, Volume 29, Issue 1, pp 83–95

Reliability of Measurements of Tongue and Hand Strength and Endurance Using the Iowa Oral Performance Instrument with Healthy Adults

  • Valerie Adams
  • Bernice Mathisen
  • Surinder Baines
  • Cathy Lazarus
  • Robin Callister
Original Article


The purpose of this study was to investigate the reliability of tongue and handgrip strength and endurance measurements in healthy adults using the Iowa Oral Performance Instrument. Fifty-one healthy participants (21 males, 30 females; age range = 19–57 years) were tested on four occasions 1 week apart to determine test–retest reliability. The primary outcome measures were isometric tongue and handgrip strength (best of three trials) and sustained isometric endurance. Small increases (changes in group mean) in both anterior (1.7 %) and posterior (2.5 %) tongue strength and handgrip strength (5 %) between weeks 1 and 2 were observed with no change in subsequent weeks, suggesting that there is only a small learning effect for these measurements. The within-subject variation (mean-typical error expressed as a coefficient of variation [CV]) indicated higher than desirable initial variation for anterior (CV 10.8 %) and posterior (CV 11.8 %) tongue strength and handgrip strength (CV 15.2 %) but this was reduced in weeks 2–4. Intraclass correlation coefficients (ICC) indicated acceptable and improved reliability for both anterior (ICC 0.77–0.90) and posterior (ICC 0.79–0.86) tongue strength and handgrip strength (ICC 0.69–0.91) after week 1. Additional exploratory analyses were conducted with a subset of data to determine whether two values within 5 kPa (tongue) or 15 kPa (handgrip) provide superior strength reliability. Neither tongue nor hand endurance measurements were sufficiently reliable. These findings suggest that tongue and handgrip strength values demonstrate acceptable reliability, especially if familiarization is provided. Further investigation is needed to reduce sources of variability in tongue endurance measurements.


Reliability Test–retest Anterior Posterior Tongue Deglutition Deglutition disorders 


  1. 1.
    Youmans S, Stierwalt JAG. Measures of tongue function related to normal swallowing. Dysphagia. 2006;21(2):102–11. doi:10.1007/s00455-006-9013-z.PubMedCrossRefGoogle Scholar
  2. 2.
    Crow HC, Ship JA. Tongue strength and endurance in different aged adults. J Gerontol Med Sci. 1996;51A(5):M247–50.CrossRefGoogle Scholar
  3. 3.
    Lazarus CL, Logemann JA, Pauloski BR, Rademaker AW, Larson CR, Mittal BB, Pierce M. Swallowing and tongue function following treatment for oral and oropharyngeal cancer. J Speech Lang Hear Res. 2000;43(4):1011–23.PubMedGoogle Scholar
  4. 4.
    Nicosia MA, Hind JA, Roecker EB, Carnes M, Doyle J, Dengel GA, Robbins J. Age effects on the temporal evolution of isometric and swallowing pressure. J Gerontol A Biol Sci Med Sci. 2000;55(11):M634–40. doi:10.1093/gerona/55.11.M634.PubMedCrossRefGoogle Scholar
  5. 5.
    Robbins J, Levine RL, Wood J, Roecker EB, Luschei ES. Age effects on lingual pressure generation as a risk factor for dysphagia. J Gerontol A Biol Sci Med Sci. 1995;50A(5):M257–62. doi:10.1093/gerona/50A.5.M257.CrossRefGoogle Scholar
  6. 6.
    Robin DA, Goel A, Somodi LB, Luschei ES. Tongue strength and endurance: Relation to highly skilled movements. J Speech Hear Res. 1992;35(6):1239–45.PubMedGoogle Scholar
  7. 7.
    Robin DA, Somodi LB, Luschei ES. Measurement of tongue strength and endurance in normal and articulation disordered subjects. In: Moore CA, Yorkston KM, Beukelman DR, editors. Dysarthria and apraxia of speech: perspectives on management. Baltimore: Paul H Brookes Publishing Co; 1991. p. 173–84.Google Scholar
  8. 8.
    Solomon NP, Robin DA, Luschei ES. Strength, endurance, and stability of the tongue and hand in Parkinson disease. J Speech Lang Hear Res. 2000;43(1):256–67.PubMedGoogle Scholar
  9. 9.
    Stierwalt JA, Robin DA, Solomon NP, Weiss AL, Max JE. Tongue strength and endurance: relation to the speaking ability of children and adolescents following traumatic brain injury. In: Robin DA, Yorkston K, Beukelman DR, editors. Disorders of motor speech: assessment, treatment, and clinical characterization. Baltimore: Brookes Publishing Co.; 1996. p. 241–56.Google Scholar
  10. 10.
    Stierwalt JA, Youmans SR. Tongue measures in individuals with normal and impaired swallowing. Am J Speech Lang Pathol. 2007;16(2):148–56.PubMedCrossRefGoogle Scholar
  11. 11.
    Youmans SR, Stierwalt J, Clark HM. Measures of tongue function in healthy adults. Paper presented at the American Speech-Language-Hearing Association, Atlanta, GA, 2002.Google Scholar
  12. 12.
    IOPI Medical LLC, Iowa Oral Performance Instrument: Users Manual; 17 Sep 2008. Available at http://www.iopimedical.com/.
  13. 13.
    Steele CM, Bailey GL, Molfenter SM, Yeates EM. Rationale for strength and skill goals in tongue resistance training: A review. Perspect Swallow Swallow Disord. 2009;18(2):49–54. doi:10.1044/sasd18.2.49.CrossRefGoogle Scholar
  14. 14.
    Hopkins WG. Measures of reliability in sports medicine and science. Sports Med. 2000;30(1):1–15.PubMedCrossRefGoogle Scholar
  15. 15.
    Solomon NP, Lorell DM, Robin DA, Rodnitzky RL, Luschei ES. Tongue strength and endurance in mild to moderate Parkinson’s disease. J Med Speech Lang Pathol. 1995;3(1):15–26.Google Scholar
  16. 16.
    Solomon NP. Changes in normal speech after fatiguing the tongue. J Speech Lang Hear Res. 2000;43(6):1416–28.PubMedGoogle Scholar
  17. 17.
    Clark HM, Henson PA, Barber WD, Stierwalt JAG, Sherrill M. Relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments. Am J Speech Lang Pathol. 2003;12(1):40–50.PubMedCrossRefGoogle Scholar
  18. 18.
    Lazarus CL, Logemann JA, Pauloski BR, Rademaker AW, Helenowski IB, Vonesh EF, MacCracken E, Mittal BB, Vokes EE, Haraf DJ. Effects of radiotherapy with or without chemotherapy on tongue strength and swallowing in patients with oral cancer. Head Neck. 2007;29(7):632–7. doi:10.1002/hed.20577.PubMedCrossRefGoogle Scholar
  19. 19.
    Neel AT, Palmer PM, Gass CA. Can IOPI be used to measure tongue pressure for speech sounds? J Med Speech Lang Pathol. 2008;16(1):235–41.Google Scholar
  20. 20.
    Solomon NP, Clark HM, Makashay MJ, Newman LA. Assessment of orofacial strength in patients with dysarthria. J Med Speech Lang Pathol. 2008;16:251–8.Google Scholar
  21. 21.
    Youmans S, Youmans G, Stierwalt JAG. Differences in tongue strength across age and gender: Is there a diminished strength reserve? Dysphagia. 2008;24(1):57–65. doi:10.1007/s00455-008-9171-2.PubMedCrossRefGoogle Scholar
  22. 22.
    Palmer P, Neel A, Sprouls G, Morrison L. Swallow characteristics in patients with oculopharyngeal muscular dystrophy. J Speech Lang Hear Res. 2010;53(6):1567–78.PubMedCrossRefGoogle Scholar
  23. 23.
    Neel AT, Palmer PM. Is tongue strength an important influence on rate of articulation in diadochokinetic and reading tasks? J Speech Lang Hear Res. 2011;55(1):235–46. doi:10.1044/1092-4388(2011/10-0258.PubMedCrossRefGoogle Scholar
  24. 24.
    Chang C, Chen S, Ko JY, Lin YH. Early radiation effects on tongue function for patients with nasopharyngeal carcinoma: a preliminary study. Dysphagia. 2008;23(2):193–8. doi:10.1007/s00455-007-9128-x.PubMedCrossRefGoogle Scholar
  25. 25.
    Gingrich LL, Stierwalt JAG, Hageman CF, LaPointe LL. Lingual propulsive pressures across consistencies generated by the anteromedian and posteromedian tongue by healthy young adults. J Speech Lang Hear Res. 2012;55(3):960–72.PubMedCrossRefGoogle Scholar
  26. 26.
    Bohannon RW, Schaubert KL. Test–retest reliability of grip-strength measures obtained over a 12-week interval from community-dwelling elders. J Hand Ther. 2005;18(4):426–8. doi:10.1197/j.jht.2005.07.003.PubMedCrossRefGoogle Scholar
  27. 27.
    Solomon NP, Munson B. The effect of jaw position on measures of tongue strength and endurance. J Speech Lang Hear Res. 2004;47(3):584–94.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Hopkins WG. A New View of Statistics: Precision of measurement, 2011. Available at http://sportsci.org/resource/stats/precision.html. Accessed 5 July 2012.
  29. 29.
    Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Mahwah: Erlbaum; 1988.Google Scholar
  30. 30.
    Hopkins WG. A new view of statistics, 2006. Available at http://www.sportsci.org/resource/stats/index.html. Accessed 5 July 2012.
  31. 31.
    Palmer PM, Jaffe DM, McCulloch TM, Finnegan EM, Van Daele DJ, Luschei ES. Quantitative contributions of the muscles of the tongue, floor-of-mouth, jaw, and velum to tongue-to-palate pressure generation. J Speech Lang Hear Res. 2008;51(4):828–35.PubMedCrossRefGoogle Scholar
  32. 32.
    Kays S, Hind J, Gangnon R, Robbins J. Effects of dining on tongue endurance and swallowing-related outcomes. J Speech Lang Hear Res. 2010;53(4):898–907.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Vitorino J. Effect of age on tongue strength and endurance scores of healthy Portuguese speakers. Int J Speech Lang Pathol. 2010;12(3):237–43. doi:10.3109/17549501003746160.PubMedCrossRefGoogle Scholar
  34. 34.
    Clark HM, Solomon NP. Age and sex differences in orofacial strength. Dysphagia. 2012;27(1):2–9. doi:10.1007/s00455-011-9328-2.PubMedCrossRefGoogle Scholar
  35. 35.
    Clark HM. Specificity of training in the lingual musculature. J Speech Lang Hear Res. 2012;55(2):657–67. doi:10.1044/1092-4388(2011/11-0045.PubMedCrossRefGoogle Scholar
  36. 36.
    Clark HM. Neuromuscular treatments for speech and swallowing: a tutorial. Am J Speech Lang Pathol. 2003;12(4):400–15.PubMedCrossRefGoogle Scholar
  37. 37.
    Hewitt A, Hind J, Kays S, Nicosia M, Doyle J, Tompkins W, Gangnon R, Robbins J. Standardized instrument for lingual pressure measurement. Dysphagia. 2008;23(1):16–25. doi:10.1007/s00455-007-9089-0.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Valerie Adams
    • 1
  • Bernice Mathisen
    • 2
  • Surinder Baines
    • 3
  • Cathy Lazarus
    • 4
    • 5
  • Robin Callister
    • 1
  1. 1.Priority Research Centre in Physical Activity and Nutrition, Faculty of Health and Medicine, School of Biomedical Sciences and PharmacyThe University of NewcastleCallaghanAustralia
  2. 2.Faculty of Health Sciences, LaTrobe Rural Health SchoolLaTrobe UniversityBendigoAustralia
  3. 3.Faculty of Health and Medicine, School of Health SciencesThe University of NewcastleCallaghanAustralia
  4. 4.Department of Otorhinolaryngology Head & Neck SurgeryAlbert Einstein College of Medicine of Yeshiva UniversityBronxUSA
  5. 5.Thyroid Head and Neck Research Center, Thyroid Head and Neck Cancer (THANC) FoundationBeth Israel Medical CenterNew YorkUSA

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