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 breastfeeding.

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 breastfeeding. 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 maybe have a better understanding of the current research across disciplines on an international level.

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. List at least 2 professionals that should be consulted if TOTs is suspected after a functional assessment.
5. List at least 2 surgical techniques for TOTs.
6. Identify at least 2 goals of a pre-op TOTs plan of care.
7. Demonstrate at least 3 neuromuscular education activities for pre and post op TOTs (1 buccal, 1 labial, 1 lingual).

Lori L. Overland MS CCC-SLP, C/NDT, CLC, FOM 

Robyn Merkel-Walsh MA, CCC-SLP, COM®

Schedule:

Timed Agenda

Registration Fees:

Option 1: Functional Assessment of Tethered Oral Tissues (TOTs) [Dec 6]

$250 = Registration / With Practicum 3806

$292 = Registration + Textbook 2598 / With Practicum 3806

Option 2: Functional Remediation of Tethered Oral Tissues (TOTs) [Dec 7]

$250 = Registration / With Practicum 3804

$292 = Registration + Textbook 2598 / With Practicum 3804

Combo Package: Functional Assessment of Tethered Oral Tissues (TOTs) AND Functional Remediation of Tethered Oral Tissues (TOTs) [Dec 6-7]

$450 = Registration / With Day 1 Practicum 3806 & Day 2 Practicum 3804

$492 = Registration + Book / With Day 1 Practicum 3806 & Day 2 Practicum 3804

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HOW TO VIEW AND ACCESS YOUR COURSE + DEADLINES

TalkTools®️ is an AOTA Approved Provider of professional development. Provider #: 5282 and 0701. This live, virtual course is offered at 12 contact hours or 1.2 CEUs, intermediate level, in the categories of OT Service Delivery and Foundational Knowledge. The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA.

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

Total of 1.2 ASHA/AOTA CEUs

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)

NOTE: This course welcomes IBCLC, dentists, surgeons, ENTs, occupational therapists, and RDHs -- however, we caution that only licensed professionals with Orofacial Myofunctional Therapy and/or feeding therapy within their scope of practice provide direct services.

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