Picky Eater - Orofacial Myology

Heidi Miller  Instagram

HeidiSLP@heidimillerspeech.com 

www.heidimillerspeech.com

www.helppickyeaters.com Protocol

International Association of Orofacial Myology

OMD - Oral Motor Disorders:

• Mouth Breathing
• Tongue Thrusting
• Noxious Oral Habits (Thumb Sucking, Nail Biting)
• Restricted Frenum
• TOT (Tethered Oral Tissue) What is TOT?
• Airway Disruption - Adenoids, Tonsils; think ENT involvement
• Abnormal Movement
• Dental Malocclusions
• Sensorimotor Disfunction

Myofunctional Therapy: Retraining the patterns of the tongue, lips, jaw, and facial muscles through a series of specialized and targeted exercises to change existing patterns.

Goal: correct and eliminate the symptoms of dysfunctional oral habits that may be influencing improper muscle patterns, which can affect the normal growth, development, and function of the face, jaw and temporomandibular joints. 

* address the cause of orofacial dysfunctions, instead of just the symptoms.

Evaluation: Myofunction Screening Form

• Functional Classification of Ankyloglossia Based on Tongue Range of Motion Ratio (TRMR)
• Dr Zaghi’s Grade Classification 

Goals from Reflective Smiles -

        

   Develop;

1. harmonious facial muscle patterns
2. (&learn) proper tongue placement at all times – particularly with swallow
3. a correct swallow pattern (not a forward tongue swallow)
4. oropharyngeal muscles (throat, soft palate and uvula muscle tone) 
5. muscle strength and tone in tongue 
6. ability to dissociate among articulators
7. a lingual palatal seal 
8. Improve inner oral suction 
9. Develop a proper chewing technique

Exercises:

1. Lingual elevation – tongue to spot stretches 
2. Pointy Tongue  (Helps the child establish lingual control to clear residue and access food in molars, they may not have been able to do this before; use cocktail straw) 
3. Tongue side to side – Child moves tongue side to side to molar 
4. Cave – Suction tongue to roof of mouth  
5. Create inner oral suction with Straw (Pops)
6. Lip seal & strength with Button
7. Groove Touch Exercise – This helps to establish the “bowl” in the tongue where the bolus gets transferred prior to swallow
8. Chew toy + puree/ dissolvable foods or crumbs: to teach chewing
9. Bite on side  - skips the step of moving to the side (teaches to lateralize tongue and rotary chew)
10. Teach Lateral chew before anterior chew 
11. Introduce advanced textures following the dissolvable and chewable
12. Add condiment to facilitate flow
13. Eat Around the plate - increase moisture helps and helps clear residue when there are motoric deficits

Visual Steps to Eating (HMS Protocol)

1. Hold it
2. Kiss it
3. Lick it
4. Bite into it
5. Nibble
6. Eat it

• ZaghiMD Website
• Standford pdf
  
• Myofacial BlogSpot

Additional Resources

1. Paragon Health Blog Library
2. Reference: Engelke, W., Jung, K. and Knösel, M., 2011. Intra-oral compartment pressures: a biofunctional model and experimental measurements under different conditions of posture. Clinical oral investigations, 15(2), pp.165-176
3. Tongue Tie Basics
   
4. OMD and Myofacial TalkTools
   
5. https://www.donofrioslp.com/research
   

Course Slides