Orofacial myofunctional disorders (OMDs) are patterns involving oral and orofacial musculature that interfere with normal growth, development, or function of orofacial structures. Orofacial musculature dysfunction can occur at any stage in life. So, let’s look more into oromyofunctional disorders and how skilled treatment can help. (ASHA, 2022).

What can be addressed in oromyofunctional disorder treatment?

• Obtaining proper lingual resting posture with tongue on palate
• Breathing patterns, specifically promoting nasal breathing
• Tongue thrust
• Sleep breathing disorders
• Oral habit elimination (i.e. finger/thumb sucking)
• Temporomandibular joint pain
• Long-term stability of orthodontic treatment
• Tongue & lip tie
• Difficulty chewing and/or swallowing
• Articulation errors relating to atypical patterns

Who provides services for oromyofunctional disorders?

• Speech-Language Pathologists
• Occupational and Physical Therapists
• Lactation Consultants
• Osteopathic Physicians
• Dental Hygienists, Orthodontists, and ENTs
• Sleep Specialists and Craniosacral Specialists
• Chiropractors and Massage Therapists

Overall, a licensed healthcare professional who has secondary training to support oromyofunctional disorders is a desired provider.

Goals of oromyofunctional therapy

The main goals of therapy are, firstly to establish nasal breathing. Secondly, to achieve tongue resting posture on hard palate. Thirdly, to correct atypical swallow and speech patterns (ie: tongue thrust). Providers work to achieve these goals through isolated jaw, lip, cheek, and tongue exercises with behavior modifications. Treating therapists work along with allergists, ENTs, and dentists when referral is necessary to address airway, dental occlusion, and tongue and lip tie confirmation diagnosis and treatment.

Bodywork is also another important component to achieve proper body posture. Proper posture helps to meet overall OMD goals. Therefore, the treating therapist would refer to a physical therapist if bodywork is needed. The remediation of oromyofunctional disorders improves overall facial structure, dental occlusion, and swallowing and speech impairments. To learn more about tongue ties and other tethered oral tissues issues, check out this MOSAIC blog. Click here to learn more.

The pictures above refer to an 11 year old female at initial evaluation and then 6 months after. She completed oromyofunctional treatment for tongue thrust elimination. She achieved nasal breathing, proper tongue resting posture on palate, and eliminated tongue thrust swallow pattern in therapy. Her open bite improved greatly with the completing behavior modifications and isolated exercises in skilled oromyofunctional treatment. Subsequently, elimination of these behaviors will ensure her orthodontic longevity.

References

1. “Orofacial Myofunctional Disorders.” American Speech-Language-Hearing Association, American Speech-Language-Hearing Association, https://www.asha.org/practice-portal/clinical-topics/orofacial-myofunctional-disorders/.

2. “OMDs.” Function-Focus, www.function-focus.com/omds. Accessed 22 Feb. 2022.

Family game nights are a great way to bring everyone together for a little fun competition. They are also be a good way to boost language skills too! In addition to spending quality time with your family, playing games together can help with improving turn taking skills, attention, and cooperation. One great game to play with kids is Zingo.

What is Zingo?

Zingo is for kids four years and older. If you are willing to provide some extra help and attention, it can be played with children as young as two (with some modifications of course). This game takes a new spin on classic Bingo, and you can play with up to six people. Each player receives a board with 9 pictures and words on it. Then you take turns sliding the “Zinger” to dispense picture cards. The first person to fill their board is the winner.

Zingo Modifications

Zingo boards are two sided. The green side has fewer images in common so it is less competitive. The red side has more images in common so it is more competitive. You can modify game time by just trying to get three images in a row, or by matching the four corners. If you are playing a friendly game, you can pass the Zinger back and forth. The person whose turn it is gets those tiles or share them with someone in need.

You can also play that the first person to call out the tile they need gets it if you decide not to take turns being the dealer. If you want to add an exciting twist, you can play speed Zingo. The adult or dealer slides the Zinger and children race to grab the tiles they need without taking turns. Detailed instructions and tips on how to encourage more advanced thinking skills can be found here.

The Right Zingo for You

There are four different versions of Zingo to choose from. Original Zingo is a basic picture matching game. This is the best version for young children. Zingo 1, 2, 3 focuses on counting and addition. With Zingo Word Builder, you work to find missing letters to make words, and in Zingo Sight Words, you try to find matching sight words.

How to Encourage Language During Play

Use all of the Zingo games in different ways to build up your child’s expressive and receptive language skills. You can talk about the pictures, numbers, or words you find and what they mean. Take it to the next level. Find objects around the house that match the pictures or words on the tiles or make sentences using the target words. If you are playing number Zingo, you can count out your child’s favorite snack to go with the number they get. You can also use the boards to play “I spy” and work on describing and identifying the pictures. For example, “I spy something in the sky, it’s very hot, and it’s yellow.” If your child guesses “sun,” they get that tile.

There are so many different ways you can play this game to incorporate different skills. That is why it is always a go to game kid in speech therapy at MOSAIC. For more activities to do with your kids, check out our School’s Out Summer Activities and Infant Play Activities, and remember, if you have any questions about your child’s development, you can always call MOSAIC and speak to one of our skilled therapists.

Praxis, also known as motor planning, is the ability to combine information from the environment and successfully perform actions to completion. Despite this brief definition, the ability to perform praxis is quite involved. Occupational therapists often break praxis abilities down into specific parts.

Praxis – Ideation

Part one is called ideation, in which we use varying brain functions to support ideas. Ideation is the ability to grasp what is being seen and develop an idea as how to use objects in the environment to develop a course of action. How to spot ideation? Look at how your child plays with simple items. Is there intention and a bit of complexity to the moves? Can the blanket switch hands, fold up, cover different body parts, become a tent, etc.? If struggles are apparent with several items, and play appears limited, it may be due to ideation.

Arousal and Rhythmicity

Part two is arousal and rhythmicity. We need to be able to perform actions in a rhythmical manner. We also need to match our arousal or energy to the rhythm to perform. Difficulty with rhythmicity is often most apparent in how a child times their movement. People may describe children who struggle in this area as clumsy.

Complete Movement Efficiently

Part three is the ability to complete or execute the movement efficiently. Planning and sequencing movements with the ability to make real-time adaptions is the foundation for learning a multitude of skills. To help get a better idea of what a motor difficulty may look like, see the chart below.

When a difficulty is present in any one of these parts, it will affect the overall presentation of movement. Professionals use a variety of terms to describe the difficulties observed, including dyspraxia, developmental dyspraxia, coordination, or perceptual motor difficulties. Some children will end up with a diagnosis of Developmental Coordination Disorder. Meanwhile, others who present with difficulties will not have a diagnosis.

Regardless of the confusing terms, OTs are one group of therapists with the skills to address such motor issues in children. Therefore, they have specialized skills in understanding primitive reflexes, motor control based on neurological components, sensory processing, and perceptual processing. Our occupational therapists will assess which parts are leading to the difficulty and then help remediate the difficulty with fun and engaging activities. Above all, remember that it is never too late to address motor challenges! The positive outcomes can be considerable for a child. Lastly, if you have concerns, reach out to MOSAIC today to schedule a free screen or a full evaluation.

References

1. dyspraxiausa.org

2. www.dyspraxiafoundation.org.uk

3. Dyspraxia from an Occupational Therapy perspective by Natasha Patten BSc (Occupational Therapy)

4. CE-Article- September-2019.pdf (aota.org)

Every house has cups! If there are children in the home, they are often plastic which are perfect when it comes to cup activities. Here are some fun and simple activities for kids to do with cups. Each activity helps develop a variety of skills.

Memory

Arrange colored cups in various order / direction ( vertical, horizontal, diagonal) then rearrange and have child move back to original order. The more cups the higher the challenge. In addition to working on visual memory skills children can learn strategies to help with memory (repeating the pattern).

Stacking

Cups can be stacked in pyramids of all sizes and shapes or made into walls or towers. You are only limited by the number in your stash. Kids are working on eye hand coordination, bilateral skills, and motor planning. Math skills can be added as they count their stacks or create patterns with different colors.

Bowling with Cups

What kid does not like knocking things over?! Set up a mini bowling alley using overturned cups. Use the traditional triangle set up or be creative. Tennis balls work great for knocking them over. This game will help build eye hand coordination, visual perceptual skills, and motor planning. Playing in teams will help develop social skills of working together, turn taking and social communication skills.

Target Practice with Cups

Cups can make great targets for Nerf guns. Make the target more challenging by dangling them from a doorway. Other options are to set them up and try to toss a ping pong ball into them (a kid twist on a college game!). You can also tape them to the edge of a table and try to roll balls across the table into them. Fun variations include using a straw to blow light weight balls / cotton balls into the them or having them roll a ball down a paper towel roll (this one requires more planning and organizing to complete).

Up and Down

This is a group game that requires room to run. Divide kids into an Up team and a Down team. Scatter as many cups as possible around the playing area with half of them up and the other half down. Kids then race to flip over cups to their designated direction (up or down). When they hear, “STOP,” whichever team has the most cups pointing their way wins.

So, if you are looking for some fun and simple ways to keep kids entertained, try some of these out. These games can also be great for a family get together, birthday parties, and sleep overs. For more ideas or advice on building play skills, check out Building Play Skills for Healthy Children and Families.

It seems everywhere you look, we are a nation obsessed with tongue ties. But why? What is the great debate? Let’s break it down.

“The reason we’re hearing about tongue-tie more now is that the last 10 to 11 years have demonstrated that the part of the tongue responsible for suction is the middle of the tongue, not the tip,” says Bobby Ghaheri, MD (otolaryngologist). This research refers to the part of the tongue restricted by a posterior tongue tie which Ghaheri states is “still under the front of the tongue but less visible.” Hence the name, posterior tongue tie. Frena is a small band of tissue that extends from the floor of the mouth to the bottom of the tongue. In addition to tongue ties, tethered oral tissue (TOTs) can define six other oral frena located bilaterally, in the upper and lower buccal cavities or cheeks, and upper and lower lips. Frena can either support movement or restrict it. However, frena cannot be stretched due to their collagen make up.

What is a Tongue Tie?

A tongue tie, or ankyloglossia, will present as an overly short or thick frenulum that restricts the tongue’s movement. Similarly, a lip tie can occur as well as buccal cavity ties. There are different classifications of each, however assessing function is what drives treatment or intervention.

Signs of TOTs in infancy may include difficulty breastfeeding causing failure to thrive and/or maternal pain. It can also be an issue causing “picky” eating or difficulty transitioning to solids. A child may develop a lisp due to structural problems and other issues may be evident across the lifespan. The following images depict restriction of the frena vs. supporting function.

What are all the Acronyms?

Let’s clarify the acronyms seen in the literature and on social media. These terms also identify team members when a tethering of tissue is present or identified.

• TOTs – Tethered Oral Tissue
• IBCLC/CLC – Individual/International Board Certified Lactation Consultant; if breastfeeding is an issue, this is one professional to consult.
• SLP – Speech Language Pathologist; professionals who have training in feeding, speech, and oral sensory motor function. Can have training and/or a certification in orofacial myology.
• OT – Occupational Therapist; can be TOTs informed and can assist in posture and alignment of the body, oral motor dysfunction, and body work such as craniosacral therapy or myofascial release.
• PT – Physical Therapist; can be TOTs informed and have continuing education in craniosacral therapy, myofascial release, or more. There can be torticollis with tongue ties and PTs are essential practitioners in this area.
• RDH -Registered Dental Hygienist; can be trained in orofacial myofunctional therapy.
• OMD -Orofacial Myofunctional Disorder; one or more of the following can be an OMD: abnormal tongue resting posture, teeth grinding, lip incompetency and/or noxious oral habits, nasal breathing issues, tongue thrust swallowing, chewing difficulties, or oral placement issues related to speech.
• OMT – Orofacial Myofunctional Therapy; a treatment modality used to treat OMDs. This is not a profession.
• COM – Certified Orofacial Myologist; SLPs can become a COM, which is an extensive process involving clinical and written exams and continuing education requirements to maintain certification.
• ENT – Ear, Nose, and Throat doctor or otolaryngologist. An ENT may assess structure, complete a release, and/or to assess an airway.
• Dentist/Orthodontist – professionals on TOTs team for assessment and intervention.

What to do when Tongue Ties or TOTs are Present:

In infancy, a pediatrician can refer to IBCLC, SLP, etc. A diagnosis of TOTs does not immediately mean a release is necessary. An assessment of function will determine intervention. A speech language pathologist can conduct this assessment and be vital in pre-op care, post-op care, and functional therapy, whether oral sensory motor or orofacial myofunctional (only after the age of four). Following assessment, a release is considered with relation to age and the severity of the restriction both in classification and in function. A dentist or ENT may release a tie via laser or scissors. They will prescribe stretches to complete after the procedure, and an SLP can complete treatment in collaborative care if trained accordingly.

The Takeaway 

In conclusion, when researching a proper assessment of oral structures with possible restrictions, consult professionals knowledgeable in the area, whether dentist, SLP, PCP, IBCLC, or ENT. Function is a determining factor for the indication to release or not. Navigating TOTs is a team effort in evaluation and treatment. A speech language pathologist is a professional that can be instrumental in oral motor development, feeding, and speech across the lifespan, and orofacial myology after the age of four. Choose a team wisely! Untreated oral ties can lead to a host of problems, including dental and orthodontic issues such as altered jaw and teeth development, breathing issues, reflux, head and neck pain, chronic jaw issues and/or difficulty chewing, poor dental hygiene, digestive issues, sleep apnea, and speech issues.

If you are struggling breastfeeding, it may not be related to TOTs. Check out What Exactly is a Good Latch? for breastfeeding tips.

References

1. Tongue Tie – What Everyone Needs to Know

2. TOTs 101 for Parents

Curious about visual perceptual skills? Your occupational therapist may use a variety of terms to describe challenges your child may be having with vision. Firstly, it’s important to understand that when discussing vision, the term acuity refers to how well the eyes can see (i.e. whether or not a person needs glasses). Visual perception, however, refers to how the brain sees and interprets the information. Then, after ruling out other visual concerns related to acuity and oculomotor skills, your therapist may conduct a variety of visual perceptual tests.

Visual Perception Skill Assessments

The assessments your OTs have access to here at MOSAIC are: “Test of Visual Perceptual Skills”, “Motor Free Visual Perceptual Test”, and the “Beery VMI”. Some of the assessments test just the eyes and the brain’s interpretation, and some of the assessments test visual perceptual skills in combination with visual motor skills (involvement of the hand). Also, there are a variety of sub categories in most of these assessments:

• Figure ground
• Spatial relations
• Discrimination
• Form constancy
• Visual and sequential memory
• Visual closure

Therefore, all of these terms are skills kids need to be successful with school and everyday functions.

Visual Perceptual Skill Terminology

• Figure ground refers to the eyes’ ability to see a specific item amongst a busy background. (Locating a specific sock in a busy sock drawer)
• Spatial relations refers to the eyes’ ability to understand the position of objects in relation to oneself or in relation to other objects. (Spacing of letters on the paper in relation to the line or in relation to other letters)
• Visual discrimination is the eyes’ ability to tell the difference of main features in an item’s position, shape, form, and color (Telling the difference between capital letters versus lower case letters)
• Form constancy refers to your eyes’ ability to identify an item whether it’s upside down, turned over, a different color, or a different size (Being able to identify letters when looking at a newspaper from the other side of the table)
• Visual memory and sequential memory are the eyes’ ability to look at something for a given time and be able to recognize it and its sequence after a brief lapse in time. (Remembering a family member’s phone number)
• Visual closure is the eyes’ ability to recognize objects or letters when only parts of the item is visible. (Recognizing the item in a dot to dot picture)

How to get Help

Your child could likely have challenges with one or many of these sub categories. All areas of vision greatly impact your success with academics. For example, if you are seeing challenges with reading and writing, first be sure to rule out any visual concerns. Schedule and appointment with an optometrist before seeking further testing for visual perception. An optometrist will gather a baseline on acuity and oculomotor skills. But, if you aren’t sure and need more guidance, schedule a free screen with one of our occupational therapists. They will determine if your concerns warrant a full evaluation or a referral out to a vision specialist! Also, you can check out another MOSAIC blog on visual perception here.