Orofacial Myofunctional Disorders (OMD)
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"***Orofacial Myofunctional Disorders***
With an orofacial myofunctional disorder (OMD), the tongue moves forward in an exaggerated way during speech and/or swallowing. The tongue may also lie too far forward during rest, or may protrude inappropriately between the upper and lower teeth during speech, swallowing, and at rest.
Although a "tongue thrust" swallow is normal in infancy, it usually decreases and disappears as a child grows. Continued forward tongue posture may cause a child to look, speak, and swallow differently than other children of the same age. Older children may become self-conscious about their appearance.
The team of professionals traditionally involved with the treatment of OMD includes a dentist, an orthodontist, a physician and a speech-language pathologist. Dentists are concerned when the pressure of the tongue against a child's gums interferes with the normal process of tooth eruption. Both dentists and orthodontists may be involved when constant, continued tongue pressure against teeth interferes with normal tooth eruption and alignment of the teeth and jaws. Physicians rule out the presence of a blocked airway (e.g., from enlarged tonsils or adenoids or from allergies) that may cause forward tongue posture. Speech-language pathologists assess and treat the effects of OMD on speech, rest postures, and swallowing.
The speech-language pathologist is an integral member of the
orofacial myofunctional team.
Causes of OMD
One study showed that family heredity can be involved in determining such factors as the size of a child's mouth, the arrangement and number of teeth, and the strength of lip, tongue, mouth, and facial muscles.
Some problems with functioning of mouth or face muscles are caused by environmental factors such as allergies. For children with allergies, it is often difficult to breathe normally through the nose because of nasal airway blockage. These children often breathe with their mouths open, tongues lying flat on the bottom of their mouths. Lip muscles may lose their strength and tone if an open mouth posture continues for a long time.
Enlarged tonsils and adenoids may also block airways, creating an open-mouth breathing pattern. An open-mouth breathing pattern, or the appearance of an open-mouth breathing pattern, can become habitual and continue even after successful medical treatment of the airway blockage.
OMD may also result from behaviors such as excessive thumb or finger sucking, lip and fingernail biting, excessive lip licking, and teeth clenching and grinding. Persistent thumb sucking, in particular, may change the shape of a child's upper and lower jaw and teeth, requiring speech, dental, and orthodontic intervention. The effect of the problem depends on how often the oral habit is practiced and how long the habit is maintained.
Effects on Speech
Some children develop sound errors, called speech misarticulations, as a result of OMD. OMD most often causes sounds like s, z, sh, zh, ch and j to sound differently than they usually do. For example, an "s" may sound and look like a "th"; the word "some" may sound like "thumb." Additionally, production of the sounds t, d, n, and l may be misarticulated because of weak tongue tip muscles. Sometimes speech may not be affected at all.
Role of Speech-Language Pathologist
The speech-language pathologist, with special education and training in the treatment of OMD, is an integral member of the orofacial myofunctinal team. Speech-language pathologists evaluate and treat open-mouth posture, swallowing disorders and speech misarticulations that result from OMD. These professionals specialize in evaluating lip, palate, tongue, and facial muscles both at rest and during the complex movements needed to produce clear speech and adequate swallowing. They assess and analyze speech sound errors and develop a speech treatment plan to help a child change his/her oral posture and articulation, when indicated.
Speech treatment techniques to help both speech and swallowing problems caused by OMD may include increasing awareness of mouth and facial muscles; increasing awareness of mouth and tongue postures; completing an individualized oral muscle exercise program to improve muscle strength or coordination; and establishing normal speech articulation and swallowing patterns.
If airways are blocked due to enlarged tonsils and adenoids or allergies, speech treatment may be postponed until medical treatment for these conditions is completed. In persons with excessive and persistent unwanted oral habits (e.g., thumb/finger sucking, lip biting), speech treatment may first focus on eliminating these behaviors before the speech and swallowing patterns are addressed.
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©1997-2005 American Speech-Language-Hearing Association
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