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What is PIOMI?

PIOMI is a 5-minute oral motor intervention that results in earlier feeding readiness, increased feeding efficiency, and significantly shortens the transition time from tube feeding to full oral feeding, thus decreases their length of stay. The therapy provides assisted movement to activate muscle contraction and provides movement against resistance to build strength in the perioral area of premature infants. PIOMI results in more sustained breastfeeding at 1 year of age. PIOMI also significantly improves neurodevelopment after discharge in fine motor, gross motor, language, and social-emotional domains, and better outcomes on the INFANIB at 1 year of age. 

PIOMI Mission Statement

Using PIOMI, Dr. Knoll seeks to globally educate NICU staff and parents in oral motor therapy to improve oral feedings, reduce length of hospital stays, and improve development post discharge into early childhood.


Brenda Lessen Knoll



Brenda S. Lessen Knoll received her B.S.N. at Illinois Wesleyan University School of Nursing in 1989. In 1995 she earned her M.S. as a Maternal-Child Community Nurse Specialist at the University of Illinois at Chicago and in 2008 earned her Ph.D. in Neonatal Science from UIC. 


In addition to her tenured Associate Professorship at Illinois Wesleyan, Dr. Knoll continues generating new research in preterm infant oral motor therapy, and reviews for several peer reviewed scientific journals in the fields of Neonatal Nursing, Pediatric Nursing, and Therapy. She provides in-person and off-site training for PIOMI at healthcare agencies internationally, including offering live Webinars for education and for training.  A Train the Trainer course is also available. Dr. Knoll has a background as a registered professional nurse in a level IV NICU, and has worked in Obstetrics, Pediatrics, and Home Health. Her administrative positions include Nursing Care Management and Clinical Education Coordinator, as well as serving on medical center community advisory and philanthropy boards. 

Honors & Memberships

Dr. Lessen Knoll is a member of the National Association of Neonatal Nurses, The National Association of Neonatal Therapists, the Academy of Neonatal Nurses, the Association of Women’s Health Obstetrical and Neonatal Nursing, and Sigma Theta Tau International Honor Society of Nursing. In 2012 Dr. Knoll received the Illinois Board of Higher Education Nurse Educator Fellowship Award. She has served as the Chair of the OSF Community Advisory Board, the OSF Quality Safety & Service Council at OSF St. Joseph Medical Center, and is a founding member of Women Empowered at OSF St. Joseph Medical Center Foundation. She was nominated for the JOGNN Best of Writing 2020 for her published research on the effects of PIOMI in a Thai NICU. She continues to present work and consult with researchers around the world. 

The Story of PIOMI

Dr. Knoll is the founder/author of the Premature Infant Oral Motor Intervention (PIOMI), which she developed for use on premature infants as young as 29 weeks gestation (approx. 2.2 pounds) to prepare them for oral feeding, thus earlier discharge. The intervention is a sequential series of 8 steps that target the tongue, palate, cheeks, and lips to "train the brain" to key a neuromuscular response to touch and pressure within their mouths, thus preparing them for future bottle or breast feeding. The PIOMI requires no equipment (other than a person's pinky finger) and only 5 minutes to administer. The fidelity (reliability) of the intervention was formally tested and published in 2015, establishing it as a tool with a sound training program and 98% reliabilities among users. 


Dr. Knoll  worked with a professional media team including a producer, videographer, audio engineer and graphic designer to produce a PIOMI Training Bundle of printed materials and film a training video. The video demonstrates the techniques of the PIOMI step by step on a live preterm infant. This resulted in 7 published and copyrighted (2012) materials collated into a Training Bundle: a professional instructional video (TwinStar Media, Inc., 2012); a “Trailer” of the video; two versions of the PIOMI instruction tool (a professional version and parent version); a Quick Reference Guide; and a Reliability Rating Tool. These training materials (including video) are available for download through  The video is a streaming capable file that can be loaded onto programs such as "Healthstream" for broader training purposes.  The professional version of the tool  is also available for download in 10 languages ( Mainland Chinese, Taiwanese, Italian, Portuguese, Spanish, Persian, Thai, Turkish, English and Hindi.) This Training Bundle is used both at on-site competency-based training visits to NICU's who wish to implement PIOMI, and/or for download for therapists already familiar with oral motor practices on preterm infants.


The dissemination of Dr. Knoll's work through presentations and publications has sparked worldwide interest by clinicians to use PIOMI as their standard of practice for oral motor therapy in their NICUs. There are over 65 publications (40 are Randomized Controlled Trials) published that have tested PIOMI on various ages of preterm infants, at different frequencies per day, different numbers of days it is continued, and with several adjuvant therapies (adding breast milk to the lips, using it within an infant driven feeding framework, having parents do the therapy, etc.). These RCTs have tested PIOMI across several different countries and cultures of care, including in the USA, China, Denmark, Italy, Thailand, Iran, India, Turkey, Brazil, Egypt, Pakistan, Australia, Indonesia, Greece, Korea and Canada. All studies have shown positive improvement in feeding skills and a subsequent decreased length of hospital stay. Most recently, infant neurological batteries have shown that PIOMI results in improved neurobehavioral organization and function after discharge into early childhood, revealing a sustainable neurological benefit beyond just feeding. 


Dr. Knoll travels to do on-site competency-based training on PIOMI, assists in protocol development, and serves as a consultant or advisor on thesis/dissertation committees internationally. She also offers virtual live PIOMI Training Webinars with international participants through 

• PIOMI in the News •

"Thank you again for your patience with us and for finally bringing your fantastic program to LVHN Reilly Children’s Hospital!  Everyone I talked to was impressed with your research and excited about starting PIOMI."

Wendy Kowalski, MD

Medical Director NICU

Lehigh Valley - Reilly Children's Hospital

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