Functional Assessment and Remediation of Tethered Oral Tissues (TOTs)
Functional Assessment and Remediation of Tethered Oral Tissues (TOTs)
Functional Assessment and Remediation of Tethered Oral Tissues (TOTs)

Functional Assessment and Remediation of Tethered Oral Tissues (TOTs)

Come be one of the FIRST clinicians to hear Robyn and Lori's new TOTs class and get a discount on pre-ordering Functional Assessment and Remediation of TOTs!

Date: January 27, 2018

Location: Iselin, NJ

Presenter: Robyn Merkel-Walsh, MA, CCC-SLP | Lori Overland, MS, CCC-SLP, C/NDT, CLC

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BOOK PRE-SALE -- pre-order your TOTs book at 50% discount ($25). Click through to order: Functional Assessment and Remediation of TOTs

  • 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.


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.


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. list at least 2 professionals that should be consulted if TOTs is suspected after a functional assessment.

    Timed Agenda

    $150 Early Bird Rate - until 11/27/17
    $190 Standard Rate - 11/28/17 to 1/12/18
    $200 Late Registration - 01/13/18 to day of

    Fee includes: 0.6 CEUs (ASHA/AOTA approved), course supplies, workbook & certificate of completion.

    Recommended Tools:

    Host organization: Advanced Therapy of America

    Venue: Advanced Therapy of America | 1 Ronson Road | Iselin, NJ 08830


    Robyn Merkel-Walsh, MA, CCC-SLP has specialized for over 21 years in Oral Placement and myofunctional disorders in children. She is employed by the Ridgefield Board of Education, runs a private practice in Ridgefield, NJ, is the board chair of the Oral Motor Institute, and is a member of the TalkTools® speakers bureau . . . more

    Lori Overland, MS, CCC-SLP, C/NDT, CLC is a speech and language pathologist with more than 35 years of professional experience. Lori specializes in dealing with the unique needs of infants, toddlers, pre-schoolers and school-aged children with oral sensory-motor, feeding and oral placement/speech disorders . . . more