Functional Assessment & Remediation of Tethered Oral Tissues (TOTs)™

1.2 ASHA CEUs •  - click through for more info on our CEU Policy and Process

Instructors: Robyn Merkel Walsh | Lori Overland

DAY 1 - FUNCTIONAL ASSESSMENT

COURSE DESCRIPTION

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.

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.

LEARNING OUTCOMES

Participants will be able to: 

1. list three forms of TOTs.
2. identify at least 3-5 functional impacts of TOTs on feeding skills.
3. list at least 3 speech sounds that may be affected by TOTS.
4. to list at least 2 professionals that should be consulted if TOTs is suspected after a functional assessment.

Instruction Level: Intermediate. The learning outcomes and objectives are relevant for inter-professional practice and education (IEP) programs; and can be applied across the client's lifespan in a variety of settings (schools, private practice, clinics/hospitals)

Target Audience:  SLPs, OTs, IBCLC, dentists, surgeons, ENTs and RDHs. 

NOTE:  While TalkTools welcomes all to attend and learn the course content, it is the responsibility of the professional to determine if applying the techniques fits within the scope of their practice.

TIMED AGENDA

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DAY 2 - FUNCTIONAL REMEDIATION

COURSE DESCRIPTION

Tethered Oral Tissues (TOTs) is the restriction of the frena or frenulum, which are small folds of tissue that connect bone to tissue and support or limit movement. While not a new condition, the term TOTs was coined by Kimberly Benkert, RDH and later by Dr.Kevin Boyd in 2014 to describe restriction of the frenula in the tongue (ankyloglossia),lip (lip-tie) or buccal frena. There are many “hot topics” about treating TOTs ranging from the need for surgery to whether or not pre- and post-op care is necessary. Lori and Robyn have done extensive literature review on TOTs and have collected several years’ worth of clinical data in preparation of this course to explore these controversies and focus on an evidence-based approach to treatment. This course provides participants with a “task analysis” of TOTs interventions, based on Robyn and Lori’s theoretical foundation that the oral sensory-motor system cannot be separated, and therefore when TOTs is diagnosed the impact on movement impedes the way the person processes sensory information for feeding and speech. Any movement in the body can be broken down into smaller motor units, and Robyn and Lori have created a series of neuromuscular re-education techniques ranging from passive to active to work with patients across the life span with a range of cognitive skills. This class will walk through interventions for both pre-feeding and feeding for: breast, bottle, cup, spoon, solid and straw feeding(s) in addition to the oral placements required for speech clarity. Pre and post- operative considerations as well as surgical procedures will be discussed. Neuromuscular re-education of the cheeks, lips and tongue will be presented and numerous demonstrations, practicums and video slides will teach participants to execute a functional remediation program. Exercises may be executed in the school, hospital or clinic-based settings based on the impact on education or activities of daily living. Finally, Robyn and Lori have added a new section on toddlers and strategies for success with this challenging population.

LEARNING OUTCOMES

1. Participants will be able to list at least 2 surgical techniques for TOTs.
2. Participants will be able to identify at least 2 goals of a pre-op TOTs plan of care.
3. Participants will be able to execute at least 3 neuromuscular education activities
   for pre and post op TOTs (1 buccal, 1 labial, 1 lingual).

Instruction Level: Intermediate. The learning outcomes and objectives are relevant for inter-professional practice and education (IEP) programs; and can be applied across the client's lifespan in a variety of settings (schools, private practice, clinics/hospitals)

Target Audience: SLPs, OTs, IBCLC, dentists, surgeons, ENTs and RDHs. 
While TalkTools welcomes all to attend and learn the course content, it is the responsibility of the professional to determine if applying the techniques fits within the scope of their practice. 

Content Disclosure: This presentation will focus on treatment methods related to the use of TalkTools® OPT resources. Other similar treatment approaches will receive limited or no coverage during this lecture.

TIMED AGENDA

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