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The Effectiveness of the Iowa Oral Performance Instrument (IOPI) to
Differentiate Infants Diagnosed with Dysphagia
1Zacharias,
E., 1Seikel, J. A., 1Sorensen, D., 1Hardy, A., 1Flipsen, P., & 2Devine, N.
1Communication
Sciences & Disorders, and Education of the Deaf, Idaho State University
2Department
BACKGROUND
Estimated
prevalence of feeding disorders in the United States
ranges from 25% to 45% in typically developing children and from
33% to 80% in children with developmental delays, per summaries of
investigations reporting these figures (Burklow, Phelps, Schultz,
McConnell & Rudolph, 1998, Linscheid, 2006).
 A healthy
preterm baby may rely on oral feeding as early as 34
weeks. Aspiration places an infant at risk for aspiration pneumonia.
Any abnormalities in the swallow appear to occur after multiple
swallows. Most infants who aspirate do not show signs, such as a
cough, indicating silent aspiration. There is a need for normative
data to develop a better understanding of typical oral motor
development for feeding (Delany and Arvedson, 2008).
Deficits
in tongue strength have direct implication on the oral phase
of the swallow and therefore effect the pharyngeal phase of the
swallow as well. A quantitative measure of tongue strength in infants
has the potential to aid in the assessment and treatment of pediatric
dysphagia (Porter & Short, 2009).
Nicosia,
Roecker, Carnes, Doyle, Dengel, and Robbins (2000)
noted multiple-peaked swallows in their study where the first peak
had a higher pressure than the second lower pressure after the
bolus had left the oral cavity. Furthermore, this was observed in all
participants for the liquid bolus. Nicosia (2000) described how the
first peak pressure was to propel the bolus into the pharynx and the
second lower pressure peak was after the bolus had exited the oral
cavity.
HYPOTHESES
of Physical and Occupational Therapy, Idaho State University
PROCEDURE
 The participants caregivers were administered a questionnaire to evaluate
the birth history, developmental growth and any complications with sucking
or swallowing the infant may have had since birth.
 The Cradle Side Swallow Assessment was used to evaluate the infants’
feeding abilities.
 The IOPI was utilized to obtain three peak pressures in kPa while the infant
was swallowing or sucking on the bulb.
 The IOPI was connected to digital recorder to collect real time data while the
infant was sucking on the bulb. The infant was administered 1mL of breast
milk or formula to elicit a nutritive suck.
 The following data was abstracted :
Jitter percentage was defined as the average period difference
between the consecutive cycles divided by the average period
multiplied by 100 (Horii, 1982). Jitter percentage was obtained for the
sucking interval and the suck- swallow interval for each of the trials that
the participants underwent.
The sucking interval consisted of time between consecutive sucks, and
did not include a swallow.
Suck-swallow interval was the time between successive swallow
events.
 Descriptive analysis (mean, standard deviation, and minimum and
maximum values) were computed for each trial performed for both
groups. Mean peak pressure and percentage of sucking jitter were
computed by gestational age in one month increments.
will be a difference in the peak pressure when you compare
the infants diagnosed with dysphagia and those with a typical
swallow.
Normative
data will be provided for infants ranging in age from 0-6
months.
METHODS
Participant

14 infants with a typical swallow.

3 infants with dysphagia
•
2 were diagnosed with dysphagia secondary to reflux
and 1 diagnosed after the study with Noonan Syndrome.

Infants were both breast and bottle fed.

Ranged in gestational age from 42-63 weeks.

Nutritive and non-nutritive sucking data was collected.
 This graph depicts a non nutritive suck from a male diagnosed
with Noonan Syndrome who had a gestational age of 58
weeks. Five second graph with a 5 Hz low pass. Note the
proximity of the waves that gets further apart as time
increased.
 This was the first data collected from this participant. His
subsequent graph indicated a slower sucking rhythm, which
was detected using a 4 Hz low pass filter. And by his third
graph, he stopped sucking for a portion of the data.
RESULTS
Table 1
Descriptive Analysis for Peak Pressure
n
Min
SD
Mean
Median
Non Nutritive Suck in an Infant with a Typical Swallow
This study found no difference in tongue strength between infants with a
typical swallow and those diagnosed with dysphagia and dysphagia
secondary to reflux. Mean data for infants with a typical swallow was
23.46 kPa, while infants diagnosed with dysphagia had a mean of 20.22
[
kPa, respectively. While no difference
was found in tongue strength
between the groups form this study, analysis of the data is cautioned
due to the limited number of participants of infants diagnosed with
dysphagia.
It was hypothesized that a difference would emerge between infants with a
typical swallow and those diagnosed with dysphagia with a larger
number of participants and a wider array of impairments. This is based
on the fact that participant 6 had peak pressures that were on average
10 kPa less than the mean peak pressure from infants with a typical
swallow. This is approximately half of the peak pressure of the infants
with a typical swallow. Based on the peak pressure from this participant,
if the sample were larger and included participants who varied more in
severity, then a significant difference could appear between the two
groups.
Findings revealed that there was no difference in the organization between
infants diagnosed with dysphagia and infants with a typical swallow. This
finding is cautioned due to the limited number of participants in the
dysphagia group. It is the hypothesis that a larger number of participants
combined with more participants who had more severe impairments
would reveal a difference in the sucking organization. This is based on
the finding that participant 6, who had severe dysphagia, in three
different trials was found to become less organized on all of the trails.
This indicates that there could be a difference noted and that the level of
impairment does play a difference in the infant being able to organize
their suck.
Findings revealed that there is no difference in the sucking regularity
between infants diagnosed with dysphagia and those with a typical
swallow. The mean sucking jitter, which looks at the variability between
the sucking intervals, indicated that both groups were around the same
sucking jitter of 24.9%.
Max
Infants with
14
16 kPa
4.64
23.46 kPa
24 kPa
31 kPa
a Typical
Swallow
Infants with
3
12 kPa
6.59
20.22 kPa
20 kPa
30 kPa
dysphagia
Note. SD= Standard Deviation. Min= Minimum Value. Max=Maximum Value. n =
number of participants.
Experimental Design

Single subject design

Independent variable: swallowing abilities
(typical swallow or diagnosed with dysphagia)

Dependent variables: Peak pressure during a swallow,
suck sequence, and suck-swallow sequence.

Control Variables: labial strength.
Instrumentation

IOPI Northwest Model 2.1 by IOPI™ Northwest Co., LLC,
Carnation, WA, was used to measure swallow pressure
and collect real time data of suck and suck-swallow sequence.

Sony ICD-UX200Fdigital recorder.

Cradle Side Feeding Evaluation

1mL plastic pipette

Parent Questionnaire
Non Nutritive Suck in an Infant Diagnosed with Noonan Syndrome
Non Nutritive Suck for an Infant with Reflux Symptoms that was Untreated
There
.
DISCUSSION
Conclusion
While there was no significant difference noted in the peak pressures
generated between the two groups, there is evidence that indicates if the
sample size was larger and the degree of involvement reflected what is
typically seen in the population, than there may be a significant
difference noted between the two groups.
 This graph depicts a non nutritive suck from a male infant with untreated
reflux who had a gestational age of 54 weeks. Five second graph with a
5 Hz low pass filter. Note the number of consecutive swallows with the
limited sucking intervals.
 Compare the above graph to the graph below of the same infant, but it
depicts a nutritive suck. Notice the similarities in the limited amount of
sucking bursts along with the irregularity of the sucking rhythm.
References
Burklow, K. A., Phelps, A. N., Schultz, J. R., McConnell, K., &
. Pediatric Feeding
Rudolph, C. (1998). Classifying Complex
Disorders. Journal of Pediatric Gastroenterology and Nutrition,
27, 143–147.
Delaney, A.L., & Arvedson, J.C. (2008) Development of
Swallowing and Feeding: Prenatal Through First Year of Life.
Developmental Disabilities Research Reviews 14.2, 105-117.
Linscheid, T. R. (2006). Behavioral Treatments for Pediatric
Feeding Disorders. Behavioral Modification, 30(1), 6–23.
Nicosia, M., Hind, J., Roecker, E., Carnes, M., Doyle, J.,
Dengel, G., & Robbins, J. (2000). Age Effects on the Temporal
Evolution of Isometric and Swallowing Pressure. The Journals of
 This graph depicts a non nutritive suck from male who had a
gestational age of 53 weeks. Five second graph with a 5 Hz
low pass filter. Note the swallow followed by the sucking burst
and then proceeded by another swallow.
Gerontology. Series A, Biological Sciences and Medical
Sciences, 55.11, M634-M640.
Porter, Nancy L. & Short, Robert. (2009) Maximal Tongue
Strengths in Typically Developing Children and Adolescence.
Dysphagia, 24, 391-397.