IOPI System: Iowa Oral Performance Instrument
Swallowing Therapy With Measurable Results
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Tongue Strength
Pressure as a Measure of Strength
Tongue Elevation Strength
Tongue Exercise using BIOFEEDBACK

Clinical importance
Knowing a patient’s tongue strength is clinically useful for several reasons:
  • DECIDING whether tongue weakness is involved in oral stage swallowing problems and/or dysarthria:
  • If the tongue is weak, you can start tongue strengthening therapy.
  • If the tongue strength is normal, you can eliminate weakness as a cause of the swallowing or peaking problems, and thus concentrate on other more useful therapies.
  • DOCUMENTING that a patient’s tongue is weak, and therefore that strengthening exercises are justified. This may be important to administrators who are concerned with the cost of delivering such therapy.
  • ASSESSING the results of tongue strengthening therapy over time:
  • If tongue strength doesn’t increase over time, then perhaps the patient is not really doing her exercises, or not doing them forcefully enough.
  • If the tongue strength does increase, even a little bit, it can be "rewarding" for the patient to see concrete evidence that she is becoming stronger.
  • EXERCISING the patient’s tongue. Performing tongue exercise using an IOPI® can give the patient very specific "targets" to achieve with their efforts, and give them immediate feedback about improvement.

Pressure as a Measure of Strength
Measuring the maximum pressure that a person can produce by squeezing a compliant bulb against the hard palate to estimate the strength of the tongue was a completely novel idea when the IOPI was patented. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see References).

Tongue Elevation Strength
Tongue elevation strength is the maximum pressure of the tongue pressing against the hard palate. The IOPI measures this when the Tongue Bulb is placed in the “standard” position – agianst the hard palate just behind the alveolar ridge. The image to the right shows this position. You can simulate this placement if you suck on your thumb: the pad of your thumb will be pressing against the hard palate behind the alveolar ridge and your tongue will be pressing on your thumb nail instead of a Tongue Bulb.

IOPI Crossection Diagram
Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “standard” position. Therefore, there is a great deal of information, derived from many different laboratories and clinics, about tongue elevation strength. This information suggests the following generalization:

(1) Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times.

(2) There is considerable variability in tongue strength in a population of adults reporting no swallowing or speech problems (see Normal Values). There is a clear central tendency, however, with an average maximum pressure of about 60 kPa, and a range of 40-80 kPa.

(3) Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population.
Tongue Exercise using BIOFEEDBACK
Evidence exists to show that tongue exercise in dysphagia patients, as documented with the IOPI, can lead to improved swallowing outcomes. The IOPI allows the clinician to use protocols that have been proven to work in exercise science. The clinician sets the pressure target on the IOPI’s biofeedback light array and instructs the patient to squeeze the bulb until they turn the top green light on. The patient is visually reinforced for hitting their target.