By Lauren Johnston

Through myofunctional therapy, speech therapists are seeing improvements in patients with a number of issues, including sleep apnea, reductions in orthodontic relapse, an increase in airway health, and improved speech and feeding skills. Emerging research is showing the correlation between speech sound disorders and myofunctional disorders.

“There’s one study that focused on kids who had enlarged tonsils,” said Lauren Hughes, CCC-SLP, the owner of Expressions Pediatric Therapy in Birmingham. “One group had palate expansion before they were to have their tonsils removed, and the other group had their tonsils removed before they had palate expansion. There were significantly more kids in the first group that didn’t need their tonsils taken out because their airway had widened enough so they could nasal breathe. It helped the tonsils reduce, and they weren’t inflamed anymore.”

While speech sound disorders involve pronunciation of different sounds, myofunctional disorders involve the functions of the tongue, face and mouth.

“Myofunctional therapy has been around in some iteration for over 100 years,” Hughes said. “It started in the orthodontic community, and they realized that the function of the muscles of the face affected the structure of the teeth and the palate. Then speech therapists brought it in around the 1960s to provide therapy.”

Utilizing this form of therapy, speech therapists can help patients retrain the muscles of their tongue, face and mouth to work properly. This is done by addressing issues like tongue posture, breathing and swallowing. The exercises are individualized to each patient and range from foundational skills to more refined skills.

“One of the key components of myofunctional therapy is teaching the mouth to rest correctly,” Hughes said. “Your tongue should be lightly suctioned to the roof of your mouth. Your lips should be lightly closed, but not pressing hard. Your teeth should be a few millimeters apart.”

Hughes, who specializes in orofacial myology, motor-based speech and feeding disorders, partners with ENTs, orthodontists and physical therapists to treat patients holistically. Myofunctional therapy often starts with training the mouth to rest correctly and pinpointing any structural airway issues, which may require a referral to an ENT.

The next step involves identifying any other issues or weaknesses with the jaw, lips, face or tongue. Hughes will work on strengthening the muscles in the mouth. She might also work with dissociation issues, which refer to a lack of coordinated movement between the tongue, lips, and jaw, meaning the muscles involved in these functions are not working independently as they should.

“Once we get that going, we can see some improvement even in attention and focus,” she said. “There is true neurological ADHD, but sleep disordered breathing can also look like ADHD. There has been research to show that if it is caused by sleep disordered breathing, we can improve some of those symptoms.”

For adults, Hughes has seen success in patients with TMJ facial pain, improved quality of sleep, and better tolerance of sleep appliances, like a CPAP machine.

When the palate isn’t wide enough, myofunctional therapy can improve dental crowding and shift teeth in younger children. Patients with speech and feeding issues also benefit from myofunctional therapy. By implementing this therapy first, children struggling with speech issues improve faster. They will often need less speech sound therapy or sometimes none at all after undergoing myofunctional therapy and oral motor strategies. Children struggling with feeding issues, like chewing hard food, often see improvement within one to two months.