Adults with low forward carriage

Sandra, Hello. I have started seeing my first few patients and I have a few questions. It’s been easy for me to diagnosis and see what the issue is and why they need therapy but the TX plan part is a little harder. I have a pt (adult) that has lower resting posture and she presses the tip against her lower alveolar ridge which is now causing bone loss. She doesn’t thrust so I am strictly working on rest posture. Do you have any recommendation for what exercises I should be using? I am finding that most of them are for rest posture due to thrusting and she can do many things but strictly needs her tongue placement up. Thanks for your help. I hope all is well.

Hi, Don’t worry so much about the presence or absence of “thrusting” as that usually refers to speech articulation or to swallowing, both of which are not the main concerns in this case. They are merely symptoms as we discussed in class. Here is what I would do when seeing adults such as you described: During the evaluation, be very, very certain that there is no restriction due to inadequate lingual frenum function. The reason I mention this is because a restricted lingual frenum could contribute to a forward low tongue carriage..so rule that out first. Then, I would pay heavy attention to the ability to separate lingual and mandibular movements in all three directions. If she cannot perform those (and most patient are not able to perform the vertical excursions to spot and down, independently), then that is where I would begin treatment/therapy. Remember that working on the rest posture won’t help until they pass or maximize proficiency examination #1 in the Myo Manual. If you forgot any of the concepts related to that, be sure to contact me. Also, as a grad of NHS, be sure to join and participate in our private Facebook group for our family of grads only.   Then you can freely share with other of our grads, all of whom had the course and come from the same “place” as far as training. Once your patient passes the proficiency exam, go through the suctioning exercises to see where she has difficulties. See if she has excessive saliva collection; if so, you’ll know that you have to address the suctioning section exercises and move forward from there. If she had trouble perfecting the posterior suction release, you had to take your time and make sure she “gets” it. It’s important to remember that rushing into tongue placement before preparing the groundwork will usually lead to failure. We used to begin with tongue to spot, skipping half of what we now know is necessary to establish a good foundation for treatment. That discouraged many patients and professionals in the past and we certainly don’t ever want to go back to those cookbook approaches. In fact, it was out of that need for more basic exercises that the Myo Manual evolved. I hope this helps get you started. Let me know what else I can help you with…and I’m so proud of you, my grad who “jumped right into the work of helping patients with orofacial myology disorders”….Way to go and keep positive as you see more and more of the things we went through in class. Don’t be hard on yourself since no one can remember everything and we all do go through some trial and error as we progress. My best, Sandra