Development of a Prototype Tongue Strength Measurement Device and Evaluation of the Test–Retest Reliability of Tongue Strength and Isometric Endurance: A Psychometric Study

Document Type : Original Articles

Authors
Peyman Amirifar 1
Marziyeh Poorjavad 2
1 Department of Speech Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
2 PhD, Department of Speech Therapy, School of Rehabilitation Sciences AND Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
10.48305/jrrs.2026.46962.1174
Abstract
Introduction: The tongue plays a vital role in swallowing and speech, and neurological disorders such as stroke may cause tongue weakness and functional impairment. Conventional tongue strength assessment is predominantly qualitative and dependent on clinical judgment, limiting its ability to quantify tongue pressure and monitor functional changes. Given the lack of commercially available tongue-strength measurement devices in Iran, this study aimed to design and develop a prototype device and to evaluate the test–retest reliability of tongue-strength and isometric-endurance measurements in healthy young adults.
Materials and Methods: The study comprised two phases. In the first phase, a prototype device was designed and developed. In the second phase, the test–retest reliability of tongue strength and isometric endurance measurements was assessed in 50 healthy young adults.
Results: A device incorporating a thin, flexible sensor was developed. The device was easy to use in healthy individuals and was designed to measure four indices of tongue function: strength, isometric endurance, isotonic endurance, and power. Test–retest analysis demonstrated statistically significant agreement between measurements obtained at the two assessment sessions for both tongue strength and isometric endurance. The intraclass correlation coefficients were 90% for tongue strength and 91% for isometric endurance.
Conclusion: The prototype was designed to assess four indices of tongue function: strength, isometric endurance, isotonic endurance, and power. The reliability assessment demonstrated very high reproducibility of tongue strength and isometric endurance measurements in healthy young adults. Further studies are needed to examine reliability in older adults and in individuals with oropharyngeal impairments, and to establish the validity of measurements obtained with the device.
Keywords
Dysphagia
Instrumental assessment
Tongue
Strength
Endurance
Subjects
1.     Sasegbon A, Hamdy S. The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia. Neurogastroenterology and motility: the official journal of the European Gastrointestinal Motility Society. 2017; 29(11): e13100.
2.     Lee JH, Kim HS, Yun DH, Chon J, Han YJ, Yoo SD, et al. The Relationship between Tongue Pressure and Oral Dysphagia in Stroke Patients. Annals of rehabilitation medicine. 2016; 40(4): 620-8.
3.     Christmas C, Rogus-Pulia N. Swallowing Disorders in the Older Population. Journal of the American Geriatrics Society. 2019; 67(12): 2643-9.
4.     Cullins MJ, Connor NP. Reduced tongue force and functional swallowing changes in a rat model of post stroke dysphagia. Brain Research. 2019; 1717: 160-6.
5.     Potter NL, Bajwa A, Wilson EH, VanDam M. Developmental Changes in Tongue Strength, Swallow Pressures, and Tongue Endurance. Dysphagia. 2020; 36(5): 854-63.
6.     Youmans SR, Stierwalt JA. Measures of tongue function related to normal swallowing. Dysphagia. 2006; 21(2): 102-11.
7.     Kim HD, Choi JB, Yoo SJ, Chang MY, Lee SW, Park JS. Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. Journal of Oral Rehabilitation. 2017; 44(1): 59-64.
8.     Park JS, Lee SH, Jung SH, Choi JB, Jung YJ. Tongue strengthening exercise is effective in improving the oropharyngeal muscles associated with swallowing in community-dwelling older adults in South Korea: A randomized trial. Medicine. 2019; 98(40): e17304.
9.     Moon JH, Hahm SC, Won YS, Cho HY. The effects of tongue pressure strength and accuracy training on tongue pressure strength, swallowing function, and quality of life in subacute stroke patients with dysphagia: a preliminary randomized clinical trial. International Journal of Rehabilitation. 2018; 41(3): 204-10.
10. Husaini H, Krisciunas GP, Langmore S, Mojica JK, Urken ML, Jacobson AS, et al. A survey of variables used by
speech-language pathologists to assess function and predict functional recovery in oral cancer patients. Dysphagia. 2014; 29(3): 376-86.
11. Namiki C, Hara K, Tohara H, Kobayashi K, Chantaramanee A, Nakagawa K, et al. Tongue-pressure resistance training improves tongue and suprahyoid muscle functions simultaneously. Clinical interventions in aging. 2019; 14: 601-8.
12. Burkhead LM, Sapienza CM, Rosenbek JC. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia. 2007; 22(3): 251-65.
13. McCormack J, Casey V, Conway R, Saunders J, Perry A. OroPress a new wireless tool for measuring oro-lingual pressures: a pilot study in healthy adults. Journal of neuroengineering and rehabilitation. 2015; 12: 32.
14. Rezende BA, Furlan RMMM, Casas EBdL, Motta AR. Clinical assessment of the tongue in healthy young adults. Revista CEFAC. 2016; 18: 559-67.
15. Ball S, Idel O, Cotton SM, Perry A. Comparison of two methods for measuring tongue pressure during swallowing in people with head and neck cancer. Dysphagia. 2006; 21(1): 28-37.
16. Yoshikawa M, Yoshida M, Tsuga K, Akagawa Y, Groher ME. Comparison of three types of tongue pressure measurement devices. Dysphagia. 2011; 26(3): 232-7.
17. Yoshida M, Groher ME, Crary MA, Mann GC, Akagawa Y. Comparison of surface electromyographic (sEMG) activity of submental muscles between the head lift and tongue press exercises as a therapeutic exercise for pharyngeal dysphagia. Gerodontology. 2007; 24(2): 111-6.
18. Ono T, Hori K, Tamine K-i, Maeda Y. Evaluation of tongue motor biomechanics during swallowing—from oral feeding models to quantitative sensing methods. Japanese Dental Science Review. 2009; 45(2): 65-74.
19. Hewitt A, Hind J, Kays S, Nicosia M, Doyle J, Tompkins W, et al. Standardized instrument for lingual pressure measurement. Dysphagia. 2008; 23(1): 16-25.
20. Stojanović G, Radovanović M, Vasiljević D, Kojić T, Pivaš B, Puškar T, et al. Comparison of Performances of Flexible Tailor-Made Force Sensing Resistors Fabricated Using Inkjet and Xurographic Techniques. Journal of Sensors. 2019; 2019(1): 9181492.
21. Pérez B, Vito A, Sánchez I, Uzcátegui G, Gonzalez Y. Measuring occlusal bite forces with a force sensing resistor. 2014.
p. BSB25-BSB30.
22. Gu Y, Bai Y, Xie X. Bite Force Transducers and Measurement Devices. Frontiers in bioengineering and biotechnology. 2021; 9: 665081.
23. Clark HM. Specificity of training in the lingual musculature. Journal of speech, language, and hearing research: JSLHR. 2012; 55(2): 657-67.
24. Moon JH, Hong DG, Kim KH, Park YA, Hahm SC, Kim SJ, et al. Effects of lingual strength training on lingual strength and articulator function in stroke patients with dysarthria. Journal of Physical Therapy Science. 2017; 29(7): 1201-4.
25. Munro BH. Statistical methods for health care research: Lippincott Williams & Wilkins; 2005.
26. Clark HM, Henson PA, Barber WD, Stierwalt JA, Sherrill M. Relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments. American journal of speech-language pathology. 2003; 12(1): 40-50.