Help, no orofacial myologists are here in England!

Hello Sandra Just contacting you as we are interested in knowing more about your Myo Manual. We are English and here in the UK it seems that the practice of Orofacial Myology is non-existent.

I have thought about coming there to train your therapists.  I, too, am surprised that there are none who have taken a course.  I have taught people from Australia, India, all over South America, Bulgaria, etc., and would love to train speech pathologists in England.  (And Ireland, Scotland). Do you have any contact with the speech or dental fields?  I don’t have the time to find out the names of those whom I should contact in order to come there and give my 28 hour intro course, but I’m game for it…I love England and sometimes I even speak “English”… (well, American style, at least, LOL!)  What city/town do you live in? 

Our son B, who is now 16, has just finished orthodontic work.  He is now in retainers but has a tongue thrust problem that we are concerned will detrimentally affect his teeth positioning again.

Who called your attention to B’s myo problem, his orthodontist?  If so, good for the orthodontist; sadly, with no one to whom to refer, it still doesn’t help matters.  If his orthodontist wants to come or send someone to Orlando for training, then that would be a big boost to the orthodontist’s business.  That might be an avenue to think about.  Here are some questions:

• How did B’s teeth/occlusion look before the ortho began? Crowding? Open bite?  Other? 
• Does he have a history of any negative oral habits such as thumb/finger sucking, long time pacifier (I forget which term you use for pacifier??), etc.
• Does he have imprecise speech, especially when speaking rapidly?  Or a lisp?  Other noticeable articulation issues?
• Have him open his mouth as widely as possible and keep it open as he tries to elevate his tongue tip to the place behind his upper front teeth.  Can he reach all or most of the way up there?  Is the tissue under his tongue, the frenum, long and free enough to move about the mouth easily?
• Have him try to suction his tongue flat to his palate and see how much overlap the tongue has…can he fit the suctioned tongue into the U-shape of his palate?
• Is B continuing to be a mouth breather?   Any history of allergies or any allergies suspected?  Enlarged tonsils or adenoids?  The mouth breathing is definitely an issue and the causes or past cause that created it, should be determined before any therapy can succeed.
• Do you see his tongue when it is at rest?  Where is it?  My guess is that it is either between the teeth or against them.  The resting posture is probably the most damaging aspect of all as it put the jaws into an “over” open position, which in turn affects the way teeth erupt.  For years, we blamed the swallow and talked a lot about “tongue thrust” but we know now that it is only one symptom and does not “cause” the problem.                                                           After much searching for help here in the UK and not finding any we are now looking further afield for some support.  We noticed that you have worked in this area very successfully and have produced and sell the “Myo Manual”.  I suppose our question is, do you consider this is suitable for parents to use as a tool?  I don’t have any specialist training but I am willing to learn and if the manual isn’t too ‘technical’ then I am sure we will find it useful.   Although the Myo Manual is not theoretical, but rather a program for clinicians to use as their guide, I hate to see you spend the money on it because it truly works well when someone has either taken my course or has had some similar background in this area.  I have sold it to a parent who was a doctor, another to an adult who wanted to work on herself because she was, I believe, in Ireland…can’t remember for sure.  But I don’t think it will be worthwhile.  Although I have only done SKYPE to consult with patients who see my course “graduates,” I suppose that could be a possibility for B…not ideal, but a possibility.  How does he feel about the idea of doing therapy?  How many years did he wear the ortho appliances? We have already started some basic general exercises that we have found on the internet but I would like to be able to ideally assess Ben’s problem a little more thoroughly and work on the areas he particularly needs help with.  The problem with trying various exercises is that they are hit and miss, out of sequence, and often unfair to the client.  Exercises that work on the following are good:
• Separation of the mandible/lower jaw from the tongue movements (in other words, the jaw is stabilized and the tongue moves independently of the jaw).  Then, it should be accomplished without any device or hand supporting the jaw.
• Suctioning the tongue to the palate
• I’m guessing he has weak lip closure and resistance (“strength”, but I use that word lightly); some lip exercises could help him, especially since you describe what I would call an incompetent upper lip (short distance between the upper lip and the base of the nose…it should be around 15 mm in length).

You don’t want to do any exercise that emphasizes the tongue being pushed against an object, or the tongue being aimed outside of the mouth to make a point, etc.  Keep the tongue inside for exercises.  (Exception would be if he is tongue tied and has just received therapy to release the lingual frenum, but that is not the case at this time). Also lift up his upper lip and check the tissue under the lip in front of his upper central teeth.  This is another frenum, called the labial/lip frenum.  It should not be so tight or short that it impedes the ability to move the upper lip freely.  As you can see, it is not simply to give him X number of exercises and it does the trick.  I wish it were that easy; there are many therapists, who not having taken a course, try arbitrarily to help patients, without fully understanding that first the client must maximize the abilities of the tongue, lips, and other structures/functions.  Once the client can do the above, then they learn how to use the improved muscle functions in chewing, suctioning, and swallowing (often in speaking, too!) Then they incorporate it into eating and drinking; then habituate what they have learned into activities throughout the day, and eventually at night time. That’s it in a nutshell…LOL!

I am only guessing at the moment as I have not been able to find anyone to look at his case but I suspect the following may be true: he has a higher than usual roof to this mouth – as he is a persistent mouth breather.  His lower jaw was set back too far, which has been corrected (to some degree we think) by his orthodontic work.  He can make a lip seal with a slightly crinkled chin and it seems to me that his top lip is also a little short.  He seems to have quite good control over his tongue – he can point it easily and has started to work on reverse swallowing with us.  We also did see a speech therapist several months ago who was happy with his muscle tone generally and pointed out that he didn’t tongue thrust at rest. Anyway, it seems that there is a lot for me to learn to enable me to tackle this with our son and so was wondering if you can provide me with any advice/help/recommendations.  As I mentioned, we are especially interested in having some direct guidance and so if you think the Myo Manual would be helpful to us then your comments on this would be much appreciated. Thank you so much for your time. I hope this gives you more information to “chew” on…. Thanks for contacting me, Sandra