Lingual Strengthening Using Resistance

Research by Dr. Lazarus and Dr. Robbins has focused heavily on lingual strengthening.  Many of these research articles have proven to us that lingual strengthening using resistance such as an IOPI does increase not only tongue strength and at times, tongue mass, but also improves the overall swallow.  This same research has also shown us that using a tongue depressor is just as effective as a more expensive device.

 The nice thing about these more expensive devices, such as the Iowa Oral Performance Instrument, or IOPI is that they allow visual representation of strength, but also allows you to visually set a goal for your patient.  The IOPI is a box that is attached to a tongue bulb.  The bulb is pushed between the tongue and the palate, the cheeks and the teeth or the lips and the teeth.   It gives you a visual line showing the amount of effort exerted with a number representation.  This not only allows you to track where the patient functions during that session, giving you measurable outcomes to report to insurance, but it also allows you to set a goal for your patient to try to beat.

 Dr. Robbins created a device similar to the IOPI called the Madison Oral Strength Trainer (MOST).  This device has a 5 point piece that fits on the palate with 5 pressure sensors to measure lingual strength with your patient.  This device will cost you nearly $2000.   The MOST is connected to a laptop to track progress and strength of your patient.

 The creator of TheraSip, those wonderful micro resistant straws I recently blogged about, has created a device called the Tongue Press.  It does not have a fancy computer with it to track or collect data regarding your patient’s strength or progress.  This is a very simple device with 2 clear plastic tubes which can be filled with water, with a red level in the top tube with bulbs on both ends.  After the device is set per instructions (included with the device) the patient puts the tongue bulb between the tongue/palate, lips/teeth or cheek/teeth and squeezes.  Strength can be measured by movement of the red level.  The nice part of this device…..it costs a mere $20.

 While the computers are always nice to have and very functional, if you don’t have $1000-$2000 to spend on a device, you can always use tongue depressors for lingual strengthening or the new Tongue Press.

 The main thing we need to remember is to utilize evidence based practice in our therapy.  There is plenty of evidence base regarding lingual strengthening that we can incorporate into our therapy.

 Lazarus, C. Logemann, J.A., Huang, C.F. and Rademaker, A.W. (2003).  Effects of two types of tongue strengthening exercises in young normals.  Folia Phoniatrica et Logopaedica, 55, 199-205.

 Robbins, J.A., Gangnon, R.F., Theis, S.M., Kays, S.A., Hewitt, A.L., and Hind, J.A. (2005).  The effects of lingual exercise on swallowing in older adults.  Journal of the American Geriatric Society, 53, 1483-1489.

 Robbins, J.A. (2003, March).  Oral strengthening and swallowing outcomes.  Perspectives on Swallowing and Swallowing Disorders, 12, 16-19.

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