for clinical populations.