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Iowa Oral Performance Instrument
Transcript of Iowa Oral Performance Instrument
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?
The Iowa Oral
Maximizing Tongue Pressures for Functional Outcomes
Developer: Dr. Erich Luschei
WHEN is the IOPI useful?
Amyotrophic Lateral Sclerosis*
Head and Neck Cancer
Oculomuscular Pharyngeal Dystrophy
Traumatic Brain Injury
Apraxia of Speech
WHO Should Use the IOPI?
50% of MIP
Sample Therapy Plan
lingual press repetitions
times per day,
days per week for a period of
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
Resistance Oropharyngeal (I-Pro Therapy)
Principles of Plasticity and
or Lose it
Better than no treatment
Lacks benefit of biofeedback
An inexpensive alternative
(Formerly known as Madison Oral
Strengthening Therapeutic Device)
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
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
Maximum Tongue Pressure
Pmax Normal Population
Range = 40-80 kPa
Average = 63 kPa
Older Adults =
Tongue Elevation Strength
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)
Cloud management system
Multiple pressure sensors
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
Raele Robison and Jennifer Kordell