Professional Perspectives on Myofunctional Therapy

This is  a round table discussion from a group of physical therapy colleagues.  Much like dentistry, there are many different schools of thought and approaches to orofacial physical therapy.  Here is the transcript from the interaction-

Thomas:  

I came across an interesting article on parafunction as seen from the perspective of Orofacial Myofunctional Therapy(attached). 
intrigued by the concept I found another article by Myofunctional Therapist Joy L. Moeller, BS, RDH

http://www.myofunctional-therapy.com/articles.html
To me, there are commonalities between their treatment focus and ours (PT) e.g. elimination of parafunction. Apparently this treatment approach has been around for over 30 years.
They link themselves with  International Association of Orofacial Myology
http://www.iaom.com/#
Interestingly, the author of the online article will be presenting at the AAOP conference in Denver.
Has anyone heard about Orofacial Myofunctional Therapy, or International Association of Orofacial Myology?….. or taken courses form them?
Any experiences working with Myofunctional Therapist? 

Mike:


I have looked at taking their course for some time, but honestly struggle with the cost they are asking. IF I compare their cost to say Crafta, Craft hands down is just an amazing program, albeit different than myofunctional therapy. So Mark has taken 2 of their courses and I am sure can give you his opinion, and of course Jennifer is certified thru them so you could use her as a resource. Many of the things myofunctional Therapy talks about, Rocabado has preached in his classes for years, again not sure who came first Rocky or Myofunctionaltherapy, but none the less Rocabado does not cover nearly as extensively how to treat many of these issues that kids face during growth and development. I think there is value in what they offer, it really comes down to, at least in my practice, what I have time to treat and want to treat etc. I also understand for this stuff to work, the kids and parents at home have to like do the exercises at least 2 times a day and can take like 30 min each time, etc so I question what kind of compliance you really get. It also frustrates me that Myofunctional therapy teaches this to speech therapists, OTs, etc but the program does not educate them about TMD, jaw mechanics, etc, so while they might help one issue, it scares me without a more comprehensive approach, are they causing further TMD issues, etc, but again mark can attest to this more than I.

 Mark:


I would concur with everything Mike said below.

The Myofunctional courses are very expensive; however, a very comprehensive education of the extrinsic and intrinsic muscles of the tongue and their action during taste, speech, mastication and deglutition.

Furthermore, detailed discussion of developmental morphology and the tongues’ contribution to airway are discussed.

The many exercises taught are all designed to increase oral volume, improve tongue posture and function, alleviate tongue restriction, control growth and development of the palate and dentition, and to improve airway.

I found the exercises, although numerous, to be fairly straightforward and remedial.

Unfortunately, the Myofunctional folks are touting themselves the “best choice” for referral by all and any Dental practitioner for issues outside their scope including CMDs and target audiences for their courses are primarily Orthodontists, Sleep Med docs, Dental Hygienists and Speech Pathologists.

The “treatments” are exercise based, time consumptive with 80% of impact occurring over a 2 month window and required monthly follow up and advancement over one year.  As the instructions are quite simple the algorithm, in my opinion, does not follow the medical model for insurance purposes and more appropriate to charge on a cash basis.

That said, I did gain very valuable information with regard to airway, oral mycology, and developmental morphology.  I have referred 15-20 patients for frenectomy over the past several months, multiple referrals to ENT and OMS for nasal airway and T&A consults, and Orthognathic mandibular advancement; issues that I wouldn’t have been so keen to identify before these courses.

Jennifer is a much bigger fan and a respected colleague. Here are her thoughts…

Jennifer:


I have appreciated everyone's comments around myofunctional therapy. I also struggled with the cost of this course and that of other Myofunctional courses by Sandra Coulson from Denver, CO and Kim Benkhert from Chicagoland. Everyone's course is about $2000 to enter you in the field of Myofunctional therapy. I explained to the AOMT who has asked me  to teach the posture section of their advanced course that PTs will have a hard time paying that much. 

That being said, I have grown so much in the understanding of how the tongue, if you train it to be on the roof of your mouth will stop bruxism. I do get quite a few referrals from Myofunctional therapists that say that the patients TMD is not allowing them to follow the exercises due to pain. Joy moeller's course is the only one I've taken along with her advanced course that goes into sleep studies and working in a multidisciplinary team. It is not a difficult course to take compared to CRAFTA which I'm taking this weekend but I really do look at the head and neck much differently and have been referring patients like mark mentioned for ENT consults, laser frenectomies and to orthodontist that are expanding children and adult  palates. 

I think it's worth it. In just one course, you have a bunch of new tools. 

Stefanie:


I really don't know much about OMT...but I am just back from Barcelona following the CRAFTA advanced course and we spent half a day just talking about chewing.  As well, by using a neurodynamic approach and mobilizing the mechanical interfaces of the cranial nerves...great differences can be made in tongue strength and function.  We also spend a lot of time mobilizing the cranial system, with amazing results affecting sinus' and breathing….


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Summary:  


As you can see, it seems there is some very valuable information included in the Myofunctional Therapy curriculum.  The biggest concerns appear to be cost and patient compliance.  Hopefully, this helped give intrigued individuals a clearer picture of the curriculum as a whole.  It seems to be very beneficial for helping to make appropriate referrals for your patients to ENT, sleep medicine, oral surgeons, and T & A clinicians.