International SYMPOSIUM on OROFACIAL MYOFUNCTIONAL Therapy roma 6,7,8 giugno 2014

1. 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.
OROFACIALSTRENGHTASSESSMENT
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.
Engelke,JungeKnosel,2011)
http://www.iopimedical.com/Home.html
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.
http://www.iopimedical.com/Home.html
PROPOSAL FOR PROCEDURES IN ORTHODONTIC CASES
(Adamsetal.,2013)
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.