Myofunctional Therapy
Myo means muscle. Function means operating in a particular way. Myofunctional refers to muscles working in coordination. Myofunctional therapy involves re-training improperly functioning tongue and facial muscles.
Mouth breathing, thumb sucking, and other habits weaken the tongue and facial muscles. The weakened muscles lead to a cascade of detrimental health effects impacting breastfeeding, jaw development, swallowing, speech, dental bite, temporomandibular joint movement, digestive issues, behavior, oral hygiene, orthodontic treatment stability.
Myofunctional therapy corrects improperly functioning tongue and facial muscles. It involves strengthening the tongue and facial muscles by teaching you to reposition them to the appropriate position. You will learn to keep the tongue on the roof of the mouth. You will also learn to swallow correctly with the tongue pressing firmly against the hard palate.
Myofunctional therapy is painless, and the exercises are simple. When specific muscles of the face function properly, other muscles will follow suit, resulting in the tongue and facial muscles' coordination. Regular exercise every day for several months can correct an improper muscle pattern. With myofunctional therapy, you can regain the joy of eating, speaking, breathing, and sleeping more soundly. Cosmetic improvements can help restore your confidence and self-esteem. Myofunctional therapy reduces snoring and obstructive sleep apnea by maintaining airway tone and minimizing airway obstruction.
What is the link between feeding and speech?
Speech problems may develop from weak tongue and face muscles. You may have a lisp or difficulty articulating sounds. You cannot form normal speech sounds from the incorrectly postured lip and tongue muscles.
What are the advantages of breast feeding?
Breast feeding strengthens the tongue and facial muscles, promoting the forward and outward growth of the face.
Why do some infants have difficulty sucking?
A tongue tie or weak lips unable to seal around the nipple can impair breastfeeding.
How can thumb sucking and pacifiers cause harm?
A thumb, straw, sippy cup, pacifier, or anything else that prevents the tongue from resting on the roof of the mouth can cause facial growth, teeth, swallowing, and speech changes.
Why do some kids prefer soft foods?
Some children prefer soft foods because their muscles are weak and chewing is arduous. Slowly introducing harder foods may stimulate the tongue and facial muscles' strength and enhance the face's harmonious development.
Why is chewing on one side harmful?
Chewing only on one side develops muscles on one side of the face, causing facial imbalance. The bite also changes, and unequal stress is placed on the temperomandibular joint connecting the jaw to the skull.
How does myofunctional therapy help with braces?
Promoting proper oral posture of the tongue stabilizes teeth position and diminishes the risk of orthodontic relapse after removing braces.
What causes a bad bite?
Mouth breathing, swallowing incorrectly, and harmful habits such as thumb sucking alter jaw development and proper dental occlusion.
What causes TMJ dysfunction?
Unilaterally chewing, mouth breathing, nail-biting, grinding or clenching your teeth, resting your hand on your chin, muscle strain from stress, and trauma can cause TMJ. Earaches, headaches, tinnitus, ear fullness, and jaw issues such as pain, clicking, and immobility can occur. Improving oral posture and facial and tongue strength can ameliorate TMJ dysfunction.
How do weak muscles affect beauty?
Weak muscles additionally impact beauty, giving the face a dull, sluggish appearance from parted lips. Grimacing by pursing and tightening the cheeks, chin, and lips muscles to swallow can give the chin a knobby appearance from overused muscles. Straining facial muscles can cause wrinkles.
Can myofunctional therapy improve snoring and sleep apnea?
Many people who snore or have sleep apnea may not realize it is, in part, due to poor oral posture. Muscle composes your breathing tube, not bone. Weakened muscles from poor oral posture can lead to a narrowing or collapse of your breathing passageway. Improving the tone of your airway can substantially improve your snoring and sleep apnea.
How can you tell if someone is a mouth breather?
Nasal congestion, parched lips, long face, forward head posture, sagging cheeks, and dark circles around the eyes are telltale signs of mouth breathing.
IOPI Pro
Sleep and Brain utilizes the Iowa Oral Performance Instrument (IOPI) to measure lip and tongue strength and endurance. This instrument allows us to objectively document deficits that justify treatment, differentiating between muscle weakness and problems of motor control, providing biofeedback during exercise programs, and motivating you by showing you progress from muscle exercise therapy.
The IOPI measures strength by measuring the maximum pressure you can produce in a standard-sized air-filled bulb by pressing the bulb with your lips and tongue.
Lip strength is essential for bilabial sounds in speech, food bolus containment, and mastication. Lip compression strength depends on the strength of the muscles surrounding the mouth. The bulb, placed under the lips at the corner of the mouth, measures the maximum pressure created when you press your lips together and "purse" as hard as you can. Tongue compression strength depends on the maximum pressure created when you press your tongue against the bulb and the roof of the mouth.
The tongue is critical for swallowing. It presses food against the palate and out to the sides. Next, it forms the food bolus, elevates, and sweeps it posteriorly, triggering the swallowing reflex. Tongue endurance is the ability to exert a submaximal force for an extended period. Why might tongue strength and endurance be necessary? Many people have difficulty a half bagel with peanut butter, carrot sticks, and milk. Swallowing difficulties are a common and under-recognized complication of obstructive sleep apnea.
It is essential to distinguish anterior (i.e., the front) from posterior (i.e., the back) tongue strength and endurance. The anterior tongue is composed primarily of smaller type 2 "fast-twitch" muscle fibers that position and shape the tongue for speech, chewing, and swallowing. The posterior tongue is composed primarily of larger type 1 "slow-twitch" muscle fibers that provide the driving force for swallowing.
We can also assess tongue fatigability by measuring its endurance. Low endurance values are an indicator of a high fatigability. We measure endurance with the IOPI by quantifying the length of time to maintain 50% of the maximum pressure. For instance, the average anterior tongue endurance is 15 to 30 seconds. Low endurance is less than 10 seconds. How you feel on a particular day and your willingness to be uncomfortable influences endurance values.
The IOPI has a vertical row of lights. The higher the pressure you produce, the higher the position of the light that turns on. Producing a pressure that can turn on the top light can be thought of as hitting the target. It is visually reinforcing to hit the target.
We obtain objective measurements during your initial examination. From these measurements, we determine if muscle strength and endurance are normal or abnormal. If the strength and endurance are normal, we can eliminate weakness as a cause of the swallowing, speech, or breathing problem. If the strength and endurance are weak, we can begin strengthening exercises. If the strength and endurance are not increasing over time, we can asses if you are performing the exercises enough or forcefully enough. If the strength and endurance does increase, even a little bit, it can be rewarding for you to see objective evidence of improvement.
Normal Distribution Curves
Anterior Tongue strength
Lip strength
Our strength training protocols apply exercise science principles:
60% effort week 1, 80% effort weeks 2-8
3 sets of 10 reps
3-5 days/week
6-8 weeks
We customize our exercise protocols by determining the target value, the number of times to illuminate the green light, and, for each repetition, how long to illuminate the top light before releasing pressure on the bulb. The customization is also based on whether the exercises are rehabilitative or preventative and your individual goals.
A strength training protocol example is listed below:
Bulb position - Anterior tongue
Pmax - 18 kPa
Effort Level - 60%
Target Value = (Pmax)(0.6) = 11 kPa
Frequency = 3 sets of 10 repetitions
We re-evaluate weekly, if possible, to ascertain your progress and adjust the protocol as needed.
We can utilize myofunctional therapy to monitor, prophylactically treat, and rehabilitate the oral musculature in various conditions:
Monitoring
Monitor disease progression
ALS
Parkinson's Disease
Monitor therapy effects on oral motor strength and endurance
Didgeridoo for Obstructive Sleep Apnea
Speech therapy
Prophylactic Treatment
Promoting proper facial development in children
Preventing sarcopenic dysphagia in the elderly
Strengthening before an intervention that causes oral muscle atrophy
Head and neck surgery
Radiation Therapy
Rehabilitation
Strengthening after an event
Stroke
Traumatic Brain Injury
Strengthening as a primary or adjunctive treatment
Sleep-disordered Breathing
Speech
Maintaining oral motor strength during a degenerative disease process
ALS
Parkinson’s Disease
Make it stand out
We have practiced myofunctional therapy for over twenty years. Our myofunctional therapy success, in part, is derived from addressing the ten principles of plasticity.
Use it or Lose it: Muscles either strengthen or atrophy
Use it to improve it: Training strengthens muscles
Intensity: We set targets as a percentage of maximum effort and progressively increase difficulty
Repetition: Exercise science dictates our protocol frequencies
Specificity: We identify weak muscles to increase strength or endurance (or both)
Interference: Maladaptive behaviors can interfere with learning good habits.
Time: We initiate treatment early before maladaptive behaviors set in
Age: Our training-induced changes affect all ages but more readily the young
Transference: Changing muscle function as a result of targeted training can help learn other similar skills
Salience: Biofeedback is motivational
Frequently Asked Questions
How effective is myofunctional therapy for obstructive sleep apnea?
“Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes improve in adults. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments.’
Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA. Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. SLEEP2015;38(5):669–675.
What is the protocol for achieving optimal tongue strength?
The goal tongue strength is 60 kPa.
Sleep and Brain will set the starting kPa when the IOPI Trainer is dispensed.
The tongue pressure target should be increased by 1 kPa approximately every one to three days until 60 kPa tongue strength is achieved.
The target tongue pressure setting should not be increased quickly as you may “cheat” and utilize your lower jaw achieve the target tongue pressure.
The lower jaw must remain quietly stable with all effort exerted by the tongue during the exercises.
Hold the tongue bulb tube using one hand.
Place a finger on the other hand between the upper and lower teeth and ensure that no pressure is exerted on the finger when doing the exercises to assist in immobilizing the lower jaw.
What is the protocol for achieving optimal tongue endurance?
The goal tongue endurance is 30 kPa.
Tongue endurance can be optimized after tongue strength is optimized to 60 kPa.
The tongue pressure should be sufficient to achieve the green light and disallowing the light to drop three light levels.
The tongue pressure should be maintained at this level for at least 15 seconds and preferably 30 seconds.
How often do you use the IOPI trainer?
The ideal number of tongue press repetitions is three sets of 10 in the morning, three sets of 10 in the afternoon, and three sets of 10 in the evening per exercise physiology.
Given the regimen above may not be conducive to lifestyle, Sleep and Brain recommends completing at least 100 repetitions for day at your convenience.
The exercises should be performed at least 5 days per week for approximately three months.
The IOPI Trainer should be returned after 60 kPa tongue strength and 30 kPa tongue endurance is achieved.
Do you need to use the IOPI Trainer indefinitely?
In the process of tongue strength and endurance optimization, it is the expectation that you will learn proper oral posture.
Lips closed, teeth together, and tongue firmly on the roof of your mouth at rest.
Swallowing with lips closed, teeth together, and tongue pressing and pushing food from a front to back motion on the mouth roof
Where should you place the tongue bulb in your mouth?
Please see page 16 of your IOPI Trainer user manual for bulb placement visuals.
How do you enter the program mode to adjust the target value?
Turn the device off
Press and hold the target button
With the target button held down, turn on device until PROG is displayed on the bottom left corner of the screen
Let go of the buttons
To adjust the target value, press the up or down arrow until the screen shows the desired pressure value
Exit the program mode by pressing the power button to turn the unit off
The steps above are described on page 14 of the IOPI Trainer user manual.
The steps above are demonstrated in the following IOPI Medical video.
How do you clear the error “ERR” message?
Enter the program mode as described above
Hold down the reset button while a countdown from 3 is displayed on the screen, followed by “- - -” and “000.”
Exit the program mode by pressing the power button to turn the unit off
The steps above are described on page 14 of the IOPI Trainer user manual.
The steps above are demonstrated in the following IOPI Medical video.
If the “ERR” message is flashing, the Target and Power buttons must be held through the startup of the device for 10 seconds.
What are the use contraindications for Iowa Oral Performance Instrument?
Age under three
Risk of seizure
Pain disorders involving the jaw muscle or temporomandibular jointCan the tongue bulb be re-used?
One person can use and re-use the tongue bulb if cleaned between uses. It is best if you replace the tongue bulb monthly.
How do you clean the tongue bulb?
Clean the tongue bulb by rubbing all surfaces with a mild dishwashing soap and water.
Rinse thoroughly, shake off any extra water, and let air dry.
Do not place in dishwasher or in boiling water.
What if the tongue bulb is too slippery to perform the exercises?
If you can't stabilize the tongue bulb, you may not be able to stabilize a bolus of food. Focus on stabilization first.
Can the tongue bulb be re-used?
An individual can re-use the tongue bulb if they clean it between uses.
When does the tongue bulb need to be replaced
Replace the tongue bulb if it stays flattened or dimpled after compression.
It would be best to replace the tongue bulb monthly.
