This content was created by Hallie Bulkin. This content was uploaded by Hallie Bulkin. This is a YouTube podcast episode titled "Episode 194: Can We Do Myo Therapy With A Palatal Expander?" (created 2023-01-03, last edited 2026-01-21) hosted and narrated solely by Hallie Bulkin. The episode is an informational podcast segment about orofacial myofunctional therapy, addressing the common clinical question of whether to pause myofunctional therapy during palatal expansion. Hallie explains the airway-first principle, emphasizes that the answer "depends" (type of expander, whether the palate is open or closed, the patient’s stage in therapy, and individual goals), warns against blanket rules, and recommends coordinated decision-making among providers (orthodontists, myofunctional therapists, speech therapists). The episode includes a standard medical-disclaimer and guidance that some therapy elements can often continue while others may be paused until adequate palatal contact and space are available.
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Hi and welcome to episode 194 of the Untethered Podcast. Today it's your host, Hallie and we are diving into the question that I get very frequently. Do we need to pause myofunctional therapy during palatal expansion? So let's dive in. Quick disclaimer.
All information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses.
Let's get started. So let's dive into this. This is not going to be very long tonight. I know I've said that about all of the recent ones are a little bit shorter than usual. Last week is a little bit longer arguably, but I get this question a lot and I recently did a training on back on December 7th. It's available inside the mile membership. Talking about like treatment, timing, order of treatment, especially when there's different specialists involved and needs and really how it should always be airway first. Right? We need airway kind of drives everything. We can't work on correct oral posture if we can't nasal breathe. Can we work on getting the tongue moving? Can we working getting the tongue to understand where the spot is. Can we work on other things? Sure. But we're not going to achieve correct oral rest posture until the tongue can physically reach the top of the mouth, number one. Number two, it also needs to have enough space to live up there. Okay, so. So when I get the question, do we need to pause myofunctional therapy orofacial myofunctional therapy while a child is in palatal expansion? That depends. Okay, what kind of expansion are we talking about? Is the palate left open or closed? Right. Like an ALF appliance, for example, leaves the palate open. You could arguably continue therapy. Now, if a child's really struggling and you want to give them a couple of months to gain a little bit more space for their tongue, even though it's going to take longer than that to ultimately gain all the space they need, you know Maybe that's the discussion you have, right? What is, what does that individual patient need? If you have, like my children, for example, had rapid, rapid paddle expanders with both forward and lateral growth components upper and lower. The tongue is not resting in its normal position with those appliances in. And it's really hard to. You can't get the tongue to make full contact with the upper palate in that case. Now, for them, this was like a couple months that they were in these appliances. And so we paused myofunctional therapy because they, they were at a point also in their myo where they needed more space. They also are not going. You're not going to get that feedback that the tongue gets when it makes contact with the palate that says, oh, yeah, hey, this is where I'm supposed to be. This is where the tongue is supposed to live, right? We're not going to, we're not going to have the same type of results. So it depends. It depends on the appliance at play. It depends on where you are in your myo journey. If you're just beginning my own, there's actually a lot that we work on outside of, like, lingual palatal suction, like getting the tongue to suction to the palate and living. We're not going to have it living up in the palate on day one. There are other things that we address in terms of getting the tongue to work separately, right? Dissociate from the jaw, from the mandible, having it work separately from the jaw and the lips. We work on other orof facial structures outside of the tongue as well. So depending on the goals, even with upper and lower rapid paddle explainers that may be taking up space, it may still be appropriate to continue myo up until a certain point. And then if you get to the point where you go, you know what? We got to pause until these appliances are taken out and replaced with something else, whatever this next step might be, right? It's so highly individual. The reason why I want to address this is because, one, this question comes up a lot. But two, I also see, like, hard, fast statements that, yes, we have to discontinue myofunctional therapy. And this is coming sometimes from the. From the expansion provider, like the orthodontist or the dentist. And sometimes it's coming from the myofunctional therapist side of things. And the answer is, it depends. There's no hard, fast rule that says we have to stop for three months, six months, nine months, a year. I mean, I hear all These different random numbers. And I'm like, where. Where did you get that from? Like, where was that number pulled out of? Because when that same amount of time is applied to every appliance and every patient, that doesn't make sense. Okay, so question what's being told and if it makes sense for you as the patient or the patient sitting in front of you, and have a discussion with the team of providers that. That are working on so that you can come together and decide together what makes the most sense. What are the goals in Mayo right now? Are there other things you're working on? Sometimes speech pathologists, for example, might be working on speech or language or accepting, you know, expanding food repertoire, other types of things. Now, arguably, we might be waiting to work on expanding repertoire or speech sounds until we've gotten further through the MYO program. Like, that's what we typically do, because we find it's much easier to address when there's more space for the tongue. The airway is patent. We know the child has certain foundational skills or adults sometimes, too. Right? But what is the goal for that patient right now? And before anybody makes a blanket statement, whether it's from the myofunctional therapy side toward dental ortho, or the orthodontist side towards myofunctional therapy side, we need to talk to each other's providers and be careful what we're recommending, because we could actually be disrupting the progress that is necessary for that child's case. So, again, short and sweet. Probably the shortest of all of them recently, but we are entering the holidays, and I know you guys are probably wanting to just, like, relax and be with your families if you're trying to escape them and listening to podcasts. I have plenty of others if you haven't listened in the past. This is probably my shortest podcast ever, but that is my answer to that question, and I hope this is helpful. It's something I definitely wanted to address because it comes up a lot. It depends, and it really needs to be individualized. So there you have it. All right. Hope everybody's having a great holiday season. And come hang out with me on Instagram over at hellybulcken. You have questions you want answered on the podcast, feel free to drop them in my. You know, you can DM me and drop your questions and say, hey, I have a question. You know, that would be great to hear you talk about on the podcast, because I love doing these types of episodes that really address questions and then leave them here on the podcast. So that we can find them later, and I'm not constantly re answering the same questions or reinventing the wheel. So I hope everyone's having a great holiday season and I'll chat with you next week. Bye.
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