Essay on the Occasion of the Internet
Appearance of the CCMF at the beginning of 2005
Application of Myofunctional Therapy
Under a strict scientific view the headline is not precisely formulated which leads to the question, if, any way it could be formulated correctly for everybody. The here described item commonly is referred to as „Myo". I learned about that, when a mother told me: "My child gets „Myo" ". The expression „Myo", and it is indeed used as such, is the most condensed abbreviation imaginable for a therapeutic treatment of Neuromuscular Dysfunctions in the oro-facio-cranio-cervical are of the human body, i.e. neck, head, face, mouth. Neuromuscular Dysfunctions, also referred to as Dyskinesies are insufficiencies in the nerve-muscle-complex. This in round numbers describes the matter, our Web Company is involved in. Details will be following. The next question ensuing:
How is our clientele made up ?Overall „Myo" is applied with children having a speech defect. This term again sends a scientist on the warpath. We will have to render this precise at a separate opportunity. Hopefully a colleague among the readers will be willing to give a precise definition of the "speech defect"- he is, hereby, invited to write his comment. Anyway the complete statement, that „Myo" is practiced with children showing a speech defect is somehow, let's say, quite simplified. We already have criticized „Myo" and the speech defect and now find "children" likewise imprecise. No, there is no age limit for our therapy. If we would constrain ourselves to treat only children with a speech defect, where to put the suckling , who ( not yet able or willing to talk ) has got problems with sucking, with breathing trough the nose instead of, incorrectly, through the never closed mouth / lip slit, who has developed a dysfunction in a way, that he is sucking on his lower lip or is protruding the tongue frequently out of his mouth ( which adults, too, often show as a dysfunction or Habit.)
Just talking about the latter: Who should care about the "aged face" when we would restrict our therapeutic efforts to children only? The aged face, in which the "lines are derailed" because part of the muscle lines are constantly cramped in a too high nutral tone, part kept hypotone, resulting, besides this, in an unfavorable physiognomy. We shall later on talk about the possible "catastrophic" consequential symptoms. But for the central part of the age pyramid:
Trough the course of our life we may, by stress, a "Tick" or disease acquire such a majestic bouquet of dysfunctions, that life will be sustainably complicated.
Putting Neuromuscular Dysfunctions in a scheme is a complex task. As we have started with dividing age groups, we should continue in this order: Child, adult, aged. An other possibility would be to a division with anatomical regions. As unfavorable, as malfunctions neither arrange to age categories nor anatomical regions. They are, in every respect, crossing all borders. We may list the dysfunctions in alphabetical orders or, as I did it in my book : „ Myofunktionele Therapie, Band 3", put the physiotherapeutic exercises in an alphabetical order an add to each the problems they are used for.
Early child stage: In the beginning in the described region ( neck, head, face, mouth) presumably three problem sections are most striking in showing up with problems: Breathing, sucking , swallowing. Additionally but for the time being still subordinate to those primarily noted: The use of the hearing apparatus, the voice and the eye ( as far, as the problems are bound to the Neuromuscular; there are muscle exercises for all these fields, for the muscles of the auditive membrane bones , the vocal cord muscles, the eye musculature.) Here the sufficiently known statement about the " hen and egg" has to be brought up. With the evidence of textural alterations the question arrises, whether the disordered function had gained the textural changes or vice versa.
In the Early Child Stage we may in the very beginning likely exclude the possibility of the texture change by dysfunction. In those cases either a therapy is requested enabling a restoration of textural changes by stretching / lengthening of hypomobilities or stenoses, curing of hypermobilities and probably certain hyperplasies by movement limitation, the above mentioned tongue and lip problems by strict supervision and teaching. But even applying surgical procedures without alternative should be recognized as an inevitable procedure, preceded, supplemented and in rehabilitation accompanied by Myofunctional methods.
A field of engaged discussion in this connection is the way of nursing a suckling by breast, bottle and the "correct" teat and or dummy. Here a further idiom urges into discussion, the "tongue thrust".It is widely accepted, that the suckling uses the front part of the tongue like a piston, shoving it on- and backwards. If this "Tonguethrust" is not eliminated in time and persists, it inevitably leads to a twisting of the arch of the jaw respectively the teeth. From this time on till the later childhood age the therapy of swallowing deficiencies is applied, mainly to the first tongue third, dividing the swallowing act into three phases: 1. Oral Cavity, 2. Pharyngeal Cavity, 3.Esophagus. Mispositioning of the tongue and the lip closure are resulting in aberrant behavior in the airstream management in the nasal / pharyngeal cavity. It is, indeed, possible to expand the air stream cross section of the nose via training the breathing technique. Nose surgery is amongst devoted pulmologists not the first means of choice. Therefore an early diagnosis of the breathing behavior is recommended. With hearing it is quite the same.
A small child, which is not adroit to hear the spoken word correctly, will likewise not be able to reproduce correctly. Thus problems from the suckling stage may be progressed to early childhood and maximized. Moreover acquired habits more and more gain importance like sucking on a snuggle cloth or animal, on a wrong dummy which sometimes tauntingly is called pacifier. It, too, as every thing being snuggled at ( and here not counted up expressis verbis) cause lots of trouble. With the beginning of the reproduction of speech the " hot phase" of speech education begins. Publications on this matter are filling walls of shelves - here therefor only a short mentioning. For the early child stage one should be open to make out the inception of all possible habits. They never are unharmful. Every stressing of texture transgressing the capacity of the physiological frame will result in pathological consequences. When then the dental arch begins to fill up, our cooperation with the orthodontist starts. Provocatively formulated: Orthodonty without Myofunctional Therapy is not possible.
In the later childhood here the succession of the milk teeth has to be supervised. We, for example notice hindrances by tongue-, cheek-, lip- biting or -pressing, and more and more the chewing muscles, the Mandibula Adductors are beginning to play a role. Continued protrusion of the mandible, occluding permanently conducted , pressing. bruxing will lead to permanent misposition of the mandible. This unfavorably effects the dental arches and parodontal tissue as well, as the muscles and temporomandibular joints. We still equally see the problems from the early child stage with respiration.
In adult stage the disorders in the mandibula adductors , the "chewing muscles", most likely are playing a main role. The consequences are remarkable texture degenerations with teeth, the tooth bed, jawbone, the chewing muscles themselves and the TM-joints. Modifications from the early phases are still imminent as, for example the snuggling. Here it is more rarely the thumb as rather the pencil, match, lips, fingernails, nail bed skin shreds, hairs from the pigtail or beard. We still observe cheek-, lip-, tongue- biting or -pressing. Mouthbreathing plays an important role.
Visioning the old, we encounter the (exaggerated) result of all the nontherapied derelictions: Teeth have been lost, prosthetic appliances are disturbing the swallow, the tongue positioning, the lipposture and equitably the position of the mandible. But likewise the face surface shows typical mutations. We observe a mixture of dysbalance between the muscle trails. Some exhibit a too low tone, others remain in a too high one. It is a characteristic appearance, for example, in the mouth region with feeble cheek muscles and mouth angle levators - the mentalis, however, is propped up, the lip cleft meager and drawn to length. The result is the sullen-morose senile expression.
The Musclefunctiontherapist will invent a solution for all those problems counted up ( and those not mentioned) and find exercises which, consequently practiced, are promising success. Which, finally, brings me to an essential point of all therapy efforts:First of all you should, of course, have the opportunity of a proper diagnosis. Further on you should convince the patient, that a treatment is necessary. Then you additionally have to induce, that he has to carry a crucial part himself with controlling and training. Compliance. Musclefunctiontherapy is not just Physiotherapy. It means for the patient training the own conduct and a steady self monitoring.
This is the specific reason for our disadvantages.
(E.Thiele, Januar 2005)
Since our website is still quite young, we feel free not only to inform about "brand-new" contributions, but also to refer to those, which though dated back some time but are of considerable importance for our discipline.The subsequently partly cited article was published in : ZM Zahnaerztliche Mitteilungen, Nr. 22, 16.11.2003:Kieferorthopaedische Fruehbehandlung; Baerbel Kahl-Nieke, Poliklinik fuer Kieferorthopaedie, Universitaetsklinikum Eppendorf.
This particular synopsis in short terms reflects some of the essentials of Myofunctional Therapy.E. Thiele,May.2005
The orofacial Dyskinesy it a dysfunction of the stomatognathic musculature based on an unconsciously proceeding reflex pattern . From the aetiological view primary, inducing and secondary, adaptive dysfunctions can be differentiated. The orofacial Dyskinesy include visceral swallowing patterns and tongue pressing, cheek sucking and biting, mouth breathing, lip sucking and pressing as well as mentalis dysfunctions and sucking habits. The professional curing of a dyskinesiy may lead to spontaneous dentoalveolar and skeletal reparation if accompanied by sufficient compliance. In a persistency case assisting appliances as the vestibular plate, Face Former or shields may gain the desired success [Klocke et al. 2000]. An lone appartive treatment of a morphological abnormality will rarely bring about normalization.
Report on the Symposium at the Competence Center for LMPN Malformations
of the Quality Circle Cervico-Cranial-Myofunction "CCMF"
Siegen, April 23. 2005
"Therapy of LMPN Malformations with special consideration given to the bio-psycho-social guidelines of the WHO".
The Center for LMPN Malformations at the DRK- Childrens Hospital Siegen and the Quality Circle CCMF had issued invitations to a transdisciplinary symposium in Siegen.The chairman was Professor Dr. Dr. Josef Koch, who is the speaker of the Competence Center, who was also a founding member of the Web CompanyWWW.CCMF.DE .
Professor Koch is an expert on the rehabilitation of people with Lip-Mandible-Palate-Nose-Malformations, and has been awarded the Bundesverdienstkreuz (Order of Merit of the Federal Republic). He had organized the symposium along the bio-psyche-social theme, following the guidelines promoted by the World Health Organization (WHO).The participants were graciously welcomed by the head of the Children Hospital Siegen, Mr. Jochen Scheel. He proudly pointed out that despite the generally difficult situation in the public health sector at the present time, this hospital is entering upon a clearly visible expansion phase. This is occurring thanks to the effective support of Professor Koch and his team.
In his opening lecture Professor Koch made it clear that his main interest is in the early, structure-relevant surgical correction of the so called "clefts", the LMPN-Malformation, and that this should be performed according to strict standards, and in light of the latest scientific insight, as expressed in a WHO-Classification. Only by reducing the astonishingly great information deficit will the ineffective treatment and the frequently resulting psycho-social disorders be avoided.The editor of the CCMF-Website promised all meeting participants to put the summaries of all five papers on the Web, where they will be retrievable in the near future under the above address. The board will endeavor to communicate the contents by not merely presenting a short version of what stuck in the memory of the editor. Therefore, great effort will be made to put a summary on our website that has been supplied by the lecturer himself. These efforts are kindly supported by Mrs. M. Grzonka, the team ENT-Specialist.
After Professor Koch had introduced the basic concept, the participants were informed about the prior-, during- and post-treatment features of the basic procedure involved in the early surgical correction of the LMPN-Malformation.
Dr. Holger Petri reminded the listeners of the essential details of the physiology of development. In order to understand both the complex surgical operation technique and the requisite accompanying therapy it is imperative that the anatomical and physiological relationships are continuously kept in mind. You can only reach a goal that you understand, and then only when you know the path to follow to get there.
Dr. Hubertus Koch gave the audience an impression of the necessary, goal-oriented operation technique. Without highly skilled and creative conscientious attention to detail in the reconstruction of the anatomic-physiological structure of all of the involved tissues all other therapeutic approaches are indeed nothing more than approaches.
We have to take advantage of the broad therapeutic range of the team, not only with regard to the various anatomical defects, but also with respect to the patient age (and, accordingly, quite different curability) from six months old up to the advanced years.
Moreover, patients can sometimes have experienced insufficient previous treatment elsewhere, often with negative results.
Dr. Magdalena Grzonka, representing the ENT-Medicine, pointed out to the audience the interaction of therapeutic success in the mandible-nose-pharynx region and in the auditory organ. One can readily imagine the situation in which a specialist is battling a disease within his area of expertise in vain, while in the neighboring field (physically as well as scientifically) scarcely anything is being done. Although none of the team members deliberately neglects the importance of neighboring disciplines, and may even be well versed in them himself, and keeps "the flanks open", there may be a missing feature in the therapy plan, with consequences to both the patient and society.
Mrs. Wiedemann, Mrs. Lihl and Mr. Hammel revealed the whole spectrum of possibilities for early consultation and early therapy, also including tight integration with both the patient and family. The psycho-social aspects of the overall therapy of these kinds of disorders can only have good success if there is also sufficient cooperation from both the patient and the family.
Dr. Ulrike Kinzler, a practicing orthodontist with many years of experience in her own office, was in a position to report on the influence of various prior treatments, which sometimes led to negative results. She seemed convinced of the great advantages of the concept presented by Koch et al, which greatly simplifies and facilitates the orthodontic work upon LMPN-patients.
Dr. Klaus Berndsen represented our position of the Myofunctional Therapy. It is based on the assumption, that the above-mentioned therapy methods and successes can only be of permanent value, if, at the same time, pre-, concurrent-, and follow up-treatments are able to "switch on" the neuromuscular feed-back circles.
The editor would like to remind you that the subject "mechanotransduction" for the function of the pressoreceptors in the neuromuscular feed-back circle is a rather fashionable topic of investigation worldwide at the present time. For our field of interest those feed-back mechanisms have always been the fundament of our chance for influence. If we succeed in getting the physiological self-regulation going with the aid of MFT (Myofunctional Therapy), we will be both able to support and extend the successes in surgical LMPN-Therapy.
In his presentation Dr. Klaus Berndsen stressed the possibility of simplification and acceleration of the MFT procedure by the use of accessories such as the Oral Stimulation Plate or the Face Former. In this way the application of MFT exercises might be accomplished more efficiently.
For expert information please read the contributions of the lecturers, which will appear soon on our websiteWWW.CCMF.DE .
This symposium has certainly cleared away impediments to further cooperation between the different specialist sections and will thereby be of great benefit to our common patients.
Erhard Thiele, Kiel, 25.04.2005
Presently worldwide intensive investigations are carried out in all medical areas about the topic Mechanotransduction. In short terms it means, how special cells are reacting on mechanical pressure in the texture. Formerly known under the expression Pressoreceptors. The transformation of a mechanical physical stimulus via a chemical reaction into a neuro-electrical signal. On our special field we are confronted with a multitude of, sometimes pathological phenomena which are guiding reflex sequences or are caused by muscular hyper- or hypotension or by the strain of the " Multiple Movement Syndrome". This makes these new findings quite important for our therapy methods. A practitioner of course has to do some reading to become familiar with this topic. In the Internet we presently find a whole lot of contributions. I noticed one special hint in the Internet. It is a dissertation paper, the abstract of which is copied below.
Bischofs, Ilka Bettina:
Elastic interactions of cellular force patterns
Potsdam, Univ., Diss., 2004
im Internet unter: http://pub.ub.uni-potsdam.de/2004meta/0076/door.htm
Adherent cells constantly collect information about the mechanical properties of their extracellular environment by actively pulling on it through cell-matrix contacts, which act as mechanosensors. In recent years, the sophisticated use of elastic substrates has shown that cells respond very sensitively to changes in effective stiffness in their environment, which results in a reorganization of the cytoskeleton in response to mechanical input.
We develop a theoretical model to predict cellular self-organization in soft materials on a coarse grained level. Although cell organization in principle results from complex regulatory events inside the cell, the typical response to mechanical input seems to be a simple preference for large effective stiffness, possibly because force is more efficiently generated in a stiffer environment. The term effective stiffness comprises effects of both rigidity and prestrain in the environment. This observation can be turned into an optimization principle in elasticity theory. By specifying the cellular probing force pattern and by modeling the environment as a linear elastic medium, one can predict preferred cell orientation and position.
Various examples for cell organization, which are of large practical interest, are considered theoretically: cells in external strain fields and cells close to boundaries or interfaces for different sample geometries and boundary conditions. For this purpose the elastic equations are solved exactly for an infinite space, an elastic half space and the elastic sphere. The predictions of the model are in excellent agreement with experiments for fibroblast cells, both on elastic substrates and in hydrogels.
Mechanically active cells like fibroblasts could also interact elastically with each other. We calculate the optimal structures on elastic substrates as a function of material properties, cell density and the geometry of cell positioning, respectively, that allows each cell to maximize the effective stiffness in its environment due to the traction of all the other cells. Finally, we apply Monte Carlo simulations to study the effect of noise on cellular structure formation.
The model not only contributes to a better understanding of many physiological situations. In the future it could also be used for biomedical applications to optimize protocols for artificial tissues with respect to sample geometry, boundary condition, material properties or cell density.