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  • Reema Prakash M.S., CCC-SLP

Orofacial Myofunctional Therapy: Buzzword or Evidence-Based Practice?

What exactly is orofacial myofunctional therapy? Is it the latest buzzword or is there scientific evidence to the practices that are touting not just facial morphology changes but also life-altering and in some cases life-saving changes? Today on the blog we discuss how Speech-Language Pathologists use orofacial myofunctional therapy to address specific issues.  

 



Before we talk about the therapy, let’s talk about the disorder.  An orofacial myofunctional disorder (OMD) is characterized by improper tongue, jaw, and lip positioning during swallowing, feeding, and speaking. Commonly known as a tongue thrust. Patients (children and adults) with OMDs may present with one or more of the following:

 

  • Tongue ties

  • Low tongue posture

  • Tongue thrust while swallowing (Reverse swallow pattern)

  • History of poor nursing and difficulty transitioning to solid foods or ‘messy eating’

  • Dental malocclusions, teeth grinding

  • Lisps and other speech sound errors

  • Mouth breathing

  • Disordered sleep breathing

  • Chronic respiratory infections

  • History of oral habits like thumb/digit sucking, nail-biting, etc.

 

In addition to impairing oral functions, the potential disordered breathing patterns may also lead to diminished capacity to achieve optimization of a range of human functions relevant to the speech-language pathology, including:

• Learning and academics (Kuroishi et al., 2015; Galland et al., 2015; Gozal, 2008; Goodwin et al., 2005) 

• Cognition (Smith et al., 2017; Hunter et al., 2016; Brockman et al., 2012; Kohler et al., 2009; Gottlieb et al., & 2004)

• Socialization (Singh & Zimmerman, 2015 & O’Brien et al., 2011) 

• Behavioral and emotional health (Kouros & El-Sheikh, 2015; Lee et al., 2014, Bebee, 2006)

• Autonomic function (Gozal et al., 2014 & Liao et al., 2011)


These conditions can co-occur with speech misarticulations, seen as ‘lisps’ (frontal or lateral lisps). Often in these instances, the articulation disorder may not be purely developmental or phonological in nature, but rather a result of poor oral placement.


A thorough speech evaluation is recommended to analyze the nature of the errors (structural, sensory, or neurophysiological), ascertain the cause, and select the right combination of therapy approaches. An examination of the oral peripheral mechanism can uncover functional deficits by observing how each articulator performs on motor tasks to assess strength, range of motion, speed of movement, and whether or not extraneous movements or groping are observed during volitional motor tasks. These observations are key in helping SLPs differentially diagnose various conditions, as well as determining if targeted assessments are warranted, such as myofunctional or motor speech evaluations.

 

Now, Orofacial Myofunctional Therapy (OMT) is the “neuromuscular re-education” or “re-patterning” of the movements of oral and facial musculature. OMT includes behavior modification, mouth, face, and tongue exercises, and strategies to facilitate proper feeding, swallowing, and oral rest tongue posture throughout the day. Similar to speech therapy, for feeding and swallowing therapy, it is essential to know the etiology/cause (OMD/sensory/combination/co-morbidities) which will help determine the right speech therapy approaches. There is often an overlap in diagnosis and treatment between pediatric feeding and OMT. The remediation of an OMD positively impacts functional eating, drinking, oral rest tongue posture, and swallowing.


As a practicing SLP for over 18 years,  I am very aware of the pitfalls of using non-speech oromotor exercises for developmental speech sound errors. We need to acknowledge that these [orofacial myofunctional therapy] exercises do NOT directly treat speech disorders. They are correcting improper movement and resting postures; however, since a lot of speech issues may come out of these improper movements and resting postures, it’s not surprising to see speech improve. The difference between orofacial myofunctional therapy and non-speech oromotor exercises has to do with the purpose of the method being used, and the goal one has in mind (The Marshalla Guide, Pam Marshalla)

 

Orofacial myofunctional treatment includes several approaches and an inter-disciplinary approach works best. The SLP may refer to and collaborate with Pediatricians, Dentists, Lactation consultants, Otolaryngologists, Allergists, Osteopathic medical physicians, Oromaxillofacial surgeons, Physical therapists, Craniosacral therapists, and Occupational therapists.

 

If you are wondering whether you or your child has an OMD and need myofunctional therapy, contact your dentist, doctor, or SLP today. At Resonate Therapy Solutions, we work with children and adults for their speech, swallowing and myofunctional therapy needs. Schedule a consultation with us today.


References

  1. The Marshalla Guide: A Topical Anthology of Speech Movement Techniques for Motor Speech Disorders & Articulation Deficits Written by Pam Marshalla

  2. Orofacial Myofunctional Disorders Written by: Mary Billings, MS, CCC-SLP, COM™, Kristie Gatto, MA, CCC-SLP, COM™, Linda D’Onofrio, MS, CCC-SLP, Robyn Merkel-Walsh, MS, CCC-SLP, and Nicole Archambault, MS, CCC-SLP

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