Original Paper
Folia Phoniatr 1992;44:238-244
W. Bigenzahna L. Fiscfvnanb U. Mayrhofer-Krammelh Department of Phoniatrics. Second ENT Clinic, University of Vienna, and Dr. Wilhelm Brenner-Institutc. Vienna Medical Association (Dental Medicine Section). Vienna. Austria
Myofunctional Therapy in Patients with Orofacial Dysfunctions Affecting Speech
Abstract Tongue thrusting, deviate swallowing, mouth breath ing, orofacial muscle imbalance, deviate mandibular movement and malocclusion are the most important orofacial dysfunctions underlying disorders of articu lation. Their development is linked to early bottle feeding and sucking habits. The phoniatrician is charged with the early detection of orofacial dysfunc tions affecting speech. Early correction of habits and retraining by speech therapy are important preventive measures. Case histories, phoniatric and myofunc tional diagnoses and dental/orthodontic findings were compiled for a total of 103 patients aged 3-30 years (11 ± 4 years). Forty-five patients have completed a regimen of myofunctional therapy. For these patients
highly significant improvements in lip strength, lip clo sure, breathing and tongue placement as well as in the swallowing pattern and orofacial muscle balance have been observed. Concomitantly, tw'o thirds of the pa tients (66%) attained normal articulation. Speech de fects were resistant to therapy in only 2 cases. In den tal/orthodontic practice myofunctional therapy is used for retraining abnormal positions and functions of the orofacial muscles so as to create a normal occlusal rela tionship. The results of this study show that myofunc tional therapy is highly instrumental also in phoniat rics as a special form of treatment for disorders of articulation.
Zungenpressen. Schluckstörung. Mundatmung, orofa ziales Muskelungleichgewicht, abweichende Unterkie ferbewegung und Malokklusion sind die wichtigsten orofazialen Dysfunktionen, die mit Artikulationsstö rungen einhergehen können. Ihre Entstehung wird durch frühzeitige Flaschennahrung und Lutschge wohnheiten beeinflusst. Die Früherkennung sprach lich relevanter orofazialer Dysfunktionen ist Aufgabe der Phoniatrie. Frühzeitiger Habitabbau und logopädische Frühförderung sind wichtige präventive Mass nahmen. Bei 103 Patienten im Alter von 3-30 Jahren (Durchschnittsalter 11 ± 4 Jahre) wurden eine Ana mneseerhebung, phoniatrische, myofunktionelle sowie zahnärztliche Befunddokumentation durchgeführt. Durch die bei bisher 45 Patienten abgeschlossene
myofunktionelle Therapie konnte eine hochsignifi kante Verbesserung der Lippenstärke, des Lippen schlusses, der Atmung, der Zungenruhclagc. des Schluckmusters und des orofazialen Muskclungleichgewichtes erreicht werden. Damit einhergehend ergab sich bei 2/3 der Patienten (66%) eine normale Artiku lation, nur bei 2 Patienten waren die Artikulationsstö rungen therapieresistent. In der Zahnhcilkundc/Kicfcrorthopädic wird die myofunktionelle Therapie zur Korrektur von Fehlhaltungen und -funktionen der oro fazialen Muskulatur und zum Aufbau einer normalen Okklusion eingesetzt. Die Ergebnisse dieser Studie zei gen, dass die myofunktionelle Therapie auch in der Phoniatric als spezielle Therapieform zur Behandlung von Artikulationsstörungen eingesetzt werden kann.
DDr. Wolfgang Bigenzahn II. Univcrsiläts-HNO-Klinik Garnisongassc 13 A-1090 Vienna (Austria)
©1992 S. Karger AG. Basel 0015-5705/92/ 0445-0238S2.75/0
Downloaded by: Lund University Libraries 130.235.66.10 - 11/23/2018 1:48:20 AM
Myofunktionelle Therapie bei Patienten mit sprachlich relevanten orofazialen Dysfunktionen
Traitement myofonctionnei de malades atteints d un dysfonctionnement orofacial affectant le langage
Introduction
Orofacial dysfunctions which often under lie disorders of articulation include tongue thrusting, deviate swallowing, mouth breath ing, orofacial muscle imbalance, deviate man-
de la force labiale, de la fermeture des lèvres, de la res piration, de la position de repos de la langue, du schéma de déglutition et du déséquilibre musculaire orofacial. Parallèlement, les deux tiers des malades (66%) ont montré une articulation normale, chez 2 malades seulement les troubles de l'articulation étaient rebelles au traitement. En chirurgie dentaire/chirurgie maxillaire, le traitement myofonctionnei est mis enjeu pour la correction de malpositions et de dysfonction nements de la musculature orofaciale ainsi que pour le rétablissement d’un rapport occlusif normal. Les résul tats de cette étude montrent que le traitement mvofonctionnel peut aussi s’employer en phoniatrie sous forme thérapeutique spéciale dans le traitement des troubles de l’articulation.
dibular movement and malocclusion. These dysfunctions bear on the primary and second ary functions and are interrelated with the masticatory system. A contributory effect of parafunctional activities is often observed (fig. I ). Authors from various disciplines dis-
Fig. 1. Relationships (T) and in terrelationships (I) in the stomatognathic system between primary functions, secondary functions, dysfunctions, parafunctions, and the masticatory system as well as possible therapeutic measures (#) Nms = Neuromuscular system: Tmj = temporomandibular joint; ENT = ear-nose-throat; At = adenotomy; Te = tonsillectomy.
239
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Les dysfonctionnements orofaciaux majeurs accompa gnés parfois de troubles de l’articulation sont: pression de la langue contre la voûte palatine, anomalies de la déglutition, déséquilibre musculaire orofacial, anoma lies des mouvements mandibulaircs et anomalies de la dentition. Leur survenue est influencée par une ali mentation précoce au biberon et l’habitude de suce ment. La détection précoce des dysfonctionnements orofaciaux relève de la phoniatrie. Une désaccoutu mance et une correction logopédique précoces repré sentent des mesures préventives importantes. 103 ma lades âgés de 3 à 30 ans (âge moyen 11 ± 4 ans) ont été soumis à un interrogatoire et à des explorations plioniatriques. mvofonctionnclles et dentaires. Le traite ment myofonctionnei, achevé à cette date chez 45 malades, a permis une amélioration très significative
cuss different etiological factors [2-4. 9. 11 — 13]. Tongue thrusting and associated oro facial muscle imbalance, which are often ‘ac tive deterrents’ to correct speech production, are seen as indications for myofunctional therapy (MFT) adjusted to patient age [5. 7, 8. 10].
MFT as developed by Garliner [7] is used in dental/orthodontic practice for retraining abnormal positions and functions of the oro facial muscles so as to create an orofacial environment in which a normal occlusal rela tionship can be more easily established and maintained. The aim of this phoniatric study was to investigate the extent to which MFT for myofunctional disorders is effective in correcting speech defects.
Subjects and Method One hundred and three patients, aged 3-30 years (11 ± 4 years. 39% male and 6 1 % female), with orofa cial dysfunctions affecting speech were studied be tween 1988 and 1990. Patient data included a case his tory. phoniatric and myofunctional diagnoses as well as dental/orthodontic findings. Observations about the
240
Bigenzahn/Fischman/ Mayrhofcr-Krammcl
pregnancy and the perinatal and postnatal periods, statomotor development and sucking and eating habits were compiled. Clinical assessment involved the headand-neck position when seated, breathing, facial ex pression. lip appearance and lip closure as well as the resting position, tonicity and motility of the tongue. Myofunctional diagnostics concerned the outer and inner circles of orofacial muscular function. Tongue thrusting was diagnosed during mastication, swallow ing and speech: deviate swallowing was studied palatographically with the Payne Technique [7], Lip strength was measured with the Force Scale [7], The degree of orofacial muscle imbalance was rated on the basis of tongue thrusting, lip strength, deviate swallowing, weak or strong masseter muscles and overdeveloped mcntalis muscle. Three groups of articulation disor ders were distinguished: AD/I = interdental tip alveo lar sounds Ini /d/ III /I/: AD/II = dentalized. interdental or laterally released fricatives /s/ /z/ /// and affricates /fl'/ /d.V (lisps), and the combination of AD/I and AD/II. Potential morphologic causes o f impaired nose breathing (e.g. adenoids), abnormal resting position of the tongue, e.g. due to enlarged tonsils, and reduced motility of the tongue by a foreshortened frenum were diagnosed and eliminated surgically where necessary before the inception of MFT. An indication for tonsil lectomy was based on the sonographic imaging of ton sil size and the scope of the impression on the posterior part of the tongue (fig. 2). Dentition was classified according to Angle [ 1]. and open and crossbite established in a model analysis.
Myofunctional Therapy: Orofacial Dysfunctions
Downloaded by: Lund University Libraries 130.235.66.10 - 11/23/2018 1:48:20 AM
Fig. 2. Real-time sonogram showing an enlarged tonsil (TS) and the scope of the impression (ar rows) on the posterior part of the tongue (TG).
Articulation disorders
Before MFT
After MFT
No AD. % AD/1 only. % AD/II only. % AD/1 and AD/II. %
0 11 4 84
66 ,1 10 14
p
c 0) w -=■ 2 c
_p
Mean SE SD
“ P < 0 .0 5 -
< 0.01_
© CO 03
2 £
1 "
Fig. 3. Increase in lip strength 0 -1
i
i
Improvement No change AD/I
Discussion
Articulation disorders in preschool chil dren are often a cardinal symptom of orofa cial dysfunctions, the differential diagnosis of which is a task for the phoniatrician. A major causative factor for orofacial dysfunctions may be incorrect swallowing patterns [13]. The early change from breast feeding to bottle feeding, especially when the hole of the nipple is enlarged, leads to abnormal oral sensations and deviate muscle function (tongue thrust ing) [6]. The additional persistence of noxious sucking habits beyond age 3 contributes to the development of oral and perioral dysfunc tions and morphologic changes in the stomatognathic system [12], Parafunctional ac tivities influence orofacial dysfunctions and have a direct or indirect impact on the masti catory system (fig. 1). Articulation disorders are considered to be of multifactorial origins [14], Myofunctional disorders of the orofacial region are a major etiological factor for the misarticulation of the tip alveolar sounds /n/ Id/ /t/ /l/ (AD/I) and of the fricatives /s/ /z/ /(/ and affricates /(|7 /ds/
i
i
i
Improvement No change AD/I I
(lisps; AD/II). Lisps are often associated with tongue thaisting, deviate swallowing and oro facial muscle imbalance [7], The preconditions for the correct articula tion of the tip alveolar sounds are an increase in lip strength and complete lip closure to gether with normal breathing. The improve ment of tongue placement at rest achieved through MFT facilitates the correct articula tion of the fricatives and affricates. The results of the present study show that MFT can be used successfully in phoniatric practice as a special therapeutic regimen for the correction of speech defects associated with orofacial dysfunctions. In many cases prior elimination of ENT-specific problems (e.g. adenotomy. tonsillectomy, frenotomy) will create favorable conditions for MFT and speech therapy (fig. 1). MFT has proved effec tive in correcting myofunctional disorders and orofacial muscle imbalance and is there fore fundamental to the elimination of certain types of articulation disorders (AD/I. AD/II) which are often resistant to conventional speech therapy.
24 3
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(lb) in patients with and without improvement of articulation disor ders. AD/I = Interdental tip alveo lar sounds Ini Id/ III IV: AD/I I = lisps.
1 Angle EH: Malocclusion of the Teeth, cd 7. Philadelphia. White Manufacturing, 1907. 2 Barret RH. Hanson ME: Oral Myo functional Disorders. St. Louis. Mosby. I97S. 3 Bigen zahn W: Myofunktionelle Stö rungen der Orofazialrcgion im Kin desalter. Klinik - Ätiologie - Thera pie. Laryngol-Rhinol-Otol 1990:69: 231-236. 4 Bloomer H: Speech defects in rela tion to orthodontics. Am J Orthod 1963:49:920-929. 5 Breitwieser HG: Therapeutische Möglichkeiten bei myofunktionellen Störungen. Phoniatrie und Pädaudiologic. Köln. Deutscher Ärztcverlag. 1989.
244
6 Dahan J: Orale Wahrnehmung und Motorik. Fortschr Kieferorthop 1985:46:442-460. 7 Gariiner D: Myofunctional Therapy in Dental Practice. Brooklyn. Bartel Dental Co.. 1974. 8 Hahn V: Myofunktionelle Therapie. Ein Beitrag zur interdisziplinären Fundierung aus der Sicht der Sprachbehindertenpädagogik. Mün chen. Profil-Verlag. 1988. 9 Jann HW: Tongue thrustingas a fre quent unrecognized cause of maloc clusion and speech defects. NY State Dent J 1960:20:72-81. It) Hammcrle E: Logopädisch orien tierte oro-faziale Therapie. Inns brucker Therapiekonzept. UnivKlinik Hör-, Stimm- Sprachstörun gen. Unpublished. 1991.
11 Palmer J: Tongue thrusting: A clini cal hypothesis. J Speech Hear Dis ord 1962:27:323-333. 12 Sergl HG: Psychologic der l.ulschgcwohnheiten. Fortschr Kicfcrorthop 1985:46:101-112. 13 Straub WJ: Malfunction of the tongue. Part II: The abnormal swal lowing habit: Its causes and effects and results in relation to orthodon tic treatment and speech therapy. Am J Orthod 1961:47:596-617. 14 Van Riper C. Irwin J: Artikulations störungen. Diagnose and Behand lung. Berlin. Marhold, 1976.
Bigenzahn/Fischman/ Mayrhofer-Krammel
Myofunctional Therapy: Orofacial Dysfunctions
Downloaded by: Lund University Libraries 130.235.66.10 - 11/23/2018 1:48:20 AM
References
Folia Phoniatr 1992;44:238-244
W. Bigenzahna L. Fiscfvnanb U. Mayrhofer-Krammelh Department of Phoniatrics. Second ENT Clinic, University of Vienna, and Dr. Wilhelm Brenner-Institutc. Vienna Medical Association (Dental Medicine Section). Vienna. Austria
Myofunctional Therapy in Patients with Orofacial Dysfunctions Affecting Speech
Abstract Tongue thrusting, deviate swallowing, mouth breath ing, orofacial muscle imbalance, deviate mandibular movement and malocclusion are the most important orofacial dysfunctions underlying disorders of articu lation. Their development is linked to early bottle feeding and sucking habits. The phoniatrician is charged with the early detection of orofacial dysfunc tions affecting speech. Early correction of habits and retraining by speech therapy are important preventive measures. Case histories, phoniatric and myofunc tional diagnoses and dental/orthodontic findings were compiled for a total of 103 patients aged 3-30 years (11 ± 4 years). Forty-five patients have completed a regimen of myofunctional therapy. For these patients
highly significant improvements in lip strength, lip clo sure, breathing and tongue placement as well as in the swallowing pattern and orofacial muscle balance have been observed. Concomitantly, tw'o thirds of the pa tients (66%) attained normal articulation. Speech de fects were resistant to therapy in only 2 cases. In den tal/orthodontic practice myofunctional therapy is used for retraining abnormal positions and functions of the orofacial muscles so as to create a normal occlusal rela tionship. The results of this study show that myofunc tional therapy is highly instrumental also in phoniat rics as a special form of treatment for disorders of articulation.
Zungenpressen. Schluckstörung. Mundatmung, orofa ziales Muskelungleichgewicht, abweichende Unterkie ferbewegung und Malokklusion sind die wichtigsten orofazialen Dysfunktionen, die mit Artikulationsstö rungen einhergehen können. Ihre Entstehung wird durch frühzeitige Flaschennahrung und Lutschge wohnheiten beeinflusst. Die Früherkennung sprach lich relevanter orofazialer Dysfunktionen ist Aufgabe der Phoniatrie. Frühzeitiger Habitabbau und logopädische Frühförderung sind wichtige präventive Mass nahmen. Bei 103 Patienten im Alter von 3-30 Jahren (Durchschnittsalter 11 ± 4 Jahre) wurden eine Ana mneseerhebung, phoniatrische, myofunktionelle sowie zahnärztliche Befunddokumentation durchgeführt. Durch die bei bisher 45 Patienten abgeschlossene
myofunktionelle Therapie konnte eine hochsignifi kante Verbesserung der Lippenstärke, des Lippen schlusses, der Atmung, der Zungenruhclagc. des Schluckmusters und des orofazialen Muskclungleichgewichtes erreicht werden. Damit einhergehend ergab sich bei 2/3 der Patienten (66%) eine normale Artiku lation, nur bei 2 Patienten waren die Artikulationsstö rungen therapieresistent. In der Zahnhcilkundc/Kicfcrorthopädic wird die myofunktionelle Therapie zur Korrektur von Fehlhaltungen und -funktionen der oro fazialen Muskulatur und zum Aufbau einer normalen Okklusion eingesetzt. Die Ergebnisse dieser Studie zei gen, dass die myofunktionelle Therapie auch in der Phoniatric als spezielle Therapieform zur Behandlung von Artikulationsstörungen eingesetzt werden kann.
DDr. Wolfgang Bigenzahn II. Univcrsiläts-HNO-Klinik Garnisongassc 13 A-1090 Vienna (Austria)
©1992 S. Karger AG. Basel 0015-5705/92/ 0445-0238S2.75/0
Downloaded by: Lund University Libraries 130.235.66.10 - 11/23/2018 1:48:20 AM
Myofunktionelle Therapie bei Patienten mit sprachlich relevanten orofazialen Dysfunktionen
Traitement myofonctionnei de malades atteints d un dysfonctionnement orofacial affectant le langage
Introduction
Orofacial dysfunctions which often under lie disorders of articulation include tongue thrusting, deviate swallowing, mouth breath ing, orofacial muscle imbalance, deviate man-
de la force labiale, de la fermeture des lèvres, de la res piration, de la position de repos de la langue, du schéma de déglutition et du déséquilibre musculaire orofacial. Parallèlement, les deux tiers des malades (66%) ont montré une articulation normale, chez 2 malades seulement les troubles de l'articulation étaient rebelles au traitement. En chirurgie dentaire/chirurgie maxillaire, le traitement myofonctionnei est mis enjeu pour la correction de malpositions et de dysfonction nements de la musculature orofaciale ainsi que pour le rétablissement d’un rapport occlusif normal. Les résul tats de cette étude montrent que le traitement mvofonctionnel peut aussi s’employer en phoniatrie sous forme thérapeutique spéciale dans le traitement des troubles de l’articulation.
dibular movement and malocclusion. These dysfunctions bear on the primary and second ary functions and are interrelated with the masticatory system. A contributory effect of parafunctional activities is often observed (fig. I ). Authors from various disciplines dis-
Fig. 1. Relationships (T) and in terrelationships (I) in the stomatognathic system between primary functions, secondary functions, dysfunctions, parafunctions, and the masticatory system as well as possible therapeutic measures (#) Nms = Neuromuscular system: Tmj = temporomandibular joint; ENT = ear-nose-throat; At = adenotomy; Te = tonsillectomy.
239
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Les dysfonctionnements orofaciaux majeurs accompa gnés parfois de troubles de l’articulation sont: pression de la langue contre la voûte palatine, anomalies de la déglutition, déséquilibre musculaire orofacial, anoma lies des mouvements mandibulaircs et anomalies de la dentition. Leur survenue est influencée par une ali mentation précoce au biberon et l’habitude de suce ment. La détection précoce des dysfonctionnements orofaciaux relève de la phoniatrie. Une désaccoutu mance et une correction logopédique précoces repré sentent des mesures préventives importantes. 103 ma lades âgés de 3 à 30 ans (âge moyen 11 ± 4 ans) ont été soumis à un interrogatoire et à des explorations plioniatriques. mvofonctionnclles et dentaires. Le traite ment myofonctionnei, achevé à cette date chez 45 malades, a permis une amélioration très significative
cuss different etiological factors [2-4. 9. 11 — 13]. Tongue thrusting and associated oro facial muscle imbalance, which are often ‘ac tive deterrents’ to correct speech production, are seen as indications for myofunctional therapy (MFT) adjusted to patient age [5. 7, 8. 10].
MFT as developed by Garliner [7] is used in dental/orthodontic practice for retraining abnormal positions and functions of the oro facial muscles so as to create an orofacial environment in which a normal occlusal rela tionship can be more easily established and maintained. The aim of this phoniatric study was to investigate the extent to which MFT for myofunctional disorders is effective in correcting speech defects.
Subjects and Method One hundred and three patients, aged 3-30 years (11 ± 4 years. 39% male and 6 1 % female), with orofa cial dysfunctions affecting speech were studied be tween 1988 and 1990. Patient data included a case his tory. phoniatric and myofunctional diagnoses as well as dental/orthodontic findings. Observations about the
240
Bigenzahn/Fischman/ Mayrhofcr-Krammcl
pregnancy and the perinatal and postnatal periods, statomotor development and sucking and eating habits were compiled. Clinical assessment involved the headand-neck position when seated, breathing, facial ex pression. lip appearance and lip closure as well as the resting position, tonicity and motility of the tongue. Myofunctional diagnostics concerned the outer and inner circles of orofacial muscular function. Tongue thrusting was diagnosed during mastication, swallow ing and speech: deviate swallowing was studied palatographically with the Payne Technique [7], Lip strength was measured with the Force Scale [7], The degree of orofacial muscle imbalance was rated on the basis of tongue thrusting, lip strength, deviate swallowing, weak or strong masseter muscles and overdeveloped mcntalis muscle. Three groups of articulation disor ders were distinguished: AD/I = interdental tip alveo lar sounds Ini /d/ III /I/: AD/II = dentalized. interdental or laterally released fricatives /s/ /z/ /// and affricates /fl'/ /d.V (lisps), and the combination of AD/I and AD/II. Potential morphologic causes o f impaired nose breathing (e.g. adenoids), abnormal resting position of the tongue, e.g. due to enlarged tonsils, and reduced motility of the tongue by a foreshortened frenum were diagnosed and eliminated surgically where necessary before the inception of MFT. An indication for tonsil lectomy was based on the sonographic imaging of ton sil size and the scope of the impression on the posterior part of the tongue (fig. 2). Dentition was classified according to Angle [ 1]. and open and crossbite established in a model analysis.
Myofunctional Therapy: Orofacial Dysfunctions
Downloaded by: Lund University Libraries 130.235.66.10 - 11/23/2018 1:48:20 AM
Fig. 2. Real-time sonogram showing an enlarged tonsil (TS) and the scope of the impression (ar rows) on the posterior part of the tongue (TG).
Articulation disorders
Before MFT
After MFT
No AD. % AD/1 only. % AD/II only. % AD/1 and AD/II. %
0 11 4 84
66 ,1 10 14
p
c 0) w -=■ 2 c
_p
Mean SE SD
“ P < 0 .0 5 -
< 0.01_
© CO 03
2 £
1 "
Fig. 3. Increase in lip strength 0 -1
i
i
Improvement No change AD/I
Discussion
Articulation disorders in preschool chil dren are often a cardinal symptom of orofa cial dysfunctions, the differential diagnosis of which is a task for the phoniatrician. A major causative factor for orofacial dysfunctions may be incorrect swallowing patterns [13]. The early change from breast feeding to bottle feeding, especially when the hole of the nipple is enlarged, leads to abnormal oral sensations and deviate muscle function (tongue thrust ing) [6]. The additional persistence of noxious sucking habits beyond age 3 contributes to the development of oral and perioral dysfunc tions and morphologic changes in the stomatognathic system [12], Parafunctional ac tivities influence orofacial dysfunctions and have a direct or indirect impact on the masti catory system (fig. 1). Articulation disorders are considered to be of multifactorial origins [14], Myofunctional disorders of the orofacial region are a major etiological factor for the misarticulation of the tip alveolar sounds /n/ Id/ /t/ /l/ (AD/I) and of the fricatives /s/ /z/ /(/ and affricates /(|7 /ds/
i
i
i
Improvement No change AD/I I
(lisps; AD/II). Lisps are often associated with tongue thaisting, deviate swallowing and oro facial muscle imbalance [7], The preconditions for the correct articula tion of the tip alveolar sounds are an increase in lip strength and complete lip closure to gether with normal breathing. The improve ment of tongue placement at rest achieved through MFT facilitates the correct articula tion of the fricatives and affricates. The results of the present study show that MFT can be used successfully in phoniatric practice as a special therapeutic regimen for the correction of speech defects associated with orofacial dysfunctions. In many cases prior elimination of ENT-specific problems (e.g. adenotomy. tonsillectomy, frenotomy) will create favorable conditions for MFT and speech therapy (fig. 1). MFT has proved effec tive in correcting myofunctional disorders and orofacial muscle imbalance and is there fore fundamental to the elimination of certain types of articulation disorders (AD/I. AD/II) which are often resistant to conventional speech therapy.
24 3
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(lb) in patients with and without improvement of articulation disor ders. AD/I = Interdental tip alveo lar sounds Ini Id/ III IV: AD/I I = lisps.
1 Angle EH: Malocclusion of the Teeth, cd 7. Philadelphia. White Manufacturing, 1907. 2 Barret RH. Hanson ME: Oral Myo functional Disorders. St. Louis. Mosby. I97S. 3 Bigen zahn W: Myofunktionelle Stö rungen der Orofazialrcgion im Kin desalter. Klinik - Ätiologie - Thera pie. Laryngol-Rhinol-Otol 1990:69: 231-236. 4 Bloomer H: Speech defects in rela tion to orthodontics. Am J Orthod 1963:49:920-929. 5 Breitwieser HG: Therapeutische Möglichkeiten bei myofunktionellen Störungen. Phoniatrie und Pädaudiologic. Köln. Deutscher Ärztcverlag. 1989.
244
6 Dahan J: Orale Wahrnehmung und Motorik. Fortschr Kieferorthop 1985:46:442-460. 7 Gariiner D: Myofunctional Therapy in Dental Practice. Brooklyn. Bartel Dental Co.. 1974. 8 Hahn V: Myofunktionelle Therapie. Ein Beitrag zur interdisziplinären Fundierung aus der Sicht der Sprachbehindertenpädagogik. Mün chen. Profil-Verlag. 1988. 9 Jann HW: Tongue thrustingas a fre quent unrecognized cause of maloc clusion and speech defects. NY State Dent J 1960:20:72-81. It) Hammcrle E: Logopädisch orien tierte oro-faziale Therapie. Inns brucker Therapiekonzept. UnivKlinik Hör-, Stimm- Sprachstörun gen. Unpublished. 1991.
11 Palmer J: Tongue thrusting: A clini cal hypothesis. J Speech Hear Dis ord 1962:27:323-333. 12 Sergl HG: Psychologic der l.ulschgcwohnheiten. Fortschr Kicfcrorthop 1985:46:101-112. 13 Straub WJ: Malfunction of the tongue. Part II: The abnormal swal lowing habit: Its causes and effects and results in relation to orthodon tic treatment and speech therapy. Am J Orthod 1961:47:596-617. 14 Van Riper C. Irwin J: Artikulations störungen. Diagnose and Behand lung. Berlin. Marhold, 1976.
Bigenzahn/Fischman/ Mayrhofer-Krammel
Myofunctional Therapy: Orofacial Dysfunctions
Downloaded by: Lund University Libraries 130.235.66.10 - 11/23/2018 1:48:20 AM
References
