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Premature Infant Oral Motor Intervention (PIOMI) Translating Interventional Research into Interdisciplinary Practice



Because the PIOMI was developed in partnership between an RN and an SLP, bot disciplines must work together to advance the evidence on it, and to train NICUs on how to implement it for use as an oral motor standard of care. This presentation is a description of the process of translating evidence to practice, focusing on how to do this successfully among different disciplines (RNs and SLPs). Rogers Diffusion of Innovation model is presented as a guide with detailed steps explicated from the model. An on-site PIOMI training done by an RN (Lessen) to a group of both RNs and SLPs in an NICU in Bethlehem PA is used as case study. This is one of the data collection sites for a research study by Lessen & Leach on the effects of the PIOMI on cue-based feeding and LOS.
Premature Infant Oral Motor Intervention (PIOMI)
Translating Interventional Research into Interdisciplinary Practice
Brenda S. Lessen, PhD, RN
Illinois Wesleyan University, School of Nursing
Feeding Difficulties in Preterm Infants
PIOMI = Reduced LOS by 2.6 days
Oral Musculature
Feeding difficulty and
prolonged hospitalization
Inability to maintain physiological stability
and weight during oral feeding progression
Lack of coordination of
suck, swallow, & breath
Functional and neurologic immaturity of the
oral motor structures
Immature sucking skills
Exposure to negative oral stimuli
Preterm infants have poor oral-motor control related to:
weaker muscle tone around mouth
less sensation
decreased lip strength and lip seal
less tongue strength
Decreased sucking strength and endurance
To assess the effect of the Premature Infant Oral Motor
Intervention (PIOMI), on feeding progression and length of
hospital stay in preterm infants < 30 weeks PMA
Provides assisted movement to activate muscle contraction.
Provides movement against resistance to build strength.
Focus is to increase functional response to pressure and to
movement, and control of movement for the lips, cheeks, jaw,
and tongue.
Cheeks, lips, gums, tongue and palate are targeted using a
specific oral motor techniques for 3 minutes
Ends with non-nutritive sucking for 2 minutes
The PIOMI group transitioned to total oral feedings 5 days sooner than controls
(p = 0.043)
29 week PMA infants tolerated the PIOMI. Of the182 times the PIOMI was done, it
was never terminated due to adverse responses of infants. There were only 4
single delays for apnea, which were self-corrected, and the PIOMI was continued.
Study Timeline
The PIOMI group was discharged 2.6 days sooner than
controls (p = .541)
A 3-day decrease in LOS would save our nation more than
$2 billion annually
26-29 29 30
weeks PMA
Eligible PIOMI
DischargeBirth Feeding Progression
Future Research
Multi Site Sample
Dose-response studies
More times per day
Longer period of days (to discharge?)
Nurse/Parent responses to the PIOMI
PIOMI on cardiac infants
PIOMI on “known poor feeders”
Effect on Breastfeeding
Parents administering PIOMI
Evaluate Training methods
PIOMI = 5 days sooner to Total Oral Feeds
Experimental Control
M = 23.4 M = 18.1
15 20 25 30
total days to full feed
15 20 25 30
total days to full feed
Days from 29 weeks PMA to Discharge
Difference of 2.6 days
Translating Evidence….
The Intervention
Reliability Study on the PIOMI: 98% Agreement
Into Practice…
Diffusion of Innovations Model
Rogers (2003)
Adoption of an innovation is influenced
by the nature of it and the manner in which
it is communicated to users in a social system.
Translational Theory
KNOWLEDGE: Person becomes aware of
the innovation & what it
PERSUASION: Person forms favorable or
unfavorable attitude
towards innovation
DECISION: Person engages in
activities towards a choice
to adopt or reject
IMPLEMENTATION: Person puts innovation
into use
CONFIRMATION: Person evaluates results of
using innovation
Publication of the PIOMI
One-on-one discussions
with researcher on unit
Disseminate publication to
the “innovators” on unit
Establish website:
Cross all disciplines
Enhanced by staff
involvement in the research
A positive Reliability Study
Compatibility with unit
Already familiar with oral
Researcher engages key
players in discussions
Policy makers
Target “Opinion Leaders”
and “Early Adopters”
10% of system members
adopt an innovation =
rapid adoption by
remaining members
Strong interpersonal ties
with opinion leaders is more
effective than mass-media
Tipping Points:
FREE (no equipment)
Benefits (feeding)
East of Use (simple)
Time (quick)
Adopt as Unit/Department
Researcher consulted in
policy development
Nurse Practice Council
Feeding Council
Train Staff
PIOMI “Super-Users”
or “Champions”
Develop professional
training materials
Quick Reference
Reliability Checklist
Evaluate training methods
Periodic testing of reliability
Continue research
Training Materials
Primary Reference
Lessen, B.S. (2011) Effect of the Premature Infant Oral
Motor Intervention on Feeding Progression and Length of Stay in
Preterm Infants, Advances in Neonatal Care, 11 (2), 129-139.
Interobserver 100% 97.20% 95.52% 97.57%
Interuser 97.59%
RN A and RN B 100% 95.83% 93.33% 96.39%
RN A and RN C 100% 97.87% 97.87% 98.58%
RN B and RN C 100% 97.92% 95.45% 97.79%
Test-Retest 97.58%
RN A 100% 100% 95.65% 98.55%
RN B 100% 100% 95.35% 98.45%
RN C 100% 100% 87.23% 95.74%
Structure Purpose Frequency Duratio
Cheek Stretch Improve range of motion and
strength of cheeks, and
improve lip seal.
2x each cheek 30 sec
Lip Stretch Improve lip range of motion
and seal.
1X each lip 30 sec
Upper and Lower Lip Curl Improve lip strength, range of
motion, and seal.
1X each lip 30 sec
Gum Massage Improve range of motion of
tongue, stimulate swallow, and
improve suck.
2X 30 sec
Lateral Borders of Tongue Improve tongue range of
motion and strength.
1X each 15 sec
Midblade of Tongue Improve tongue range of
motion and strength, stimulate
swallow, and improve suck.
2X 30 sec
Elicit a Suck Improve suck, and soft palate
N/A 15 sec
Non-Nutritive Sucking Improve suck, and soft palate
N/A 2 min
For Information
Academy of Neonatal
Nurses: Mother Baby
Chicago, IL
September, 2012
Each child with cerebral palsy is unique, as the characteristics of their impairment, which applies to the oro-motor function as well. This chapter describes the challenges that the child, the caregiver, and the rehabilitation therapist can encounter with regard to feeding, underlining the importance of referring to the physiological phases of development and appropriate facilitations to promote the child’s oro-motor skills. The brief description of physiological swallowing is followed by an overview of dysphagia in CP, together with indications on what to observe in both the term and preterm infant and a selection of practical suggestions for therapeutic intervention. When addressing the problems of feeding, the rehabilitation therapist needs to pay attention to the positioning of both the child and the caregiver and to the sensory characteristics of the environment. Facilitation techniques and tools to promote the infant’s oro-motor functions are discussed, together with their use during daily life activities such as eating, drinking, and oral hygiene.KeywordsCerebral palsyOro-motor functionsEnvironmentFeeding facilitations
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