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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

 

文献索引（部分）

• Lin CH, Chung SY, Lin CT, Hwu YJ. Effect of tongue-to-palate resistance training on tongue strength in healthy adults [published online ahead of print, 2020 Jul 26]. Auris Nasus Larynx. 2020;S0385-8146(20)30168-1. doi:10.1016/j.anl.2020.07.014

《Effect of tongue-to-palate resistance training on tongue strength in healthy adults.》

• Lee KH, Jung ES, Choi YY. Effects of lingual exercises on oral muscle strength and salivary flow rate in elderly adults: a randomized clinical trial. Geriatr Gerontol Int. 2020 Jul;20(7):697-703. doi: 10.1111/ggi.13944. Epub 2020 Jun 2. PMID: 32489001.

《Effects of lingual exercises on oral muscle strength and salivary flow rate in elderly adults: a randomized clinical trial.》

• Su HT, Wang LM, Yang CF, Lee LH, Brajot FX. Language, speech, and oromotor function in children with Pompe disease. Neuromuscul Disord. 2020;30(5):400-412. doi:10.1016/j.nmd.2020.03.003

《Language, speech, and oromotor function in children with Pompe disease.》

• Komagamine Y, Kanazawa M, Yamada A, Minakuchi S. Association between tongue and lip motor functions and mixing ability in complete denture wearers. Aging Clin Exp Res. 2019;31(9):1243‐1248. doi:10.1007/s40520-018-1070-2

《Association Between Tongue and Lip Motor Functions and Mixing Ability in Complete Denture Wearers.》

• Lee JH, Choi SY. Criteria to assess tongue strength for predicting penetration and aspiration in patients with stroke having dysphagia. Eur J Phys Rehabil Med. 2020 Aug;56(4):375-385. doi: 10.23736/S1973-9087.20.06180-8. Epub 2020 Apr 24. PMID: 32329588.

《Criteria to Assess Tongue Strength for Predicting Penetration and Aspiration in Patients With Stroke Having Dysphagia.》

• Pizzorni N, Ginocchio D, Bianchi F, Feroldi S, Vedrodyova M, Mora G, Schindler A. Association between maximum tongue pressure and swallowing safety and efficacy in amyotrophic lateral sclerosis. Neurogastroenterol Motil. 2020 Aug;32(8):e13859. doi: 10.1111/nmo.13859. Epub 2020 Apr 26. PMID: 32337820.

《Association between maximum tongue pressure and swallowing safety and efficacy in amyotrophic lateral sclerosis.》

• Paris-Alemany A, Proy-Acosta A, Adraos-Juarez D, Suso-Marti­, La Touche R, Chamorro-Sanchez J. Influence of the Craniocervical Posture on Tongue Strength and Endurance [published online ahead of print, 2020 May 22]. Dysphagia. 2020;10.1007/s00455-020-10136-9. doi:10.1007/s00455-020-10136-9

《Influence of the Craniocervical Posture on Tongue Strength and Endurance.》

• Van den Steen L, Baudelet M, Tomassen P, Bonte K, De Bodt M, Van Nuffelen G. The effect of tongue-strengthening exercises on tongue strength and swallowing-related parameters in chronic radiation-associated dysphagia [published online ahead of print, 2020 Apr 30]. Head Neck. 2020;10.1002/hed.26179. doi:10.1002/hed.26179

《The effect of tongue-strengthening exercises on tongue strength and swallowing-related parameters in chronic radiation-associated dysphagia.》

• Yano J, Yamamoto-Shimizu S, Yokoyama T, Kumakura I, Hanayama K, Tsubahara A. Effects of Tongue-Strengthening Exercise on the Geniohyoid Muscle in Young Healthy Adults. Dysphagia. 2020;35(1):110-116. doi:10.1007/s00455-019-10011-2

《Effects of Tongue-Strengthening Exercise on the Geniohyoid Muscle in Young Healthy Adults.》

• Van den Steen L, De Bodt M, Guns C, Elen R, Vanderwegen J, Van Nuffelen G. Tongue-Strengthening Exercises in Healthy Older Adults: Effect of Exercise Frequency - A Randomized Trial [published online ahead of print, 2020 Feb 5]. Folia Phoniatr Logop. 2020;1-8. doi:10.1159/000505153

《Tongue-Strengthening Exercises in Healthy Older Adults: Effect of Exercise Frequency - A Randomized Trial.》

• Hwang NK, Kim MJ, Lee G, Yoon T, Park JS, Jung Y. Effect of tongue-strengthening training combined with a tablet personal computer game in healthy adults. J Oral Rehabil. 2020;47(5):606-612. doi:10.1111/joor.12944

《Effect of tongue-strengthening training combined with a tablet personal computer game in healthy adults.》

• Vanderwegen J, Van Nuffelen G, Elen R, De Bodt M. The Influence of Age, Sex, Visual Feedback, Bulb Position, and the Order of Testing on Maximum Anterior and Posterior Tongue Strength in Healthy Belgian Children. Dysphagia. 2019;34(6):834-851. doi:10.1007/s00455-019-09976-x

《The Influence of Age, Sex, Visual Feedback, Bulb Position, and the Order of Testing on Maximum Anterior and Posterior Tongue Strength in Healthy Belgian Children.》

• Van den Steen L, Vanderwegen J, Guns C, Elen R, De Bodt M, Van Nuffelen G. Tongue-Strengthening Exercises in Healthy Older Adults: Does Exercise Load Matter? A Randomized Controlled Trial. Dysphagia. 2019;34(3):315-324. doi:10.1007/s00455-018-9940-5

《Tongue-Strengthening Exercises in Healthy Older Adults: Does Exercise Load Matter? A Randomized Controlled Trial.》

• Van den Steen L, Van Gestel D, Vanderveken O, et al. Evolution of self-perceived swallowing function, tongue strength and swallow-related quality of life during radiotherapy in head and neck cancer patients. Head Neck. 2019;41(7):2197-2207. doi:10.1002/hed.25684

《Evolution of self-perceived swallowing function, tongue strength and swallow-related quality of life during radiotherapy in head and neck cancer patients.》

• Steele CM, Peladeau-Pigeon M, Barbon CAE, et al. Modulation of Tongue Pressure According to Liquid Flow Properties in Healthy Swallowing. J Speech Lang Hear Res. 2019;62(1):22-33. doi:10.1044/2018_JSLHR-S-18-0229

《Modulation of Tongue Pressure According to Liquid Flow Properties in Healthy Swallowing.》Free PDF

• Saccomanno S, Di Tullio A, D'Alatri L, Grippaudo C. Proposal for a myofunctional therapy protocol in case of altered lingual frenulum. A pilot study. Eur J Paediatr Dent. 2019;20(1):67-72. doi:10.23804/ejpd.2019.20.01.13

《Proposal for a myofunctional therapy protocol in case of altered lingual frenulum. A pilot study.》Free PDF

• Potter NL, Nievergelt Y, VanDam M. Tongue Strength in Children With and Without Speech Sound Disorders. Am J Speech Lang Pathol. 2019;28(2):612-622. doi:10.1044/2018_AJSLP-18-0023

《Tongue Strength in Children With and Without Speech Sound Disorders.》Free PDF

• Pitts LL, Kanadet RM, Hamilton VK, Crimmins SK, Cherney LR. Lingual Pressure Dysfunction Contributes to Reduced Swallowing-Related Quality of Life in Parkinson's Disease. J Speech Lang Hear Res. 2019;62(8):2671-2679. doi:10.1044/2019_JSLHR-S-18-0366

《Lingual Pressure Dysfunction Contributes to Reduced Swallowing-Related Quality of Life in Parkinson's Disease.》

• Pereira TC, Furlan RMMM, Motta AR. Relationship between mouth breathing etiology and maximum tongue pressure. Relação entre a etiologia da respiração oral e a pressão máxima da língua. Codas. 2019;31(2):e20180099. Published 2019 Apr 1. doi:10.1590/2317-1782/20182018099

《Relationship between mouth breathing etiology and maximum tongue pressure.》Free PDF

• Park JS, Lee SH, Jung SH, Choi JB, Jung YJ. Tongue strengthening exercise is effective in improving the oropharyngeal muscles associated with swallowing in community-dwelling older adults in South Korea: A randomized trial. Medicine (Baltimore). 2019;98(40):e17304. doi:10.1097/MD.0000000000017304

《Tongue strengthening exercise is effective in improving the oropharyngeal muscles associated with swallowing in community-dwelling older adults in South Korea: A randomized trial.》Free PDF

• Park JS, Hwang NK, Kim HH, Choi JB, Chang MY, Jung YJ. Effects of lingual strength training on oropharyngeal muscles in South Korean adults. J Oral Rehabil. 2019;46(11):1036-1041. doi:10.1111/joor.12835

《Effects of lingual strength training on oropharyngeal muscles in South Korean adults.》

• Park HS, Oh DH, Yoon T, Park JS. Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double-blind, randomized controlled trial. Int J Lang Commun Disord. 2019;54(3):479-484. doi:10.1111/1460-6984.12453

《Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double-blind, randomized controlled trial.》

• O'Connor-Reina C, Plaza G, Garcia-Iriarte MT, et al. Tongue peak pressure: a tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome. Sleep Breath. 2020;24(1):281-286. doi:10.1007/s11325-019-01952-x

《Tongue peak pressure: a tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome.》

• Mul K, Berggren KN, Sills MY, et al. Effects of weakness of orofacial muscles on swallowing and communication in FSHD. Neurology. 2019;92(9):e957-e963. doi:10.1212/WNL.0000000000007013

《Effects of weakness of orofacial muscles on swallowing and communication in FSHD.》Free PDF

• McKay R, Smart S, Cocks N. Investigating Tongue Strength and Endurance in Children Aged 6 to 11 Years [published online ahead of print, 2019 Dec 2]. Dysphagia. 2019;10.1007/s00455-019-10081-2. doi:10.1007/s00455-019-10081-2

《Investigating Tongue Strength and Endurance in Children Aged 6 to 11 Years.》
 

PN 1-3100-DL	IOPI吞咽障碍评估和训练舌压仪（豪华套装）	电邮询价
PN 1-3100-SD	IOPI吞咽障碍评估和训练舌压仪（标准套装）	电邮询价
PN 1-3200	IOPI吞咽障碍评估和训练舌压仪（训练套装）	电邮询价
PN 5-6010	标准舌压测量球囊（适用于，豪华套装和标准套装）—1盒10个	电邮询价
PN 5-6105	训练用舌压测量球囊（适用于，训练套装）—1盒5个	电邮询价
PN 5-0001	连接管（适用于，豪华套装和标准套装）	电邮询价
PN 5-8101	IOPI报告生成单元	电邮询价
PN 5-3001	橡胶面部模型	电邮询价
PN 800-3102	患者进展数据表，15张	电邮询价
PN 800-3103	舌头压力测量球囊定位表	电邮询价
PN 800-3203	培训治疗师-患者使用说明；15张	电邮询价

 

 

 

 

 

 

 

 

 

 

 

 

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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

iowa oral performance instrument,IOPI 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

iowa oral performance instrument,IOPI 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

iowa oral performance instrument,IOPI 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

iowa oral performance instrument,IOPI 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

iowa oral performance instrument,IOPI 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203

iowa oral performance instrument,IOPI 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. 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 speech 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 insurance providers and 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 performing the prescribed 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 improvement. 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 in 1992. Since that time, many research studies have been published that have used the IOPI or IOPI-like instruments to measure tongue strength (see Publications). 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 target pressure 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. 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 “anterior” position – 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 thumbnail instead of a Tongue Bulb. Most published reports on tongue strength have used the IOPI with the Tongue Bulb in the “anterior” 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: Repeated measurements of tongue strength in the same individual are quite reliable, particularly after the patient has done the task a few times. 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. Patients with oral phase swallowing problems have a tongue strength that is significantly lower than the normal population. LIP STRENGTH Why Measure Lip Strength? Inadequate lip strength may contribute to problems with deglutition, such as food containment during chewing. If lip weakness is severe, it also may interfere with the production of plosive speech sounds. Such weakness would probably be obvious, but being able to accurately "track" the degree of weakness would enable the clinician to determine whether the weakness is getting better or worse, and/or determine if training improves lip strength. Additionally, observing lip weakness in a patient may help identify abnormalities within the nervous system such as subtle cortical dysfunction, or disease processes gradually affecting the function of the facial nerve. Lip Strength Measurement To measure lip strength, an IOPI bulb is placed inside the cheek just lateral to the corner of the mouth and the patient squeezes the IOPI bulb against the buccal surface of the teeth by pursing the lips as hard as possible. Although the bulb is not directly between the lips, it is valid because the pressure developed in the bulb depends upon the strength of the circumferential muscle complex that surrounds the mouth, in particular the obcularis oris. It is tension in these muscles that allows the lips to be compressed against one another. IOPI® PRO - Deluxe Kit PN 1-3100-DL INCLUDES: 1 IOPI Pro 1 Pro Carrying Case 5 Tongue Bulbs 1 Connecting Tube 1 Accuracy Check Kit 1 Set of AA batteries 1 User Manual Patient Progress Datasheets (15 page pad) Tongue Bulb Positioning Sheet 2-year warranty Plus: • 1 IOPI Report Generator • 1 Additional Connecting Tube IOPI® TRAINER KIT PN 1-3200 INCLUDES: 1 IOPI Trainer 1 Trainer Carrying Case 5 Trainer Bulbs 1 Set of AA batteries 1 User Manual Trainer Patient Instructions 2-year warranty TONGUE BULBS (Pro & Series 2 Devices) - Box of 10 PN 5-6010 TRAINER BULBS (Trainer Device) - Box of 5 PN 5-6105 CONNECTING TUBE (Pro & Series 2 Devices) PN 5-0001 IOPI® REPORT GENERATOR PN 5-8101 INCLUDES: 1 IOPI Report Generator Software (PC-based) 1 USB Drive 1 Mini-USB to USB Cable RUBBER FACE MODEL PN 5-3001 Useful for demonstrating bulb placement Fits in Pro Carrying Case pouch Dimensions: 8" x 6" x 3/8" PATIENT PROGRESS DATASHEETS (15 page pad) PN 800-3102 TONGUE BULB POSITIONING SHEET PN 800-3103 TRAINER PATIENT INSTRUCTIONS (15 page pad) PN 800-3203