Tongue strength and endurance among typically developing children and children with idiopathic speech sound disorders in the United Arab Emirates

PLOS ONE RESEARCH ARTICLE Tongue strength and endurance among typically developing children and children with idiopathic speech sound disorders in the United Arab Emirates Mohammed Safi ID1, Dalia Mohammad Alzyod2, Maxwell Peprah Opoku ID3*, Yasser E. Agamy4 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Speech Language Pathology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE, 2 Speech Language Pathologist, United Arab Emirates University, Al Ain, UAE, 3 Special Education Department, College of Education, United Arab Emirates University, Al Ain, UAE, 4 General Physician and Clinical Tutor, Thumbay University Hospital Complex, Ajman, United Arab Emirates * Abstract OPEN ACCESS Citation: Safi M, Alzyod DM, Opoku MP, Agamy YE (2023) Tongue strength and endurance among typically developing children and children with idiopathic speech sound disorders in the United Arab Emirates. PLoS ONE 18(7): e0289400. https://doi.org/10.1371/journal.pone.0289400 Editor: Nour Shaheen, Alexandria Medicine: Alexandria University Faculty of Medicine, EGYPT Received: April 13, 2023 Background Tongue strength and endurance in adults have been extensively studied, but data on these parameters in young children remain largely unavailable. Aims This study aimed to collect normative objective tongue strength and endurance data from a pediatric population in the United Arab Emirates (UAE) and to examine the effects of age and sex on these parameters. Accepted: July 18, 2023 Published: July 31, 2023 Methods Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0289400 This normative study included a total of 65 typically developing (TD; n = 36) children and children with idiopathic speech sound disorders (ISSDs; n = 29). The participants were assigned to four age groups (range: 3–8 years) and stratified by sex. Data on their tongue strength and endurance were collected using the Iowa Oral Performance Instrument. Copyright: © 2023 Safi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Tongue strength scores and endurance time increased with age in both the TD and ISSD groups. Sex had no statistically significant effects on tongue strength or endurance in either group. Furthermore, tongue strength and endurance time scores were higher in the TD group than in the ISSD group. Data Availability Statement: Data cannot be shared publicly because of ethical restrictions. Data are available from the United Arab Emirates University Ethics Committee (contact via research. Conclusions Results The data obtained in this study would add important normative data to the database of standardized measurements for maximal strength and endurance scores in the pediatric PLOS ONE | https://doi.org/10.1371/journal.pone.0289400 July 31, 2023 1 / 13 PLOS ONE ) for researchers who meet the criteria for access to confidential data. Funding: The author(s) received no specific funding for this work. Tongue strength and endurance among young children in the UAE population of the UAE. Future research is encouraged to collect additional data that can help healthcare professionals objectively evaluate children with feeding, swallowing, and speech sound production difficulties. Competing interests: The authors have declared that no competing interests exist. Introduction The tongue is an important muscle that plays a dual role in swallowing and speech mechanisms. Anatomically, it consists of two muscle groups (intrinsic and extrinsic); precise changes in their positions and pressure accomplish different functions [1]. Normal swallowing requires the maintenance of adequate tongue pressure and endurance [2]. Consequently, the assessment of tongue strength and endurance and their effects on swallowing and speech is an important component of the comprehensive evaluation of speech and language [3]. Objective lingual muscle strength measurement is also an essential addition to clinical evaluation and should replace subjective measurements [4]. Therefore, there has been a recent movement in clinical research toward the development of objective tongue strength measurement tools [4]. Unfortunately, studies on tongue strength and endurance are rare in the Middle East. Several devices are used by clinicians to measure tongue strength data and facilitate therapy planning and training. For instance, SwallowSTRONG (Swallow Solutions, LLC, Madison, WI, USA) uses sensors in the mouthpiece to measure tongue pressure at four locations [5, 6]. Similarly, Tongueometer™ (E2 Scientific Corp., Walnut, CA, USA) is a device that offers four modules for assessing and increasing tongue strength and endurance, in addition to providing easy data and report access through mobile applications [7]. Another device is the Iowa Oral Performance Instrument (IOPI1), which is used to measure tongue strength, tongue endurance, and lips is measured by recording the maximum pressure produced by an individual via pressing an air-filled bulb against the hard palate with the tongue [8, 9]. The IOPI1 has been used successfully in studies on oral phase swallowing function in dysphagic populations [9] and is considered a standard tool for tongue pressure measurements and lingual muscle-strengthening interventions [10]. It reportedly has good inter-rater reliability [11] and test–retest reliability [12] for tongue endurance. In a more recent study, Potter et al. [13] reported high intrasubject test–retest reliability (r = 0.89) in the control group during evaluation. This probably makes the IOPI a useful tool for studying tongue strength and endurance among children in a novel context, such as the UAE. Although there are abundant data related to tongue strength and endurance in the adult population [9, 14, 15], data on these parameters remain limited in the pediatric population [15–20]. Demographic differences in muscle strength exist. In fact, the effects of child characteristics, such as age and gender, on skeletal muscle strength have been well established [21]. Although inconclusive, findings on the effects of demographic variables on tongue strength have been found to be nonstatic [21–25]. For instance, replication studies comparing the tongue strength data of English speakers with those of Portuguese, French, and Korean speakers have found cultural differences. For instance, Vitorino [25] reported that healthy Portuguese speakers had lower tongue endurance scores compared with English speakers. Jeong et al. [22] compared the tongu (...truncated)