Importance of Proficiency Exam #1

Hi Sandra, Hope this finds you well!  I have a question about lingual-palatal suction and the “Sucking/Suction Exercises” on page 30 of your manual.  Those exercises (i.e., Knotty Straw, Baby Straw, Squeaky Swallows, Long Smooches, Diagonal Straw Exercise)—are they more for being able to suction the liquid and food onto the tongue, or are they also for lingual-palatal suction?  I’m thinking they are more for suctioning substances onto the tongue.   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 routinely do tongue pops (involving the middle and back of the tongue) and an M&M meltdown that usually help with this, but I recently saw a boy who had to work on tongue pops for three weeks before he could really get that mid- and back tongue to elevate and stay up.  I was starting to get concerned that he wasn’t going to get it, but thankfully, his mom worked with him a whole lot at home.  In looking through your manual, I wasn’t sure exactly what might address this problem.  Also, can you please tell me what causes a gulping sound while drinking water?  I knew at one time, but now I have forgotten what causes it, so I don’t know how to correct it!   Thank you for your help

Hi, it’s difficult to take exercises out of context and select a particular purpose for them separately.  They are meant to maximize the patient’s abilities for sucking/suctioning overall, prior to the latter part of the program where foods and liquids are introduced.  If I had to “guess” the individual benefits for any given patient, it would be difficult, but here are some of my thoughts:

Knotty Straw is a basic exercise that should be accomplished to assure readiness for all types of bolus suctioning/trapping/preparation.  Baby Straw was put into the Myo Manual more for “fun” and challenge for older kids/adults who want to go beyond the “Knotty Straw.”  SqueakySwallow is next because it gets the action moving inward and upward to offset the prior forward “thrusting” action.  Long Smooches is used in those cases where the client was unable to perform the “kissing” section during the oral exam.  It relates somewhat to the Knotty Straw as to its effects and goals.   The Diagonal Straw is a must.  It builds on the Posterior Suction Release that is a requirement in the Proficiency #1 exam.  It cannot be achieved until the Posterior Suction Release is strong.  This tells/shows us that the suctioning strength and ability to create the vacuum intraorally is adequate. Think of the Myo Manual program as a sequential method and be careful of jumping ahead when the profic exam #1 hasn’t been maximized or passed. If they have passed that first prof exam, they should be able to lift the tongue, shape the tongue as needed, bowl it, etc.  How old is this client?  If you are talking about a very young kiddo, I’d need more info and have more questions to help you create an individualized program for him/her. This sounds more like an oral motor problem than a myo one.  Or maybe even dyspraxia?  I would be more “invasive” in actually elevating his tongue with a tongue depressor, etc.  if he isn’t able to perform your directives merely by listening and trying to do them. If this is a youngster of 6 or older, you would probably be best off in beginning in Phase One of the Myo Manual and doing your best to maximize all those areas before moving ahead.  In some situations, you might not be able to move through Phase 2 as well or as fast as you wish, but Phase 1 is critical to maximize.  If he can get to the point to do the Elevator Disk, even fairly well, that is a great accomplishment. You asked, “Can you please tell me what causes a gulping sound while drinking water?  I knew at one time, but now I have forgotten what causes it, so I don’t know how to correct it!”   It usually indicates aerophagia, or swallowing air along with the saliva or food/liquids.  Again, remember that the drinking activities are much further along and one can expect gulping or other “malfunctions” related to liquid intake if the basics have not yet been set.I hope this has been helpful.  Let me know more about the particular client and perhaps I can add more suggestions. Always good to hear from you and to see you putting on your “Myo thinking cap” about various clients!!