Neuromuscular rehabilitation of orofacial functions

Neuromuscular rehabilitation of orofacial functions

1. Introduction 

• Orofacial neuromuscular rehabilitation is “that which acts on the central nervous system to correct dysfunctions, eliminate parafunctions and, more generally, all behaviors and postures which disrupt the morphogenesis of the dental arches.” 
• Also called behavioral therapy, it tends to restore a function disturbed in its coordination and its efficiency

2. Definitions

Dysfunctions: Dysfunctions are poorly performed functions. In the orofacial area, they concern swallowing, chewing, occlusion, pronunciation and ventilation.

Parafunctions: these are repetitive and impulsive behaviors whose performance can disrupt the morphogenesis of the arches or alter the play of the ATM.

The most common are bruxism, onychophagia, finger sucking and tics.

3. Neuro-muscular rehabilitation of orofacial functions.

Neuromuscular rehabilitation of orofacial functions

Furby

”  Defines habit as the tendency of the nervous impulse to follow

 the most frequently used route.

Habits of the nervous system must be corrected by education and changing the patient’s mental state

3.1 Active neuromuscular rehabilitation

This behavioral therapy is called “active”,

because it involves the will and consciousness of the subject without resorting to the use of devices. It consists of modifying a habitual motor activity by appealing to the psychic faculties of individuals

3.1 .1 Its principles:

• make the patient aware of erroneous postures and praxis 
• give him the means to practice the praxis and maintain these correct postures 
• automate these acquisitions 

3.1 .2 Its opportune moment: 

Depending on the engrammation which ends around the age of 10, because all the neural circuits necessary for establishing the function are put in place. 

It is possible from the age of 4-5 years, but requires a sufficient IQ. However, the ideal age is 7-8 years, during the development of the child’s logical thinking.

According to CHATEAU, rehabilitation may be possible at an advanced age (in adults within the framework of restraint).

• Can it be combined with another orthodontic therapy?

• Cannot be used with removable equipment
• Can be combined with multi-attachment appliances or extra-oral forces

3.1 3 Rehabilitation of dysfunctions 

Functional rehabilitation allows, through rehabilitation of the disturbed function:

• Recreate physiological conditions that do not generate morphogenetic disorders.
• Acquisition of new automatisms and maintenance of established architectural harmony. 
• Behavioral therapy According to Cauhépé:  

”  You have to make the reflex conscious, then teach the child to perform a very simple but correct movement. Immediately, you see all the abnormal muscular synergies disappear and gradually, the normal reflex takes place.”

Indications for rehabilitation

Contraindications to rehabilitation

The goals of rehabilitation

• Correcting lip, tongue and respiratory dyspraxia
• Eliminate parafunctions
• Allow the patient to adapt to this new function
• Automate the corrected functions (proprioceptive work).

Neuromuscular rehabilitation of orofacial functions

Reeducation of tongue posture at rest: 

It is done by showing the patient the correct tongue position

Ventilation rehabilitation by  : 

Restoration of nasal ventilation: 

• After removing any obstacles, restoring nasal ventilation is the first objective to achieve because it conditions lingual posture.
• Correction of ventilatory behavior should be carried out as early as possible, around 4 or 5 years of age, before any other orthodontic action. 

Then we establish: 

• Learning to blow your nose 
• Nostril wing opening work 
• Alternate Nostril Ventilation Exercise 
• Automation of abdominodiaphragmatic ventilation 

Salivary swallowing rehabilitation 

• Using a syringe, place a drop of water on the back of the tongue.
• Ask to place the tongue in the corrected position, then to tighten the dental arches.
• The practitioner holds the lower lip to avoid any movement on the skin muscles
• Ask the patient to swallow saliva without changing the position of the tip of the tongue, gradually pushing the drop of water along the palate and crushing the tongue against it, from front to back. 

 Chewing rehabilitation 

• Ask the child to become aware of his chewing 

• Eliminate any discomfort or pain
• Grinding of occlusal prematurities to release growth
• Recommend a balanced diet 

  Speech rehabilitation:

It is done by a speech therapist. Rehabilitation aims to normalize lingual supports when pronouncing different phonemes.

Rehabilitation begins with work on the isolated phoneme, then a correction of the supports during the sequence of several phonemes 

• The palatals “L, N, D, T”

1st session: LA_NA_DA_TA ( ²⁰ times / day)

2nd ^session : LALA NANA DADA TATA 

3rd ^session : the bike goes fast / Eva avoids the bike 

• The sibilant “S”

 Make CRA- CRO- CRRR squealing sounds

Simone soaps a dirty cloth, a friend passes by and greets her.

Neuromuscular rehabilitation of orofacial functions

        Deleting parafunctions

                Nothing replaces a gentle psychological approach to the child, by drawing his attention to the bad influence of his harmful habits. The operator can even give him the means to stop his tic, (such as the use of adhesive bandages around the thumb which allows the child to realize it in case of forgetfulness, use of a bitter varnish, pajamas with sewn sleeves).

 4.2 Passive behavioral therapy

• Neuromuscular rehabilitation with device 
• Several types of devices (see functional therapy course) can contribute to the correction of dysfunctional behaviors such as: 

The passive functional education gutter

5. Conclusion 

• Behavioral therapy is one of the treatment methods used in ODF. Its principle is to act directly on the central nervous system, and not on facial tissues, as other methods do. It is applied either in isolation or, most often, in conjunction with other therapeutic procedures. 
• Today, neuromuscular rehabilitation is developing:
  1. by proposing prevention which aims at the acquisition of non-pathogenic behaviors in the areas of feeding, ventilation, pronunciation and posture.
  2. by improving its rehabilitation techniques thanks to the contributions of physiotherapists and speech therapists who are playing an increasing role in the application of this therapy
  3. relying increasingly heavily on psychotherapy. 
• Good oral hygiene is essential to prevent cavities and gum disease.
• Regular scaling at the dentist helps remove plaque and maintain a healthy mouth. 
• Dental implant placement is a long-term solution to replace a missing tooth.
• Dental X-rays help diagnose problems that are invisible to the naked eye, such as tooth decay. 
• Teeth whitening is an aesthetic procedure that lightens the shade of teeth while respecting their health.
• A consultation with the dentist every six months is recommended for preventive and personalized monitoring.
• The dentist uses local anesthesia to minimize pain during dental treatment.

Neuromuscular rehabilitation of orofacial functions