Use of the Iowa Oral Performance Instrument in Orofacial Myofunctional Assessment

Ricardo Santos ricardosantos_tf@hotmail.com

SLP | MSc in Speech and Hearing Sciences | PhD student in Sciences and Health Technologies | SLP at Private Hospital of Trofa (Portugal) | Lecturer in the Speech Therapy Department in the School of Allied Health Sciences - Polytechnic Institute of Porto | Invited Professor in the MSc of Orofacial Miology (ESSA) and in the Postgraduate Program in Orofacial Miology (IEPAP).

International Symposium on Orofacial Myofunctional Therapy Rome | 6,7 e 8 June 2014

INTRODUCTION

AN ADEQUATE FORCE OF THE TONGUE IS ESSENTIAL TO PERFORM ADEQUATELY THE OROFACIAL FUNCTIONS.

IT´S IMPORTANT TO PROMOTE THE MAINTENANCE OF THE TEETH IN PROPER POSITION, CONSIDERING THE

RELATIONSHIP BETWEEN THE FORCE PERFORMED BY THE TONGUE (CENTRIFUGAL FORCE) AND THE FORCE

PERFORMED BY THE LIPS AND CHEEKS (CENTRIPETAL FORCE).

METHOD

RESULTS AND DISCUSSION

CONCLUSIONS

A NARRATIVE REVIEW OF THE LITERATURE WAS CONDUCTED, WITH THE FOLLOWING TERMS "IOWA ORAL PERFORMANCE INSTRUMENT" OR "IOPI" AND "TONGUE STRENGTH" IN JOURNALS

PUBLISHED IN ENGLISH, WITH PEER REVIEW, FROM 1991 UNTIL 2013.

(1) USEFUL TOOL IN ORAL MYOFUNTIONAL ASSESSMENT, ESPECIALLY IN CASES OF SLIGHT CHANGES WHERE CLINICAL

EVALUATION IS PARTICULARLY DIFFICULT.

(2) CAN FACILITATE COMMUNICATION AMONG THE DIFFERENT PROFESSIONALS INVOLVED IN THE TREATMENT OF

ORTHODONTIC PATIENTS.

(3) PROMOTE THE DEVELOPMENT OF A MORE ACCURATE PROGNOSTIC, AS WELL AS COMPLEMENT THE SUBJECTIVE /

QUALITATIVE ASSESSMENT.

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QUALITATIVE EVALUATION QUANTITATIVE EVALUATION

REFERENCES

The Iowa Oral Performance Instrument (IOPI) was the one with the highest reliability for the evaluation of orofacial structures and the most used to assess the strength of the tongue.

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NONE OF THE ARTICLES (N = 39) REFERS TO THE USE OF IOPI IN ORTHODONTIC CASES, AND HALF OF THESE STUDIES WERE PERFORMED IN HEALTHY SUBJECTS AND MOST OF THE

OTHER PARTICIPANTS HAD DYSPHAGIA (SWALLOWING NEUROLOGICAL DISORDER). THE FEATURES AND POSSIBILITIES OF THE INSTRUMENT EVIDENCED IN THE LITERATURE (EFFICIENCY IN

MEASURING STRENGTH OF THE TONGUE), APPEARS TO BE EVIDENCE ENOUGH TO ALLOW THEIR USE IN ORTHODONTIC CASES.

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PROPOSAL FOR PROCEDURES IN ORTHODONTIC CASES

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TONGUE ELEVATION

Anterior-median Position Posterior-median Position

(Adams et al, 2013; Clark et al, 2012; Clark & Solomon, 2011)

STRENGHT EVALUATION PROCEDURES - PRELIMINARY INSTRUCTIONS - CORRECT BULB POSITION - VERBAL COMMAND (EG. “PRESS HARD”)

- REST BETWEEN TASKS

PROPOSED MEASURES - IPMAX: MAXIMAL ISOMETRIC PRESSURE (KPA) (BEST OF 3 TRIALS OR AVG) (SUSTAINED PRESSURE FOR 5-10 SECONDS; REST

TIME: 30 SECONDS)

ENDURANCE EVALUATION PROCEDURES - VERBAL COMMAND (“HOLD AS LONG AS YOU CAN”)

- REST FOR 5 MINUTES BETWEEN TASKS

PROPOSED MEASURES - 50% DA IPMAX (x seconds)

BULB POSITION

Limitations in terms of reproducibility of the obtained data and the

correlation between and within evaluators.

TONGUE LATERALIZATION

Molars Region

LIPS COMPRESSION

CHEEKS COMPRESSION (BUCCINATOR) TONGUE ELEVATION ENDURANCE (EG)

[1] Adams V, Mathisen B, Baines S, Lazarus C, Callister R. (2013). Reliability of measurements of tongue and hand stength and endurance using the Iowa Oral Performance Instrument with healthy adults. Dysphagia. [2] Clark, H.M., O’Brien, K., Calleja, A., & Corrie, S.N. (2009). Effects of directional exercise on lingual strength. Journal of Speech, Language, and Hearing Research. 52: 1034-47. [3] Clark HM, Henson PA, Barber WD, Stierwalt JAG, Sherrill M. (2003). Relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments. Am J Speech Lang Pathol. 12(1):40–50. [4] Clark, H.M., & Solomon, N.P. (2012). Age and sex differences in orofacial strength. Dysphagia.27: 2-9. [5] Engelke W, Jung K, Knosel M. (2011). Intra-oral compartment pressures: a biofunctional model and experimental measurements under different conditions of posture. Clin Oral Invest. 5:165-176.

(4) CLINICAL AND RESEARCH APPLICABILITY FOR ORTHODONTIC PRACTICE, ESPECIALLY IN CASES OF ORAL MIOFUNCTIONAL

CHANGES (E.G. REVERSE SWALLOW).

(5) ALLOWS TO COMPARE VALUES IN DIFFERENT MOMENTS OF INTERVENTION (E.G. BEFORE AND AFTER MIOFUNCIONAL

THERAPY), STAGES OF ORTHODONTIC TREATMENT (E.G. BEFORE AND AFTER CORRECTION OF ANTERIOR OPEN BITE) AND

OBJECTIFY THE EXISTENCE OF EFFECTIVE IMPROVEMENT OF THE PARAMETERS EVALUATED.

(6) PROMOTING RESEARCH INTO INTEGRATED CLINICAL PRACTICE AND STUDY OF EFFICACY BASED ON THE EVIDENCE OF THE

RESULTS.