“Myofunctional Therapy Dictionary”
Welcome to the Myofunctional Therapy Program!!! This program is designed to remediate a “reverse swallow pattern” or “tongue thrust.” A tongue thrust pattern is when the tongue protrudes forward during swallowing, speech, and when the tongue is at rest. This motion can adversely affect the teeth and mouth. A person swallows from 800 to 1,000 times every 24 hours. This motion exerts a pressure against the dentition. If a person suffers from a tongue thrust, this continuous adapted swallow pattern can force the teeth out of alignment, the palate to become misshapen, or cause a distortion to a variety of speech sounds.
During your time in this program, you will be given a course of exercises that must be completed in a hierarchy, or specific order. Practice is extremely important! We ask that you practice your scheduled exercises 3 times per day. It is very important that you space your (3) practice times over the course of an entire day. This works on something that we call “muscle memory.” Muscle memory is your brain’s ability to remember the correct positions and movements that we work on in this program. As you practice these exercises, you will see that some exercises will be decreased and taken off and others will be added. In addition, some exercises require the use of “bands.” These are small rubber bands that are placed on the tip of the tongue. We use these bands to make sure that the tongue is making the right movements. If the bands move, the tongue did something wrong. This program takes an average of 8-9 months to complete, as long as you practice and do what is recommended. There will be several re-evaluations over the course of the program. This will be done to check your progress and reassess your strength. If there are any articulation concerns, these sounds will be focused on in the third stage of the myo program, after your tongue strength and coordination have been improved and the correct swallow pattern has been taught. It is very important that we focus on the strength and coordination before tackling any articulation issues. If you do not have the strength or coordination needed, you will not be able to produce the sounds successfully.
The following is a list of exercises and vocabulary that you will need to know for this program. This list may not include all the exercises, as your therapist may add others specifically designed for you. Please keep this “dictionary” in your speech folder, along with the homework sheets that you will receive during your sessions. Your Therapist will demonstrate these exercises as they are introduced.
The “spot” – the bump is just behind your upper front teeth; it is also known as the alveolar ridge. When bringing your tongue to your spot, with the band on the tongue tip, make sure you go just behind that bump. See diagram. The “spot” is pictured by the small oval just behind the front teeth.
Out/in – tongue straight out and pointy, keeping it off your lower lip, and then pull it back in as far as you can without curling it. When using the band, make sure that you don’t hit your teeth or lips and the band does not move.
Up/Down – pointy tongue up the spot and then back down behind your bottom teeth. Make sure that your tongue does not curl or bend when going up to the spot. Bands are not used in this exercise.
Out/up – tongue straight out and pointy, keeping it off your lower lips, and then up to the spot. When using the band, make sure that you do not hit your teeth and the band does not move.
Spot Pops – made by producing the “tsk” or “t’ sound on the spot. Make sure that you go slowly so that your tongue is making the sound by hitting the spot and not your teeth. Bands are not used in this exercise.
Side to Side – move your tongue from one corner of your mouth to the other, without moving your jaw. Your jaw should not shift from side to side with your tongue while moving your tongue. Bands are not used in this exercise.
Pull – made by pulling your tongue up so that it is stuck against the roof of your mouth, or palate.
Hold pull pop – tongue up to the spot first, pull, and then pop to make a “click” sound. Bands are not used in this exercise.
Hold pull pull – tongue up to the spot first, pull, and then pull even harder, with your mouth open wider “funny face”. Bands are not used in this exercise.
Jaw pull – tongue up to the spot first, pull, and then bite and open 3 times without letting that pull fall. Three bites equal one exercise. Bands are not used in this exercise.
Slurp swallow – tongue up to the spot, squirt water under your tongue with a spray bottle, bite down, slurp, and then swallow with lips open. When using the band, hold the band against your spot so that you do not swallow it. Check to see if the band stayed in its place after the exercises is completed. Watch yourself in the mirror to make sure that your tongue does not peek out of any spaces between your teeth.
2-band jaw pull – same as the jaw pull but it is done with 2 bands on the tongue. See diagram of band placement below.
1234 swallow – up, bite, think swallow. Tongue up to the spot, bite, think of something yummy (to make you salivate), and swallow with your lips open and without letting your tongue fall off the spot. When using the band, make sure that you hold the band against your spot so that you don’t swallow it. Check to see if the band stayed in its place after the exercises is completed. Watch yourself in the mirror to make sure that your tongue doesn’t peak out of any spaces between your teeth.
The perfect swallow – UP PULL BITE SWALLOW You must remember these rules!!! You will be quizzed on these rules periodically throughout your sessions. These are the motions that your tongue must use to swallow all the time. Your tongue tip “anchors” to the spot as the rest of your tongue creates a wave to swallow.
2-band swallow – 2 bands are placed on your tongue (see diagram below). Follow the rules to the perfect swallow:
UP PULL BITE SWALLOW.
2-band-no-band swallow – pretend to put 2 band on your tongue and then follow the rules to a perfect swallow: UP PULL BITE SWALLOW
3 band swallow – place 3 bands on your tongue (see diagram below). Follow the rules to the perfect swallow: UP PULL BITE SWALLOW
4 band swallow – place 4 bands on your tongue (see diagram below). Follow the rules to the perfect swallow: UP PULL BITE SWALLOW
Bolus, or “ball” – the collective ball of food that is made by your mouth as you chew.
Cracker exercises – these exercises are designed to begin to teach your tongue how to swallow food using the Perfect Swallow. The food is chewed and made into a “bolus” on the mid-back of your tongue. You then swallow the food using the Perfect Swallow. A band will be used when doing these exercises. The purpose is to swallow the food while still holding the band with the tip of your tongue. When doing these cracker exercises at home, please chose a dry food such as saltine crackers, pretzels, or goldfish crackers. Sugary (ie. cookies) and buttery foods (ie. Ritz crackers) will dissolve faster with your saliva and will be difficult to form into a ball.
Meal exercises – these exercises are designed to teach your tongue how to swallow ALL foods using the Perfect Swallow. During your sessions, you will be asked to bring in a meal to practice with. Any food is perfectly acceptable. There are no foods that we will not work on. Again, the food is chewed and made into a “bolus” on the mid-back of your tongue. You then swallow the food using the Perfect Swallow. A band will also be used during these exercises.
Drinks – this exercise is designed to teach your tongue how to swallow liquids using the Perfect Swallow. Your tongue tip must always be on your spot when you swallow.
Night swallows (phase 1) – this exercise focuses on “carryover.” At this point, you should be swallowing using the Perfect Swallow at all times. Directly before going to bed every night, you must say “I promise to swallow right all night long” and then do a Perfect Swallow (UP PULL BITE SWALLOW). This must be repeated 10 times in row. Someone must then watch you for 2-3 minutes after you have fallen asleep and rate your swallows according to the following:
Great – lips are closed and the patient swallows without any changes to the patient’s mouth
Good – lips are closed to swallow but facial grimaces/movements are seen
Fair – lips are open but close to swallow, facial grimaces/movements are seen
Poor – lips are open, there is drooling, tongue is forward in mouth, facial grimaces/movements are seen
Night swallows (phase 2) – during this phase, you make a promise to someone else to swallow correctly. Directly before going to bed every night, you must say “I, _(name)_, promise you, (name)_, that I will swallow right all night long” and then do a Perfect Swallow (UP PULL BITE SWALLOW). This must be repeated 10 times in a row. Someone must again watch you for 2-3 minutes after you have fallen asleep and rate your swallow according to the same guidelines above.
Time charts – time charts are given for carryover. During this exercise, you must “check” where your tongue is throughout the day. You will be picking several times, or moments, during the day when you must ask yourself “where is my tongue?” If it is up on the spot, give yourself a “O” for “on the spot.” If it is not on your spot and laying on the bottom of your mouth or pushing against your teeth, give yourself a “N” for “not on the spot.” If you forget to check your tongue at a specific time, give yourself a “F” for “forgot.” You may also be asked to chart your lips, as your lips should be closed at rest.
Reminders and Associations – these are designed to remind you to keep your tongue on the spot all the time. Reminders and associations are set up between you and your therapist to put your tongue on the spot at certain times. Examples of reminders and associations would be when you see a stop sign, someone calls your name, or when you hear a dog barking you will be reminded to close your lips or put your tongue on the spot.
Lip Exercises – lip exercises are designed to counteract the effects of the tongue thrust on the teeth. As your tongue thrusts forward, it pushes a force against your teeth. When your lips are strong they will help (but not correct!) your teeth from coming forward.
Tugs of War / Button Pull – this exercise is done by placing a button against your teeth, between your lips and your teeth. The string is then pulled using quick, tight movements in 3 different directions: middle (string is pulled straight out), up (string is pulled at a 45 degree angle upward), and down (string is pulled at a 45 degree angle downward.)
Grandpops – this lip exercise is made by pressing your lips together and making a loud popping sound. It looks like you are a “grandpa with no teeth.”
Lip massages / Sad face pops – this exercise is made by covering your top lip with your bottom lip and making a loud popping sound. It looks like you are massaging your top lip with your bottom lip or making a sad face.
Tape lips – this exercise may be added during the time charts or night swallows. If you are having difficulty keeping your lips closed at all times, you will be asked to tape your lips so that you will be trained to keep your lips closed. One piece of tape goes across your mouth and another goes up and down, forming a cross.
Masseters – the masseter muscle is used in chewing. You can feel this muscle when you hold your fingers on your cheeks right in front of your ear lobe and bite down. You will feel this muscle bulge. During the masseter exercise, you must feel for this spot and bite down, holding the bite for 10 seconds. You then relax and massage the muscles with your fingers. This is followed by a perfect swallow (UP PULL BITE SWALLOW). Repeat six times with no bands.
Word lists – these word lists are designed to teach you the correct placement of /t,d,n,l/ (on the spot!) and to teach your tongue the little quick movements that are needed during speech. Always remember to make all /t,d,n,l/ sounds on the spot.
Speech Sounds – speech sounds are targeted in specific positions (isolation, initial, medial, final) and contexts (word, phrase, sentence, reading, and conversation)
Isolation: sound is produced by itself, in isolation
Initial: sound is produced at the beginning of a word
Medial: sound is produced in the middle of a word.
Final: sound is produced at the end of a word
Word: sound is targeted only in a single word
Phrase: sound is targeted in a specific word used in a short 3-4 word phrase
Sentence: sound is targeted in a specific word used in a complete sentence
Reading: sound is targeted in all positions while reading
Conversation: sound is targeted in positions during conversation
Desensitization Diet – these exercises are designed to increase sensory awareness of the mouth and decrease excessive saliva and drooling. If added to your program, your therapist will provide you with a list of activities.
Band placement
