Myofunctional Therapy

 


What is Myofunctional therapy?

“Myofunctional therapy is a specifically prescribed regimen of exercises designed to correct oral facial muscle imbalance and deviant swallow patterns.  It is an ancillary program used in conjunction with and to enhance necessary and appropriate dental, medical, and speech treatment. Myofunctional therapy assists the orthodontist, oral surgeon,  physician from pediatrics to geriatrics, and specialties such as ENT, speech pathology, occupational and physical therapy with the correction of various symptoms that interfere with the successful results of their prescribed treatments. As a holistic approach, myofunctional therapy treats oral facial muscle imbalance in such a way that, once corrected, the muscles will function appropriately with all interrelated body systems. It enhances oral awareness, which is the foundation for all oral motor development.” (Institute for Myofunctional Therapy)

 

Myofunctional therapy has been shown to be effective in correcting oral myofunctional disorders such as tongue thrust swallow, improper tongue and mouth resting posture, improper use of oral musculature for chewing and swallowing, and eliminating finger-sucking habits (Nelson, 2001).


Oral myofunctional therapy utilizes a team approach that may include the following: 
 

orthodontist

pediatrician

physical therapist

chiropractor

gastroenterologist

plastic surgeon

     allergist

s
peech-language pathologist

dental hygienist

periodontist

oral surgeon

ear, nose and throat specialist

                                                           (Moeller, 2008)

 

Variables that must be addressed by the team sometimes include: (a) anatomical differences, such as high and narrow palatal vaults, malocclusions, restricted frenulums, and lip incompetency, (b) oral behaviors, such as thumb/finger/pacifier sucking, licking the lips, teeth grinding, and mouth breathing, (c) medical conditions, such as obstructions to the airway, and upper respiratory complications, and (d) associated speech problems.

 

“According to ASHA and consistent with the World Health Organization, orofacial myofunctional intervention is intended to:   

       

4Take advantage of strengths and work on weaknesses related to underlying structures and functions that affect the client's orofacial myofunctional patterns and related speech and swallowing patterns

4Facilitate the client's activities and participation by assisting the person to acquire new orofacial myofunctional skills and strategies

4Tone down related aspects to decrease barriers and improve facilitators of successful communication and participation, and to provide appropriate accommodations and other supports, as well as training in how to use them.

4Provide recommendations for reassessment or follow-up, or in a referral for other services, if necessary.”                                          (ASHA, 2004)

*see appendix B for additional policy statements

 
 

Therapy may include any or all of the following:

• Elimination of damaging oral habits (digit sucking, nail biting)
• Reduction of unnecessary tension and pressure in the muscles of the face and mouth.
• Strengthening of muscles that do not adequately support normal functioning.
• Development of normal resting postures of the tongue, jaw, and facial muscles.
• Establishment of normal biting, chewing, and swallowing patterns.


                                                                               (Greider)

 


Pretreatment Considerations:
 

If a client has an obstructed airway , its cause must be  determined . Some causes may be enlarged tonsils and adenoids,  or allergies. These problems must be eliminated before treatment of tongue thrust. Correcting these problems eliminate  the tongue thrust altogether because when the client can breathe nasally there is no need to keep the tongue in a lowered position. Speech treatment can only begin once these problems are corrected. (ASHA, 1997 )

 

Swallowing therapy involves:

J Education regarding appropriate chewing patterns

J Practicing forming  food into bolus.

J Increasing self-awareness of the masseter (chewing) muscles

J Maintaining correct placement of tongue when swallowing

J Sequential positioning of the tip, mid-portion, and back of the tongue.

J The normal swallow is habituated by incrementally increasing the difficulty of the task.  After client masters individual swallows and sips of liquid, consecutive swallows during continuous drinking is worked on. Progress of carryover is monitored.                                                (White, M. L)

 

The age to begin therapy:

Evaluation to determine if there are any factors that require early intervention is done at age four. Treatment to help children discontinue finger sucking  can start at age five. Elimination of these habits can often result in spontaneous improvement and /or correction of dental, speech, and OMD problems. Complete training usually begins at seven or eight years old  (Grider). According to  Ramp and Panbacker (1977), myofunctional therapy should not be done with children under 11 years of age, and according to some researchers, as will be explained in the content of this presentation, OMT should not be considered before puberty. 

 

Length and timing of therapy:

The length and timing of therapy vary according to the severity and nature of the oral myofunctional disorder. In most cases therapy is a short-term process with the active stage lasting about three months. The client usually is given homework to practice for about 5-10 minutes daily. Follow up visits may be required with decreasing frequency over 6-12 months. (Grider)   

 

  Overview of efficacy research:  

After making an extensive review of the professional  literature dealing with myofunctional therapy and non speech oral motor intervention for speech sound sounds of children,  one can only conclude that there can be  no uniform consensus of its efficacy in all situations of oral motor and orofacial disorders, despite the accolades of its advocates . According to Bathel, (2009) “the logic, theory, and evidence against the use of non-speech oral-motor exercises are not sufficient to deter those SLPs who will continue to use what works.  In fact, recent research has shown that myofunctional therapy may have even broader applications than originally envisioned, and can be applied in novel ways as in the case of the 6 year old Down’s syndrome girl who no longer needed a food tube after undergoing myofunctional therapy (Gibbons et al., 2007; researched by Sitko, this report)  and even to such classical disorders as obstructive sleep apnea ( Barreto e Silva Pitta, 2007; researched by Ausband, in this report).

 

  Tongue thrust controversy:

It is important to note that some researchers view tongue thrusting merely as a normal transitional stage. This view is corroborated by a recent study of newborns which documents that normal infants exhibit tongue thrusting at birth as an inborn adaptive behavior conducive to infant-maternal bonding. In fact, infants with low APGAR score and those requiring special intervention actually had fewer tongue thrusting ‘episodes’ (Hentschel et al., 2007). This actually correlates with Mason and Proffit’s contention that, eventually, most tongue thrusters develop a normal adult swallow pattern between eight and twelve years of age without therapy. They argue that the “myofunctional therapist often takes credit for what nature can provide without treatment” and feel that swallowing therapy is not warranted before puberty. When lisping and tongue thrust or malocclusion coexist before puberty, only articulation therapy for correcting phonetic placement is indicated. Only when tongue thrust and an associated malocclusion persist past puberty, would swallowing therapy be warranted. 

 History of Myofunctional Therapy: 

  
&1800’s-1900: Recognition by dentists of impact of oral habits on occlusion

 

&1907- Edward H. Angle, “grandfather of orthodontics”, writes in Dental Cosmos that mouth breathing is the leading etiological cause for malocclusion

 

&1918- Beginning of first OMT program. In “Living Orthodontic Appliances”, Dr. Alfred P. Rogers suggests corrective exercises to promote proper muscle function.

 

&1970-1980- Founding of:

1) Myofunctional Therapy Association by Daniel Garliner and Dr. Roy Langer

2) International Association of Orofacial Myology (IAOM) by Dr. Marvin Hanson et al

 

Presently, the IAOM is the only professional organization in the world that trains therapists in oralfacial myofunctional therapy, although the Institute of Myofunctional Studies in Alpharetta, GA also purports to train therapists (2009).                                             (Myofunctional Therapy 2008)

 

&1975-With the encouragement of the dental profession, Myofunctional therapy becomes part of the “armamentarium of the SLP”  (ASHA, 1974)