The Role of SLP
Orofacial Myofunctional Disorders (OMDs) are abnormal movement patterns involving muscles of your lips, tongue, and jaw during other functional activities, such as speaking and swallowing, or at rest. If you have speech concerns related to an underlying orofacial myofunctional disorder, you should schedule an appointment with a speech and language pathologist – but not just any speech therapist. It may surprise you to learn that most speech therapists are NOT trained in orofacial myology; however, at Pittsburgh Orofacial Myofunctional Therapy, LLC, this is our speech/language pathologist’s area of expertise!
We have also built a team of other trusted professionals – ENTs, dentists, and others – to collaborate with on you or your child’s treatment, as needed.
OMDs and Speech Sound Disorders
Oral motor developmental milestones associated with eating and drinking coincide with similar milestones in speech development. OMDs may cause a disruption in the acquisition of basic oral motor skills and therefore also the other more complex movements that are built upon them. One of the most common signs of an OMD is a tongue thrust, which may be evident during speaking or swallowing.
Speech issues are only one facet of an orofacial myofunctional disorder but possibly one of the most easily recognizable. Speech difficulties related to OMDs could be related to difficulty nasal breathing or lack of strength, mobility, or coordination.
Some individuals may have a genetic propensity for an orofacial myofunctional disorder. For example, Down Syndrome and Cerebral Palsy have been associated with low muscle tone as well as receptive and expressive language development delays. Speech and language therapy may help acquire age-appropriate speech and language skills and master communication.
Possible causes of OMDs affecting speech and language
Some of the possible causes of orofacial myofunctional disorders affecting speech or language skills can include:
Tethered oral tissues (also referred to as a “tongue, lip, or buccal ties”).
Oral soft tissue restrictions can limit the full range of motion of the lips and tongue. Restrictive frenal attachments can prevent comfortable resting posture involving the tongue up and lips together, and they can also prevent individuals from meeting targets required for proper speaking or swallowing. For example, a lip tie may affect the ability to close the lips during speech sounds requiring the lips to be together. A tongue tie may prevent the tongue from reaching the roof of the mouth or the upper front teeth during certain sounds. When the tongue or lips cannot function properly, other muscles are used to compensate.
Compensatory muscle patterns may be observed during some alveolar sounds (the sounds we produce touching the tongue to the ridge behind the upper teeth – /t, d, n, l, s, z/) and palatal sounds (the sounds we produce using the roof of the mouth – /sh, ch, J, r/) due to restricted tongue movements.
Note: We screen for possible restrictive frenal attachments in our speech and orofacial myology evaluations.
Nasal airway obstructions due to allergies or a physical obstruction (such as enlarged tonsils or a deviated septum)
Nasal airway obstruction will force mouth breathing. Mouth breathing has been associated with poor speech, particularly distorted /s/ and /z/ production or lisping. During mouth breathing, the tongue rests low and forward in the mouth with the lips opened. This is poor oral rest posture. Some sounds may be more challenging to pronounce when starting in this position. Also, nasal breathing is used during active speaking (not just mouth breathing), so an inability to effectively nasal breathe may impact speech.
Prolonged oral sucking or biting habits
Sucking and biting habits place the tongue, lips, and jaw in positions that are not ideal. In children with sucking habits, muscles required for sucking can be well-developed, while other musculature, such as jaw muscles used for chewing may need to be strengthened. Jaw grading and stability are important components of speech production. Finger sucking, nail biting, pacifier use, and other oral habits can also affect positioning of the tongue, lips, and jaw at rest and therefore also have the potential to impact speech development.
Inability to meet expected developmental milestones
Prolonged bottle feeding or tube feeding may affect speech and swallowing by preventing normal milestones in oral motor development from occurring.
One may be predisposed to speech issues because of familial facial features. For example, ankyloglossia (also known as a “tongue tie”) is known to run in families. Individuals with certain genetic syndromes (such as those known to cause low tone) may also be pre-disposed to OMDs.
These causative factors may affect the starting point of the tongue, lips, and jaw for speaking as well as the movement patterns your speech production Articulatory errors affect speech clarity and overall communication skills.
Our SLP carefully assesses for articulatory errors, language difficulties and dysphagia associated with an OMD. After a detailed assessment, she will set a baseline and design an individualized intervention plan.
It is important to correct these issues early. Long-term dysfunctional muscle use and compensatory muscle patterns can lead to jaw pain and poor facial growth patterns.
Some red flags that your child may be experiencing an orofacial myofunctional disorder include:
- Mouth breathing (day or night)
- Tongue thrusting during speech or swallows
- Messy or picky eating
- Persistent sucking or biting habits (including nail biting, thumb sucking, and pacifier use)
Our speech therapist will assist you with techniques and strategies to achieve correct oral movement and positioning for speech clarity and eating. This is done through improving muscle strength, proprioception, awareness.
Therapeutic approaches are different for adults and children and can vary based on individual needs. You may need to attend therapy sessions until you master smaller goals and can then generalize it. That might mean a few sessions or a series of sessions. Some of the techniques our speech therapist may employ include:
TALKTOOLS ORAL PLACEMENT THERAPY
Oral Placement Therapy (OPT) combines traditional auditory/visual speech therapy methods with tactile-proprioceptive techniques to improve speech clarity. OPT is used to improve articulator awareness, placement (dissociation, grading, and direction of movement), stability, and muscle memory. These strategies can be applied methodically to improve oral motor skills needed for breast/bottle feeding, transitioning to solids, spoon feeding, open cup and straw drinking, chewing, bolus control and formation, and more.
PROMPTS for Restructuring Oral Muscular Phonetic Targets is a tactile-kinesthetic (touch and feel) approach where a SLP places his/her hands on the client’s face to guide his/her jaw, lips, and tongue to move correctly to form words.
BECKMAN ORAL MOTOR
Beckman oral motor interventions are non-verbal prompts (using hands and tools) to encourage and assist in motor movements of the tongue, lips, and jaw for the functions of feeding and speech. These techniques can be used on both infants and adults and can be a great treatment option for individuals who cannot volitionally participate in other traditional therapies.
- Dynamic Temporal and Tactile Cueing (DTTC)
DTTC is a treatment approach designed to improve planning and programming for speech movements and can be used in the treatment for childhood apraxia of speech.