Kourtney Kardashian’s "Poosh Your WELLNESS" Festival features “Tongue THERAPY” WITH The Breathe Institute!
When Kourt’s team at Poosh.com reached out to us, we could tell that the public awareness and perception of Orofacial myofunctional therapy was trending up in a big, positive way. After working with Poosh to deliver a summary of the "tongue exercises" that we are working with Kourtney on, were asked if we could join in the fun at the Poosh Your Wellness Festival online!
The Poosh team wanted us to share some of the tips and exercises that TBI's orofacial myofunctional therapy team is providing to Kourtney and the fam, and to give some info on how myofunctional therapy can help to release tension in your neck and shoulders, improve sleep, strengthen your lip muscles, and so much more. The tips are straight from Kourt’s therapists (TBI's own Maryam Norouz, and Kathy Soto) and are the same ones she’s been assigned to do daily.
Somewhat unexpectedly to some perhaps, through their wonderful work at Poosh, Kourt and team are providing a great platform for spreading important health and wellness information to a diverse and broad audience who would otherwise maybe not know where to look for accessible, engaging, relevant health and lifestyle content. It is exciting to all of us at TBI be able to collaborate to those ends!
We look forward to producing more exciting wellness content alongside the lovely and wonderful team at Poosh, and are grateful for the opportunity to share how adhering to our TBI mantra: "Tongue up, Lips Closed, Healthy Breathing, Through the Nose", can help us all breathe better, sleep better, feel better, and yes even look better too. ;)
Check out the segment here!
About Poosh: Poosh is the modern guide to living your best life. Our mission is to educate, motivate, create, and curate a modern lifestyle, achievable by all. I decided to launch Poosh because I felt that there was something missing in the healthy lifestyle space. Healthy living gets a bad rap; it’s as though if you care about what you put in - or on - your body, then you’re not sexy or cool. But this just isn’t true, and Poosh is here to prove just that. People are constantly asking me how I do it all, from being a single mom to working full-time to still maintaining a social life. I get endless questions about food, kids, beauty, and fashion, so I decided to create Poosh, a curated experience and a destination for modern living. - Kourtney K.
Welcome To The TBI Family Dr. Zolnierczyk !
We had the fortune of meeting Dr. Erica (as she is known by her patients) when she was a stand-out participant in our 5 day online course on sleep, breathing and functional frenuloplasty. You can tell a lot about a person by the kind of questions they ask, and Dr. Erica asked a lot of smart questions.
Another trait that stood out was how she always rightly referred to her team as more than "just staff", it was so clear that she understood the incredible value of the people she works alongside, and was just as willing to learn and grow as she was to teach and lead. So when she reached out to us immediately following the course, and wanted to know what was next, we were happy to invite her to apply for our Surgical Proctoring Mini-Residency program.
Dr. Zolnerczyk wasted no time, she and her husband and colleague Paul came out to our office in Los Angeles to shadow Dr. Soroush Zaghi, and then we set a date for the TBI Travel Squad (In this case Dr. Zaghi, Leyli Norouz-Knutsen, Sarah K. Hornsby, and Chad Knutsen) to journey to Orland Park, IL to see Dr. Erica work in her natural habitat.
We were immediately welcomed by warm smiles, and wonderful windy city hospitality, and of course their resident french bulldog Mini (who became fast friends with Chad).
During the procedures, Dr. Zaghi was able to see her surgical confidence rise to the level of her competence, and by the time the two days and 10 procedures were done, we felt beyond confident that the Chicago area was in good hands with Dr. Erica Zolnierczyk as a TBI Affiliate.
Dr. Erica Zolnierczyk completed her undergraduate education at Loyola University Chicago receiving a Bachelor of Science in Biology Cum Laude. After completing her Bachelor’s degree, Dr. Zolnierczyk went on to Southern Illinois University School of Dental Medicine where she earned her Doctor of Dental Medicine (DMD) degree in 2011. She currently lives in Orland Park and serves the surrounding community. Dr Erica has been practicing General Dentistry with a focus on facial and airway development, prevention and cosmetics. She knows that listening to her patients will enable her to provide them with the best care possible.
In closing, we will leave you with a few photos from the two awesome days we were able to spend with Dr. Zolnierczyk, Paul, Joy, and the whole amazing team at the very aptly named, Inspire Dental Wellness!
The tongue is an important oral structure that affects speech, position of teeth, periodontal tissue, nutrition, swallowing, nursing/eating, speaking, and much more. Ankyloglossia (tongue tie) is a congenital anomaly that is generally characterized by an abnormally short, thick lingual frenulum which affects movement of tongue.
Until recently, the methods commonly used for screening and defining tethered oral tissues have been limited in their inclusion of "function" as a key variable in assessment.
Conventional definitions of ankyloglossia have been based on assessments of “free tongue length”. In the past decade, research advances have been made that examine mobility using the tongue range of motion ratio (TRMR) while the tongue tip is extended towards the incisive papilla (TIP). This measurement has indeed been helpful in assessing for variations in the mobility of the anterior 1/3 of the tongue (tongue tip to apex), however it can be insufficient to adequately assess the functional mobility of the posterior two-thirds of the body of the tongue.
This cross-sectional multicenter cohort study examined Six-hundred and eleven (611) subjects ages three (3) and up from the general population. Subjects were surveyed in a standardized fashion by interdisciplinary professionals trained in the evaluation of oro-facial myofunctional disorders at ten (10) different sites including researchers in the United States, Hong Kong, Estonia and Ireland as part of the Functional Airway Evaluation Screening Tool (FAirEST) study.
Measurements of tongue mobility using the validated Tongue Range of Motion Ratio (TRMR) were performed during two functional movements:
a) with the tip of the subject’s Tongue on Incisive Papilla (TIP) - see fig. 1, and
b) while the subjects tongue was held in Lingual Palatal Suction (LPS) - see fig. 2.
Objective TRMR measurements were compared with subjective self-assessments of resting tongue position, ease or difficulty elevating the tongue tip to the palate, and ease or difficulty elevating the tongue body to the palate.
The advantage of the LPS (fig. 2) measurement is that it best describes one of the main functional outcome goals of myofunctional therapy: achieving tongue body to palate contact requisite for establishing ideal resting oral posture and swallow mechanics. LPS measurements have been used to track progress with tongue strengthening and rehabilitation in myofunctional, speech and swallow therapy protocols.
Dr. Soroush Zaghi, the principal investigator of this study said: “We can now fully appreciate the potential strength of the LPS measurements in identifying limitations in posterior tongue mobility that may be associated with functional deficits or submucosal restrictions that are not readily identified by other grading scales.”.
After all the intensive exploration (which is now one of the largest case series on the subject in the literature), it was concluded that this study validates TRMR-LPS as a useful, functional metric for assessing posterior tongue mobility.
It is research endeavors and studies such as this one that continue to inform and advance medicine and science, and everyone from providers, to patients benefits.
To learn more about The Breathe Institute, visit www.thebreatheinstitute.com
While many have crawled into their shells during the ongoing global situations surrounding all of us, some have used the time to delve even deeper into learning and expanding their knowledge and skills. We are excited to announce that one such passionate and forward thinking healthcare provider has just joined the ranks of TBI Affiliates; Dr. Tim Herre.
Dr. Herre is a third generation dentist who graduated from the UMKC School of Dentistry. As a holistic, biological dentist he aims to connect the dots between the mouth and whole body health for his patients. His passion is identifying growth and development concerns for young children, and collaborating with other practitioners to allow his patients to flourish into healthy adults. He also helps his older patients to thrive by harnessing the healing power of proper breathing, sleep and real food.
His holistic practice in Leawood, Kansas focuses on TMJ, sleep/airway, tongue tie treatment, orthodontics and rejuvenation based dentistry.
Beyond his work as a clinician, Dr. Herre also volunteers his time to action oriented collaborations such as the AAPMD Airway CoLab, and has furthermore joined with his fellow TBI affiliates to collectively provide over $250,000 of care free of charge to underserved communities.
No health journey is a straight path and in connecting his own dots, Dr. Tim is constantly learning and growing with his amazing mentors in the dental field and by partnering with numerous national organizations, including The Breathe Institute.
We had such a fantastic time hosting Dr. Herre for his TBI Mini-Residency and could not be more thrilled to now have Dr. Herre and his outstanding team come into the fold as TBI Affiliates officially!
Learn More abour Dr. Tim Herre at dentalhealthbyherre.com/
By Trish Aquino
“All your tests are normal.”
If everything is so “normal,” why do I feel so bad? Is this all in my head? Am I making it up? Am I just lazy? Am I crazy?
As long as I can remember, I suffered from insomnia. And I mean really bad insomnia. Before my dad died when I was five and a half years old, I clearly remember lying awake at night, unable to sleep, listening to my parents chatting in the living room. I dreaded going to bed at night, even at that young age, because I knew I wouldn’t sleep. I knew that that horrible internal vibrating would take over and sleep would not come.
As a child I suffered from constant headaches, with neck and upper back stiffness and pain. I had stomach aches, chronic constipation, and chronic sinusitis and bronchitis. Swallowing was always difficult and was accompanied by TMD, the aforementioned insomnia, anxiety and panic attacks.
I complained constantly to my mom who told me I was just a hypochondriac and was making things worse than they really were. And when I ended up annually at the doctor’s office having a battery of tests run, all of which were always ‘normal,’ the doctor echoed my mother’s beliefs, making me feel more isolated and alien than ever.
I was twenty-two years old when I also began having one bladder infection after another which ultimately lead to the diagnosis of IC (interstitial cystitis) and I received my first diagnosis of IBS. The internist told me it was the worst case he’d seen in his twenty-five years of practice and referred me to a psychotherapist.
This began my conscious journey of trying to heal myself. I loved psychotherapy and I loved learning. I’ve always been interested in why we say and do the things we do and I believed that the more I knew, the more I could help myself and help others. Once I found myself repeating the same stories, I knew it was time to move on. Therapy had given me tools and a deeper understanding of human nature, but the insomnia and other symptoms continued.
I did Rolfing, myofascial release, and other forms of very painful body work. I tried Reiki and acupuncture, sound and color healing as well as transformational breathing and chiropractic adjustments. When none of this worked, I went on to theta brainwave healing, Native American healing, essential oils, NLP (Neuro-Linguistic Programming) and hypnotherapy, even studying and becoming a certified clinical hypnotherapist myself. I was determined I was going to find answers.
Sadly, while I had accrued invaluable information, tools, and resources, and had actually helped many other people, I was still suffering as the insomnia continued, evening worsening with many of the therapies I had undergone and I found myself withdrawing.
I was referred to a renowned neuropsychiatrist who told me within the first five minutes of our appointment that no one would ever guess the pain I lived with every day. He was so kind and understanding and he gave me such hope! He did a brain study and saw that my brain wouldn’t go into delta for more than two to four minutes at a time and he told me I was born with an abnormal brain. He thought I had ADD and began me on treatment but everything worsened and my weight dropped so significantly (I was not overweight to begin with) that he thought I had celiac disease. He became so alarmed he went back and reviewed my original brain study and told me he had missed something and had made me worse. He said I needed a calming antidepressant and started me on the lowest dose of Celexa then had me cut it in half with a pill cutter. Within twenty minutes I began shaking terribly and could feel my core was beginning to convulse so he had me take a Xanax. When that calmed me down, he switched me to Lexapro but I had the same reaction. This was over the course of two days and it took me two full weeks for my core to stabilize and for any kind of appetite to return. I stopped seeing him soon after.
I was really tired of being judged by family, by friends, by the doctors and practitioners whose help I sought. There were several doctors who really thought they knew what was going on and that I would be an easy fix. When they turned out to be mistaken, they often had no idea what to do with me nor how to complete the relationship and did so badly. This only fed my incredibly negative beliefs about myself and I began to feel hopeless.
I was in my forties, losing friends and losing faith, when I found craniosacral therapy.
The therapist seemed to understand my symptoms and explained that I had a high, narrow palate which could be treated by a dentist with a palate expander called an ALF. I was with an ALF dentist the next week.
He told me how people with high, narrow palates have restricted airways, and how the ALF would correct that and I would be breathing and sleeping well soon, but that was not my experience. After ten years with a lower device and a night guard then three years with the ALF, my teeth were so flared that I had excessive gum recession, exposed nerves and bone, and ended up losing a molar.
In the end the ALF had expanded my palate a mere 1.82mm but had flared my teeth 7.15mm and left me with periodontal damage and the need for restorative work.
On a brighter note, this experience led me to a myofunctional therapist, who immediately recognized my tongue-ties and referred me to Dr. Soroush Zaghi. During the frenuloplasty he made a cut that released my neck and skull.
As long as I can remember I have had very limited range of motion in my neck and head. This pain, tension, and significant tightness was actually something I felt internally from my skull all the way to my toes. I felt as if my internal body was constantly tense, girding itself against something that threatened my very existence. I now understand it actually was protecting me against the chronic waves of adrenaline that flooded my body every few minutes throughout the day, every day; leaving me shaking, my heart and pulse racing, and bewildered by what was happening in my body. Adrenaline is corrosive and it was battering my internal organs, slowly eroding my energy and my health.
Today we are hearing more and more about something called fascia. It is a flexible, fibrous sheath with multiple layers that holds our muscles on our bones and our internal organs together. Fascia was historically referred to by doctors and surgeons as connective tissue that holds everything together but that was all. This biological fabric is actually a sensory organ that literally communicates to our central nervous system about whatever it is covering. It permeates every muscle, nerve, bone, tendon, and vein, as well as holding emotions. And with emotional and/or physical trauma it loses its flexibility and hardens, like compression wear tightening, restricting movement and causing pain.
Along this interconnected highway is a fascial chain called the deep front line. One continuous link that begins at the floor of the mouth and tongue and travels down through the interior throat, the entire chest and diaphragm, lumbar, psoas, hips, thighs, calf muscles, all the way down to the feet and toes!
So, when Dr. Zaghi made that deep cut, I felt a release, along with a deep sense of relief as it traveled down through my chest and gut, the muscles letting go in a way I had never experienced, all the way into my legs and feet. I felt that inner holding and tension of a lifetime simply let go. My head was as weightless as a helium balloon and I had never felt that light or that free before and I began laughing and crying simultaneously.
While my tongue-tie release was a success, my sleep did not improve and I continued to have symptoms so Dr. Zaghi suggested we do a cone beam CT scan to rule out any maxillofacial structural issues. When analyzing CT of the head and neck, we expect the posterior airway space to be approximately 10-15mm wide to ensure low risk for symptoms of sleep disordered breathing. However, looking at my CT scan, Dr. Zaghi discovered that my posterior airway was only 1-2mm wide. In that moment, it all became clear. He told me there was no way I would ever have been able to sleep well and that I never would unless this was corrected surgically. No palate expansion device was going to work.
Dr. Zaghi suggested I do an at-home sleep study so that we could get a clear look at what was going on when I slept. We found that my RDI was 23.7 and much higher than my AHI of 15.6. RDI stands for Respiratory Disturbance Index which indicates how many times arousals and disturbances occur due to lack of oxygen. AHI stands for Apnea Hypopnea Index which indicates pauses in breathing (apnea) and periods of very shallow breathing (hypopnea.)
What I have is UARS (Upper Airway Resistance Syndrome.) UARS is a sleep disorder characterized by the narrowing of the airway that causes arousals and disturbances to sleep, triggering the nervous system and releasing adrenaline into the body. Patients with Upper Airway Resistance Syndrome often complain of difficulty falling asleep and staying asleep. They describe chronic fatigue, excessive daytime sleepiness, and/or mood disturbances, anxiety, or mental stress characterized as “fight-or-flight.” For all those years when I laid down to sleep, this is exactly what was happening to me. My airway was collapsing and my body was overwhelmed with adrenaline. During the day I was hanging on, barely able to function, growing more and more desperate, and searching for answers that never came; until I found Dr. Zaghi.
To open my airway, I am going to need maxillomandibular advancement surgery also known as MMA.
But I have an HMO and the MMA surgery is not an option with them. The older I got the harder it was for my body to bear the burden of a lifetime of sleep disordered breathing and the chronic flow of adrenaline and cortisol that ensued. This physical pain coupled with the pain of not knowing what was wrong with me, and the fear that I was never going to get better sent me into a downward spiral of despair. I had gone into adrenal fatigue with Hashimoto’s Disease and hypothyroidism about nine years before and had been unable to work since, so paying out of pocket for the MMA surgery was cost prohibitive. To say I was frustrated would be an understatement and as result, and out of sheer desperation, I turned to yet another palate expander called the DNA. My teeth are no longer flared but there is no possibility of advancement based on my specific appliance’s design.
I am at a crossroads. Because of the amount of advancement I require to breathe, no holistic appliance is going to work. My husband and I have spent hundreds of thousands of dollars seeking help that either did nothing, or made me worse. And so, I have made a decision. I am going to move forward with the MMA surgery. The details have not been worked out yet, but the decision has been made and I am excited!
I have learned so much and I want to give help, hope, and knowledge to others out there experiencing what I have, suffering as I have.
When I found my first ALF dentist, I didn’t know anything about airway restrictions or high, narrow palates and crossbites. I didn’t know how devastating mouth breathing was, or what that even implied. I didn’t know which questions to ask but simply trusted him implicitly. He never told me just how narrow my airway was or that the ALF could have some negative side effects in regards to my oral health. I did ask my DNA dentist questions, but in retrospect I didn’t ask enough, and again, trusted that he was doing what was in my best interest. Both of these (and many other) holistic palate expansion devices are wonderful products and work really well with the right candidates. I am not a good candidate for any holistic palate expander and I fully accept that now. No amount of positive thinking is going to change that. In fact, I am a little narrow but really only require 4mm of palate expansion whereas I require 1 full cm of advancement. If I never expand my palate those 4mm it will not affect my quality of life whereas not gaining that 1cm advancement will. The thought of my life remaining the same fills me with a deep sense of hopelessness and I know I must find a way. I have so much life inside me and so much to contribute and now have a level of support, care, and expertise that I have never known before!
If you are having problems sleeping, experiencing chronic daytime fatigue, have anxiety, if you snore or have chronic sinus congestion and mouth breathe, please, know there is help out there! Dr. Soroush Zaghi and The Breathe Institute are quite literally saving my life and Dr. Zaghi is training doctors and dentists all over the world in this customized and holistic model of care.
Please reach out. Dr. Zaghi and his team of caring and compassionate experts are here to help get you on track and living your life to the fullest! I can personally attest to that!
Wishing you happiness and radiant health!
As the Breathe Institute has grown, one of the most amazing benefits has been the incredible people we have the opportunity to collaborate with. We could not be more grateful for all the relationships we have been able to form with so many outstanding providers, and today we want to honor our latest TBI Mini-Resident and Affiliate!
Dr. Ratti Handa, was born into a family of dentists so she is no stranger to oral health. After graduating from Tufts University Dental School in 1998, she earned her Bachelor of Dental Science degree from the ABMS Institute of Dental Sciences and completed her residency at the Safderjung Hospital’s Department of Oral Surgery in India.
As a perpetual learner, Dr. Handa has continued her education with organizations such as the Pankey Institute, The Spear Institute, The Stewart Center, and of course now with us here at TBI.
Her skills as a cosmetic dentist reinforce her passionate work as an airway specialist, which enables her to see patients in a holistic way, with a variety of schools of thought to draw from. To deepen her knowledge further, Ratti recently also graduated as an integrative health coach from the International Integrative Nutrition (IIN) Academy and continues to be an active member of the American Dental Association (ADA), the Massachusetts Dental Society (MDS), and The Indian Dental Association.
We know that our journey with Dr. Handa has only just begun, and we cannot wait to see countless more lives be improved by the work she does, and that we all do together.
TLDR?: Dr. Zaghi lectures for the International Surgical Sleep Society (ISSS) in support of Myofunctional Therapy and Functional Frenuloplasty as a safe and effective treatment methodology for certain sleep and airway issues. Video below.
Dr. Zaghi was recently invited to present and contribute to a debate about the pros and cons of myofunctional therapy and frenuloplasty as part of a series of online lectures developed for the International Surgical Sleep Society (ISSS).
For those who are not aware of the ongoing controversy, a previous blog post by Dr. Eric Kezarian claims that: “There is no proven benefit to oral myofunctional therapy or frenuloplasty for the treatment of obstructive sleep apnea in adults as it is commonly practiced in the United States. If you are an adult and want to use exercises to treat your sleep apnea, go to Brazil for people that are using tested approaches."
These attempts at debunking the results we see everyday (in well over 2000 patients in just our office alone) amounts to what we feel is little more than an expression of a biased point of view (RE: the role of oral myofunctional therapy and frenuloplasty).
What is very disheartening about the standards of care in modern medicine, is the all too common resistance to consider other perspectives. Dr. Kezirian "encourage[s] practitioners to perform research" yet subsequently tries to belittle the 3-year long research project we accomplished alongside an expert team of clinicians and researchers. The author continues by stating that “there have been no objective studies examining effects on OSA since that time.” We would like to ensure our readers that we are in the process of finalizing the data collection from our objective follow-up study, however the limitations of human research during COVID-19 caused us to experience a huge set back. We as an Institute wholeheartedly believe that studying this topic systematically will benefit everyone.
Our 2019 manuscript entitled “Lingual frenuloplasty with myofunctional therapy: Exploring safety and efficacy in 348 cases.” was the largest most systematic reviewed research to date on this topic. Despite being recognized by the journal of Laryngoscope Investigative Otolaryngology (a peer-reviewed journal), in Dr. Kezirian’s “con” debate, he claims that our research was “nice” but should have been published as a case series, not a level-3 study. His statement implies that the numerous journal reviewers have overlooked or otherwise made an error in their decision making process. We however, as well as the reviewers, believe that the level of evidence for our study is indeed Level 3 because it was a consecutive cohort study of a very large number of patients. Level 4 studies usually correspond to nonconsecutive, hand-selected reports of a few case studies. Our Retrospective cohort study involved 348 of 420 consecutive patients who were treated with lingual frenuloplasty and myofunctional therapy.
We also would like Dr. Kezirian and anyone else who has been keeping up with this debate to know that beyond our frenuloplasty research, we have made great progress towards standardization by helping to bridge channels of communication amongst many different practitioners, offices and organizations worldwide.
These ongoing collaborations include, but are not limited to outstanding groups such as:
And many more...
Dr. Kezirian asked us to show him "something to change [his] mind" and openly challenged the entire field to deliver proof. We feel that as a community, we have been and and continually working on accomplishing this goal. A few examples include:
We would also like to highlight a particularly poignant comment by the late Dr. Christian Guilleminault on Dr. Kezarian’s blog post; “Ignorance of what is existing and published is not a good excuse”.
With that said, we would like to take this opportunity to honor all the research and work that was accomplished before. Despite Dr. Kezirian’s claim that Dr. Guilleminault’s research was mainly aimed at pediatric patients, the truth is that Dr. Guilleminault literally coined the term “sleep apnea” and first started curing the disorder by performing tracheostomies. The reason he took an interest in pediatric patients was purely to intervene early with his focus on disease prevention not disease management, since he had seen so many adult patients over his long career who could have prevented their current health challenges altogether if they were treated appropriately earlier in life. This is especially why our entire team at TBI is so committed to bringing myofunctional therapy to the forefront of healthcare.
We do agree with Dr. Kezirian regarding the informational void when it comes to frenuloplasties and OSA, and that objective scientific evidence is needed. We also agree that we need systematic approaches for defining exercise selection and, more importantly, studies of these protocols (hence the collaborations and programs listed above). It is our hopes that with the knowledge and evidence we are gaining daily in clinical practice and our active collaboration with the International orofacial myofunctional therapy community, we can continue to collect and organize this evidence behind this functional approach to sleep and breathing. In fact, our Lingual Frenuloplasty paper was one of the top three most downloaded articles of the year in Laryngoscope Investigative Otolaryngology.
We also want to take this opportunity to remind our readers that all debates can (and should) include an element of friendship and strong collegiality. Dr. Zaghi has an open line of communication with Dr.Kezirian and has always welcomed his input and suggested research ideas. It is important for us as a community to remember the importance of open-mindedness, and willingness to hear others perspectives, especially those with whom we disagree so as to either strengthen our own convictions, or adjust them to fit new understandings whatever the case may be.
We urge our readers to consider these wise words from Goethe:
“In the sciences, people quickly come to regard as their own personal property that which they have learned and had passed on to them at the universities and academies. If someone else comes along with new ideas that contradict the Credo and in fact even threaten to overturn it, then all passions are raised against this threat and no method is left untried to suppress it. People resist it in every way possible: pretending not to have heard about it; speaking disparagingly of it, as if it were not even worth the effort of looking into the matter. And so a new truth can have a long wait before finally being accepted.”
Society needs orthodontists, oral surgeons, otolaryngologists, MFT’s, and we must leave no stones unturned in our quest. We need to work with our colleagues in disciplines outside of our own and learn all of our options.
We thank the journal reviewers from “Laryngoscope” for supporting our research. They felt that “This is an interesting manuscript and provides good information in an area where there is limited high quality scientific information,” and we hope that if you feel the same way, you will take a quick moment to share your thoughts with us in the comment thread below. Your feedback and support is essential in moving this field forward.
Finally, we leave you with one of Dr. Zaghi’s favorite quotes:
“You're never too young to learn, and never too old to change”.
--Russell M. Nelson
A Commentary by: Heather A. Vukelich, MS, CCC-SLP
It’s important for speech-language pathologists to understand the research, origins, and history behind the practice of oral sensory-motor therapy, so they may;
1) further the research,
2) practice ethically,
3) further the development of assessment and treatment, and
4) use evidence-based literature to support their work.
As a speech-language pathologist for 17 years, I have practiced oral sensory-motor assessment and treatment for 12 of those years. This has been an extremely rewarding career. The question always arises, “Is oral sensory-motor therapy evidence-based?” Therefore, it seemed necessary to evaluate this area and review the findings in order to learn and share an answer to this question with parents, colleagues, etc.
I began with a comprehensive, topical bibliography tracing the journey of oral sensory-motor assessment and treatment literature over the years (Bahr, 2008). This 50-page, peer-reviewed article cites works categorized by specific areas of content. The areas included, but were not limited to: Feeding, Oral Motor Assessment, Oral Motor Treatment, Oral Motor Function, Oral Motor Disorders, etc.
A must-read for all of the speech-language pathologists and researchers interested in this topic is the extensive academic contributions of Diane Bahr, MS, CCC-SLP, CIMI. Here are a few of the most salient contributions that would be an amazing resource to all interested in the historical context of this debate.
Another article written by Pamela Marshalla (2007) was entitled Oral Motor Techniques Are Not New. This article compiled terms used historically to describe oral motor exercises in 84 speech textbooks from 1912 until 2007. Therefore, it seemed the topic of oral sensory-motor treatment had been studied for almost 100 years. Marshalla (2011) also described the evolution of oral sensory-motor therapy from 1928 until 2009 in a blog post.
Here are a few key points in the article by Bahr (2008) worth mentioning to further the study of oral sensory-motor therapy.
Another article written by Pamela Marshalla (2007) was entitled Oral Motor Techniques Are Not New. This article compiled terms used historically to describe oral motor exercises in 84 speech textbooks from 1912 until 2007. Therefore, it seemed the topic of oral sensory-motor treatment had been studied for almost 100 years. Marshalla (2011) also described the evolution of oral sensory-motor therapy from 1928 until 2009 in a blog post.
It’s valuable to mention many early oral sensory-motor references were presentations, papers presented, and seminar handbooks. Here are some of them:
Feeding literature was found in the 1950’s and 1960’s. These included suck, swallow, and breathe, as well as mastication studies. “It is interesting to note that many of the articles were published outside of the field of speech-language pathology. There were numerous articles published in the fields of medicine, dentistry, psychology, nutrition, and occupational therapy.” (Bahr, 2008). Morris and Klein (1987) wrote one of the first literature-based, comprehensive books on feeding called Pre-Feeding Skills: A Comprehensive Resource for Feeding Development.
Marshalla (1995) was one of the first to use the term “oral-motor” relative to speech in her book Oral-Motor Techniques in Articulation and Phonological Therapy. Bahr (2001) wrote the first masked, peer-reviewed textbook reporting on the unique processes of feeding and motor speech (i.e., same muscles used with differing pressures and motor plans). It was titled Oral Motor Assessment and Treatment: Ages and Stages.
While not called “oral sensory-motor assessment and treatment,” the findings of this brief literature review suggest this topic has been studied throughout the past 100+ years using terms such as feeding, swallowing, motor speech, etc. Currently, much literature is evolving in many countries and a number of fields (e.g., orofacial myology, dentistry, and speech-language pathology). Therefore, further action is needed to address oral sensory-motor assessment and treatment in university programs with increasing research opportunities for speech-language pathologists.
About The Author:
Heather Vukelich, MS, CCC-SLP is a LEVEL 4 ACCOMPLISHED TalkTools instructor and owner of Happy Kids Therapy in Danville, California. Heather’s business is located inside the Down Syndrome Connection of the Bay Area where she focuses on Oral Placement, feeding and speech therapy for people of all ages. Heather’s specialty is working with people with Down Syndrome which includes in-depth knowledge and resources regarding: diet, communication programs, sign language, education, orthodontics and facial development, physical and sensory needs as well as behavioral strategies. Heather attended graduate school at Gallaudet University in Washington, DC. Heather has spoken at the National Down Syndrome Congress, as well as for Down syndrome groups across California including DSCBA, SVDSN, TBODS, and Club 21.
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.
Originally Posted at: https://www.goinmeditations.com/post/how-to-get-sleep-during-these-uncertain-covid-times
Are you noticing its more difficult to fall asleep since this time of COVID 19 hit?
Do you have difficulty falling back asleep if you wake up during the night?
Stress, Anxiety & SleeP
As many of you know, stress and poor sleep go hand-in-hand. The research is clear on this bidirectional relationship and Dr Matthew Walker outlines it clearly in his important book Why We Sleep "The two most common triggers of chronic insomnia are psychological: 1) emotional concerns, or worry, and 2) emotional distress, or anxiety."
The two most common triggers of chronic insomnia are psychological:
1) emotional concerns, or worry, and
2) emotional distress, or anxiety.
So it makes sense why more of us are having difficulty getting quality sleep at night. These times are bringing a heightened sense of anxiety, stress and uncertainty, which are contributing to poor sleep.
In addition to the anxiety and stress that is present during these times, there is also a range of things that are coming from this time of COVID 19 that further disrupt sleep.
Getting to Sleep
So what can we do about it?
While sleep issues are multifaceted and often require a thorough assessment through a sleep clinic (I can't recommend The Breathe Institute highly enough for this), here are some things that you can incorporate into your routine this evening that will help counterbalance the added stress from the COVID pandemic.
Create a routine and schedule for sleep and wake.
Also, give yourself a “wind-down” window before bedtime. Just like it takes time too cool down after 30 minutes of vigorous cardio exercise, give yourself a chance to wind down before bed. Lower the lights, turn down the music, don’t look at screens, and put your to-do list away.
...particularly in the afternoon. Caffeine has a half-life of 5-7 hours for most people, meaning that it takes that long for half of the caffeine to work its way through the system. Implement a caffeine curfew for yourself, so you have had your last cup of java by 11am or 12pm, giving yourself a chance to metabolize as much of the caffeine before bedtime as possible. For more on caffeine, watch a video I posted recently on IGTV.
Use guided meditation for sleep...
...to help combat “bedtime thoughts” and allow your body to reach a relaxed state. In times of increased stress and uncertainty, two things that can disrupt sleep happen. One, when you close your eyes at bedtime, suddenly “bedtime thoughts” and worries have a longer list of things to think about.
Second, the body is in a stressed state - the "fight or flight” sympathetic nervous system state, where the primary goal is to keep us safe and alive by being attentive (alert) to our surroundings. To fall asleep, the body ideally is in a relaxed state, and be able to relax its “guard”. Guided meditation for sleep helps by giving your attention something to focus on, other than the worry list, such as the breath or sensation.
Guided meditation for sleep helps by giving your attention something to focus on, other than the worry list, such as the breath or sensation.
Moreover, meditation can help shift the body from the stress state to a calm state, thereby creating the conditions in which your body can ease into sleep.
There are many options for guided meditations for sleep...
Go In - Calm Down & Sleep
Aura & Insight Timer
Spotify and YouTube.
May you sleep well.
Cassandra Carlopio is the founder of Go In Meditations, a mindfulness and sleep expert, collaborative provider at The Breathe Institute, and thousands of people fall asleep to her meditations each night.
She also offers individual and corporate sessions, using mindfulness and meditation to improve performance.
Go In meditations- guided meditation app with a range of meditations for sleep and calm, as well as breathing exercises and more exploratory meditations
Spotify for guided meditations for sleep
Youtube for a range of guided meditations for sleep and calm and presence.
Insight Timer & Aura - meditation and mindfulness apps