Current Research 

  


Oral Myofunctional Therapy Applied on Two Cases of Severe Obstructive Sleep Apnea Syndrome. (Reviewed by Rochel Ausband)

Barreto e Silva,  P., Farias Pessoa, A.,  Sampaio, A.  L. L., Rodrigues, R.N., Tavares, M.G, and Tavares, P. (2007). Oral myofunctional therapy applied on two cases of severe obstructive sleep apnea syndrome.  International Archives of Otorhinolaryngology , 11, 350 – 354.

 
Purpose: The purpose of this paper is to explore the possibility of applying myofunctional therapy as an alternative treatment for snoring and obstructive sleep apnea (OAS) because of its purported ability to increase the muscle tone of the oral musculature and mobility of the oral and cervical structures w hich can be hypotonic in apnea patients.

Method: This case study used 2 patients, a 37 year old male patient, and a 55 year old female patient, with severe OAS who were recommended for Myofunctional therapy because of previous inability to benefit from use of Continuous Positive Airway Pressure (CPAP) because of discomfort from the mask, or to the use of a restraining dental appliance for various reasons,  nor were they prospective candidates for surgery.  Progress in therapy was noted via a questionnaire given to the patients after 16 weeks of myofunctional therapy.

Myofunctional therapy consisted of improving body posture, basic relaxing and breathing exercises to stimulate the mouth, jaw, and articulators, followed by a ‘reinforcement’ period aimed at maintaining the accomplished goals, increasing the ‘tonus and mobility’ of the orofacial and pharyngeal musculature.  The  following muscles were targeted: floor of the oral  cavity, tongue, especially the genioglossus,  mastication muscles, buccinators, masseter, lateral and medial pterygoid, digastgric, soft palate, uvula, supra hyoid and infra-hyoid muscles, pharyngeal musculature in addition to breathing, mastication and deglutition functions.

Results: The results confirmed the hypotheses that since hypotonia of the upper airway leads to the collapse of the oropharynx and airway, patients with OAS would likely benefit from myofunctional therapy which is the domain of the SLP. As expected, after 16 sessions of myofunctional therapy, followed through with a daily regimen of exercises specifically designed for the targeted muscles, marked improvement was reported in all areas:  reduction in sleep disturbance, cheek asymmetry, orofacial tonus and mobility, TMJ symptoms, and gains in memory lapses.

Implications for the SLP:

This report demonstrates how the collaboration between different professionals, commonly described as the ‘team approach,’ can bring about novel results for classical disorders. The very idea of using a speech therapist for snoring and obstructive sleep apnea could raise eyebrows. Yet this article shows the broad applications of myofunctional therapy as well as the expanding specialty roles of the SLP.

 

Evaluation of a New Concept in Myofunctional Therapy: (Reviewed by Esther Reinhold)


Berndsen, S., Bull, J., Kahl-Nieke, B., Korbmacher, H. M., Schwan, M. (2004). Evaluation of a new concept of myofunctional therapy in children. The International Journal of Orofacial Myology, 3, 39-52.

 
A 2004 study was done to evaluate an innovative concept of myofunctional therapy in comparison with the conventional therapy approach. Forty five children in need of myofunctional therapy, aged three to sixteen years, were divided into two groups: nineteen, serving as controls, were referred to myofunctional therapy in private practices in Hamburg. The remaining twenty six were treated with “Face Former therapy” at the Department of Orthodontics. The orofacial function of each of the children had room for improvement. The total observation time was six months. After three months, and overall clinical assessment was performed by a speech pathologist, who documented all progress made. The exam included assessment of lip strength, palatography to document the swallowing pattern, logopedic diagnosis, and an orthodontic examination. The children treated with the “Face Former therapy” showed a significant improvement in palatal tongue positioning during swallowing. They achieved stronger lip pressure and habitual mouth closure within a shorter period of time than the children treated with conventional myofunctional therapy. However, at the end of the six months’ observation time there was no significant difference in lip strength between the two groups. In conclusion, “Face Former therapy” seems to present a fine alternative to conventional myofunctional therapy. Longitudinal studies will follow to judge whether the established orofacial balance could be stabilized, i.e. to track if the established physiological orofacial function becomes automatic.



 


Evaluation of Swallowing Patterns of the Tongue using Real-Time B-mode Sonography. (Reviewed By Chaya Scharf)

Ardakani, F. E. (2006).  Evaluation of swallowing patterns of the tongue using real-time B-mode sonography. The Journal of Contemporary Dental Practice, 7(3), 1-8.

 

The purpose of this study was to assess the effectiveness of dynamic B-mode sonography for visualization of the swallowing patterns of the tongue in order to distinguish between normal and abnormal swallowing. The study consisted of 65 patients. There were 20 children (10 male and 10 female) between the ages of eight and sixteen, and 20 adults (7 male and 13 female) between the ages of 17 and 35 years, all of who had dysfunctional tongue movement, such as tongue thrust or speech disorder along with skeletal or dental abnormality, such as open bite, mandibular prognathism or maxillary protrusion. In addition, there was a control group which consisted of 25 adults (12 female and 13 male) between the ages of 20 and 29, who had an Angle Class I occlusion with normal tongue function.

The forty patients’ swallowing patterns were divided into groups of 10 normal, 12 inconsistent and 18 abnormal. Eight patients with a swallowing abnormality had Angle Class I occlusions, two patients had Class II, and the rest of the ten patients had Class III. Most of the inconsistent or abnormal swallowing patterns were found in cases of mandibular prognathism. Swallowing patterns were confirmed sonographically as abnormal in eight of the 17 patients with an anterior open bite. Five with an anterior open bite were rated as having an inconsistent swallowing pattern, being that the initial upward and forward movements during swallowing alternated and so no main swallowing pattern could be evaluated. In the control group, the swallowing pattern of 15 subjects was classified as normal. The remaining 10 subjects were considered inconsistent being that there was mainly no upward pattern of movement.

The results of this study support the use of video based B-mode ultrasound as a non invasive, direct visualization of the movements of the tongue in freely selected coronal or sagital planes with sufficient resolution. However, additional studies are needed before this technique can be suggested as an appropriate method for examining the progress of individual orthodontic and functional therapy. 

 

Reducing Tube Feeds and Tongue Thrust: Combining an Oral-Motor and Behavioral Approach to Feeding.
(Reviewed By Esther Sitko)


Gibbons, B. G., Williams, K. E., & Riegel, K. E. (2007). Reducing tube feeds and tongue thrust: Combining an oral-motor and behavioral approach to feeding. American Journal of Occupational Therapy, 61, 384-391.
 

A study was conducted to determine the efficacy of myofunctional therapy. The study was done on a six-year-old girl with Down’s syndrome. She had tongue thrust and was on a G-tube as a result of that. She also had food refusal. An oral-motor treatment package was implemented to reduce tongue thrust and allow food to be swallowed.  For one part of the treatment the therapist put Stage 2 baby food thickened with rice cereal on the side of a rubber-tipped Nuk massage brush. She placed the Nuk brush in middle of the tongue and swirled the brush around depositing the food on the tongue.  The therapist then pulled the brush forward to flatten the tongue. After 175 feeding sessions over 24 treatment days, tube feedings were eliminated and tongue thrust was greatly reduced. This intervention demonstrates the success of myofunctional therapy.