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Iowa Oral Performance Instrument

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on 29 November 2015

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Transcript of Iowa Oral Performance Instrument

63
MIP
kpa
Thank You!
Reduced Tongue Strength Implications
Longer oral transit times

Poor bolus control

Reduced oral and pharyngeal clearance

Increased risk of aspiration

Communication difficulties (dysarthria)

Original Purpose? Obtain tongue pressure readings in children.

Originally tested beam substrates that were available, but deemed unsuitable.

Pain, strength, or force?

Collaboration with Dr. Donald A. Robin to invent circuitry and test reliability.

Normal Tongue Physiology During Swallowing
WHY is the IOPI useful?
IOPI Overview
The Iowa Oral
Performance Instrument:
Maximizing Tongue Pressures for Functional Outcomes

Developer: Dr. Erich Luschei
WHEN is the IOPI useful?
Cerebrovascular Accident
Multiple Sclerosis
Parkinson's Disease
Amyotrophic Lateral Sclerosis*
Head and Neck Cancer
Oculomuscular Pharyngeal Dystrophy
Traumatic Brain Injury
Apraxia of Speech

WHO Should Use the IOPI?
CLINICAL PERSPECTIVES
Rehabilitative Viewpoint
34 kPa
50% of MIP
Endurance/Strength
Sample Therapy Plan
Pmax =
34 kPa

10
lingual press repetitions
3
times per day,
3
days per week for a period of
8
weeks




Sample Therapy Plan Week #1
Training Target: 60% of Pmax = 20 kPa

10 lingual press repetitions = 1 set
3 sets performed during 1 training session
3 training sessions per day
3 days of training per week
8 weeks of lingual resistance training

Sample Therapy Plan Weeks 2-8
80% of Pmax = Increasing therapy targets after recalibration

Training continues at new Pmax beginning at week 2
Swallowing pressures collected at weeks 2, 4, and 6
Isometric tongue pressures also collected at weeks 2, 4, and 6
Training concludes after week 8 and final measures taken
Isometric Progressive
Resistance Oropharyngeal (I-Pro Therapy)
Principles of Plasticity and
I-Pro Routines
Intensity
Repetition
Use it
or Lose it
Time
Specificity
IOPI Alternatives
Tongue Depressor?
Better than no treatment
Lacks benefit of biofeedback
Subjective measurement
An inexpensive alternative
More accessible


Swallow-STRONG
(Formerly known as Madison Oral
Strengthening Therapeutic Device)
DEMONSTRATION
Uncovering potential benefits of using the IOPI as a standard clinical screener
Deepen our understanding of tongue functioning along the swallowing continuum
Classifying MIP values and ranges into functional categories
Future Research Directions
IOPI Medical, 2013
Connor, 2003; Robbins, 2005
Maximum Isometric Tongue Pressure
Tongue Pressures During Swallowing
IOPI
FUNCTIONAL RESERVE
Robbins et al., 1995; Steele et al., 2013; Coyle et al., 2014
Clinical Swallowing Examination
Aims to identify poor tongue strength
< 40 kPa suggests impairment

Rehabilitative Method for Treatment
Aims to improve function of the tongue
Assess tongue pressures over time
Adams et. al, 2013
Biofeedback Expanded
DEMONSTRATION
Lip Compression
Maximum Tongue Pressure
Pmax Normal Population
Range = 40-80 kPa
Average = 63 kPa
Older Adults =
56 kPa
Pmax =
Tongue Elevation Strength
NORMATIVE DATA
IOPI, 2013
Loni Arrese, MS, CCC-SLP
Dr. Catriona Steele
T = Pmax x (E/100)
T= Target value
Pmax = Peak tongue pressure
E = Effort (%)
(American College of Sports Medicine, 1990)
IOPI Medical, 2013
Robbins et al., 2005
Robbins et al., 2005
(Robbins et al., 2005)
( Lazarus et al., 2003)
Limited Research
Cost factor
Cloud management system
Visual Biofeedback
Multiple pressure sensors
SwallowSolutions, 2014
References
1. Adams, V. et al., (2013). A Systematic Review and Meta-analysis of Measurements of Tongue and Hand
Strength and Endurance Using the Iowa Oral Performance Instrument (IOPI). Dysphagia, 350-369.
2. American College of Sports Medicine position stand. The recommended quantity and quality of exercise
for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exer 1990;22: 265–274.
3. Connor, N. (2008). Differences in Age-Related Alterations in Muscle Contraction Properties in Rat Tongue
and Hindlimb. Journal of Speech and Language Hearing Research, 51, 818-827.
4. Coyle et al., (2014). ASHA Convention: SwallowStrong Case Series
5. IOPI., http://www.iopimedical.com. 2013.
6. Lazarus, C. et al., (2003). Effects of Two Types of Tongue Strengthening Exercises in Young Normals. Folia
Phoniatrica Et Logopaedica, 199-205.
7. Robbins, J. et al., (1995). Age Effects on Lingual Pressure Generation as a Risk Factor for Dysphagia. The
Journals of Gerontology Series A: Biological Sciences and Medical Sciences, M257-M262.
8. Robbins et al.,(2005). The Effects Of Lingual Exercise On Swallowing In Older Adults. Journal of the
American Geriatrics Society, 1483-1489.
9. Steele, C. (2013). Optimal Approaches for Measuring Tongue-Pressure Functional Reserve. Journal of
Aging Research, 1-7.
10. SwallowSolutions., http://www.swallowsolutions.com. 2014




















Literature Review
Raele Robison and Jennifer Kordell
Full transcript