Written By: Cynthia Cogswell, MA, CCC-SLP
I see many patients with articulation disorders and associated orofacial myofunctional disorders. While they have knowledge of the field of speech therapy, exposure to myofunctional therapy is limited or nonexistent. This article is meant to serve as an introduction to the cultural and historical context of myofunctional therapy and its evolution as a fundamental aspect of articulation training Orofacial myofunctional disorders have been discussed in the literature for over 100 years.
In the late 1800’s, Edward Angle, D.D.S., also known as the “Father of Modern Orthodontics,” published Malocclusion of the Teeth. He recognized the influence of mouth breathing on the resting posture of the tongue and lips and viewed compromised resting posture as the primary hindrance to orthodontic treatment. In fact, he asserted that negative oral habits must be eliminated for successful orthodontic treatment to occur.
Another early pioneer, Alfred Rogers, D.D.S., became interested in the effect of function on structure and developed exercises to improve muscle function and tone. He believed that the muscles of mastication and expression had a significant impact on developing the bony structure of the face and that successful treatment of malocclusion was dependent upon developing functionality of those muscles.
In the 1950’s , Dr. Walter Straub, a California orthodontist, developed a myofunctional therapy program for patients with ”perverted swallowing,” or tongue thrust. He trained dentists and speech pathologists to become future myofunctional therapists. Two of those speech pathologists, William Zickefoose and Richard Barrett, went on to push the movement even further with their development of therapeutic lessons, training courses, and the eventual formation of The International Association of Orofacial Myology. Zickefoose expanded Straub’s original program and established a training academy for myofunctional therapists. Since that time, mouth breathing, with associated low tongue resting posture and tongue thrust swallowing, have been linked to articulation disorders.
In 1961, Fletcher, Casteel, and Bradley found that subjects with tongue-thrust swallow were much more likely to have sibilant distortions than subjects without tongue thrust patterns. Their findings led them to contend that speech pathologists should consider basic oral muscle patterns when remediating articulation deficits “since the tongue-thrust swallow is intimately related to speech production.” Information from studies such as this led to some controversy regarding the expanding role of speech pathologists. However, it was becoming clear that the swallow pattern had to be considered in its effect on speech. Training desirable resting postures of the jaw, lips and tongue have evolved into fundamental features of articulation therapy. As Char Boshart stated in her book, The Key to Carryover, “The desirable resting posture provides a pivotal epicenter, right in the heart of all the action: speaking, chewing, swallowing.” The elevated tongue eliminates mouth breathing, improves muscle tone and facilitates efficient speech and swallowing.
From my perspective, as a speech pathologist, I have observed faster progress and better carry-over of articulation skills when combining speech and myofunctional therapy techniques. The field of speech pathology has undergone significant change since the 1950’s, when a strong interest in orofacial myofunctional disorders took hold. In recent years, increasing numbers of therapists have pursued additional education in myofunctional disorders, having seen the benefits of myofunctional therapy as it relates to speech disorders. My hope is that this trend will continue.
Bibliography: Bochart, C. (2013) The Key to Carryover – Change Oral Postures to Fortify Speech Production, Speech Dynamics, Inc. Fletcher, S.G., Casteel, R.L., & Bradley, D.P. (1961). Tongue thrust swallow, speech articulation, and age. Journal of Speech and Hearing Disorders. 26. 202-208. Ray, J. (2003). Effects of orofacial myofunctional therapy on speech intelligibility in individuals with persistent articulatory impairments. International Journal of Orofacial Myology. 29, 5-14. Rogers, A.P. (1918). Exercises for the development of the muscles in the face, with a view to increasing their functional activity. Dental Cosmos. 60, 857-876. Stevens Mills, C. (2011). International Association of Orofacial Myology History: Origin-Background-Contributors. International Journal of Orofacial Myology. 37, 5-25.
About The Author: Cynthia Cogswell is a Speech/Language Pathologist and Orofacial Myofunctional Therapist, with a highly respected private practice in Northern California. Cynthia’s extensive background encompasses private schools, public schools, hospitals, rehabilitation units, participation on a cleft palate panel, consulting to local orthodontists, and providing staff development in-services in a school setting. She works with all ages, and has specialized training in a variety of areas, including articulation, oral-motor deficits, orofacial myofunctional disorders, receptive/expressive language skills, phonological awareness, voice disorders, social language needs, and central auditory processing disorders.