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The Speech Umbrella
The Speech Umbrella
Beyond Articulation: The Myofunctional Revolution
Have you ever wondered why some children struggle with persistent speech sound errors despite trying every traditional approach? The missing piece might be right under their tongue.
After 30+ years as a pediatric speech-language pathologist, I discovered a game-changing approach that transformed how I treat articulation disorders. Oral facial myofunctional therapy addresses the underlying muscle patterns, breathing habits, and oral resting postures that create the foundation for clear speech. This isn't just another technique—it's a fundamental shift in understanding how our oral structures develop and function.
When the tongue maintains its correct resting position against the hard palate, it creates what experts call "the central operating zone" for speech sounds. Think about efficiency: if your tongue already rests in an elevated position, it's perfectly positioned to produce most consonant sounds automatically. Yet many children with speech disorders habitually rest their tongues in a low position, forcing them to consciously remember to elevate it for proper articulation—making speech laborious rather than automatic.
The results can be remarkable. One preteen client with persistent R errors made breakthrough progress after addressing a posterior tongue tie and implementing myofunctional exercises—without using a single traditional placement technique. These moments made me realize how this approach removes barriers to success rather than repeatedly drilling sounds without addressing underlying issues.
If you're an SLP feeling stuck with challenging articulation cases or simply wanting to work smarter rather than harder, explore the fascinating world of myofunctional therapy. Check out the resources mentioned in this episode, including books by Dr. Shereen Lim and Joy Moeller, and consider how this knowledge might transform your practice. As I've discovered, "When you master nasal breathing and tongue resting posture, complex articulation targets take care of themselves."
Welcome to the Speech Umbrella, the show that explores simple but powerful therapy techniques for optimal outcomes. I'm Denise Stratton, a pediatric speech-language pathologist of 30-plus years. I'm closer to the end of my career than the beginning and along the way, I've worked long and hard to become a better therapist. Join me as we explore the many topics that fall under our umbrellas as SLPs. I want to make your journey smoother. I've worked long and hard to become a better therapist. Join me as we explore the many topics that fall under our umbrellas as SLPs. I want to make your journey smoother. I found the best therapy comes from employing simple techniques with a generous helping of mindfulness. Welcome to the Speech Umbrella Podcast.
Speaker 2:I haven't published a podcast in a long time. If you're a returning listener, thank you for tuning in again, and if you're a new listener, I want you to know I have a whole library of podcasts for your pediatric speech therapy needs. I didn't intend to go so long between podcasts, but life happens. One of the things that happened is I became a myofunctional therapist, which was quite a journey. It was a big time commitment, but I would do it again in a heartbeat because I have learned so much. This is episode 104 and it's all about oral facial myofunctional therapy. Oral facial myofunctional therapy is the precise term, but it's such a mouthful people tend to just call it myofunctional therapy or even just myo for short. I'll be referring to it as myofunctional therapy in this podcast, as myofunctional therapy in this podcast.
Speaker 2:I became interested in myofunctional therapy when I interviewed a dentist, shireen Lim, about her book Breathe, sleep Thrive for this podcast. You'll find that interview in episode 92. Her book was a real eye-opener for me and she is the one who got me interested in becoming a myofunctional therapist. Her book is full of fascinating information, but what really stood out to me was the fact that some persistent and long-standing speech disorders are being corrected through myofunctional therapy and not necessarily therapy done by a speech therapist. Since correcting speech disorders is part of our job description, I figured I better figure out what it was all about. I also recognize that much of the information in Dr Lim's book is similar to Char Bouchard's work. Char is an SLP who has devoted her career to helping SLPs understand the oral motor aspects of speech. Many people can become myofunctional therapists. In my cohort we had PTs, ots, dentists and dental hygienists in addition to SLPs. That is how we get people other than SLPs correcting speech sound disorders, not because they are working on speech directly, but because they are working on improving the function of oral muscles and speech improves as a byproduct. Another way to put it is myofunctional therapy removes barriers to developing precise articulation, and I am all about removing barriers for our clients and ourselves. It makes our job so much easier.
Speaker 2:This is my promise to you about today's podcast. If you're not already in the myofunctional world, you're going to have a new worldview of speech therapy. Once you see it, you can't unsee it. I mean that, literally Once you start observing people's faces, their jawline, their teeth, you can almost diagnose a myofunctional disorder by appearance alone. Have I sold you on myofunctional therapy yet? Okay, time to cut to the chase. Here's what we're going to cover today. We're going to talk about what oral facial myofunctional disorders and oral facial myofunctional therapy is. We're going to talk about what are the goals of myofunctional therapy. What is the relation between soft tissue and hard tissue and skeletal development? What are some common myofunctional disorders? How is this related to speech disorders? We're going to take a bird's eye view of what myofunctional therapy could look like for an SLP things to consider and what you can do as an SLP if you're interested in learning more.
Speaker 2:What is an oral facial myofunctional disorder, or OMD for short? This definition comes from the Academy of Oral Facial Myofunctional Therapy and it's a long one, so buckle in. Omds are disorders of the muscles and functions of the face and mouth. Omds may affect, directly and or indirectly, breastfeeding, facial skeletal growth and development, chewing, swallowing, speech occlusion, tmj movement, oral hygiene, stability of orthodontic treatment, facial aesthetics and more. Most OMDs originate with insufficient habitual nasal breathing or with oral breathing. The subsequent adaptation of the muscles and the oral facial functions to a disordered breathing pattern creates many OMDs. Oral facial myofunctional disorders may impact treatment by orthodontists, dentists, dental hygienists, speech-language pathologists and other professionals working in the oral facial area. Okay, thanks for hanging in there. That's a really long definition, but we will get more into it as we go through this podcast. What all of this means? Okay, let's talk about what the myofunctional therapy is.
Speaker 2:Oral facial myofunctional therapy is neurological re-education of the oral facial muscles. It is a rehabilitation therapy program designed to re-pattern stomatic nathic functions, that's, teeth, jaw and soft tissue such as chewing, swallowing and breathing. This is accomplished through the use of therapeutic techniques and positive behavioral modification. This definition is taken from Joy Moller's book called Is your Tongue Killing you? Let's talk about what the goals are for myofunctional therapy. We want to establish nasal breathing. We want to strengthen and tone the muscles of the tongue, lips and face. We want to promote the ideal oral resting posture and that's where the tongue rests in the mouth and establish optimal chewing, swallowing and body posture.
Speaker 2:Now the relation between soft tissue and hard tissue and skeletal development is really key to understanding the whole myofunctional world. Soft tissue can affect how hard tissue, such as bone, develops. The tongue is soft tissue and the hard palate is bone, so it's hard tissue. When the tongue is in a correct resting posture against the hard palate as a child grows it acts as a natural expander for optimal palate growth. When the palate is wide enough, there is enough space for adult teeth. Also, when the palate is wide and broad, it easily accommodates the tongue resting up against it.
Speaker 2:Some common oral facial myofunctional disorders are low tongue resting posture, mouth breathing, lingual freedom restrictions, what we commonly call tongue ties, crowded and misaligned teeth and high narrow palates. Many OMDs co-occur, such as if you're a mouth breather, then your tongue is low. Those two things happen together. That's just a sample of some OMDs. You might notice I didn't mention speech disorders. They can indeed be an OMD, but how common they are is a question worth discussing. So let's discuss how is this whole medical discipline of myofunctional disorders related to speech disorders? That's what you're all here for, right?
Speaker 2:Perhaps the number one takeaway from this podcast is the relationship between speech and tongue resting postures. A correct oral resting posture places the tongue in the ideal position for correct speech. The correct oral resting posture is with the tongue resting up against the hard palate. How many of you have emphasized repeatedly to a child working on R that the sides of their tongue need to make contact with the back molars? If our client's tongues were automatically in the correct resting posture, we wouldn't need to be saying this over and over again.
Speaker 2:I referred to Char Boshart earlier, who has written books and done multiple podcasts on this very subject, and you can find my interview with her in episode 79. In that episode she quoted one of her professors, dr Fletcher Tarr. He said the correct oral resting posture is the central operating zone for your speech sounds. A correct resting posture facilitates rapid, automatic, precise articulation because it's so efficient. Char has an analogy I really like If you were going to run some errands in your car, you do not drive your car back to your garage between every stop.
Speaker 2:That would be very inefficient and it would slow you down. If your ton is not naturally resting against your hard palate, then it is resting low. If it's resting low, then you have to remember to elevate it in order to produce most speech sounds correctly. Does everyone with a low tone resting posture have a speech disorder? The answer is no. There are many people with low resting tones who have good awareness of how they sound. They figure out the correct movements for good articulation and they are able to accommodate even if their speech is less efficient. But for our clients with speech sound disorders, some of them have a double whammy because in addition to their myofunctional issues, they also have phonological awareness issues, which is all the more reason to remove barriers for them.
Speaker 2:Myofunctional therapy is such a help in speech therapy. It is fast and efficient, provided your clients are old enough to participate in the therapy. By now you may be wondering what myofunctional therapy looks like. Here's a bird's eye view of how it works in my clinic. I start with an evaluation. A good oral facial myofunctional program will teach you how to do a thorough evaluation. Then you will know if they are ready to start myofunctional therapy and if they will be a good fit. I learned so much about really assessing oral structures in my course when I learned how to do a thorough evaluation. This is stuff I did not get in graduate school. So say your client is a good candidate. What's next?
Speaker 2:I have weekly appointments. At the beginning I put any other kind of speech or language therapy on hold during this time and the whole focus is on teaching them exercises they will do at home. Each week they get a new set of exercises and generally after two to three months they will be ready to move to exercises that help them generalize and habituate their new habits of breathing, swallowing and maintaining a correct oral resting posture. As they move into the generalization and habituation exercises, they get new exercises every other week and then every three weeks. If they have other speech or language goals, I start working on these goals during the weeks they don't get new exercises. It has often been my experience that once a client who only has speech goals has completed myofunctional therapy, they are ready to graduate. It's altogether an easier way to accomplish speech goals and I'm all for working smarter and not harder. The entire process usually takes from six months to a year.
Speaker 2:One of my first myofunctional clients was a preteen working on R and S. Some of you may know I specialize in R and I've even created an entire course around how to teach R. This particular client could not reliably produce an R, no matter what I did. Thanks to what I learned in my myofunctional course, I was able to identify a posterior tundi which he got released and that, along with myofunctional exercises, caused his R sound to emerge without me doing a single placement or elicitation method. That made me a believer. Did I still use the techniques I developed for my course? I did, as you needed some refining and generalization. The methods I teach in my course and possible are made possible are still valuable, but the whole process is much easier for my RNS clients particularly. I've been doing myofunctional therapy for a year and a half and here are some things I've learned and put into practice.
Speaker 2:It's a rigorous process for these kiddos doing these exercises two to three times a day, especially in the first two to three months. I help parents understand this and choose a time to begin that will work best for them. For example, you might want to wait until summer vacation to begin or not start just before Christmas break or not before you're going to take a two to three week vacation because you're not going to do those exercises on vacation. Parents need to understand that they will be helping their child to complete these exercises correctly and consistently. Perhaps if you have a very motivated older teen, parents don't need to be as involved, but that's the exception rather than the rule. The parents and the child need to work as a team. In the training you take to become a myofunctional therapist, you'll learn when to involve other professionals such as ENTs and dentists. You don't want to start treatment if nasal breathing is obstructed, for instance. You will want to know if a ton tie is restricting movement so you can work around that. In my program we do some exercises before a Tuntai release to help prepare them and some specific exercises after the release for the best outcome. If a child is sucking their thumb or fingers, that habit needs to be eliminated before you even think about doing myofunctional therapy and in the course that you take there usually is a habit elimination program included.
Speaker 2:Age is a big, big consideration and this is from my own experience, I've started with some really young kids and had them drop out of my functional therapy. I've had one child who was five years old complete the program successfully, but it was hard going. She was six by the time she completed it. The family had an ABA therapist who helped her with her exercises, which I think really helped the family be consistent. I have another five-year-old just about to complete the program, but I had to pause the program, do some preparation work with her and then restart it. Based on my experiences so far now, I think a child who is six or seven is generally mature enough to succeed with parent support. If you're considering a child younger than that, you'll want to think through that decision carefully. If a child is not old enough to do myofunctional therapy, I will use Prompt, which works really, really well to improve their speech and sets them up to be successful with myofunctional therapy in the future.
Speaker 2:Along with my evaluation, I schedule an online meeting with parents to explain my findings and the ins and outs of myofunctional therapy. I do this even if we aren't going to do it right away, and this helps me educate them on the value of it and the value of seeking out a dentist who has educated myofunctional issues. It just opens up the parents' eyes to the whole concept of the ton. Resting up against the palate is ideal for their palate development and it's ideal for their speech development. It helps them connect those two ideas if you can have this online meeting with them.
Speaker 2:I've learned to be flexible with my scheduling, since I have clients who are tapering off their visits to every other week or every third week. I try to schedule those bi-monthly visits or monthly visits on a specific day of the week, which helps my schedule stay full. It's important when introducing parents to myofunctional. In other words, they came to you for help with one thing which is speech or language, and now you're telling them they need something else. That can give parents the wrong impression that you're trying to sell them something extra. And this is one reason I do an online meeting with parents, so I can explain the relationship between oral structure and function and speech very clearly. I explain to them that I have taken a motor approach to speech disorders for many years with considerable success, and that I have always done motor approach to speech disorders for many years with considerable success, and that I have always done exercises to promote correct speech. Myofunctional therapy is similar to what I've done before, but it's accelerated. It's more thorough. Because the parent and child do so much work at home, progress is accelerated. I always offer them the choice to do myofunctional therapy or not, and we talk freely about whether the child is ready for it.
Speaker 2:What can you do as an SLP if you want to learn more about myofunctional therapy? I have a couple of podcasts that I mentioned the one with Shereen Lim, that's episode 92, and the one with Char Boshar, that's episode 79. There's another podcast called Airway Answers with Nicole Goldfarb, and she's one of many podcasts about myofunctional therapy, but it's one I've listened to and I enjoy it. There's some books you could read. There's Dr Lim's book Breathe, sleep Thrive. There's Is your Tongue Killing you by Joy Moeller. Joy is an instructor for the AOMT, who I took my myofunctional course through. There's Breath by James Nestor, and that's a very popular book for a general audience that introduces people to the importance of nasal breathing, among other things, and the other two books that I mentioned are more scientific in nature. There's Academy of Oral Facial Myofunctional Therapy AOMT for short. They have their Frequently Asked Questions page, which is really informative, and I'll provide links to all of these resources in the show notes, of course, and you can always send me an email if you have questions and I'd be happy to talk to you about myofunctional therapy and all things speech therapy for that matter.
Speaker 2:Now that I'm a myofunctional therapist, I find I cannot separate what I've learned in my training from speech therapy. Rather than being a helpful adjunct to our profession, like another tool in my therapy toolbox, this material is foundational to our understanding of speech development. Now that I know what I know, I'm flummoxed that it's not required coursework for SLPs. This understanding about how our palates develop and where our tongue should be resting for correct speech is super, super important. This podcast is my effort to scatter these seeds of knowledge far and wide into the SLP world. If enough of us start demanding change, I believe we can change our profession for the better. To sum up everything I've talked about today, when you master nasal breathing and ton resting posture, complex articulation targets take care of themselves. Thanks for listening.
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