Hi! I wondered if I could run a client by you who called me today. It was exciting since it was my first ‘real’ client!
The mom shared with me that her son is 14 and going into freshman year. He has an open bite on the right side and a class III malocclusion. He has a lateral production of sh – according to mom. She took him to an ortho in Indiana who told her that the only way to correct his ‘tongue positioning’ was to have tongue surgery to reduce the size of his tongue. (yikes!) He told her he had ‘macroglossia’ in laymens’ terms. Mom is a nurse and knew to get a second opinion. An ortho at the Univ. of Illinois told her that the only way to correct what he called a ‘tongue protrusion’ was to put a crib in and not mess around with any type of therapy as ‘it doesn’t work anyway’. She then got another opinion from an ortho who told her that a crib has NEVER been effective in his experience, and to either do neuromuscular facilitation (using the CD he gave her!) or seek out services for orofacial myofunctional therapy.
My question is about the neuromuscular facilitation – I know some about it and am not sure where to learn more. I did not know what to say to the mom about it and whether it is an effective approach, and was very honest with her about this. Is this something that I should know how to do in my practice and if so, how can I learn more?
Thanks so much for your time on this!
Neuromuscular facilitation, as far as I consider it, deals with brain plasticity. I am working with my cousin’s daughter, 19 years old, for example… I may have mentioned her at your course. She had an AVM, arterial-venal malformation, that burst when she was 17 years of age, essentially the equivalent of a full blown stroke, leaving her locked in. She could not even blink. I used 100% neuromuscular facilitation (as I understand it) to inch by inch bring her back into this world. Without going into it more, that is my “description or definition” of the term.
It’s really a general dumping ground, I fear, for many things. Certainly, considering what we know about lateralizing sounds, etc. this does not sound like any candidate for “tapes” to cure!
First, we have to know if the tongue CAN fit comfortably into the palate. If he has adequate space for the tongue “up there” then macroglossia is even sillier than I likely mentioned in your class. It probably doesn’t ever exist in non-syndromatic patients. If the palate is too high and/or narrow, then that might be the reason for the tongue’s moving laterally. In that case, we need the palate expanded.
It sounds more like the CL III is a culprit. Try moving your mandible forward as you attempt to make words with /s/ in them. You will lateralize, no doubt!
Is the Class III truly a skeletal one? You have to know if he is ABLE to move into a more normal occlusion or whether it is a structural Class III that needs to be attended to either orthodonitically (if not too late) or heaven forbid…surgically. The speech issue is the least of it, in my opinion. If he has a signicant class III profile, then you might not be able to help with the lateral lisp right now.
He must be able to bowl his tongue, bracing it on the inside of his upper lateral dentition and obtaining enough support to produce an acceptable /s/. Of course, he must pass or maximize Prof exam one first.
I hope I answered your questions, but if not, let me know….I’ll try harder!
We look at several things here. First of all, look at where the frenum inserts into the floor of the mouth. Is it on or right below the lower alveolar ridge? Or is it fairly far back on the floor? Also, look where the frenum inserts into the tongue itself. Is it about midway or is it closer to the tip? Or is it far down at the base of the tongue?
I wanted to get your thoughts on whether lip incompetence in an adult (in their 30’s) that has an overjet and overbite can be remediated through lip stretching exercises. Is it worth it to try?
Bi lateral linea alba was present and also extended to the inside of her lower lip. She states that she rests her tongue on the mandibular teeth and she closes and bites her tongue – which eventually causes pain and she opens her mouth.
In adult patients with TT, do you find less pain in the post frenectomy rehabilitation phase when a period of pre habilitation is undertaken, in essence conditioning the musculature as much as possible?
Are there exercises in your manual that will help a child who has difficulty in lifting the middle and back of the tongue enough to suction it to the palate?
I just screened a new resident post CVA with noted aphasia in her record and some dysarthria. On exam, her tongue had a fairly significant fissure at midline. Any recommendations for healing?
Could an improper oral rest postures/enlarged tonsils/inconsistent mouth breathing completely inhibit the ability to produce /k,g/?
I recently picked up a six year old boy who has been in speech therapy for years for production of velars. He consistently fronts /k,g/ and is not stimulable for the sounds.
I had a patient yesterday. Nine years old, forward tongue thrust. Severe allergies and asthma. These are under control as much as they are going to be. Age 9. To see orthodontist soon. So, is this one that I take as far as possible knowing it will not correct totally?
I just ordered the Swallow Right manual. Do you think it will help with this feeling that I have that I do not know how frequent and long to have the patients work each exercise?