Skip to main content
Log in

A Systematic Review and Meta-analysis of Measurements of Tongue and Hand Strength and Endurance Using the Iowa Oral Performance Instrument (IOPI)

  • Review Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

The purpose of this systematic review was to examine the evidence for the use of the Iowa Oral Performance Instrument (IOPI) to measure strength and endurance of the tongue and hand in healthy populations and those with medical conditions. A systematic search of the scientific literature published since 1991 yielded 38 studies that addressed this purpose. The IOPI was used primarily for tongue strength (38 studies) and endurance (15 studies) measurement; relatively few studies measured hand strength (9 studies) or endurance (6 studies). The majority of the studies identified used the IOPI as an evaluation tool, although four used it as an intervention tool. Half the studies were conducted in healthy people, primarily adults. Most of the other participants had disorders with dysphagia, primarily Parkinson’s disease or head or neck cancer. Age and gender, as well as a number of medical conditions, influence the values of tongue and hand strength. There is sufficient evidence to support the use of the IOPI as a suitable tool for measuring tongue strength and endurance and as an assessment tool for intervention studies, and there is growing support for its use to assess hand strength and endurance in healthy and clinical populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. IOPI Medical LLC. Iowa Oral Performance Instrument: users manual. 2008. http://www.iopimedical.com. Accessed 17 Sep 2008.

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. Clark HM, Solomon NP. Age and sex differences in orofacial strength. Dysphagia. 2012;27(1):2–9. doi:10.1007/s00455-011-9328-2.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    PubMed  CAS  Google Scholar 

  9. 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.

    Article  Google Scholar 

  10. Crow HC, Ship JA. Tongue strength and endurance in different aged adults. J Gerontol Med Sci. 1996;51A(5):M247–50.

    Article  Google Scholar 

  11. Solomon NP, Robin DA, Mitchinson SI, VanDaele DJ, Luschei ES. Sense of effort and the effects of fatigue in the tongue and hand. J Speech Lang Hear Res. 1996;39(1):114–25.

    CAS  Google Scholar 

  12. Solomon NP, Drager KDR, Luschei ES. Sustaining a constant effort by the tongue and hand: effects of acute fatigue. J Speech Lang Hear Res. 2002;45(4):613–24.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Solomon NP, Robin DA, Lorell DM, Rodnitzky RL, Luschei ES. Tongue function testing in Parkinson’s disease. In: Till JA, Yorkston K, Beukelman DR, editors. Motor speech disorders: advances in assessment and treatment. Baltimore: Paul H Brookes Publishing Co; 1994. p. 147–60.

    Google Scholar 

  17. 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 

  18. 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.

    PubMed  CAS  Google Scholar 

  19. 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.

    PubMed  CAS  Google Scholar 

  20. Lazarus CL, Logemann JA, Shi G, Kahrilas PJ, Pelzer HJ, Kleinjan K. Does laryngectomy improve swallowing after chemoradiotherapy? A case study. Arch Otolaryngol Head Neck Surg. 2002;128(1):54–7. doi:10.1001/archotol.128.1.54.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. O’Day FE, Montgomery A, Nichols M, McDade H. Repeated tongue and hand strength measurements in normal adults and individuals with Parkinson’s disease. Int J Orofacial Myology. 2005;31:15–25.

    PubMed  Google Scholar 

  23. Neel AT, Palmer PM, Sprouls G, Morrison L. Tongue strength and speech intelligibility in oculopharyngeal muscular dystrophy. J Med Speech Lang Pathol. 2006;14:273–7.

    Google Scholar 

  24. Solomon NP. What is orofacial fatigue and how does it affect function for swallowing and speech? Semin Speech Lang. 2006;27(4):268–82. doi:10.1055/s-2006-955117.

    Article  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. Stierwalt JAG, Youmans SR. Tongue measures in individuals with normal and impaired swallowing. Am J Speech Lang Pathol. 2007;16(2):148–56.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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 

  29. Yeates EM, Molfenter SM, Steele CM. Improvements in tongue strength and pressure-generation precision following a tongue-pressure training protocol in older individuals with dysphagia: three case reports. Clin Interv Aging. 2008;3(4):735–47.

    PubMed  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  Google Scholar 

  32. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097.

    Article  PubMed  Google Scholar 

  33. Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. PLoS Med. 2010;7(3):e1000251. doi:10.1371/journal.pmed.1000251.

    Article  PubMed  Google Scholar 

  34. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions, ver. 5.1.0 [updated March 2011]. 2011. www.cochrane-handbook.org. Accessed 17 Jan 2012.

  35. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1:2.

    Article  PubMed  CAS  Google Scholar 

  36. Clark H, Solomon NP. Age and sex differences in orofacial strength. Dysphagia. 2012;27:2–9. doi:10.1007/s00455-011-9328-2.

    Article  PubMed  Google Scholar 

  37. Potter NL, Kent RD, Lazarus JC. Oral and manual force control in preschool-aged children: is there evidence for common control? J Mot Behav. 2009;41(1):66–82. doi:10.1080/00222895.2009.10125919.

    Article  PubMed  Google Scholar 

  38. Potter N, Short R. Maximal tongue strength in typically developing children and adolescents. Dysphagia. 2009;24(4):391–7. doi:10.1007/s00455-009-9215-2.

    Article  PubMed  Google Scholar 

  39. 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 

  40. Stierwalt JAG, 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 

  41. Clark HM, O’Brien K, Calleja A, Corrie SN. Effects of directional exercise on lingual strength. J Speech Lang Hear Res. 2009;52(4):1034–47.

    Article  PubMed  Google Scholar 

  42. Lazarus CL, Logemann JA, Huang C, Rademaker AR. Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatr Logop. 2003;55(4):199.

    Article  PubMed  Google Scholar 

  43. 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.

    Article  PubMed  Google Scholar 

  44. Robbins J, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;53(9):1483–9. doi:10.1111/j.1532-5415.2005.53467.x.

    Article  PubMed  Google Scholar 

  45. Robbins J, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, Taylor AJ. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007;88(2):150–8.

    Article  PubMed  Google Scholar 

  46. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Mahwah: Erlbaum; 1988.

    Google Scholar 

Download references

Conflict of interest

The authors have no competing interests to declare and no author had any paid consultancy or any other conflict of interest. This material was unfunded at the time of manuscript preparation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robin Callister.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adams, V., Mathisen, B., Baines, S. et al. A Systematic Review and Meta-analysis of Measurements of Tongue and Hand Strength and Endurance Using the Iowa Oral Performance Instrument (IOPI). Dysphagia 28, 350–369 (2013). https://doi.org/10.1007/s00455-013-9451-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-013-9451-3

Keywords

Navigation