As mentioned in our last newsletter, IOPI Medical is now in the sleep market, with research showing there are benefits of using the IOPI for those who struggle with obstructive sleep apnea (OSA).

Just last month we were in Houston for the Sleep 2024 conference and to say we came back invigorated is an understatement. It was wonderful to see the same excitement we see with our dysphagia folks, starting to spread! And of course, we are thrilled about the possibility of helping even more people than we already do. It is after all our raison d’etre!

IOPI’s Clinical Consultant, Ed Bice has co-authored a new book from Plural Publishing: Adult Dysphagia Clinical Reasoning and Decision-Making Guide. The book provides clinicians with quick access to clinical information, promotes critical thinking, and provides actionable solutions for their patients. Pre-order your copy through Plural Publishing by clicking the button below or watch for its release this Fall!

There is also a rumor going around (we may have started it) that Ed will be joining us here in Seattle for December’s ASHA convention where he will be signing his book as well as giving away free copies to select lucky winners!

Many of you may already be familiar with our esteemed Clinical Consultant, Ed Bice, but did you know, you can learn from him from the comfort of your office or home? IOPI Medical offers ASHA Continuing Education Units with our two FREE courses.

The Role of Oral Musculature in Swallowing and the Therapeutic Benefits of the IOPI, will review the oral musculature and its essential functions, as well as explore exercise principles and how the IOPI can be integrated into a dysphagia treatment plan.

Our second course, Research Update, summarizes recent findings related to the IOPI.

Click the button below to register!

The word exercise is ubiquitous among clinicians who treat swallowing disorders. However, an understanding of what exercise means seems to be elusive. Burkhead et al. (2007) suggest applying exercise principles to swallowing therapy. Six years later, Carnaby and Harenberg (2013) surveyed speech pathologists in ASHA Special Interest Group 13 (Swallowing and Swallowing Disorders) to examine the percentage of clinicians who provided treatment with exercise-based interventions. Their survey found that 13% of interventions suggested by clinicians were exercise-based. The findings were basically found again in a later survey (McCurtin & Healy, 2017). That begs the question, what is an exercise?

Although not a comprehensive list, exercise principles include overload, specificity, and progressive resistance. The overload principle suggests the need to exercise intensely enough to push the system beyond regular activity (Burkhead et al., 2007). Overload is accomplished by increasing resistance. Engaging in an intense exercise that pushes the system beyond the typical activity level leads to adaptations (Trombly, 1983). Typically, the prescription of resistive exercise intensity utilizes a percentage of one repetition maximum (Shimano et al., 2006). A one-repetition maximum is the maximum force a person can produce with a muscle or group of muscles. Exercise prescriptions typically utilize 60% to 80% of the one-repetition maximum (Shimano et al., 2006). For example, when testing tongue strength, if the one repetition maximum is 40 kilopascals, the exercise prescription for strengthening is between 24 (60%) and 32 (80%) kilopascals (Robbins et al., 2007).

Another core principle is specificity (Coffey & Hawley, 2017). Task specificity indicates that the specific muscle group requiring change must be engaged in the activity (Schmidt & Lee, 2011). The principle suggests the necessity of imaging to determine specific swallow pathophysiology to know which intervention may be appropriate.

The exercise principle of progression indicates the necessity to maintain the relative physiologic load. In other words, the load placed on the system must be progressively adjusted throughout the exercise program to achieve continual gains because to increase strength, as the maximum ability increases, the resistive load increases (Kraemer & Ratamess, 2004). Considering the previous example, once tongue strength increases from 40 to 45 kPa, the target must be adjusted to reflect the 60% to 80% of one repetition maximum. With this information in mind, clinicians need to have a tool to determine when adaptation to the current load has occurred. That knowledge will provide the information necessary to determine when the target needs to be progressed.

A thought to ponder is that although exercise may eventually cause morphological changes in muscle, the growth of muscle fibers cannot account for all the gains observed in the system (Akima et al., 1999). The central nervous system also contributes to training-dependent increases. One of the primary proposed adaptations is an increase in the ability to excite the motor neurons maximally. The increased activity may be secondary to an increase in descending excitatory drive, a decrease in inhibition, and an increase in facilitatory mechanisms (Jenkins et al., 2017). Evidence shows that high-intensity training causes gains in firing frequency and synchronization of action potentials (Folland & Williams, 2007). Jenkins et al. (2017) observed greater neural adaptations in high-intensity exercise (80% 1RM) compared to low-intensity exercise (30% 1RM). The findings indicate that exercise intensity influences gains by facilitating both neurologic and morphologic changes. In the case of swallowing therapy, the neurological gains may be the more important of the two (Galek et al., 2021).

For a list of sources for this article, please click the button below to email Ed Bice directly:

The next three articles highlight the need for oral health education amongst clinicians treating dysphagia.

The articles below are only a small fraction of the number of IOPI-related studies in general. You can find many more, covering a variety of topics, by visiting https://iopimedical.com/studies/ or clicking the button at the end of the section.

Hospital-acquired pneumonia is the most common hospital-acquired infection. Non-ventilator hospital-acquired pneumonia (NVHAP) represents 60% of cases. NVHAP typically results from the aspiration of microbes from the mouth, which harbors microbes that become established on surfaces such as the teeth, tongue, and mucosa. The teeth, in particular, can support millions of microbes as biofilms, and these biofilms can expand rapidly without effective oral hygiene. Inoculation of the lung by aspirated pathogens derived from dental biofilm can facilitate an inflammatory response, increasing the occurrence of NVHAP. The pathogens are often elevated in the secretions of patients with poor oral hygiene and periodontal disease, which can directly induce inflammation in the lung when aspirated. The current study examined hospital records for Medicaid beneficiaries who acquired non ventilator hospital-acquired pneumonia. The review results suggest that preventive dental treatment 12 months prior or periodontal therapy six months prior to hospitalization is associated with a reduced risk of pneumonia.

The study investigated the knowledge, attitudes, and behaviors of dysphagia clinicians regarding oral health care. The findings showed that 41.5% of clinicians had a "high" level of knowledge concerning oral health. The study showed that most clinicians exhibit moderate knowledge, attitudes, and behavior scores, and these states are significantly associated with oral health education. The data should serve as a stimulus for clinicians caring for dysphagia patients to receive oral health education.

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/

How can we get better at serving our customers, if we don’t know the ways in which we can improve? We have developed a very brief survey that would give us extremely valuable feedback, and it only takes a minute to complete! Please click the button below to begin.

To those of you who have already completed the survey, thank you! We greatly appreciate your insight into helping us offer the best service and products possible.

Phone: (425)-549-0139
Email: info@iopimedical.com