IOPI Medical Q4 2022 Newsletter - ASHA CEU Course is Now Live... and it's FREE!

Ahhh, autumn…chilly mornings followed by warm, sunny afternoons. Although we’ve had a lovely summer, it is a welcome reprieve from the constant heat, smell of sunscreen and the “sand”wiches that inevitably come from trying to spend as much time outdoors as possible.

With the changing of the leaves comes the anticipation of all the little joys the season can bring. From cozy evenings next to the fire, to trips to the pumpkin patch perhaps… it is time to feather our nests so to speak and take time to reflect on how we want to finish out the year.

All the IOPIians are working hard as ever to ensure our customers receive only the best, but we’re also looking forward to finishing out the year strong by turning an eye toward how we can be even better. We have a few things in mind, but you’ll have to stay tuned to find out what!

This quarter we are bringing news of how to register for AHSA CEUs with our FREE course, information on the next ASHA conference in New Orleans: Reframe Your Thinking: Resilience Reinvented, and as always, helpful resources and articles.

Don’t forget to visit our always-evolving website. We are continuing to make improvements, giving you the opportunity to interact with our IOPI staff, Patient Advocacy tools, and Covid-19 resources. You can also follow us on Instagram (iopimedical), Twitter (@iopimedical) & Facebook (IOPI Medical LLC) for the latest news and information.

We recently had a heart-warming story come across our desks that we wanted to share with you. Back in March the Houston Chronicle ran a story about a young woman who at the age of 25 suffered an accident that resulted in a stroke. After spending 6 months in the hospital and being diagnosed with locked-in syndrome with the ability to only move her eyes, she began her rehab at TIRR Memorial Hermann-Kirby Glen.

As part of her rehab, her SLP implemented the use of an IOPI to improve her tongue strength. As a frame of reference, normal tongue strength ranges from 40-80 kilospascals (kpa). When she started out, her tongue strength was 1-2 kpa, and at the time the story ran, it was up to 10-14 kpa.

This young woman clearly no longer fits into the locked-in syndrome category and IOPI Medical could not be prouder to be a part of her recovery.

We love hearing these stories. They give our team such a boost and remind us all why we do what we do. Why we work long hours and are so invested in our customers.

If you have a story and would be willing to share with us, we would love to hear it. You can share as little or as much information as you and your patient are comfortable with. Please reach out to us either via email, info@iopimedical.com or phone, 425-549-0139 to share your patient stories.

Not only will these stories be wonderful to share in future newsletters and social media, but they would also be a great morale boost for our team.

The IOPI Trainer device can be a valuable tool for patients who may benefit from exercise outside their formal therapy sessions. Once maximum pressure has been obtained with the IOPI Pro device, the IOPI Trainer device is programmed to the appropriate level of resistance before being provided to the patient. The IOPI Trainer device also uses a light array that can provide motivating biofeedback. Additionally, the IOPI Trainer device records the number of successful repetitions, which allows the clinician to check if the exercise program was completed as prescribed.

Use of the IOPI Trainer device does require regular interaction with a clinician. The clinician needs to determine maximum strength with the IOPI Pro device on a regular basis and then update the program (intensity, load, progression as explained below) or determine if there is continued therapeutic benefit.

The IOPI Trainer device is designed to allow clinicians to implement a progressive resistance exercise. For the program to be effective, it is necessary to consider the principles of exercise. Three principles are load, intensity, and progression (Burkhead et al., 2007).

• Load: Increasing the force-generating capacity requires the physiologic to exceed the typical demand. A percentage of maximal strength, referred to as one repetition maximum (1RM), is used to define the resistive load. High loads maximize effect (Van den Steen et al., 2019). The foundational research in tongue strengthening employed 60% of 1RM for the first week of training and 80% for the subsequent weeks (Robbins, 2007).

• Intensity: The concept suggests that to cause neuromuscular adaptations, the system must be pushed beyond the normal activity level. And be performed for an adequate duration to facilitate change (Garber et al., 2011). Intensity can be provided by the resistive load, amount of practice, and/or duration of training. Each of these has proven critical in bringing about neuromuscular adaptations. (Burkhead et al., 2007).

• Progression: Adaptive processes will only occur if the system is continually required to exert a greater magnitude of force to meet higher demands. A systematic increase of load is necessary for further improvement (Kraemer & Ratamess, 2004). In other words, once the system has adapted to the current load, the target must be advanced for changes to occur. To accomplish this task, obtain peak pressure using the IOPI at least weekly.

The IOPI Trainer device does not allow for a “set it and forget it” mentality. There must continue to be regular assessments and changes in target or course of therapy as necessary. In the hands of a skilled clinician, there are many potential benefits to using the IOPI Trainer device.

Burkhead, L. M., Sapienza, C. M., & Rosenbek, J. C. (2007). Strength-Training Exercise in Dysphagia Rehabilitation: Principles, Procedures, and Directions for Future Research. Dysphagia, 22(3), 251-265. https://doi.org/10.1007/s00455-006-9074-z

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., . . . Swain, D. P. (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc, 43(7), 1334-1359. https://doi.org/10.1249/MSS.0b013e318213fefb

Kraemer, W. J., & Ratamess, N. A. (2004). Fundamentals of resistance training: progression and exercise prescription. Med Sci Sports Exerc, 36(4), 674-688. https://doi.org/10.1249/01.mss.0000121945.36635.61

Robbins, J., Kays, S., Gangnon, R., Hind, J., Hewitt, A., Gentry, L., Taylor, J. . (2007). The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil, 88, 150-158.

Van den Steen, L., Vanderwegen, J., Guns, C., Elen, R., De Bodt, M., & Van Nuffelen, G. (2019). Tongue-Strengthening Exercises in Healthy Older Adults: Does Exercise Load Matter? A Randomized Controlled Trial. Dysphagia, 34(3), 315-324. https://doi.org/10.1007/s00455-018-9940-5

The ASHA convention is returning as a hybrid in-person/virtual event this year in NOLA! For those of you choosing the virtual option, there will be a virtual library of pre-recorded sessions that will be open November 10-28, allowing you more time to view sessions as well as her CE credit.

While IOPI Medical will not be staffing a booth this year, our Clinical Consultant, Ed Bice will be in attendance and along with a poster presentation, he will be a presenting author on several topics:

• 9409L: Managing Dysphagia for Individuals with Dementia (Poster (Live)) @ Friday, Nov 18 9:00 AM. Role: Presenting Author. CC/Hall B1

• 1393L: Part 1 (of 2): Grand Rounds in Strength and Skill Training for Swallowing Rehabilitation (1-Hour Seminar (In-Person)) @ Friday, Nov 18 11:00 AM. Role: Presenting Author. CC/La Nouvelle AB

• 1438L: Part 2 (of 2): Grand Rounds in Strength and Skill Training for Swallowing Rehabilitation (1-Hour Seminar (In-Person)) @ Friday, Nov 18 1:15 PM. Role: Presenting Author. CC/La Nouvelle AB

• 1483L: Reinventing Swallowing Treatment: Moving beyond 50 years of diet modifications towards resilient rehabilitation (1-Hour Seminar (In-Person)) @ Friday, Nov 18 2:45 PM. Role: Presenting Author. CC/206-207

• 1526L: Reframing the Purpose of Dysphagia Care: Putting the patient front and center (1-Hour Seminar (In-Person)) @ Friday, Nov 18 4:30 PM. Role: Presenting Author. CC/220-221

To help you achieve the greatest level of success for your patients, we continue to provide you with the necessary Purchasing Advocacy tools, as well as clinical support.

Our Purchasing Advocacy tools can be found on our Medical Professionals page. Here you will find our IOPI Dysphagia Cost Tool as well as a ready-to-use Benefits of IOPI for Dysphagia PowerPoint. Just populate it with information specific to your patient’s needs.

You also have clinical support at your fingertips. Our clinical consultant, Ed M. Bice, M.Ed., CCC-SLP, is available to mentor through the advocacy process to assess and report the estimated cost of dysphagia to your facility. You can reach Ed for a patient consultation or clinical question by calling (844) 844-IOPI or emailing ed@iopimedical.com.

To access our IOPI Dysphagia Cost Tool, the Benefits of IOPI for Dysphagia PowerPoint, and tips on advocating for your patients, please visit: https://iopimedical.com/purchasing-advocacy/

As many of you have already experienced, our webinars are another fantastic resource. We currently offer on-demand versions of both our IOPI 101: Introduction to the IOPI System and Advocacy for IOPI Products in Your Dysphagia Program webinars. To view our on-demand webinars, please visit https://iopimedical.com/webinars/.

We are not currently scheduling any future dates for Live webinars as we will be focusing on the previously mentioned ASHA CEU course. So exciting!

Although community-acquired pneumonia may be related to prandial aspiration, there are no standard diagnostic criteria for “aspiration pneumonia.” To investigate clinical factors that influence the diagnosis of aspiration pneumonia, the authors examined the medical records of 803 patients diagnosed with pneumonia. The study included 134 individuals diagnosed with aspiration pneumonia and 669 diagnosed with other types of pneumonia.

The investigators found those diagnosed with aspiration pneumonia had significantly higher rates of frailty, lived in residential facilities, had a history of neurologic conditions, had a prior diagnosis of pneumonia, diagnosed dysphagia, and more likely vomited or coughed when eating. Individuals diagnosed with aspiration pneumonia were more likely to be NPO, be referred to an evaluation by a speech pathologist, and be prescribed broad-spectrum antibiotics.

The authors conclude that a clinical diagnosis of aspiration pneumonia alone may deny patients necessary investigation and management. They suggest it would be more clinically relevant to recognize all pneumonia the same, and assess swallowing function, causative organisms, and investigate alternative diagnoses or underlying causes of dysphagia. Such an approach would lead to appropriate clinical management.

The diagnosis of aspiration pneumonia in older persons: a systematic review

Yoshimatsu Y, Melgaard D, Westergren A, Skrubbeltrang C, Smithard DG. The diagnosis of aspiration pneumonia in older persons: a systematic review. Eur Geriatr Med. 2022 Aug 25:1–10. doi: 10.1007/s41999-022-00689-3. Epub ahead of print. PMID: 36008745; PMCID: PMC9409622.

https://pubmed.ncbi.nlm.nih.gov/36008745/

Knowing there are no standard criteria for the diagnosis of aspiration pneumonia, the authors performed a systematic review to identify how aspiration pneumonia is being diagnosed in elderly patients. Nine papers were included for analysis. Most of the studies employed a combination of inflammatory markers, chest imaging, and clinical symptoms to make a clinical diagnosis of aspiration pneumonia. Aspiration pneumonia was often defined as pneumonia with some relationship to prandial aspiration or the presence of dysphagia. The inferred diagnosis of aspiration pneumonia occurred in the presence of witnessed or presumed prandial aspiration, coughing on food or liquids, specific clinical presentations, abnormalities on videofluoroscopy or water swallow test, and gravity-dependent distribution of shadows on chest imaging. Patients diagnosed with aspiration pneumonia tended to be older, more frail and had more comorbidities. The systematic review concludes that although there is consensus concerning the clinical criteria to diagnose aspiration pneumonia, it is a presumptive diagnosis regarding patients’ general frailty rather than concerning swallowing function alone.

Relationships Between Survival and Oral Status, Swallowing Function, and Oral Intake Level in Older Patients with Aspiration Pneumonia

Suzuki, T., Tsujimura, T., Magara, J. et al. Relationships Between Survival and Oral Status, Swallowing Function, and Oral Intake Level in Older Patients with Aspiration Pneumonia. Dysphagia 37, 558–566 (2022).

Springer: https://doi.org/10.1007/s00455-021-10306-3
PubMed: https://pubmed.ncbi.nlm.nih.gov/33929585/

Characteristics associated with the survival of patients diagnosed with aspiration pneumonia are ambiguous. This study examined the oral status, swallowing function, and oral intake level in 29 elderly patients (82 – 95, mean 89.4) clinically diagnosed with aspiration pneumonia to determine their correlation to survival outcomes. Patients were divided into two groups based on the 90-day mortality after the first swallowing function evaluation. Thirteen of the 29 patients diagnosed with aspiration pneumonia died within 90 days. The number of patients who could not use dentures, required suctioning, and had a cough at rest were significantly higher in the deceased than in the survivors. Salivary pooling, pharyngeal stasis, diet level, and consciousness level were significantly worse in the deceased than in the survivors. There were significant differences in patients’ oral health, swallowing Function, oral intake level, and level of consciousness.

Prognostic value of geriatric nutritional risk index for aspiration pneumonia: a retrospective observational cohort study

Araki T, Yamazaki Y, Goto N, Takahashi Y, Ikuyama Y, Kosaka M. Prognostic value of geriatric nutritional risk index for aspiration pneumonia: a retrospective observational cohort study. Aging Clin Exp Res. 2022 Mar;34(3):563-571. doi: 10.1007/s40520-021-01948-2. Epub 2021 Aug 11. PMID: 34379292.

https://pubmed.ncbi.nlm.nih.gov/34379292/

The geriatric nutrition risk index (GNRI) correlates with several diseases in older adults and may serve as a prognostic tool for pneumonia outcomes. The investigation sought to determine the clinical characteristics and prognostic significance of the Geriatric nutrition risk index in 587 adult patients >65 clinically diagnosed with aspiration pneumonia. GNRI was identified as an independent prognosticator for adverse outcomes, suggesting that nutritional health plays a role in the outcomes of patients with pneumonia.