Expansion: to proceed with treatment or to wait
Q: Hi, I wanted to get your opinion regarding Myo while an expander is in place. I have been working with this 7 year old for the last month or so and she’s been doing well. She has unilateral weakness, but as she’s worked through the exercises, she’s been able to eventually even things out. For example, she is now able to suction for almost 30 seconds with the whole tongue up flat (initially the left side of the tongue would droop).
At the initial evaluation, I recommended mom get a consult by ortho for palate expansion within the next 6 months. Mom recently went to the ortho and they agree expander is necessary.
My question is, how do I proceed? Do I continue myo while she has the expander or pause therapy for now while she completes her possibly 6-month long treatment with the expander? Not sure if I was in error by beginning the therapy prior to the ortho consult.
Just feeling a little stuck…thanks in advance!
Best,
VS
A: Hi, I don’t think it was a mistake to see the young lady initially since you were able to get her to fit her tongue within her palate, from what you stated. Thus, the ratio of tongue to palatal space must not be too bad.
You didn’t say how many sessions she had or what else you have worked on. Also, you didn’t say who referred her and what was the major reason for seeing her. These often play a part in decision-making.
In general, with the information you sent, it might be prudent to wait until expansion is completed in order to be fair to the child. But, there might be exceptions. Once example that comes to mind: let’s say the mother brought the girl to see you for w/l substitution. You might be able to continue in that case. Just an example to remind you to take into consideration all of the details. With a narrow palate, most artic cases will benefit from expansion prior to addressing speech sound disorders.
If the girl has very “weak” lips, you could probably work on that along with the expansion as long as the occlusion isn’t such that lip closure is impossible or very difficult.
If you still have some questions, let me know and I’ll try to help out further ….
