There are multiple steps to the therapeutic process for myofunctional disorders or speech disorders with a muscular cause. Let’s explore the path from the first phone call to discharge!
We start with a quick phone call. “Set up a time to talk” calls are typically 15-minutes in length. It is my goal is to answer any questions you may have, make sure I am the right fit for your family, and that the timing is right. I will do my best to make sure we are not rushed and I allow up to 25-minutes in my calendar. If you have specific questions, you are also always welcome to ask via email.
To prepare for this session, please take a moment to review the intake forms on file: (1) information privacy, (2) fee and attendance policy, and (3) a quick breakdown note regarding your concerns and best phone number.
Why would we wait? Typically there is a waitlist before the assessment session. I can appreciate that most clients and families want to get started ASAP. When appropriate, I may provide a quick and easy home program before we even get started to get you moving forward right away. In our phone call, we may also discuss other areas that you may need to explore before we even begin, such as:
- If we are going to train nasal breathing, that is impossible to do if allergies are not well controlled. If you have concerns regarding allergies, please ask your primary care provider or allergist about the best way to proceed.
- Likewise, the timing of therapy with orthodontics is an important consideration. Depending on the appliances used or planned surgical procedures, we may need to split therapy into phases. Let me know the current plan of care, and we will make sure to adjust our timing accordingly. If you have any concerns regarding your child’s teeth, please consult with an orthodontist as soon as possible. The American Association of Orthodontics recommends an evaluation by age seven.
- Reflux is another huge consideration. Many of my clients have laryngopharyngeal reflux (LPR), often called silent reflux. In this subtype of acid reflux, clients may not report classic heartburn, but they will have small micro-particulates of acid that come up into the nasal cavity and the back of the throat. This will often look like frequent burping, throat clearing, or nasal congestion that cannot be explained. If you suspect concerns regarding acid reflux or other gastrointestinal disorders, please discuss this with your primary care or GI physician.
- Head and neck posture, now is the time to get started on great head, neck, and body posture. One of our therapeutic goals will likely be to achieve an ideal tongue posture. If the head and neck are forward, this moves the tongue in three-dimensional space. Posture does not need to be perfect before we start treatment; however, I encourage you to at least meet with a physical therapist to make sure you achieve the best you can at this time.
- Most of my clients come to me with concerns regarding sleep. If you have any concerns regarding sleep, please contact your primary care or sleep specialist immediately. Often there are interventions that can be started before we meet for therapy.
- Other members that may be discussed include orofacial pain specialists, chiropractors, massage therapists, and acupuncturists. These will vary widely and are typically only discussed for clients with chronic pain. If you have chronic oral or facial pain, I require clearance from your physician to start assessment and treatment.
- Recall that I am private pay only and will provide you with an insurance receipt called a “superbill” that you can submit to your insurance company for possible reimbursement. Before we even get started, I strongly encourage you to reach out to your insurance company to find out if therapy may be covered or if you need a referral or prescription. Clarity Speech Therapy does not accept Medicare. If you will be eligible for Medicare within one year you will be referred back to your primary care provider in order to find a Medicare provider.
Assessment is actually three phases, all on its own.
- You will complete a comprehensive case history form online. This form is long, but as you may already be starting to appreciate, clients with muscular-based disorders are complex. We need to make sure that now is truly the right time for therapy. Hopefully, many sections of the form won’t apply, but do your best to answer fully. After the form is completed, we will book a one-hour phone call so that I can make sure I truly understand the complexity that is you!
- The in-person assessment session is typically anywhere from 90 minutes to 2 hours. We will take an in-depth look at the muscles of the face, many of which you didn’t even know existed 🙂 We will then look at the actions of chewing and swallowing. At the end of the session, we will develop a home program based on our findings.
- Photos! Taking baseline photos is a great way to see progress over time. Photos must be taken within one week of the assessment. If you would prefer to take your own photos (or area already planning to get professional photos), a shot list with examples will be provided.
A brief home program of two to four weeks is assigned at the assessment session. This is the phase to make daily therapy a habit by establishing great routines. This phase originally began due to COVID but has become a staple in my practice. I have found that once this step was added, my average client needed three fewer therapy sessions! For some of my adult clients, we may choose to extend this to one to three months, this will be discussed on a case-by-case basis.
Now that we know what we are working on, have ruled out risk factors, and have daily habits in place, we are ready to start therapy! Weekly sessions are typically around 40-minutes, although the very first session is booked as one hour.
The duration of sessions will vary greatly based on the severity of the disorder, other symptoms (e.g., allergies or posture), the orthodontic plan, completion of the home program, family support, and more.
My goal is that we establish a set routine and then change it slightly each week to build upon your new skills, keep it a little challenging, but ultimately have you feel successful. If at any time the home program feels too easy/hard, let me know!
As you achieve your goals or depending on other circumstances, we may choose to space out sessions (e.g., alternating weeks, monthly). My goal is that you feel completely supported and successful throughout the process; if needed, I offer “check-in sessions” where we meet to answer questions, keep therapy top of mind, or take a look at one specific aspect of therapy. Let me know how to best support you!
Muscular-based disorders happen for a reason, and so there is always a risk of relapse. Ideally, we will have ruled out all risk factors. We need to be very mindful about how we discontinue therapy. Enter the maintenance phase; this is where we strategically reduce the sessions. Ideally, follow-up is completed after at least a six-month hold from active therapy.
At maintenance sessions, we will test your current oral strength and coordination, chewing, and swallowing. As you should have already achieved your goals, the best maintenance session should reveal no concerns. However, in some cases, clients may slip backward; better to catch it quickly and get back on course than to meet up years later needing to restart therapy.
Once your goals have been met and maintained, it’s time for discharge. It is never a goodbye, if you ever need help or have questions in the future, I’m here!
Have more questions, please ask! I am here to support you and your family.
Christina
