THERAPEUTIC TREATMENT AREAS

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Entering into a Myofunctional Therapy Program is not to be taken lightly and no treatment plan is identical. Length of treatment is determined on a case by case basis. Orofacial myofunctional disorders can be caused by various structural, functional or habitual reasons. Habitual causes are easier and quicker to resolve (such as eliminating oral habits) than those that also have a structural component or that have developed into functional eating/swallowing/breathing disorders (such as oral restrictions/tongue tie, reverse swallow or sleep apnea). 

OROFACIAL MYOFUNCTIONAL THERAPY typically consists of THREE Phases of Treatment. Everyone progresses through the phases at different rates. There are numerous factors that determine each individual's length of treatment, thus determining the overall cost. Several factors are in your control such as compliance and consistency in the program. Other factors are out of our control such as the severity of your overall dysfunction and the responsiveness of your orofacial muscles, a person's cognition, structural issues to address during therapy and more. 

Phase 1- Pre-Treatment Phase (Awareness/Stabilizing Stage) – Developing New Muscle Patterns 

• Duration up to 4-6 weeks; Telehealth appointments every week
• Functional Frenectomy (lingual or labial release) is performed during this phase, if indicated by physician.

This phase focuses on: 

1. Developing new muscle patterns

2. Education of proper myofunctional oral habits and treatment goals 

3. The elimination of negative behavioral oral habits 

4. Stretching exercises 

5. Range of motion exercises 

6. Strengthening and toning the intrinsic and extrinsic muscles that lift and contract the tongue

7. The importance of compliance and consistency during the ongoing home/independent portion of program.

Phase 2 – Post-Treatment Phase (Intensive Stage) – Integrating and Implementing New Muscle Patterns – Achieving Neuroplasticity

• Duration approximately 8-12+ weeks; Telehealth appointments every week
• Follow up appointments with your release provider

This phase focuses on:

1. Implementing and Integrating new muscle patterns 

2. Lingual, labial and mandibular range of motion, strength and stability

3. Proper lingual and labial positioning at rest and during swallow/speech

4. Proper swallow patterns during the swallowing of saliva and liquids

5. Proper oral phase swallow (food chewing, proper bolus formation and swallowing) 

6. The reinforcement of habit elimination

7. Speech, Voice and Fluency Skills as warranted

Phase 3 – Generalization, Habituation and Retention of ALL Muscle Patterns 

• Duration approx. 2-6 months; individually scheduled appointments every 2-6 weeks, as needed.
• The therapist monitors the patient’s independent habits and exercises; making adjustments and/or recommendations to home program as necessary.
• Exercises are tailored to integration an awareness oral patterns into daily/nightly activities regarding oral rest posture and self-observed oral habits.
• This phase of treatment will continue as needed based on therapist recommendation and/or client or physician request.
• The therapist makes referrals to other providers as needed or determined to be beneficial to client.

This phase focuses on:

1. Generalizing all patterns

2. Ease of performance

3. Generalizing integrated muscle patterns into specific daily activities (natural environment, no clinical structure)

4. Habit strengthening

5. Self-monitoring

6. Self-correction

7. New muscle patterns and proper function fully implemented into day and night

8. Retention of all newly acquired  muscle patterns

This type of therapy requires you to show up every day and do your best, otherwise you will not get your money's worth and your symptoms or conditions will likely recur. You must be actively ready to begin the change in yourself or your child. This is a health and lifestyle choice because you will be doing exercises everyday, and bringing new awareness to dysfunctional oral patterns that you have had your entire life. The most important changes are the changes that happen at home in between sessions and it is my goal to support you in incorporating gradual changes and using research-based techniques to help you and your child reach your goals. 

Orofacial myofunctional treatment does not offer a quick fix, however with consistency and dedication, it can be highly effective at normalizing orofacial dysfunction and the results can absolutely be life changing. The best results are obtained when the exercises are done daily. Therapy generally lasts between 3 and 12 months.  The program can be modified to fit your schedule.  Appointments range from weekly to monthly.

Myofunctional therapy has been shown to result in effective improvements in oral and swallowing patterns, however due to the many factors that influence these patterns, outcomes are not guaranteed. Everyone progressed through the phases of treatment at different rates. It is important to recognize that even when therapy outcome is positive, there may be a period of time before myofunctional therapy is effective. Effectiveness further depends on the patients’ maintenance of habits and exercise program developed during therapy.

COMPREHENSIVE TREATMENT PROGRAM DETAILS

You have been referred for Myofunctional Assessment or Treatment by your physician who has determined that myofunctional therapy would be a beneficial adjunct treatment in helping you meet your orofacial myofunctional goals. 

The next step is enrolling in one of my Comprehensive Myofunctional Therapy Programs. This program includes an Initial Evaluation which takes about 60-90 minutes, followed by a package of therapy sessions over a period of time (length and frequency of sessions varied per individual program). Additional session packages and/or individual sessions can be schedule as needed for established patients. Obviously, the treatment for a 7-year old habitual thumb sucker will be vastly different than the treatment for a middle aged adult struggling with lifelong sleep apnea, and undergoing various structural procedures and surgeries. Enrolling in a comprehensive Myofunctional Therapy Program is your investment and commitment to your role in the program, as well as my commitment to offering you the evaluative and therapeutic care to best optimize long term results. 

Orofacial Myofunctional Disorders (OMD's) can be caused by various structural, functional or habitual reasons. Habitual causes are easier and quicker to resolve (such as eliminating oral habits) than those that also have a structural component or that have developed into functional eating/swallowing/breathing disorders (such as oral restrictions/tongue tie, reverse swallow or sleep apnea). Most orofacial myofunctional treatment does not offer a quick fix, however with consistency and dedication, it can be highly effective at normalizing orofacial dysfunction and the results can be life changing. 

For patients who are undergoing tongue-tie surgery (frenectomy), this program typically includes 4-6 weeks of pre-frenectomy treatment leading up to your procedure followed by post-frenectomy healing protocols and myofunctional treatment to retrain the lingual muscles and eliminate any dysfunctional oral patterns. We always recommend a minimum of 12-sessions to begin with for Pre/Post Frenectomy clients.

Treatment for other concerns is determined based on each individual's myofunctional goals, as determined and/or recommended by dentist and/or speech therapist. 

Myofunctional therapy sessions are approximately 30 minutes in length. 

EVALUATIVE/THERAPEUTIC PROCESS

STEP ONE  -  MYOFUNCTIONAL EVALUATION - ALL CLIENTS MUST RECEIVE A FULL INITIAL EVALUATION PRIOR TO BEGINNING TREATMENT.  We offer In Person Assessments for our local clients in our Wellness Center located in Cooper City/Davie area in Broward County. We also offer all assessment and treatment services via Telehealth for all ages.

STEP TWO - REGISTRATION/PAPERWORK: Once your Initial Assessment is scheduled, you will immediately receive a registration link, which will ask you to provide a credit/debit card as a form of payment. 

• TO RESERVE AND SECURE YOUR ASSESSMENT, WE DO REQUIRE A $100 NON-REFUNDABLE DEPOSIT AT THE TIME OF BOOKING AN ASSESSMENT. This deposit will be applied toward the balance of your assessment fee and can be transferred in the case of cancellation or rescheduling. 
• Registration must be completed within 24 hours of scheduling your assessment in order to hold your assessment spot.
• Your appointment is not confirmed or secured until you have completed the registration and your deposit has been processed.

Once we have received your deposit, your appointment is officially confirmed and will receive additional Intake Forms, Consent Forms and Specific Checklists/Questionnaires related to your case. 

• This intake process provides valuable information that is incorporated as part of your overall assessment.
• Completed forms and questionnaires must be received 48 hours prior to your appointment.
• Remainder balance is processed 48 hours prior to your appointment.

STEP THREE - INITIATE TREATMENT :

• Treatment typically begins one week after your Evaluation
• This allows your clinician sufficient time to analyze all of the evaluative date, write your Comprehensive Orofacial Myofunctional Evaluation Report and develop your Individualized Myofunctional Treatment Plan.
• It also provides us time to prepare your Myofunctional Toolbox, and ship it out to your prior to your first session.

RISKS AND LIMITATIONS OF MYOFUNCTIONAL THERAPY

Successful myofunctional therapy treatment is a partnership between the therapist and the patient. Your team of health practitioners, myofunctional therapist are dedicated to achieving the best possible result. As a general rule, informed and cooperative patients can achieve incredible and very successful results from their therapy. Patient motivation and consistency is directly correlated to treatment outcomes. While recognizing the potential benefits myofunctional therapy, you should also be aware that as with any form of treatment there are limitations and risks. These are seldom serious enough to indicate that you should not undergo treatment, however, it is important for you to know and understand this information.

Myofunctional therapy has been shown to result in effective improvements in oral and swallowing patterns, however due to the many factors that influence these patterns, outcomes are not guaranteed. It is important to recognize that even when therapy outcome is positive, there may be a period of time before myofunctional therapy is effective. Effectiveness further depends on the patients’ maintenance of habits and exercise program developed during therapy.

Myofunctional therapy is a specialized treatment that help patients learn to improve oral habits and patterns to improve tongue placement, breathing, speaking, chewing, and swallowing, which can have a huge impact on their overall health and well-being. Myofunctional therapy includes the prevention, assessment, diagnosis, interception, and correction of myofunctional disorders, as well as habits associated with or causing these concerns. Instructions and exercises related to resting tongue posture, lip seal, swallowing pattern, chewing, swallowing, drinking, and eating will be given over the course of this program.

It is important to keep in mind that outside of the exercises given, developing an awareness for your breathing and oral postures is crucial, and additional information will be provided as needed, and on a case-by-case basis. I will provide you with all the necessary tools, tips, and techniques to help you develop awareness, but ultimately this is a skill each patient will need to cultivate on their own. Every patient is unique and will require a treatment plan made for their specific symptoms.

RESULTS OF TREATMENT AND COMMITMENT TO THE PROGRAM

Myofunctional therapy treatment usually proceeds as planned, and we intend to do everything we can to help you achieve the best results possible. However, because this type of treatment involves patient participation and at-home involvement, in addition to simultaneous treatment with other healthcare providers, we cannot guarantee that you will be completely satisfied with the results if the provided/suggested assignments and exercises are not completed outside of your scheduled appointments. Lifelong oral dysfunction will not be corrected with only 30-minutes per week. 

The success of your therapy depends on the level of cooperation and involvement that you are willing to take at home. In order to receive optimal results, it is recommended that patients practice their exercises for at least 15 minutes, 3 times per day. Some activities/exercises may be done passively or while driving. watching TV, etc. Other activities/exercises must be performed while in front of a mirror or with specific tools (all provided with program kit).

THERAPY SESSIONS

Therapy sessions are typically booked in 30 minute slots with 1:1 therapy time for 25 minutes, and the remaining time for administrative work related directly to your case including but not limited to such as documentation, planning, clinical notes, scheduling and communication with parents or other providers regarding your case, etc. Sibling therapy sessions are typically booked in 45-60 minute slots with 1:1 therapy time for approximately 20 minutes per child (or both together for 40-minutes), and the remaining time for administrative work related directly to your case including but not limited to such as documentation, planning, clinical notes, scheduling and communication with parents or other providers regarding your case, etc. Please be aware that we must strictly adhere to our session time so that we do not impact the schedule of clients before or after. Please also understand that in working with kids, we have to prepare and allow for unexpected events that may impact our ability to provide the full session time (bathroom breaks, etc). We appreciate your flexibility and assistance in adhering to our session policies. 

Sessions typically take place initially every 1-2 weeks as you master each new exercise introduced. It's important that these sessions remain consistent, as many of these exercises build upon each other and work together to achieve improvements. However, if you feel that you have not been able to practice adequately within the previous time period, it's better to reschedule for a later date than to keep the appointment and not be prepared to meet with your therapist.

It's also important that too much time does not pass between sessions. If more than four weeks pass between sessions, then the outcome of the therapy will be affected and you may not achieve optimal results. If more than three months passes between sessions, and we are unable to reach you to schedule a session, then no refund will be available. However, any unused sessions can be completed at any time and will still be available to you for up to 6 months from the start date of your therapy. After 6 months your sessions will no longer be usable.

LATE ARRIVAL/NO SHOW/CANCELLATIONS

Arriving promptly for the scheduled Telehealth appointment is required. Sessions will be charged the full amount regardless of arrival time. If you arrive more than 10 minutes late for your appointment it is important to understand that you can still be seen but only for the remainder of your scheduled session and the fee remains the same. Partial credits will not be provided. Occasionally certain situations can occur to cause the clinician to be tardy. If the clinician is tardy, you will receive a makeup of the time that was not provided.

Therapy sessions are typically booked in 30-45 minute slots with 1:1 therapy time at 25-30 minutes respectively, and rest of time for administrative work related directly to your case including but not limited to such as documentation, planning, clinical notes, scheduling and communication with other providers regarding your case, etc.

Please note that $95 will be charged for any missed sessions without written notice 24 hours in advance.

Myofunctional Spot often has a waitlist of clients who are anxiously waiting to begin therapy, and our clinical time is very valuable. Unfortunately, we are not able to hold unused open session time, as this takes away our ability to help another client in need of our services. If a client has more than two "late cancellations" (less than 24 hours before session without written notice) or more than two "no shows", they will be moved to the waitlist and their therapy time will be given to another client. If a client is moved to the waitlist, any remaining paid sessions will be good for 1  year from the date of their assessment - refunds will not be provided. Therapy may be resumed when the client is able to commit to more consistent attendance (based on clinician availability). 

REFUNDS

Refunds for therapy will be processed strictly on a case-by-case basis and will be solely at the clinician's (Dena Freedman-Muchnick's) discretion. Any partial or full refunds issued will be provided the same method that they were received. A $500 non-refundable fee will be assessed to cover the kit plus shipping and handling and any associated administrative costs. Payment processing fees may be assessed as well.

RELAPSE

Completing a myofunctional treatment program does not guarantee perfect oral patterns for the rest of one's life. Therapy will help to develop a general education and awareness of correct breathing habits, proper swallowing, proper facial/oral muscle function, resting posture of the lips and tongue, and the negative habits that must be eliminated to reach your myofunctional goals. However, as with any muscle memory or lifelong patterns and behaviors, without maintaining this awareness, old habits and muscle patterns can resurface months or years later. As long as an awareness of the myofunctional concerns are maintained, relapse should not occur. After myofunctional therapy is complete, you will not be required to practice regular myofunctional exercises, however, the overall awareness of your newly learned habits for breathing and muscle function will need to be maintained. Reminder spot check in sessions are always available whenever needed.

SPECIFIC TREATMENT CONSIDERATIONS

Allergies

Allergies are a very common problem and affect an estimated 10-30% of the population. In some cases, it may be necessary to work with a specialist to help manage and control allergy symptoms. Occasionally, patients with chronic allergy/nasal congestion may require additional medical management A referral to an Otolaryngologist (ENT), allergist, or immunologist may be recommended.

Temporomandibular Disorders (TMJ & TMD)

Through myofunctional therapy, many patients can find relief from Temporomandibular Dysfunction or pain. However, because problems associated with the Temporomandibular Joint are often multi-faceted, and can be rooted in non-muscular causes, myofunctional therapy is not guaranteed to help all patients with TMJ conditions. Clinician and client are pleased when myofunctional exercises prove to be beneficial in reducing pain or other symptoms of the Temprormandibular Joint, however please know that these outcomes will be not be consistent for every patient undergoing therapy. Treatment by other medical or dental specialists may be necessary, and referrals may be made accordingly.

Ankyloglossia (Tongue-Tie) and Release Of Oral Restrictions

Many patients experience myofunctional disorders caused by tight or restricted oral frenums (lingual, labial and buccal). This affects a significant portion of the population and therefore restricts functional oral movement.

In some cases, it is impossible to proceed with myofunctional therapy because the tongue is severely restricted and unable to function or move properly. In this circumstance, a procedure called a functional frenectomy must be performed. Without this procedure performed correctly, resting posture of the tongue, swallowing pattern, and orofacial muscle function cannot be corrected. Treatment by a highly trained ENT, dentist, or oral surgeon may be required. This may be determined at any point during therapy, and referrals to preferred providers will be made. If you choose not to have your tongue-tie released, we cannot guarantee optimal outcomes for your myofunctional therapy or we may need to terminate therapy.

Speech Therapy

Myofunctional therapy can not replace speech, language, voice or fluency therapy; these are two separate and distinct areas within the field of Speech Language Pathology. However, myofunctional therapy has been shown to improve speech when oral motor muscular concerns are the underlying issue. Myofunctional therapy can have a foundational role in correcting speech problems, and can be considered a “building block” that is often part of achieving successful speech improvement. Due to the wide variation in causes for speech concerns and disorders, it is impossible to guarantee that myofunctional therapy alone will improve your speech. Clinician reserves the right to pause myofunctional treatment and recommend speech or language evaluation and/or treatment if necessary, on a case by case basis. As a speech language pathologist, I will be able to provide any additional assessments in this area at an additional cost. Please visit www.speechlanguagespot.com for more information about developmental speech and language delays and/or disorders.

Body Work

Additional referrals may be made to various other healthcare providers inclusive of but not limited to Chiropractors, Craniosacral Therapists, Physical Therapists, etc

If any of the conditions or complications mentioned above do exist or occur, a referral may be necessary for further treatment. Fees for these additional services are not included in the cost for myofunctional therapy treatment and are determined by each separate healthcare provider.

PROVIDERS

I am committed to working with the best practitioners and doctors in your area, who understand myofunctional therapy, and can help you achieve the best health and wellness outcomes to aid in your myofunctional treatment

I strongly encourage patients to work with the providers that I recommend for best treatment outcomes in regards to

• Tongue-Tie Surgery (functional frenectomy)
• Orthodontic Treatment and Expansion
• Airway and ENT Evaluation
• Sleep Evaluation and Assessment for Sleep Disordered Breathing
• TMJ and Craniofacial Pain
• Body Work (Chiropractors, Craniosacral Therapists, Osteopaths, Physical Therapists, etc)

If you choose to work with a provider that we have not recommended, we cannot be held liable for treatment outcomes that are less than ideal or optimal. Finding the right provider for your care is crucial to your myofunctional success. Many providers in the field of orofacial myofunctional disorders (OMD) also have strong preference as to which myofunctional therapists they will refer their patients to. I am grateful for the relationships that I have built with some of the best healthcare providers in the field of OMD and I value their trust in referring their patients to me. We collaborate closely to ensure the best possible patient outcomes.

TELETHERAPY/TELEPRACTICE TREATMENT

What Technology Do I Need?

Internet/WiFi Connection: To engage in real-time therapy sessions, you will need to utilize a computer (best option), tablet, or cell phone with good internet/network connection and built in camera or external camera.

Session Time - Clinician will send you a registration link for our HIPAA compliant client portal which will be where our video sessions take place. It is the client's responsibility to make sure their network connection is working properly prior to our session. If you are having trouble connecting, please notify clinician. If clinician experiences connection/network difficulties at any time during the course of treatment, the session will be rescheduled for a later time and you will not be charged for your session.

Privacy & Confidentiality - Web Security

All video conferencing platforms are minimally secure using passwords and logins. However, confidentiality at the level of the Health Insurance Portability Accountability Act (HIPAA) cannot be guaranteed when participating in treatment over the internet. 

Teletherapy has proven to be very beneficial in the treatment of Myofunctional Disorders, and has many wonderful benefits, compared to in-person sessions. There is significant research supporting teletherapy as highly effective

We are licensed in the states of Florida and California. Please be advised: due to licensing restrictions, any Telehealth sessions with participants outside of the state of Florida or California can only be provided within a consultative or "coaching" capacity and therefore are not eligible to receive superbills or insurance reimbursement.  I look forward to working with you and helping you achieve your orofacial myofunctional goals! 

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