{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T09:19:14Z","timestamp":1775035154763,"version":"3.50.1"},"reference-count":21,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2019,10,26]],"date-time":"2019-10-26T00:00:00Z","timestamp":1572048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Dysphagia refers to difficulty in swallowing often associated with syndromic disorders. In dysphagic patients\u2019 rehabilitation, tongue motility is usually treated and monitored via simple exercises, in which the tongue is pushed against a depressor held by the speech therapist in different directions. In this study, we developed and tested a simple pressure\/force sensor device, named \u201cTonic Tongue (ToTo)\u201d, intended to support training and monitoring tasks for the rehabilitation of tongue musculature. It consists of a metallic frame holding a ball bearing support equipped with a sterile disposable depressor, whose angular displacements are counterbalanced by extensional springs. The conversion from angular displacement to force is managed using a simple mechanical model of ToTo operation. Since the force exerted by the tongue in various directions can be estimated, quantitative assessment of the outcome of a given training program is possible. A first prototype of ToTo was tested on 26 healthy adults, who were trained for one month. After the treatment, we observed a statistically significant improvement with a force up to 2.2 N (median value) in all tested directions of pushing, except in the downward direction, in which the improvement was slightly higher than 5 N (median value). ToTo promises to be an innovative and reliable device that can be used for the rehabilitation of dysphagic patients. Moreover, since it is a self-standing device, it could be used as a point-of-care solution for in-home rehabilitation management of dysphasia.<\/jats:p>","DOI":"10.3390\/s19214657","type":"journal-article","created":{"date-parts":[[2019,10,28]],"date-time":"2019-10-28T04:44:31Z","timestamp":1572237871000},"page":"4657","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Tongue Rehabilitation Device for Dysphagic Patients"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8429-5544","authenticated-orcid":false,"given":"Mario","family":"Milazzo","sequence":"first","affiliation":[{"name":"The BioRobotics Institute, Scuola Superiore Sant\u2019Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera (PI), Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0473-7037","authenticated-orcid":false,"given":"Andrea","family":"Panepinto","sequence":"additional","affiliation":[{"name":"Department of Surgical, Medical, Molecular Pathology and Emergency Care, University of Pisa, via Savi 10, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelo Maria","family":"Sabatini","sequence":"additional","affiliation":[{"name":"The BioRobotics Institute, Scuola Superiore Sant\u2019Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera (PI), Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8155-8537","authenticated-orcid":false,"given":"Serena","family":"Danti","sequence":"additional","affiliation":[{"name":"The BioRobotics Institute, Scuola Superiore Sant\u2019Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera (PI), Italy"},{"name":"Department of Civil and Industrial Engineering, University of Pisa, Largo L. Lazzarino, 2, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,10,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"953","DOI":"10.2214\/ajr.154.5.2108569","article-title":"Physiology and radiology of the normal oral and pharyngeal phases of swallowing","volume":"154","author":"Dodds","year":"1990","journal-title":"Am. J. Roentgenol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"M257","DOI":"10.1093\/gerona\/50A.5.M257","article-title":"Age effects on lingual pressure generation as a risk factor for dysphagia","volume":"50","author":"Robbins","year":"1995","journal-title":"J. Gerontol. A-Biol."},{"key":"ref_3","unstructured":"Dotiwala, A.K., and Samra, N.S. (2019, September 10). Anatomy, Head and Neck, Tongue, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK507782\/."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1007\/BF02493526","article-title":"Dysphagia and its consequences in the elderly","volume":"6","author":"Tibbling","year":"1991","journal-title":"Dysphagia"},{"key":"ref_5","first-page":"1041","article-title":"Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional management for stroke patients","volume":"169","author":"Finestone","year":"2003","journal-title":"CMAJ"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Arsava, E.M. (2017). Dysphagia Rehabilitation. Nutrition in Neurologic Disorders, Springer Nature.","DOI":"10.1007\/978-3-319-53171-7"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s00455-005-9011-6","article-title":"Decreased tongue pressure reflects symptom of dysphagia","volume":"21","author":"Yoshida","year":"2006","journal-title":"Dysphagia"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s00455-004-0010-9","article-title":"Pattern of tongue pressure on hard palate during swallowing","volume":"19","author":"Ono","year":"2004","journal-title":"Dysphagia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e17056","DOI":"10.1097\/MD.0000000000017056","article-title":"Swallowing apraxia in a patient with recurrent ischemic strokes: A case report","volume":"98","author":"Yun","year":"2019","journal-title":"Medicine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1044\/2016_AJSLP-15-0051","article-title":"A Systematic Review of Isometric Lingual Strength-Training Programs in Adults with and without Dysphagia","volume":"26","author":"McKenna","year":"2017","journal-title":"Am. J. Speech. Lang. Pathol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1055\/s-0033-1358368","article-title":"Approaches to the rehabilitation of dysphagia in acute poststroke patients","volume":"34","author":"Robbins","year":"2013","journal-title":"Semin. Speech Lang."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/BF02412424","article-title":"Pressure-flow dynamics of the oral phase of swallowing","volume":"3","author":"Shaker","year":"1988","journal-title":"Dysphagia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"16","DOI":"10.2186\/prp.1.16","article-title":"Influence of Changes in Occlusal Vertical Dimension on Tongue Pressure to Palate during Swallowing","volume":"1","author":"Nagao","year":"2002","journal-title":"Prosthodont. Res. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"M634","DOI":"10.1093\/gerona\/55.11.M634","article-title":"Age effects on the temporal evolution of isometric and swallowing pressure","volume":"55","author":"Nicosia","year":"2000","journal-title":"J. Gerontol. A-Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e1078","DOI":"10.1111\/j.1741-2358.2011.00615.x","article-title":"Maximal voluntary tongue pressure is decreased in Japanese frail elderly persons","volume":"29","author":"Tsuga","year":"2012","journal-title":"Gerodontology"},{"key":"ref_16","first-page":"385","article-title":"A novel handy probe for tongue pressure measurement","volume":"15","author":"Hayashi","year":"2002","journal-title":"Int. J. Prosthodont."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1007\/s00455-007-9142-z","article-title":"Standard values of maximum tongue pressure taken using newly developed disposable tongue pressure measurement device","volume":"23","author":"Utanohara","year":"2008","journal-title":"Dysphagia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.jpor.2008.08.008","article-title":"Newly developed sensor sheet for measuring tongue pressure during swallowing","volume":"53","author":"Hori","year":"2009","journal-title":"J. Prosthodont. Res."},{"key":"ref_19","unstructured":"(2019, October 15). Abilex* Oral Motor Exerciser. Available online: https:\/\/getabilex.com\/."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1007\/s00455-006-9013-z","article-title":"Measures of tongue function related to normal swallowing","volume":"21","author":"Youmans","year":"2006","journal-title":"Dysphagia"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1080\/17549507.2017.1387285","article-title":"Expiratory muscle strength training improves swallowing and respiratory outcomes in people with dysphagia: A systematic review","volume":"21","author":"Brooks","year":"2019","journal-title":"Int. J. Speech Lang. Pathol."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/19\/21\/4657\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:29:39Z","timestamp":1760189379000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/19\/21\/4657"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,26]]},"references-count":21,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2019,11]]}},"alternative-id":["s19214657"],"URL":"https:\/\/doi.org\/10.3390\/s19214657","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,26]]}}}