Clinical and surface electromyography evaluation pre and post orofacial myology therapy

Purpose: The objective of this study is to observe the efficacy of orofacial myofunctional therapy in children who breathe through their mouths “mouth breathers” using a clinical assessment and surface electromyography. Method: 30 nasal breath (control group) and 30 mouth breathers (study group) were evaluated initially, and the study group was re-evaluated after 12 sessions of orofacial myofunctional therapy. Assessments involved the MBGR protocol and surface electromyography. Results: The control group had significantly better scores on all nasal breathing tests compared to mouth breathers both before and after therapy. However, mouth breathers demonstrated statistically significant improvements over time with therapy. Conclusion: After twelve orofacial myology therapy sessions, the mouth breathers improved but not to normal levels. Inadequate muscular strength remained for the required tasks suggesting that additional therapeutic intervention is needed or that therapeutic success is inhibited by a vertical craniofacial growth pattern.

Guidelines for successful online service delivery in orofacial myology

Purpose: Since the advent of COVID-19, online services within most healthcare fields have become ubiquitous. This article investigates the research regarding the feasibility and effectiveness of delivering online services and provides a tutorial of ideas and information to successfully implement online orofacial myofunctional therapy. Method: This article is a compilation of evidence-based results on the topic of online service delivery and perspectives and experiences shared by three service delivery providers. Results: It is possible to compensate for the interactive differences between in-person and online myofunctional therapy. It is believed that online therapeutic services are an efficient and effective mode of service delivery. Discussion: Although online service delivery is not new, the current world-wide pandemic has brought telehealth to the forefront. In a time of increased demand for distance treatment, the orofacial myologist must rapidly develop competency and comfort within the new assessment and treatment online paradigm. It is positive to know that research to date indicates that clients within associated fields benefit from the accessibility, ease, and convenience of online service delivery. This article summarizes legal considerations, technology, treatment preparation, client motivation, and the implementation of online therapy.

The importance of the freeway space in orofacial myofunctional therapy

The purpose of this article is to explain the importance of evaluating and documenting the freeway space (interdental rest position), in initial examinations and at the completion of therapy in patients exhibiting an open mandibular resting position. The freeway space measurements obtained can be shared with parents, patients, and referral sources. To this end, the muscular, neural, and sensory components related to the freeway space are discussed, as well as airway, dental eruption patterns, tactile feedback, and orthodontic relapse considerations. An extraoral method for evaluating the dimensions of the anterior freeway space is proposed.

Orofacial myofunctional therapy with children ages 0-4 and individuals with special needs

Purpose: The purposes of this paper are to 1) define variations in terminology and treatment methodology for orofacial myofunctional disorders (OMDs) in children 0-4 years of age and in special populations, and 2) compare and contrast service delivery models for children ages 0-4 and individuals with special needs versus older children and children who are neurotypical. Method: A literature review of scholarly articles, professional presentations, poster presentations, blogs, and social media were analyzed using three tiers of evidence-based practice to include: 1) clinical expertise/expert opinion; 2) external and internal evidence and 3) client/patient/caregiver perspectives. Results: Professional texts and publications used consistent language when discussing treatment of OMDs in young children and children with special needs. Terminology and treatment approaches for young children and/or children with special needs who present with OMDs were inconsistent in social media and professional presentations. Discussion: The treatment modalities used in orofacial myofunctional therapy to stimulate oral motor responses depend upon age and cognitive status. OMDs should certainly be treated in infants, young children and individuals with special needs according to the methods of the pediatric feeding specialist. Orofacial myofunctional therapy requires volitional control and self-monitoring; as such, it is contraindicated for infants and toddlers as well as those individuals who cannot actively engage in therapeutic techniques.

The effect of an anti-slip surface on objective measures of tongue strength in healthy adults

Purpose: Instrumental assessments of tongue strength have provided clinicians with the ability to obtain quantitative measures to document lingual weakness. A technical challenge with a common instrument is that the surface of the of the bulb-shaped sensor is smooth and can be slippery when contacted by the tongue. This study evaluated whether adding a textured layer to the bulb leads to enhanced strength measures in neurologically normal adults. Methods: Maximum-effort maneuvers for anterior and posterior tongue elevation, right and left tongue lateralization, and tongue protrusion were available from 62 healthy adults using the Iowa Oral Performance Instrument (IOPI). The IOPI tongue bulb was either bare or covered with a single layer of gauze. The maximum pressure (Pmax) exerted on the bulb from three trials was used as the outcome variable for each task. Results: In addition to significant main effects for both bulb-cover and task, there was a significant interaction between the use of gauze and the direction of the tongue-strength maneuver. Pmax was significantly greater when a gauze-covered bulb was used for tongue lateralization and protrusion but not for tongue elevation maneuvers. Conclusion: Using a single-layer of gauze on the smooth tongue-bulb helped reduce slippage of the tongue and resulted in greater Pmax values when evaluating tongue strength in the lateral and protrusive directions, but not for tongue elevation. Efforts to develop a more permanent solution to texturizing the bulb’s surface are needed.

An introduction to clinical simulation (CS) for orofacial myologists: COVID-19’s impact on clinical education

COVID-19 has forced educational institutions to increasingly rely on technology to provide appropriate clinical experiences for students. Simulations and case studies have been used for decades, but COVID-19 thrust these resources into the forefront of clinical education. Clinical simulation (CS) is the use of alternative methods in the clinical preparation of students (American-Speech-Language-Hearing Association [ASHA], 2020). Forms of CS include simulators, standardized patients, virtual patients, digital mannequins, immersive reality, task trainers, and computer-based interactive experiences and often incorporate case studies (ASHA). This article draws upon clinical education in the primary certification fields for those who practice orofacial myofunctional therapy: speech-language pathology and dentistry. It is designed to be a CS primer for these clinicians by presenting types of simulation-based learning, experiences specific to orofacial myofunctional disorders (OMDs), advantages and disadvantages, supporting evidence, best practices, and enhancement of critical thinking skills. There is a need to increase the representation of OMD-related content in CS experiences.