I want to be professional for my first patient

Hi…

I’ve just scheduled my first patient!!  I am going to see him (9 yr old) next week the 23rd for the initial evaluation/assessment. He is quite developmentally delayed however Dr. William Hang, DDS, an orthodontist in Cali. recommended Myofunctional therapy for him. 

 ”Quite delayed” can mean many different things, so don’t be too hard on yourself or imagine him as a typical patient, ok?

I plan on taking the information from your sample speech/orofacial myology evaluation form from the myo manual. I am slightly nervous but confident…:-) I am going to put an email together to include the myo History Form for mom to fill out and have ready for me when I arrive. 

 Sounds like a smart idea.  So, you’ll be seeing him at his home?  That can be helpful and give you a better feel of what to expect as far as family cooperation, etc.

Would you suggest I also perform the Pre-test of proficiency at this first appt. or wait until I complete my assessment and get back with the parent on my recommendation as to treatment. 

Almost all of the profic pre-test is tested during the eval anyhow, so you can do whatever is most comfortable, but I’d wait.  It might be a challenge just getting him to respond to the eval form requests…again, depending upon what his challenges are in truth.   

I am thinking of taking all the information from the initial evaluation back home and coming up with a treatment plan. I would then email that information to the parent with the findings and suggestions of treatment. Or should I be prepared to have that ready at the evaluation?

It’s usually smarter “business” to present it in person after having eval’d him and while it is fresh in their minds.  Remember how I said that I tell them, “I treat everyone like you are my own family, so I need a few minutes to review our findings and decide what is best and what I’d do if he were my own son.”  Then, take that time alone, look at the areas “failed”…especially the critical areas and develop a general play and put it down for them.  For example, if the lips are quite weak, you might want to begin with them and also one lingual exercise.  So you could put down that you will increase lip strength to normal range, maximize lingual basic skills, and complete Phase One.  Then proceed with Phases 2 and 3 based on patient’s ability to comply with exercises, etc, etc.  I’m just winging this to let you know how you can adjust your plan for someone who is not expected to flow easily through the program.   

Would this then be the main form/contract to have a parent sign with the days and times and fees?  

When I saw people in the home, I had a pretty good feel of who and what they were by the end and I made decisions based on them, rather than each family the same.  Remember, they are expecting you to tell them what you think is best and you can go ahead and tell them.  In this case, they want the therapy so you don’t have to do a lot of convincing, I suspect.

I apologize for my questions. I want to be fully informed and professional! 

Although it is the hardest thing when you’re starting out, you have to be very relaxed as though you are merely informing them of your findings, giving suggestions, and if you are relaxed…you appear confident to them.  And if you are relaxed, you don’t sound desperate or pushy, so it works out …to BE RELAXED…LOL. 

Let me know how it goes…I know you are professional enough that you don’t have to worry or even think about it.  Treat him like your own! 

Sandra

Quick tongue tie assessment questions re norms, lateral scale

Are there average norms to use when you work with the ROM scale?
Could you tell me how to use the lateral scale?


 

Tongue sucking habit

The boy only sucks his tongue at night per mom. He had his adenoids out at 3 and sucked a pacifier until 2. He doesn’t suck anything besides his tongue now and does not use a sippy cup. He does have an open bite though. Do you have any experience with this or could you give me any pointers?


 

Tongue radiation hard to open mouth

A patients has been referred who has been treated with head and neck radiation for tonsil cancer. The reason for referral is limited ability to open following the treatment. He did not have surgery. He has severe dry mouth which is being addressed with xylitol gels and lozenges. Any suggestions for treatment exercises is greatly appreciated.


 

Should OFM disorder should be treated

Some orofacial disorders for some people should be ignored for a period of time or maybe forever.


 

RDH how to become an insurance provider

If the RDH is working with a DDS, there is a chance for dental insurance coverage. If working with an SLP, again there is a chance for coverage. The International Association of Orofacial Myology is currently trying to address that issue, having appointed a committee to get recognition of an orofacial myology code.


 

R therapy help needed

I have a client at the moment who is not making much progress. Independent movements of tongue are ok, however she can NOT maintain suction. She can click and cluck all day but can’t prolong that after many sessions trying.


 

Orthodontist asks how to use ROM for tongue tie assessment

I’d like to learn a little more about the Range of Motion measures you described in the newsletter. How do you relate MOWS and MOtts to MOmax? Is there a ratio you use to indicate limited opening? How do you instruct the “suction” position to the patient? Is your curved ROM ruler easier or better to use than a straight ruler?


 

Is there a minimum age to start therapy

Is there a minimum age you use when you decide to start therapy? The pictures and examples in the Myo Manual all show children who are about 7 years or older.


 

Palatal expander, low S position, cribs and rakes

I have a new referral who I recently saw who is about to embark on some orthodontic treatment (a palatal expander ). In addition to a tongue thrust swallow she also presents with an articulation component with an interdental pattern for alveolars and sibilants…


 
adenoids alveolar phonemes ankyloglossia anterior open bite anxious to quit sucking thumb articulation ASHA bolus control breathing space carryover certified orofacial myologists decision to quit Dental Hygienist diastema Dr. Robert Mason drooling flat suction freeway space frenectomy frenum frenum surgery habituation hyoid bone IAOM lip strength lisp lower alveolar ridge myofunctional therapy Myo Manual narrow palate open bite oral motor orofacial myofunctional disorders orofacial myology restricted lingual frenum speech language pathologist sucking habits suctioning thumb thumb sucking TMJ tongue sucker tongue thrust tongue tie unplugging the thumb