How many exercises?

Dear Sandra,
When I think of the exercises I do not know the number of repetitions of each exercise to give each day.   Do you really see the patient two times a week, does once a week work?  Is half hour enough time? The two teenagers I’d like to start with are 16, so they should be relatively easy to teach.  But since they’re busy, I’m thinking one meeting a week to start with.  I’m sure that’s ok, but again, how may exercises each day?  These are twins, one has an open mouth posture, one is a tongue thruster.  I’m supposed to call their Mom and see about getting them started.
Dear K,
I see patients only once a week now due to my own crazy schedule and most patients’ schedules as well.  As long as you give them enough so they won’t become bored and not too much so they become frustrated…once a week seems adequate for most patients.  The question of how many exercises has come up often over the years, particularly from my course grads and from those who use the Myo Manual.  I am completing a second edition that is addressing the very question you have.  Here are some of the ways I’ve included in the new edition that will let you know how many of each activity/exercise to give them.
The goal of Proficiency Exam #1 of the Myo Manual program is for each client to pass or “maximize” each of the six sections before proceeding further into treatment.  This important primary requirement is not based on “strength” but rather on the ability to perform various lingual shaping skills and excursions needed to move ahead in the program. They have to practice these well enough to demonstrate to you that they have met the criteria.  For example, to pass the section for inter-lingual differentiation, they must demonstrate slow posterior suction release 10 times in a row without error; rapid posterior suction release 25 times without error; and continuous rapid posterior suction release as teeth are closed.  Thus, the criteria to pass each section is a “goal,” rather than a certain number of times to practice.    
Other parts of the program do require repetitions in order to accomplish the goals.  For example, if they are doing lip massages, then 50 or 60 of them two or three times a day is usually required, once they are good at them, since they only take about a second each and can be done while walking, reading, etc.  These are needed to achieve the goal of attaining 3 – 5 lbs of resistive pressure as measured on the Lip Strength Scale.  I adjust the number of repetitions based on the results of testing during the next session.  In general, the types of exercises such as these are given for 10 times, 3 times a day with at least a 2 hour separation between practice sessions. 
In summary, some exercises will have criteria where the client will have to demonstrate an activity for a period of time, some require x number of correct repetitions, and some demonstrate a skill level that allows them to move forward.  Each is addressed separately with regard to how often, how well, and how consistently the client performs that activity.

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