Strength Vs. Range of Motion
For so long, we have focused on lingual strength and range-of-motion.
Instruments for Measurement
We finally have a measurement scale for lingual range of motion.
C.L. Lazarus, H. Husaini, A.S. Jacobson, J.K. Mojica, D. Buchbinder, K. Okay, M.L. Urken. Development of a New Lingual Range-of-Motion Assessment Scale, Normative Data in Surgically Treated Oral Cancer Patients. Dysphagia (2014) 29:489-499.
This study compared results in treated surgical patients vs. healthy patients. 36 patients s/p oral tongue surgery with significantly decreased tongue range-of-motion and 31 healthy individuals.
The scale was validated by correlating range-of-motion with performance status, oral outcomes and patient-related Quality of Life.
The scale was made to define lingual deficits. This is a tool that can be used for baseline and post surgery tongue range-of-motion and to track changes over time with recovery and therapy.
Lingual protrusion was measured using the Therabite jaw range-of-motion measurement discs.
Protrusion Scores: (100) Normal: > or = 15 mm past the upper lip margin
(50) Mild-mod: >1mm but <15mm pasat the upper lip margin
(25) Severe: Some movement but unable to reach upper lip margin
(0) Total: No movement
Lateralization Scores: based on ability of the tongue to touch the commissures of the mouth. Measure both right and left side.
(100) Normal: able to fully touch the corner of the mouth.
(50) Mild-Moderate: 50% reduction of movement to corner of the mouth in either direction.
(25) Severe: >50% reduction in movement.
(0) Total: No movement.
(100) Normal: complete tongue tip contact with the upper alvoelar ridge.
(50) Moderate: tongue tip elevation but no contact with the upper alvoelar ridge.
(0) Severe: No visible tongue tip elevation
Total Scores were assigned by adding the protrusion score+ right lateralization score + left lateralization score + elevation score divided by 4.
Scores were 0-100:
0=severely impaired/totally impaired
During this study, tongue strength was measured using the Iowa Oral Performance Instrument.
Jaw range-of-motion was measure using the Therabite jaw range-of-motion measurement discs.
Saliva flow was measured using the Saxon test where the patient was asked to chew a sterile 4×4 piece of gauze for 2 minutes then spit the gauze in a cup. The gauze was weighed before and after mastication.
The Performance Status Scale was used to determine diet type, speech intelligibility, impact of surgery on ability to eat socially.
The study found that lingual range-of-motion can negatively affect all aspects of a patient’s life and correlates with performance and quality of life.