KIDS APNEA.COM   The website of Allen J.Moses, DDS

RE-EDUCATING REFLEXES

Reflexes are automatic responses by the nervous system that a person does not have to think about.  Breathing, swallowing and posture are reflex activities.  Humans do not think about breathing except in special circumstances such as playing a musical wind instrument.  We don’t usually think about swallowing either.  When the tongue has adjusted to chronic mouth breathing, and there is a dysfunctional swallow the maladaptive reflex can be retrained.

There are two distinct types of oral function: tonic and phasic.  Lip and tongue resting posture would be considered tonic functions.  Swallow, speech, and breathing would be considered phasic functions.  Psychophysiologic re-education of tonic function consists of getting the tongue to stay in the roof of the mouth and keeping the lips sealed at resting posture.  This is essential for maintenance of structural and postural integrity.  In some patients, doctors need to address both tonic and phasic function to get the best possible results.  The combined problem of malocclusion and oral breathing is so complex that there is no one universal way to assure successful treatment.  Treatment should be aimed as close to ideal function as possible. 

There are two types of psychophysiological reeducation of oral function:  conscious level (cortical) and subcortical neuromuscular (reflex level).  Myofunctional therapy and speech therapy work at a conscious level, retraining by exercise such functional activities as lip posture, tongue posture, sealed lip posture, tongue activity during speech.  Myofunctional therapy treats function to express skeletal and postural changes.  Garliner and Hanson have written text books on myo-therapy.  
Studies by Falk and Wesson demonstrate that subcortical, neuromuscular facilitation also works.  They suggest exercises involving brushing, icing and pressure that get excellent results.  Caine suggests voice development to retrain oral posture.

Muscle movement retraining is not muscle strengthening.  Retraining is far more important.  Developing new muscle patterns to correct tongue and lip resting postures defines psychophysiologic re-education.  Closed lip resting posture is very important.  Integrating correct patterns of movement, posture and behavior are what prevent relapses of surgical and orthodontic cases.  Unless the old dysfunctional reflex patterns are re-educated they will persist.  Reflex patterns gain strength with time.  Re-education should begin as early as possible.

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