Functional Assessment & Remediation of Tethered Oral Tissues (TOTs)™

Course Description:

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.

Target Audience: This course will be of interest to speech-language pathologists, occupational therapists, IBCLC, dentists, surgeons, ENTs and RDHs

About the Instructors:

Robyn Merkel-Walsh, MA, CCC-SLP, COM®️ is a Licensed Speech Pathologist and Board Certified Orofacial Myologist® with over two decades of experience in the state of NJ. She is employed full time by the Ridgefield Board of Education and is the owner of Diamond Myo and Mouths In Motion Mentoring Service. She is a lecturer and author for TalkTools®. She has been elected NJ Kids Top Doctors in 2012, 2013, 2014 and 2018. Robyn received both her undergraduate and graduate degrees from Montclair State University, where she was later invited to be an adjunct/clinical supervisor. She also taught classes at Bergen Community College and is a former clinical site coordinator for Seton Hall University. She is the Board Chair of the Oral Motor Institute. She is the proud recipient of three ASHA ACE Award and the Ridgefield Woman of the Year 2019 in Business.

Specialization:

Robyn specializes in Oral-Placement, TOTs, and feeding and orofacial myofunctional disorders in children. She is Beckman and PROMPT trained. Her private practice focuses on Oral-Placement (OPT), oral motor, orofacial myofunctional (OMT), muscle and motor-based disorders in children, and she has expanded her practice to teens and adults. She conducts evaluations and Program Plans for children across the tristate area and is licensed to service patients in both NJ and NY states. She mentors therapists who are trained in feeding, oral motor and orofacial myology and assists with the TalkTools® Levels program.

Learning Objectives:

Upon completion of this course, 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. To list at least 2 professionals that should be consulted if TOTs is suspected after a functional assessment.

5. Participants will be able to list at least 2 surgical techniques for TOTs.

6. Participants will be able to identify at least 2 goals of a pre-op TOTs plan of care.

7. Participants will be able to execute at least 3 neuromuscular education activities for pre and post-op TOTs (1 buccal, 1 labial, 1 lingual).

Two Day Course Schedule

Friday, November 8 (6 Contact Hours)

9 :00- 9:30 Introduction

9 :30-10:00 Case History/Assessment Forms

10:00-10:30 Assessment

10:30-10:45 Break

10:45-12:00 Structural Assessment

12:00-12:45: Lunch

12:45- 2:45 Functional Assessments of Pre-Feeding and Feeding Skills

2:45 – 3:00 Break

3:00- 3:30: Functional Assessment of Speech Clarity

3:30:- 4:00: Additional TOTs Topics and Conclusions

4:00- 4:15 Q and A

Saturday, November 9 (6 Contact Hours)

9 :00-9:30 Introduction

9:30-10:00 Hot Topics

10:00:- 10:30 TOTs Remediation

10:30-10:45 Break

10:45-11:15 Frenectomy

11:15-12:00 Neuromuscular Re-education for Pre-Feeding

12:00-12:45: Lunch

12:45-1:30: Neuromuscular Re-education for Pre-feeding Cont.

1:30-2:45: Neuromuscular Re-education for Feeding

2:45-3:00 Break

3:00-3:50: Neuromuscular Re-education for Speech

3:50-4:00 PM TOTs and The Terrible Twos

4:00-4:15 : Q and A

Continuing Education Credits

Early Intervention credits have been requested for 12 contact hours.

All participants will receive a course completion certificate upon successful completion of the conference. No certificates will be awarded until course completion is verified on the final date of the conference.

Registration fee includes the conference, continental breakfast, and afternoon refreshments.

Lodging: A special rate at The Hyatt Place Lombard is available if you mention that you are taking a course at Easterseals DuPage.

2340 South Fountain Square Drive in Lombard, IL P:630.932.6501

Special Accommodations: Please notify us of any special accommodations you may have by contacting us at 630.261.6191.