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Purpose:
This study investigated the reliability of tongue and hand strength and endurance measurements in old adults using the Iowa Oral Performance Instrument (IOPI).
Method:
Thirty aged-care residents (6 males and 24 females) aged 79-97 years were tested on four occasions two weeks apart to determine test-retest reliability. The primary outco...
Context in source publication
Context 1
... strength and endurance data were collected with the bulb in two positions: anteromedian and posterome- dian. To obtain anteromedian measures, the IOPI bulb was placed on the centre of the tongue directly behind the front teeth (Fig. 2). The posteromedian position was defined by placing the straight edge of the IOPI bulb parallel to the anterior edge of the individual's back molars (Fig. 3). Individual bulb placement using these landmarks allowed for a standardized placement in relation to normal struc- tures within the oral cavity. Each participant was shown a picture of the correct bulb placement plus a standardized verbal description of the placement at the beginning of each testing session. The placement was then observed by the investigator prior to each measurement and further directions were provided if necessary. While individual anatomy across participants varied (palatal shape and height of the palatal vault), standardized instruction and placement demonstrations were used to ensure the bulb location was as consistent as possible. Once the bulb was in the correct position in the oral cavity, participants were given instructions to push the bulb against the roof of the mouth with the tongue as hard as possible. Maximum tongue strength involved three consecutive trials, each approximately 2 s long, with a short rest between trials while the investigator recorded the peak pressure mea- surement. No participant had a hypersensitive gag response with the bulb in the posterior ...
Citations
... Appropriate tongue strength is essential for the oral motor skills, speech-languages skills and pharyngeal phases of swallowing and contributes to the formation, placement, and manipulation of a bolus within the oral cavity and propulsion into the pharynx [28]. It was determined that the IOPI is reliable for the measurement of tongue strength [29]. ...
... A muscle with limited mobility limits the strength of the tongue and the range of motion. the tongue, as a transversely striated muscle, is characterized by the possibility of generating a certain force, which, as tested in an adult (IOPI device), amounts to an average of 53 kPa [29]. After releasing the tongue through the frenulotomy procedure, in order to increase the strength of the tongue in a situation of reduced strength, the tongue should be trained in terms of the force generated. ...
... These instruments can also assess endurance by measuring not only tongue strength, but also the time it takes to keep the tongue pressed with a constant force. Tongue endurance is measured by the time that 50% of maximal tongue strength can be sustained with feedback of the pressure ramp displayed on the tongue pressure measuring device and the waveform displayed on the monitor using specialized software (27,28). ...
Dysphagia is a common symptom of Parkinson’s disease (PD) associated with aspiration pneumonia, choking, malnutrition, and a decreased quality of life, and is a leading cause of death among patients with PD. Tongue dysfunction in patients with PD affects the oral phase of swallowing, including the formation and propulsion of a bolus into the pharynx. Assessing tongue pressure, generated between the tongue and palate, is a method that quantitatively measures tongue function and is related to dysphagia in PD. Two assessment methods are used to measure tongue pressure: tongue strength and tongue pressure during swallowing. Previous studies measuring tongue pressure in PD have reported decreased tongue strength and pressure during swallowing, as well as a prolonged tongue pressure rise time, which are symptoms associated with PD severity and dysphagia. In this mini-review, we present a method for measuring tongue pressure and discuss its relationship with dysphagia in PD. We also describe limitations and future perspectives in tongue pressure measurement research.
... Each measurement was performed in triplicate with a 60-seconds rest between repetitions. For each participant, the highest value of the strength exerted was recorded from the three measurements performed [15] for both the MTS and the MLS. ...
Adequate tongue and lip strengths are needed for normal speech, chewing, and swallowing development. The aim was to evaluate the influence of sex and age on maximum anterior tongue strength (MTS) and maximum lip strength (MLS) in healthy Spanish adults to establish reference values that can be used in clinical practice.
This cross-sectional study comprises 363 subjects (mean age 47.5 ± 20.7 years) distributed by sex (258 women and 105 men) and across three age groups: Young (18–39 years), middle-aged (40–59 years), and older adults (> 59 years). MTS and MLS were determined using the Iowa Oral Performance Instrument (IOPI). The mean MTS was 49.63 ± 13.81 kPa, regardless of sex, and decreased with age. The mean MLS was statistically higher for men (28.86 ± 10.88 kPa) than for women (23.37 ± 6.92 kPa, p = 0.001), regardless of age.
This study provides the first reference values for the standardized measurement of MTS and MLS in a healthy adult Spanish-speaking population using the IOPI.
... 9,10 The Iowa Oral Performance Instrument (IOPI) objectively and effectively measures tongue pressure and endurance in healthy populations and in those with some medical conditions. 11 The measurements of tongue pressure in association with swallowing instrumental evaluation and the application of The Dysphagia ...
... For the anterior measures, the IOPI bulb was placed in the centre of the tongue directly behind the front teeth (behind the central incisors), and for the posterior position, the bulb was aligned with the first inferior molar. 11 Participants were shown a picture of the correct bulb placement. The investigator marked the location with red tape on the plastic tube of the tongue bulb for its correct placement. ...
... For this evaluation, the bulb was placed in the anterior and posterior regions, as described above. 11 Participants were asked to push the bulb against the palate as strongly as possible with the tongue, with three tries of 2 s each and 90-s rest intervals. 11,16 The highest reading was selected for additional analyses. ...
Background:
Dysphagia is a common symptom of Parkinson's disease (PD). A delay in laryngeal vestibule closure (LVC) and a reduction in tongue pressure, may affect swallowing safety and increase the risk of pulmonary aspiration.
Objective:
To verify the relationship between tongue pressure and airway protection in PD patients: (1) comparing tongue pressure measures and physiological events in the pharyngeal phase of swallowing between PD and controls and (2) analysing the association between tongue pressure and LVC in the PD group.
Methods:
Twenty-three patients with idiopathic PD (64.9 years) and 24 healthy controls (64.1 years) participated in this study. All participants underwent the following procedures to verify tongue pressure measurements using the Iowa Oral Performance Instrument: maximum anterior and posterior pressure, isotonic and isometric tongue endurance and anterior and posterior tongue pressure during saliva swallowing. To verify swallowing safety, videofluoroscopic swallowing studies focusing on the pharyngeal phase were performed based on the MBSImP protocol.
Results:
Compared to healthy controls, PD exhibited a statistically significant decline in tongue pressure tasks: posterior maximum pressure, isotonic endurance, anterior and posterior isometric endurance and tongue pressure during posterior swallowing. Patients with PD had worse pharyngeal scores, including LVC scores, than controls. PD and incomplete LVC had lower anterior isometric endurance scores when compared to those with complete LVC.
Conclusion:
PD with incomplete LVC scored lower in the anterior isometric endurance task. We observed a potential clinical use of this task for the assessment and management of dysphagia in patients with PD.
... Despite the shown reliability of all strength measures used [24,27], remarkable increases were demonstrated for all muscle strength measures between baseline and week 1 of RT/CRT. To improve the precision of the assessment and to exclude learning curve effects, both Adams and Kraaijenga et al. suggest the use of a familiarization session before baseline measurements [24,27]. ...
... Despite the shown reliability of all strength measures used [24,27], remarkable increases were demonstrated for all muscle strength measures between baseline and week 1 of RT/CRT. To improve the precision of the assessment and to exclude learning curve effects, both Adams and Kraaijenga et al. suggest the use of a familiarization session before baseline measurements [24,27]. Current study did not use a familiarization session before the effective strength measurements. ...
Prophylactic swallowing exercises (PSE) during head-and-neck cancer (HNC) (chemo)radiotherapy (CRT) have a positive effect on swallowing function and muscle strength. Adherence rates to PSE are, however, moderate to low, undermining these effects. PRESTO already showed that the service-delivery mode (SDM), the way the exercises are offered, can influence adherence. The aim of this study was to investigate the effect of SDM on swallowing function and muscle strength during and post-CRT. In addition, the effect of overall adherence (OA), independent of SDM, was also investigated. A total of 148 HNC patients, treated with CRT, were randomly assigned to one of the three SDM’s (paper-supported, app-supported, or therapist-supported PSE) and performed a 4-week PSE program. OA was calculated based on the percentage of completed exercises. Patients were divided into OA levels: the OA75+ and OA75− group performed respectively ≥ 75 and < 75% of the exercises. Swallowing function based on Mann Assessment of Swallowing Ability-Cancer (MASA-C), tongue and suprahyoid muscle strength during and up to 3 months after CRT were compared between the SDM’s and OA levels. Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni–Holm correction was used. No significant differences were found between the three SDMs. Significant time effects were found: MASA-C scores decreased and muscle strength increased significantly during CRT. By the end of CRT, the OA75+ showed significantly better swallowing function compared to OA75−. Muscle strength gain was significantly higher in the OA75+ group. SDM had no impact on swallowing function and muscle strength; however, significant effects were shown for OA level. Performing a high level of exercise repetitions is essential to benefit from PSE.
Trial registration ISRCTN, ISRCTN98243550. Registered December 21, 2018—retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search
... Tongue pressure, lip pressure and tongue endurance were measured by the Iowa Oral Performance Instrument (IOPI) (IOPI Medical LLC; Carnation, Washington, USA), which contains a light mode display and an air-filled bulb. To measure anterior tongue pressure, the bulb was positioned on the center of the tongue, immediately behind the central incisors (24) (Figure 1). The examiner held the bulb stem at a point immediately anterior to the participant's central incisors to ensure consistent positioning of the bulb. ...
... High standard deviations were observed, which is explained by the individual variability inherent to this type of measurement, which was also verified by other authors (24,30) . Furthermore, the assessment of the pressure of orofacial structures is not an objective assessment, but a semi-objective one, as it depends on the individual's understanding and willingness to exert maximum pressure on the instrument, which increases the variability of inter-subject measurements. ...
Purpose
To compare the maximum anterior and posterior tongue pressure, tongue endurance, and lip pressure in Class I, II, and III malocclusions and different facial types.
Methods
A cross-sectional observational analytical study was carried out in 55 individuals (29 men and 26 women) aged between 18 and 55 years. The participants were divided into groups according to Angle malocclusion (Class I, II, and III) and facial type. The maximum anterior and posterior tongue pressure, tongue endurance, and maximum lip pressure were measured using the IOPI (Iowa Oral Performance Instrument). To determine the facial type, the cephalometric analysis was accomplished using Ricketts VERT analysis as a reference.
Results
There was no statistically significant difference when comparing the maximum pressure of the anterior and posterior regions of the tongue, the maximum pressure of the lips, or the endurance of the tongue in the different Angle malocclusion types. Maximum posterior tongue pressure was lower in vertical individuals than in mesofacial individuals.
Conclusion
Tongue and lips pressure, as well as tongue endurance in adults was not associated with the type of malocclusion. However, there is an association between facial type and the posterior pressure of the tongue.
Keywords
Muscle Strength; Lip; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III
... Iowa Oral Performance Instrument (IOPI) [28] IOPI is a validated measure in patients affected by oropharyngeal muscular dystrophy and is currently being used in patients with Myotonic Dystrophies (TREAT-CDM at the University of Virginia, USA; and GUP19002, grant given to vs from Telethon and the Italian Muscular Dystrophy Association) [21,28]. ...
... Iowa Oral Performance Instrument (IOPI) [28] IOPI is a validated measure in patients affected by oropharyngeal muscular dystrophy and is currently being used in patients with Myotonic Dystrophies (TREAT-CDM at the University of Virginia, USA; and GUP19002, grant given to vs from Telethon and the Italian Muscular Dystrophy Association) [21,28]. ...
Bulbar and jaw muscles are impaired in patients with Spinal Muscular Atrophy (SMA) but the assessment of their severity and progression are limited by the lack of age-appropriate and disease-specific measures. We investigated mastication and swallowing in children and adults with SMA, sitters and walkers. In a 2-year multicentre cross-sectional prospective study, lip and tongue strength (Iowa Oral Performance Instrument), chewing and swallowing (Test of Masticating and Swallowing Solids), active mouth opening (aMMO) were compared to age-appropriate normative data. The perceived burden of oro-bulbar involvement (SMA-Health Index) was recorded. 78 patients were included, 45 children (median age 7.4 years),22 adults (median age 26.8 years) on nusinersen and 11 untreated (median age 32.7 years). Forty-three percent children had reduced mouth opening, 50% had prolonged total time to eat. These issues were more prominent in sitters than in walkers (p = 0.019, p = 0.014). Sixty-six percent needed increased swallows for bolus clearance. Nusinersen treated adults had median aMMO, tongue strength and total time at TOMASS values within normal range (z score: −1.40, −1.22, −1.32, respectively) whereas untreated adults had reduced aMMO (z score: −2.68) and tongue strength (z score: −2.20). Only a minority of children (2/17) and treated adults (5/21) reported burden in swallowing or mastication compared to all untreated adults (5/5). After 16 months, mastication and swallowing were stable in treated children and adults, whether sitters or walkers. The reported multimodal approach to assess oro-bulbar functions demonstrate that swallowing and mastication are impaired in SMA despite patients’ perception. These results suggest a trend towards stabilization of oro-bulbar function in patients on long-term treatment with nusinersen.
... The measurements of the superior tongue movement obtained the highest ICC 3,1 values (>0.95). These values were slightly greater than those found for the reliability measurements of tongue force in superior movements using the IOPI device, which ranged from 0.77 to 0.90 [38]. Likewise, better ICC values were obtained when compared to the study by White et al., who reported an excellent intrarater reliability for the KSW device in a healthy population (ICC = 0.92) [19]. ...
... The inter-rater reliability of tongue force measurements using the IOPI device in subjects with different conditions was reported to be good to excellent (ICC > 0.75) [22], with the exception of a study evaluating dysarthria patients in which a moderate reliability was found (ICC = 0.535) [22,38]. However, there are no recent studies available on the evaluation of the inter-rater reliability for the IOPI in healthy subjects, and the authors of this paper believe that this should be the first step prior to measurement and use in patients. ...
... Although we can assure good reliability and responsiveness for the device presented in this study in an asymptomatic population, we cannot guarantee the same findings in symptomatic subjects yet. Only one previous study determined the SEM and the MDC of the IOPI device in asymptomatic subjects [38]. This study estimated these values using standard deviation (SD), while the present study based the calculation on the root mean square (RMS) [40]. ...
Background:
Measurements of tongue force are important in clinical practice during both the diagnostic process and rehabilitation progress. It has been shown that patients with chronic temporomandibular disorders have less tongue strength than asymptomatic subjects. Currently, there are few devices to measure tongue force on the market, with different limitations. That is why a new device has been developed to overcome them. The objectives of the study were to determine the intra- and inter-rater reliability and the responsiveness of a new low-cost device to evaluate tongue force in an asymptomatic population.
Materials and methods:
Two examiners assessed the maximal tongue force in 26 asymptomatic subjects using a developed prototype of an Arduino device. Each examiner performed a total of eight measurements of tongue force in each subject. Each tongue direction was measured twice (elevation, depression, right lateralization, and left lateralization) in order to test the intrarater reliability.
Results:
The intrarater reliability using the new device was excellent for the measurements of the tongue force for up (ICC > 0.94), down (ICC > 0.93) and right (ICC > 0.92) movements, and good for the left movement (ICC > 0.82). The SEM and MDC values were below 0.98 and 2.30, respectively, for the intrarater reliability analysis. Regarding the inter-rater reliability, the ICC was excellent for measuring the tongue up movements (ICC = 0.94), and good for all the others (down ICC = 0.83; right ICC = 0.87; and left ICC = 0.81). The SEM and MDC values were below 1.29 and 3.01, respectively, for the inter-rater reliability.
Conclusions:
This study showed a good-to-excellent intra- and inter-reliability and good responsiveness in the new device to measure different directions of tongue force in an asymptomatic population. This could be a new, more accessible tool to consider and add to the assessment and treatment of different clinical conditions in which a deficit in tongue force could be found.
... The results from these studies have suggested that lingual pressure measurements from the other devices may not be as valid as those taken with the IOPI. Although the IOPI has proven to be a suitable and effective tool demonstrating strong reliability (Adams et al., 2013(Adams et al., , 2014, some have reported that the bulb is prone to slippage, particularly when placed on the posterior tongue, and may be cost-prohibitive for some practices (Clark et al., 2003;Hewitt et al., 2008;Yoshikawa et al., 2011). ...
... The second device used in this study was the IOPI Model 3.1 (see Figure 2). Adams et al. (2014) demonstrated acceptable test-retest reliability, within-subject variation, and intraclass correlation. The IOPI device also consists of a disposable bulb that connects to the handheld device through plastic tubing. ...
... As the current gold standard objective lingual pressure manometer, the reliability and validity of the IOPI device has been well established, thus its use as a comparator in this study (Adams et al., 2013(Adams et al., , 2014. The measures taken by both devices were strongly correlated across all tasks demonstrating concurrent validity of the Tongueometer with the IOPI; however, larger studies are needed to confirm our preliminary findings. ...
Purpose
Objective measures of lingual strength are used in both clinical practice and research to provide information regarding the ability of the tongue to contribute to safe and efficient swallowing. The Iowa Oral Performance Instrument (IOPI) is the most frequently used tongue pressure manometer and is considered to be the gold standard. The Tongueometer device was developed to circumvent IOPI shortcomings including bulb slippage, cost, and patient utility. As such, the aims of this pilot study were to examine the validity of the Tongueometer and to obtain comparative adult reference values.
Method
Using the Tongueometer, participants completed three trials of anterior and posterior maximum isometric lingual pressure and regular effort saliva swallow tasks. Moreover, 41% of participants also completed all trials using the IOPI. Independent-samples t tests compared maximum means between the IOPI and Tongueometer. Concurrent validity was assessed using Lin's concordance correlations. Associations were evaluated using independent-samples t tests (sex) and Pearson correlation coefficient (age).
Results
Seventy-six healthy participants (48 women, 28 men) with no history of swallowing difficulty were included in the study ( M age = 50 ± 21). Across all lingual pressure task measures, mean maximum Tongueometer measures strongly correlated with corresponding IOPI measures (anterior: concordance correlation coefficient [CCC] = 0.74, p < .000; posterior: CCC = 0.81, p < .000; swallow: CCC = 0.62, p < .000). Tongueometer and IOPI mean anterior maximum isometric lingual pressures were not statistically different, whereas posterior lingual pressures and pressures elicited during swallowing were statistically different ( p < .01). A significant negative correlation was found between age and maximum anterior tongue pressure ( r = −.43, p < .01). No significant association of sex on maximum tongue pressure was observed.
Conclusion
Overall, this pilot research suggests that the Tongueometer is a valid tool for clinical use in measuring lingual strength and swallowing function.
... Therefore, the typical error and the coefficient of variation could be better measures of reliability because they are independent of where the individuals rank in a sample, unlike the ICC [103]. This study therefore indicates that it could be beneficial to provide additional measures of reliability using absolute estimates of reliability such as the percentage change in mean and the typical error to prevent erroneous estimation of reliability [49,50,103], as reinforced by other reliability studies [108][109][110][111][112]. Accordingly, a participant who demonstrates a percentage change in the magnitude of maximal tactile pressure that is greater than the percent coefficient of variation is viewed as demonstrating change. ...
Sensor-based devices can record pressure or force over time during grasping and therefore offer a more comprehensive approach to quantifying grip strength during sustained contractions. The objectives of this study were to investigate the reliability and concurrent validity of measures of maximal tactile pressures and forces during a sustained grasp task using a TactArray device in people with stroke. Participants with stroke (n = 11) performed three trials of sustained maximal grasp over 8 s. Both hands were tested in within- and between-day sessions, with and without vision. Measures of maximal tactile pressures and forces were measured for the complete (8 s) grasp duration and plateau phase (5 s). Tactile measures are reported using the highest value among three trials, the mean of two trials, and the mean of three trials. Reliability was determined using changes in mean, coefficients of variation, and intraclass correlation coefficients (ICCs). Pearson correlation coefficients were used to evaluate concurrent validity. This study found that measures of reliability assessed by changes in means were good, coefficients of variation were good to acceptable, and ICCs were very good for maximal tactile pressures using the average pressure of the mean of three trials over 8 s in the affected hand with and without vision for within-day sessions and without vision for between-day sessions. In the less affected hand, changes in mean were very good, coefficients of variations were acceptable, and ICCs were good to very good for maximal tactile pressures using the average pressure of the mean of three trials over 8 s and 5 s, respectively, in between-day sessions with and without vision. Maximal tactile pressures had moderate correlations with grip strength. The TactArray device demonstrates satisfactory reliability and concurrent validity for measures of maximal tactile pressures in people with stroke.
