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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
Purpose
PIOMI = Reduced LOS by 2.6 days
Oral Musculature
The PIOMI
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
Begins
PIOMI
Ends
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
1
2
3
4
Count
15 20 25 30
total days to full feed
Experimental
Control
Days from 29 weeks PMA to Discharge
Difference of 2.6 days
41.8
44.4
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
5 STEPS
KNOWLEDGE: Person becomes aware of
the innovation & what it
is
PERSUASION: Person forms favorable or
unfavorable attitude
towards innovation
DECISION: Person engages in
activities towards a choice
to adopt or reject
innovation
IMPLEMENTATION: Person puts innovation
into use
CONFIRMATION: Person evaluates results of
using innovation
•Publication of the PIOMI
Study
•One-on-one discussions
with researcher on unit
•Disseminate publication to
the “innovators” on unit
•Establish website:
www.PIOMI.com
•Cross all disciplines
involved
• Enhanced by staff
involvement in the research
• A positive Reliability Study
•Compatibility with unit
“norms”
•Already familiar with oral
motor
•Researcher engages key
players in discussions
•RN’s
•Neonatologists
•Policy makers
•Speech-Language
Path’s
•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
campaign
•Tipping Points:
•FREE (no equipment)
•Benefits (feeding)
•East of Use (simple)
•Time (quick)
•Adopt as Unit/Department
Policy
•Researcher consulted in
policy development
•Nurse Practice Council
•Feeding Council
•Train Staff
•RN’s
•SLP’s
•PIOMI “Super-Users”
or “Champions”
•Develop professional
training materials
•DVD
•PIOMI Tool
•Quick Reference
•Reliability Checklist
•Evaluate training methods
•Periodic testing of reliability
•Continue research
Training Materials www.PIOMI.com
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.
Correct
Order
Correct
Technique
Correct
Timing
TOTAL RELIABILITY*
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
n
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
activation.
N/A 15 sec
Non-Nutritive Sucking Improve suck, and soft palate
activation.
N/A 2 min
For Information
Academy of Neonatal
Nurses: Mother Baby
Conference
Chicago, IL
September, 2012