, Volume 28, Issue 2, pp 159–166 | Cite as

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

  • Jan Vanderwegen
  • Cindy Guns
  • Gwen Van Nuffelen
  • Rik Elen
  • Marc De Bodt
Original Article


This study collected data on the maximum anterior and posterior tongue strength and endurance in 420 healthy Belgians across the adult life span to explore the influence of age, sex, bulb position, visual feedback, and order of testing. Measures were obtained using the Iowa Oral Performance Instrument (IOPI). Older participants (more than 70 years old) demonstrated significantly lower strength than younger persons at the anterior and the posterior tongue. Endurance remains stable throughout the major part of life. Gender influence remains significant but minor throughout life, with males showing higher pressures and longer endurance. The anterior part of the tongue has both higher strength and longer endurance than the posterior part. Mean maximum tongue pressures in this European population seem to be lower than American values and are closer to Asian results. The normative data can be used for objective assessment of tongue weakness and subsequent therapy planning of dysphagic patients.


Tongue Strength assessment Age-related changes Endurance Deglutition Deglutition disorders 



The authors thank Joke Buelens and Kim Lambeir for their invaluable help in collecting the data.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    McConnel FM. Analysis of pressure generation and bolus transit during pharyngeal swallowing. Laryngoscope. 1988;98(1):71–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Stierwalt JA, Youmans SR. Tongue measures in individuals with normal and impaired swallowing. Am J Speech Lang Pathol. 2007;16(2):148–56.PubMedCrossRefGoogle Scholar
  3. 3.
    Clark HM, Henson PA, Barber WD, Stierwalt JA, Sherrill M. Relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments. Am J Speech Lang Pathol. 2003;12(1):40–50.PubMedCrossRefGoogle Scholar
  4. 4.
    Robbins J, Levine R, Wood J, Roecker EB, Luschei E. Age effects on lingual pressure generation as a risk factor for dysphagia. J Gerontol A Biol Sci Med Sci. 1995;50(5):M257–62.PubMedCrossRefGoogle Scholar
  5. 5.
    Yoshida M, Kikutani T, Tsuga K, Utanohara Y, Hayashi R, Akagawa Y. Decreased tongue pressure reflects symptom of dysphagia. Dysphagia. 2006;21(1):61–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Youmans SR, Stierwalt JA. Measures of tongue function related to normal swallowing. Dysphagia. 2006;21(2):102–11.PubMedCrossRefGoogle Scholar
  7. 7.
    Youmans SR, Youmans GL, Stierwalt JA. Differences in tongue strength across age and gender: is there a diminished strength reserve? Dysphagia. 2009;24(1):57–65.PubMedCrossRefGoogle Scholar
  8. 8.
    Crow HC, Ship JA. Tongue strength and endurance in different aged individuals. J Gerontol A Biol Sci Med Sci. 1996;51(5):M247–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Nicosia MA, Hind JA, Roecker EB, Carnes M, Doyle J, Dengel GA, et al. Age effects on the temporal evolution of isometric and swallowing pressure. J Gerontol A Biol Sci Med Sci. 2000;55(11):M634–40.PubMedCrossRefGoogle Scholar
  10. 10.
    Lazarus CL, Logemann JA, Pauloski BR, Rademaker AW, Larson CR, Mittal BB, et al. Swallowing and tongue function following treatment for oral and oropharyngeal cancer. J Speech Lang Hear Res. 2000;43(4):1011–23.PubMedGoogle Scholar
  11. 11.
    Robin DA, Goel A, Somodi LB, Luschei ES. Tongue strength and endurance: relation to highly skilled movements. J Speech Hear Res. 1992;35(6):1239–45.PubMedGoogle Scholar
  12. 12.
    Kays SA, Hind JA, Gangnon RE, Robbins J. Effects of dining on tongue endurance and swallowing-related outcomes. J Speech Lang Hear Res. 2010;53(4):898–907.PubMedCrossRefGoogle Scholar
  13. 13.
    Albert SM, Alam M, Nizamuddin M. Comparative study of functional limitation and disability in old age: Delhi and New York City. J Cross Cult Gerontol. 2005;20(3):231–41.PubMedCrossRefGoogle Scholar
  14. 14.
    Rantanen T, Guralnik JM, Leveille S, Izmirlian G, Hirsch R, Simonsick E, et al. Racial differences in muscle strength in disabled older women. J Gerontol A Biol Sci Med Sci. 1998;53(5):B355–61.PubMedCrossRefGoogle Scholar
  15. 15.
    Newman AB, Haggerty CL, Goodpaster B, Harris T, Kritchevsky S, Nevitt M, et al. Strength and muscle quality in a well-functioning cohort of older adults: the health, aging and body composition study. J Am Geriatr Soc. 2003;51(3):323–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Andersen-Ranberg K, Petersen I, Frederiksen H, Mackenbach JP, Christensen K. Cross-national differences in grip strength among 50+ year-old Europeans: results from the SHARE study. Eur J Ageing. 2009;6(3):227–36.CrossRefGoogle Scholar
  17. 17.
    Vitorino J. Effect of age on tongue strength and endurance scores of healthy Portuguese speakers. Int J Speech Lang Pathol. 2010;12(3):237–43.PubMedCrossRefGoogle Scholar
  18. 18.
    Lazarus C, Logemann JA, Huang CF, Rademaker AW. Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatr Logop. 2003;55(4):199–205.PubMedCrossRefGoogle Scholar
  19. 19.
    Clark HM, Solomon NP. Age and sex differences in orofacial strength. Dysphagia. 2012;27(1):2–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Solomon NP, Munson B. The effect of jaw position on measures of tongue strength and endurance. J Speech Lang Hear Res. 2004;47(3):584–94.PubMedCrossRefGoogle Scholar
  21. 21.
    Utanohara Y, Hayashi R, Yoshikawa M, Yoshida M, Tsuga K, Akagawa Y. Standard values of maximum tongue pressure taken using newly developed disposable tongue pressure measurement device. Dysphagia. 2008;23(3):286–90.PubMedCrossRefGoogle Scholar
  22. 22.
    Solomon NP, Robin DA, Luschei ES. Strength, endurance, and stability of the tongue and hand in Parkinson disease. J Speech Lang Hear Res. 2000;43(1):256–67.PubMedGoogle Scholar
  23. 23.
    Solomon NP. Assessment of tongue weakness and fatigue. Int J Orofacial Myology. 2004;30:8–19.PubMedGoogle Scholar
  24. 24.
    Palmer PM, Neel AT, Sprouls G, Morrison L. Swallow characteristics in patients with oculopharyngeal muscular dystrophy. J Speech Lang Hear Res. 2010;53(6):1567–78.PubMedCrossRefGoogle Scholar
  25. 25.
    Robbins J, Hamilton JW, Lof GL, Kempster GB. Oropharyngeal swallowing in normal adults of different ages. Gastroenterology. 1992;103(3):823–9.PubMedGoogle Scholar
  26. 26.
    Butler SG, Stuart A, Leng X, Wilhelm E, Rees C, Williamson J, et al. The relationship of aspiration status with tongue and handgrip strength in healthy older adults. J Gerontol A Biol Sci Med Sci. 2011;66(4):452–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Jan Vanderwegen
    • 1
    • 2
    • 4
  • Cindy Guns
    • 2
  • Gwen Van Nuffelen
    • 2
  • Rik Elen
    • 3
  • Marc De Bodt
    • 2
  1. 1.Department of Otolaryngology, Head and Neck SurgerySaint-Pierre University HospitalBrusselsBelgium
  2. 2.Department of Otolaryngology and Communication DisordersAntwerp University HospitalAntwerpBelgium
  3. 3.Lessius University CollegeAntwerpBelgium
  4. 4.HaachtBelgium

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