The purpose of this study was to investigate the reliability of tongue and handgrip strength and endurance measurements in healthy adults using the Iowa Oral Performance Instrument. Fifty-one healthy participants (21 males, 30 females; age range = 19–57 years) were tested on four occasions 1 week apart to determine test–retest reliability. The primary outcome measures were isometric tongue and handgrip strength (best of three trials) and sustained isometric endurance. Small increases (changes in group mean) in both anterior (1.7 %) and posterior (2.5 %) tongue strength and handgrip strength (5 %) between weeks 1 and 2 were observed with no change in subsequent weeks, suggesting that there is only a small learning effect for these measurements. The within-subject variation (mean-typical error expressed as a coefficient of variation [CV]) indicated higher than desirable initial variation for anterior (CV 10.8 %) and posterior (CV 11.8 %) tongue strength and handgrip strength (CV 15.2 %) but this was reduced in weeks 2–4. Intraclass correlation coefficients (ICC) indicated acceptable and improved reliability for both anterior (ICC 0.77–0.90) and posterior (ICC 0.79–0.86) tongue strength and handgrip strength (ICC 0.69–0.91) after week 1. Additional exploratory analyses were conducted with a subset of data to determine whether two values within 5 kPa (tongue) or 15 kPa (handgrip) provide superior strength reliability. Neither tongue nor hand endurance measurements were sufficiently reliable. These findings suggest that tongue and handgrip strength values demonstrate acceptable reliability, especially if familiarization is provided. Further investigation is needed to reduce sources of variability in tongue endurance measurements.
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Youmans S, Stierwalt JAG. Measures of tongue function related to normal swallowing. Dysphagia. 2006;21(2):102–11. doi:10.1007/s00455-006-9013-z.
Crow HC, Ship JA. Tongue strength and endurance in different aged adults. J Gerontol Med Sci. 1996;51A(5):M247–50.
Lazarus CL, Logemann JA, Pauloski BR, Rademaker AW, Larson CR, Mittal BB, Pierce M. Swallowing and tongue function following treatment for oral and oropharyngeal cancer. J Speech Lang Hear Res. 2000;43(4):1011–23.
Nicosia MA, Hind JA, Roecker EB, Carnes M, Doyle J, Dengel GA, Robbins J. Age effects on the temporal evolution of isometric and swallowing pressure. J Gerontol A Biol Sci Med Sci. 2000;55(11):M634–40. doi:10.1093/gerona/55.11.M634.
Robbins J, Levine RL, Wood J, Roecker EB, Luschei ES. Age effects on lingual pressure generation as a risk factor for dysphagia. J Gerontol A Biol Sci Med Sci. 1995;50A(5):M257–62. doi:10.1093/gerona/50A.5.M257.
Robin DA, Goel A, Somodi LB, Luschei ES. Tongue strength and endurance: Relation to highly skilled movements. J Speech Hear Res. 1992;35(6):1239–45.
Robin DA, Somodi LB, Luschei ES. Measurement of tongue strength and endurance in normal and articulation disordered subjects. In: Moore CA, Yorkston KM, Beukelman DR, editors. Dysarthria and apraxia of speech: perspectives on management. Baltimore: Paul H Brookes Publishing Co; 1991. p. 173–84.
Solomon NP, Robin DA, Luschei ES. Strength, endurance, and stability of the tongue and hand in Parkinson disease. J Speech Lang Hear Res. 2000;43(1):256–67.
Stierwalt JA, Robin DA, Solomon NP, Weiss AL, Max JE. Tongue strength and endurance: relation to the speaking ability of children and adolescents following traumatic brain injury. In: Robin DA, Yorkston K, Beukelman DR, editors. Disorders of motor speech: assessment, treatment, and clinical characterization. Baltimore: Brookes Publishing Co.; 1996. p. 241–56.
Stierwalt JA, Youmans SR. Tongue measures in individuals with normal and impaired swallowing. Am J Speech Lang Pathol. 2007;16(2):148–56.
Youmans SR, Stierwalt J, Clark HM. Measures of tongue function in healthy adults. Paper presented at the American Speech-Language-Hearing Association, Atlanta, GA, 2002.
IOPI Medical LLC, Iowa Oral Performance Instrument: Users Manual; 17 Sep 2008. Available at http://www.iopimedical.com/.
Steele CM, Bailey GL, Molfenter SM, Yeates EM. Rationale for strength and skill goals in tongue resistance training: A review. Perspect Swallow Swallow Disord. 2009;18(2):49–54. doi:10.1044/sasd18.2.49.
Hopkins WG. Measures of reliability in sports medicine and science. Sports Med. 2000;30(1):1–15.
Solomon NP, Lorell DM, Robin DA, Rodnitzky RL, Luschei ES. Tongue strength and endurance in mild to moderate Parkinson’s disease. J Med Speech Lang Pathol. 1995;3(1):15–26.
Solomon NP. Changes in normal speech after fatiguing the tongue. J Speech Lang Hear Res. 2000;43(6):1416–28.
Clark HM, Henson PA, Barber WD, Stierwalt JAG, Sherrill M. Relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments. Am J Speech Lang Pathol. 2003;12(1):40–50.
Lazarus CL, Logemann JA, Pauloski BR, Rademaker AW, Helenowski IB, Vonesh EF, MacCracken E, Mittal BB, Vokes EE, Haraf DJ. Effects of radiotherapy with or without chemotherapy on tongue strength and swallowing in patients with oral cancer. Head Neck. 2007;29(7):632–7. doi:10.1002/hed.20577.
Neel AT, Palmer PM, Gass CA. Can IOPI be used to measure tongue pressure for speech sounds? J Med Speech Lang Pathol. 2008;16(1):235–41.
Solomon NP, Clark HM, Makashay MJ, Newman LA. Assessment of orofacial strength in patients with dysarthria. J Med Speech Lang Pathol. 2008;16:251–8.
Youmans S, Youmans G, Stierwalt JAG. Differences in tongue strength across age and gender: Is there a diminished strength reserve? Dysphagia. 2008;24(1):57–65. doi:10.1007/s00455-008-9171-2.
Palmer P, Neel A, Sprouls G, Morrison L. Swallow characteristics in patients with oculopharyngeal muscular dystrophy. J Speech Lang Hear Res. 2010;53(6):1567–78.
Neel AT, Palmer PM. Is tongue strength an important influence on rate of articulation in diadochokinetic and reading tasks? J Speech Lang Hear Res. 2011;55(1):235–46. doi:10.1044/1092-4388(2011/10-0258.
Chang C, Chen S, Ko JY, Lin YH. Early radiation effects on tongue function for patients with nasopharyngeal carcinoma: a preliminary study. Dysphagia. 2008;23(2):193–8. doi:10.1007/s00455-007-9128-x.
Gingrich LL, Stierwalt JAG, Hageman CF, LaPointe LL. Lingual propulsive pressures across consistencies generated by the anteromedian and posteromedian tongue by healthy young adults. J Speech Lang Hear Res. 2012;55(3):960–72.
Bohannon RW, Schaubert KL. Test–retest reliability of grip-strength measures obtained over a 12-week interval from community-dwelling elders. J Hand Ther. 2005;18(4):426–8. doi:10.1197/j.jht.2005.07.003.
Solomon NP, Munson B. The effect of jaw position on measures of tongue strength and endurance. J Speech Lang Hear Res. 2004;47(3):584–94.
Hopkins WG. A New View of Statistics: Precision of measurement, 2011. Available at http://sportsci.org/resource/stats/precision.html. Accessed 5 July 2012.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Mahwah: Erlbaum; 1988.
Hopkins WG. A new view of statistics, 2006. Available at http://www.sportsci.org/resource/stats/index.html. Accessed 5 July 2012.
Palmer PM, Jaffe DM, McCulloch TM, Finnegan EM, Van Daele DJ, Luschei ES. Quantitative contributions of the muscles of the tongue, floor-of-mouth, jaw, and velum to tongue-to-palate pressure generation. J Speech Lang Hear Res. 2008;51(4):828–35.
Kays S, Hind J, Gangnon R, Robbins J. Effects of dining on tongue endurance and swallowing-related outcomes. J Speech Lang Hear Res. 2010;53(4):898–907.
Vitorino J. Effect of age on tongue strength and endurance scores of healthy Portuguese speakers. Int J Speech Lang Pathol. 2010;12(3):237–43. doi:10.3109/17549501003746160.
Clark HM, Solomon NP. Age and sex differences in orofacial strength. Dysphagia. 2012;27(1):2–9. doi:10.1007/s00455-011-9328-2.
Clark HM. Specificity of training in the lingual musculature. J Speech Lang Hear Res. 2012;55(2):657–67. doi:10.1044/1092-4388(2011/11-0045.
Clark HM. Neuromuscular treatments for speech and swallowing: a tutorial. Am J Speech Lang Pathol. 2003;12(4):400–15.
Hewitt A, Hind J, Kays S, Nicosia M, Doyle J, Tompkins W, Gangnon R, Robbins J. Standardized instrument for lingual pressure measurement. Dysphagia. 2008;23(1):16–25. doi:10.1007/s00455-007-9089-0.
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Adams, V., Mathisen, B., Baines, S. et al. Reliability of Measurements of Tongue and Hand Strength and Endurance Using the Iowa Oral Performance Instrument with Healthy Adults. Dysphagia 29, 83–95 (2014). https://doi.org/10.1007/s00455-013-9486-5
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