3 Ways to Learn about TOTs

What does tongue-tie mean to you as a Speech-Language Pathologist, Occupational Therapist, ENT, IBCLC, RDH, dentist, oral surgeon or parent? How can you become prepared for a patient or baby who has tongue-tie? TalkTools is here to help you put together the pieces of the puzzle that is tongue-tie.

Tethered Oral Tissue(s) or TOTs is a topic that has been more frequently discussed in the fields of lactation, speech pathology, oral surgery, orofacial myology and otolaryngology. Organizations such as the International Association of Orofacial Myology (IAOM) and the Academy of Orofacial Myofunctional Therapy (AOMT) have been highlighting this diagnosis and implications for therapy and surgery.

There are three forms of TOTs: buccal, labial and lingual. Lingual TOTs is most commonly known as “tongue-tie” or “ankyloglossia”. The Mayo Clinic in 2016 indicated that tongue-tie can affect the way a child eats, speaks and swallows, and can interfere with breast-feeding.

One of the driving factors in the increased interest in TOTs stems from current research linking sleep apnea to a short lingual frenulum, in addition to the increase awareness of the importance of breast feeding. With this topic comes some controversy, and speech pathologists are often left confused in their own role of diagnosing and treating TOTs.

Ankyloglossia, or Tongue Tie, happens when the tongue is tethered to the floor of the mouth by an unusually short or thick lingual frenulum. This new tongue-training device was developed in Israel for use examining the frena of infants and exercising their tongues pre- and post-operation for frenectomy. The Liper massages the diamond wound that is a part of the healing process of a frenectomy. The exercise stretches the surrounding tissue from frenulum in order to maintain the integrity of the diamond and prevent scarring and reattachment and promotes euromuscular re-education.
*It is NOT meant to replace a surgical procedure and there is no research to suggest you can stretch a frenulum itself. On the contrary, the research shows the tissue is striated and is unlikely to stretch.

You can order the brand new Liper device here.

With TalkTools, there are 3 ways you can learn about TOTs:

  1. The NEW TOTs Book
    Functional Assessment and Remediation of TOTs
    Authors Robyn Merkel-Walsh, MA, CCC-SLP and Lori Overland, MS, CCC-SLP, C/NDT, CLC have developed a comprehensive, evidenced-based program — the Merkel-Walsh & Overland TOTs Protocol — to assist in the identification and functional implications of Tethered Oral Tissues (TOTs) — commonly referred to as "tongue tie" or ankyloglossia.
    This practical speech and feeding program includes a pre- and post-surgical treatment plan to avoid long-term issues, such as scarring and reattachment.

    SPECIAL PRE-SALE OFFER: 50% discount off regular price!

    Pre-purchase now for only $25
    Regular price: $50
    *Please note that this is a pre-sale

  2. NEW TOTs (Tethered Oral Tissue) Live Training Workshops
    There are 4 upcoming live training workshops scheduled for the TalkTools course "Functional Assessment and Remediation of Tethered Oral Tissues (TOTs)". 
    Upon completion of this course, you will earn 0.6 ASHA & AOTA approved CEUs.

    This course explores the functional assessment of TOTs and reviews current well-respected assessment tools which describe structure. With these tools, Lori and Robyn have developed the Merkel-Walsh & Overland TOTs Protocol which looks at structure, oral motor function, pre-feeding, feeding and speech. Participants will learn to use this tool to identify the possible need for a TOTs referral, and the functional impact this diagnosis may have on feeding and speech. Their unique style of “task analysis” is a practical strategy for assessment that is immediately carried over into developing a treatment program for neuro-muscular re-education.

    Participants will learn through the concept of task analysis the specific ways in which TOTs impacts the oral motor and oral placement skills for breast, bottle, cup, straw and solid feedings in addition to speech sound production. Videos and live practicums with attendee participation will provide therapeutic intervention tasks that participants can implement with their clients immediately. The importance of pre- and post-surgical therapy will be discussed, and surgical techniques will be explored so that therapists may be have a better understanding of the current research across disciplines on an international level.

    PREMIERE: Iselin, New Jersey
    Saturday, January 27, 2018

    Don't worry! Check out the 2 upcoming courses in New York City instead:

    New York City, New York - by popular demand
    Saturday, February 24, 2018

    Instructor: Robyn Merkel-Walsh, MA, CCC-SLP

    $165 Early Bird Rate - until 01/08/18
    $205 Standard Rate - 01/09/18 through day of

    Registrations are open!

    Mark your interest on Facebook

    New York City, New York - by popular demand
    Sunday, February 25, 2018

    Instructor: Robyn Merkel-Walsh, MA, CCC-SLP

    $165 Early Bird Rate - until 01/08/18
    $205 Standard Rate - 01/09/18 through day of

    Registrations are open!

    Mark your interest on Facebook

    Orlando, Florida
    Saturday, March 10, 2018

    Instructor: Robyn Merkel-Walsh, MA, CCC-SLP

    $150 Early Bird Rate - until 1/10/18
    $190 Standard Rate - 1/11/18 to 2/23/18
    $200 Late Registration - 2/24/18 to day of

    Registrations are open!

    Mark your interest on Facebook.

  3. TOTs Poster
    This poster serves as an informative resource; it was presented at the 2017 annual American Speech-Language & Hearing Association, Saturday, November 11.

    "Functional Assessment of Feeding Challenges in Children with Ankyloglossia"
    Authors: Robyn Merkel-Walsh, MA, CCC-SLP & Lori Overland, MS, CCC-SLP, C/NDT, CLC

    Click here to view the full poster.

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