I-PRO. Nope, it’s not a new app for the iPad. It stands for Isometric Progressive Resistance Oropharyngeal Therapy.
Isometric is a sustained movement. Wikipedia:
- “Isometric exercise, a form of resistance exercise in which one’s muscles are used in opposition with other muscle groups, to increase strength, for bodybuilding, physical fitness, or strength training.”
Juan J, Hind J, Jones C, McCulloch T, Gangnon R, Robbins J. Case Study: Application of Isometric Progressive Resistance Oropharyngeal Therapy Using the Madison Oral Strengthening Therapeutic Device. Top Stroke Rehabil. 2013 Sep-Oct;20(5):450-70. doi: 10.1310/tsr2005-450
I-PRO is definitely a (new?) tool for your dysphagia toolbox!
This study looked at a single patient. A 56 year old female, 27 months s/p CVA. This patient had undergone behavioral interventions (“swallow-specific maneuvers (eg, supraglottic swallow), swallowing sensory stimulation/enhancement (eg, thermal stimulation), postural strategies (eg, head turn), and dietary modification”), UES dilatations and G-Tube with expectoration of saliva. She also had outpatient services including, as the authors state “traditional dysphagia therapy and an intensive, daily home practice program including swallowing-specific maneuvers (eg, Mendelsohn), range of movement exercises, and electrical stimulation (E-stim) during saliva swallowing tasks.”
Following traditional therapy: Video Fluorscopic Swallow Study (VFSS) was completed to see the anatomy and physiology of the swallow, looking at 12 swallows and 4 bolus consistencies. Patient was observed with liquid pooling on the vocal folds, liquid pooling in the pyriform sinus, minimal right-sided UES opening, aspiration of liquids and decreased lingual strength as measured by the IOPI.
The patient then was introduced to 8 weeks of I-PRO Therapy with a focus on the anterior and posterior tongue, followed by 5 weeks of detraining and 9 weeks of I-PRO maintenance with decreased frequency.
During the 8 weeks of I-PRO, the patient completed 10 lingual press exercises (anterior and posterior portions of the tongue) 3x/day, 3 days/week.
Detraining included 5 weeks of no lingual strengthening. After the detraining session, patient was found to have decreased isometric pressure with reduced UES oepning.
A 9 week program of I-PRO Therapy followed the detraining, which included a less intense I-PRO program. After the maintance program, anterior lingual pressure returned to the same level that it was after the 8 weeks of intervention.