ROM QTT questions
Dear Sandra, The Myo Manual will be a big help for me while working with my English/American speaking clients! As I already mentioned, I attended a Dutch OMFT workshop in March 2010, based on the literature of Zickenfoose, Garliner, yours and the speech therapist’s and dentist’s (who offered the workshop) own experience over the years. I have a lip strength meter at home and know the average norms for children age 4 – 10 years and over 10 years old. Questions: 1. Are there similar average norms to use when you work with the QTT (ROM) scale?
I believe that there would not be a difference regardless of age but there are no norms as of this time. Remember that it is used as a “quick” assessment for tongue tie, not a detailed assessment. It is more of a “red flag” that indicates you should look more deeply into the possibility of a restricted lingual frenum. Since many myo patients cannot suction flat to the palate, you have to have them put tip of tongue to spot and subtract 3-5 mm from that reading to adjust for the inability to suction. Thus, if a person’s reading is 50mm for MO, we would expect greater than 25mm for MOW (with suction). Since many cannot suction, use TTS (tip to spot/incisive papilla); this reading is between 3-5 mm greater than the suction reading would have been IF they could have suctioned. (I have gathered this information myself over several years and it is fairly accurate). 2. As mentioned in the Myo Manual one should place the notch of the ROM scale on the mandibular anterior incisor and measure the range of mm the client is able to open his/her mouth with the tongue tip on the spot, with the tongue sucked against the palate and “just open”, without any chosen tongue position.
The suctioned tongue should be as flat as possible and within the arch as well as possible; thus the tip should be near the “spot”. Many, as I stated, cannot obtain the suction, so then you would use the alternative TTS method desribed above.
Could you tell me how to use the lateral scale? It is there as a convenience to measure for lip competency, extent of inter labial space at rest, and more.
How am I supposed to position the QTT/ROM scale and what should I measure? The notch is place upon one of the lower central incisors while the patient makes the moves of opening mouth comfortably (or suctioning or TTS) and you keep the notch on the lower incisor and roll the QTT gently upward as an arc, to see what the measurement is when you touch the matching upper central incisor. If you need a photo of this, I can ask my assistant to draw it for you and send it. Let me know. 3. Is there a minimum age you use when you decide to start therapy.
Since I incorporate orofacial myology into the treatment of nearly every type of patient, I use some of the exercises and approaches on children as young as 3 years, but I would not offer the actual “program” to them since they have not usually developed the ability to make the lingual and labial movements and separations required in my program. I have used the Battle Buttons, making various alterations to suit their needs and limitations; I’ve used some of the suction exercises, and more.
The pictures and examples in the Myo Manual all show children who are about 7 years or older. Of course every client is unique and it all depends on motivation, the ability to understand the exercises, family support etc. but do you also work with 5 or 6 year old children?
Most definitely children over 4 years can be helped by many of the methods used. It is very important to do as thorough an orofacial exam as possible so you can then plan according to the individual’s needs. You can see examples of orofacial exams in the back of the Myo Manual, but without having taken my course, you will likely have questions about some of the procedures on the form. Let me know what questions you have and I’ll try to address them for you.
My best, Sandra Holtzman
