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Updated: Apr 22

YES, yes and yes!!!! I'm so excited to tell you HOW myofunctional therapy speeds up speech therapy! The progress we see in our clinic is definitely something to get excited about, so listen up.....

Generally speaking, there are two broad categories of speech sound disorders.

child with feeding issues
child with tongue tie

Functional Speech Sound Disorders: there is no known cause, this is how most Speech-Language Pathologists are trained to look at speech sound disorders.

Organic Speech Sound Disorders: these link back to a motor planning, structural, or sensory difficulty. A full and detailed assessment of the structure and functionality of the oral structure must be completed to determine the root cause of your child’s speech difficulties. It is a critical element in creating an efficient and effective treatment plan for your child’s improvement. It is important to find the root cause of the speech difficulties and errors your child is struggling with. Otherwise, you could be working against a structural or functional difficulty that will make it difficult to create lasting change in speech sound productions. This can lead to longer treatment times and frustration experienced by your child, yourself, or both.

What is the ‘go’ position?

Tongue up, lightly suctioned to the palate, lips together, teeth slightly part, jaw relaxed. It is also called correct oral rest posture.

myofunctional therapy
speech therapy

Why might I need myofunctional therapy before I start speech?

If you are running a race, you wouldn’t want to start from the parking lot, right? So why would we start in a less than optimal place for correcting speech sounds?! Optimizing lingual coordination, oral rest posture, and other skills helps get your child to the starting line, and can often times help progress their speech without direct treatment of the speech sounds. All the consonant sounds that use the tongue, with one exception, ‘th’, are created at the top of the palate.

The tongue needs to elevate, protrude, retract, and be shaped in a variety of ways to make these sounds. If our tongue is unable to make the shapes, or is restricted in its movements, it will be as though you are pushing against a brick wall — exerting a lot of effort for minimal to no results. That is why we want to start with our tongue in the ‘go’ position.

What is myofunctional therapy?

Myofunctional therapy is an oral training program focusing on correcting oral rest posture (where the tongue rests in the mouth) as well as oral preparatory phase of feeding and oral phase swallow (how you chew and swallow your food). It also can help eliminate drooling, noxious oral habits, tongue thrust, forward tongue posture, open mouth posture, and mouth breathing.

What is a tongue/lip tie? How is it diagnosed?

A tongue tie is present when the frenulum connecting the tongue to the floor of the mouth restricts the tongue’s functional range of motion and ability to function optimally. Similarly, a lip tie is present when the frenulum connecting the lip to the tissue of the upper/lower gum area attaches at a point that restricts function via lip movement, closure, and/or coordination. Function must be impacted for a frenulum to be diagnosed as a tie. Function is evaluated through a myofunctional evaluation that assesses nasal breathing, orofacial structure, lingual coordination, jaw-lip-tongue dissociation, as well as oral phase feeding skills. Function is assessed by professionals trained in orofacial myofunctional therapy, including speech language pathologists, occupational therapists, physical therapists, registered dental hygienists and/or dentists. If speech sounds are of concern, the speech/articulation evaluation can only take place with a speech-language pathologist as they are the only professionals licensed to assess and treat speech/articulation. These professionals collaborate with a trained dentist, ENT, or oral surgeon to determine the child's specific needs for optimal care.

How does it relate back to speech?

Without remediating the underlying oral motor dysfunction that may be present due to a tongue/lip tie, you are likely going to make minimal to no progress in speech sound remediation. This is why it is important to address the root cause of the speech sound disorder first so that your progress is efficient and effective over the long term. Children who spend years in speech therapy working on speech sounds but cannot carry over their progress at the word or phrase level to the sentence level and/or cannot carry progress in therapy over to connected speech outside of therapy, should have an orofacial myofunctional evaluation.

What are other signs of an orofacial myofunctional deficit?

Orofacial myofunctional disorders (OMD) presents in a variety of ways. Some other possible signs pointing toward an OMD may include:

  • open mouth posture or mouth breathing

  • poor bite pattern

  • thumb sucking

  • a small or narrow palate/mouth

  • sleep apnea

  • snoring

  • picky eating habits

  • oral phase eating issues

  • teeth grinding

  • reflux symptoms

  • pain or difficulty with breastfeeding

  • orthodontic relapse

  • articulation errors alongside difficulty with

producing clear speech

feeding therapy
child speech therapy

Hierarchy for Optimal Speech Production

Step One....Balanced orofacial muscles: symmetry and equal strength on both sides of the mouth.

Step Two....Jaw-tongue dissociation: Lingual coordination including jaw-tongue dissociation laterally, vertically, and horizontally.

What does this mean? Often upon oral motor examination, the tongue can be seen being supported by the jaw, meaning there is no independent tongue movement. Independent tongue movement (e.g., the tongue moving separately from the jaw) is important for speech sound production: if our mouth is depending on our jaw to get to the correct place for our speech sounds, then we are limited in our productions and will

not be able to modify our speech sounds.

Step Three....Eliminate noxious oral habits: it is ideal to eliminate thumb sucking, sippy cups, or pacifiers prior to speech sound work. That said, if there is an orofacial myofunctional disorder at play and the habit is needed because the tongue cannot or does not rest up in the palate, it may be the case that these habits subside during the course of myofunctional therapy/articulation work as new habits are developed (e.g., correct oral rest posture AKA the “go” position).

Step Four....Appropriate rest posture: eliminating tongue thrust, getting the tongue elevated on the palate, and in a good starting position.

Why is this important? When starting any race, we want to start in the right place. We train, we get ready, and we start the race at the starting line. In speech, our starting line for all consonant sounds is the roof of our mouth. If our tongue is resting low and forward in our mouth, our tongue is creating a compensation or is unable to reach the appropriate place for speech.

What is the correct resting posture? We want our tongue to be up and lightly suctioned to the roof of our mouth, with our lips together and our teeth slightly apart when it is not in use. This promotes nasal breathing which is ideal.

Step Five....Speech sound production: once all the pieces are operational, it is so much more efficient and easy for your child to correct the errored speech sounds and your child's speech will take off!

myofunctional therapy
child with open mouth posture

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