Episode 264: Therapeutic Readiness with Autumn R. Henning, MS, CCC-SLP, COM®️, IBCLC

Hi and welcome to episode 264 of the Untethered Podcast. Today we have Autumn Reid Henning, mscccslp.com ibclc rejoining us. Autumn graduated from the University of Kentucky with a Master's degree in Communication Disorders. She's currently appointed in good standing as an Assistant professor with a voluntary faculty series in the Department of Communication Sciences and Disorders at the University of Kentucky College of Health Sciences. She was a founding board member for the International Consortium of For Oral Inculofringular Professionals, icap. Autumn specializes in orofacial function and development throughout the lifespan in her specialty private practice, Chrysalis oroFacial in Greenville, South Carolina. Autumn has been invited to speak for many prestigious conferences and organizations. She's written professional articles and has been featured on podcasts. She's also trained thousands of professionals from varying fields through her own continuing education courses. Her flagship course is tots training. Autumn is married to Dr. Zach Henning and they have a daughter, McKenna Henning. They reside in the Greer, South Carolina area with their mother, beloved cats. Her hobbies include travel, reading, church, and any activity with her family. 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, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner, 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, airway tether, dural tissue, and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest Posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started.

Foreign.

Hello Autumn. Welcome back to the podcast.

That's right, thanks for having me. What is this, number three or number four? I don't even know.

I don't even know either. I feel like I'd have to actually go to the website and look.

You know, any excuse to to talk to you.

I love it. I love it. And ditto. Yeah, and I know today we're going to be talking about a topic that you're super passionate about. And I think you have a course that recently came out on this topic, Therapeutic readiness. So for those who may be new to even the term therapeutic readiness, maybe I'll turn it over to you and like, just tell us, like, what does therapeutic readiness mean to you? Like, what is the context around that term?

Yeah, great question. So in the myofunctional and feeding therapy and lactation space, there's, you know, traditionally there's been a lot of talk about, okay, after the procedure, what do you do after to rehabilitate per se. And initially there was not a lot of talk about what do you do beforehand. And a lot of therapists, I feel like just kind of wash their hands. Well, there's a tongue tie. Nothing I can do until after it's released. And I speak from experience. This is how I come up with courses and teach is because of my experience. I can tell you I've tried it both ways. I was that therapist that was like, well, there's a structural issue. Can't really do a whole lot until that's taken care of. And so in recent years, more professionals out there have been talking about someone being ready for a release and things like that. But it's honestly been like, no one's really had a bunch of like, criteria or actual benchmarks. It hasn't been tangible. And so I, I looked back on like my social media and stuff, and I've been planning this course for literally like two to three years. And I just had to like, nail it down and get it in my head. And you know, when you treat, some of it is like intuition and just knowing and, you know, just, just going with your gut and. But being able to teach, you really have to make it very clear, right, to, to talk about what, what you're.

Trying to get across.

And so therapeutic readiness is just kind of a term that I came up with of what do we want to achieve before a tongue tie release procedure? What factors are there that if we achieve beforehand, do we have better outcomes, you know, better quality of healing, faster treatment course, all of those things. And so that, that's in a nutshell, what therapeutic readiness is. So, yeah, we, we put it out there with specific criteria.

I love that. And I think that's so important because one of those big questions that we get so frequently is like, how do you know a patient is ready for a release? Or how do you know that they've hit a wall or they can't go any further? And I feel like you, I'm like, I feel like I always had this criteria in my head or I had like a certain, like, knowing just from working with the patient that like, okay, this particular individual has gotten as far as they're going to get. Now it is time for that next step. If that's where we're headed or they're not interested in that release. We're kind of like, we've taken you as far as we can go right now. Like, let's put this on hold and maybe we'll revisit this if X, Y and Z happens down the line and call us back kind of thing. And so I think it's helpful to be able to put measurable, tangible guidelines, if you will, around something just to at least have that jumping off point for, especially for people who are newer to this conversation.

Right. And I also think it's a really good education tool for providers too, of like, hey, these are the things that need to happen before you ever, you know, release the tongue.

Or.

Also for patients of, hey, these are the things we're going to be doing before embarking on this. And so that they know, especially patients that are like, hey, can we just do therapy? You know, we are going to do therapy. And this is like a check and balance as well, like meeting that therapeutic readiness. And then if we stop progressing, then we know, hey, we've tried therapy. We're as far as we're going to get. And that procedure is actually indicated. So I think it serves a few purposes. And, you know, a lot, a lot of the reason this course was so hard to get out there because there's so much nuance to it. When is a baby ready for a release? Right. There's so many timing factors and you have to consider the family and, you know, the breast milk supply and all of those things. It's just a different ball game. And the other, it was pretty easy for me to like, really nail down like the older children and adults, but infants were tougher. And then toddlers and preschoolers, right, are pretty tough just because of the variety of how they present and, you know, the cognitive level and, you know, the fun, terrible twos, that sort of thing. So, so how, you know, they can't do full on Myo and so how do you get them ready in that oral motor feeding, ish therapy sort of way. And so that's, that's what we aim to do and.

Yep. Yeah. Has it been well received by the teams of professionals that you work with or is it something that you really feel like you've kind of honed in on with them?

I would say it was a natural progression of. With them. And, like, as I was kind of developing this, essentially, I noticed trends in patients and how they progressed and how they did after their procedure.

And.

And I would, like, communicate that to the release providers. And, you know, over. Over time, you know, we've developed that trust. And so our providers don't do releases unless we say, okay, this person is. Is ready. We've just defined what ready means. And so, yeah, I think it's been good. I think it's been also really good for our therapist just to, like, have that, you know, and it's been a mental checklist for me. But actually having something that you can say, okay, we've done all the things that we can do. You know, this is really needed and necessary, that sort of thing. So, yeah, in my community, it's been really well received. I've. I've started writing it on my reports so that if a patient decides to go get their release tomorrow. Yeah. At least my recommendation was not until they've been therapeutically ready. And that's written so that if they do go and have a release done by some provider out there, that if it doesn't go well, that's not what I recommended. So I think that's. That's helpful as well.

Yeah. Yeah. And I think it's also. I don't. It's not refreshing, but I'm trying to think of the word to hear that, like, there are still providers that, you know, exist around you that are not the perfect providers either. Because, you know, at the end of the day, I think a lot of people come to me all the time and they're like, hey, how do you get your providers to, you know, how do you get them on board? How do you get them to not release until you feel the patient is ready? And I'm like, well, it's not just me, Right. There is, like, a team approach, and we've all kind of come to. To have a discussion together about, like, what that looks like from each of our perspectives, and that allows us to kind of come to the table and go like, okay, a patient is ready when X, Y and Z happens. Which sometimes may be different based on the patient, maybe different based on, you know, the patient's needs. It could be, how dire is the situation? Do we have a kid who is headed towards a feeding tube? Or do we have a kid where we have wiggle room and time to play around and we can kind of take a more leisurely approach in therapy? And, you know, it's like there's the perfect world and then there's reality. Right. And so every case sometimes varies and that's where I start to get these questions where, you know, like in my own course, right. You know, I'll get students asking me, well, like how do you know when like this patient was ready versus that patient? And I'm like, this is that dance between art and science that as you work with more patients and you start to understand different patients needs and you really step into understanding who's sitting in front of you. Plus you build out that team, you can have these discussions, right, with the parents of the patient, if we're talking about a pediatric case, with the patient, if it's an adult, with the other providers that are on the team to really understand like what is best case scenario for this patient and then what is reality if best case scenario it doesn't appear to be what's going to happen. Right. So I'm like, it's one of those things where I feel like that conversation comes up so much. And I know you've got providers you work really beautifully with, but I know that also not every provider is like our BFF or someone we work with commonly. That may be on the same page as us. And that's also real life for sure.

And you said a lot of points that I wanted to elaborate on. But you know, I think as, as therapists we, we want a guideline, we want to check the box, we want to almost like a lot of perfectionistic people in this, this field, it just is. And so I always say there's, there's ideal and then there's real. And then I always say that protocols are based on probability. So protocols are not set in stone. You, you set things and you have like a general framework for what works for most patients and most people. But I think the mark of a, a great therapist is teasing out those individual needs and knowing when to like deviate from that either, you know, speed things up, slow it down, go a different direction and have those, those conversations. So I do say that in the course, like, hey, this is a framework. This is not every patient has to do everything. You have to balance that with those other factors. So it is nice to have like food for thought and like a general trajectory and framework. But you have to still do your job as a therapist and weigh those individual situations and needs. And so I think that's somewhat of the challenge, especially with people newer to this space in regards to tongue tie. They're like, well, what's a normal Tongue look like? I'm like, well, it can look like a lot of stuff because it matters how it moves, right?

Yeah.

So just have it. You know, they want like a slam dunk case and just very straightforward. And you're right, it's, it's science, but it's also an art for sure.

Yeah. So like somebody coming in who maybe doesn't really know you yet, let's say they haven't taken Todd's training or your other courses. Would you recommend that they take TOTS training first before they take a course like therapeutic readiness? Or is it something that someone could jump into regardless of like.

Yeah, I think that's a great question. I think it depends on where they are in their journey. Like if they're already treating patients affected by tongue ties, yes, touch training could definitely help. And I think, I think there's a misnomer about touch training in that it's not just an informational tongue tie course. Right. It's the overview and implementation of our model of care. So even professionals that have been doing this 20 years and been treating tongue ties and whatnot knows the ins and outs of them. It has challenged them and given them more information on a different way of doing things and a model of care and, you know, has been valuable. I would say that, you know, you don't have to take touch training by any means to take the pre release paradigm and the therapeutic readiness course. You know, you definitely just obviously need to be familiar with tongue tie and be seeing patients with it, otherwise it won't really make sense. So I would say not. Not a brand newbie. Yeah, just understanding some of the foundational principles. But yeah, that's what I'd say.

That's helpful because I know a lot of, you know, a lot of times I get those questions about some of my own courses too. And they're like, if I'm doing X, is this appropriate for me? I actually had somebody email me about like my MYO course asking me if it would be appropriate for them to take it. And they work with adult dysphagia. And these are like very, you know, cognitively impaired individuals who really don't sound appropriate for myo. Right. And I'm thinking, like, where on my webpage does it appear that this course would be anything close to what you're looking for to help these patients? And I don't know if it's more of just like, I'm looking for something different. Could this apply kind of a question and like, no, it really doesn't apply. You know, Traditional MYO is not for your aspirating dysphasia adult who's functioning at a. You know, and. And it was interesting, too, because these are individuals who have been, you know, they're. They're lower cog cognition, and so they have struggled with feeding their entire lives. They're not new. They're not stroke patients. Right. They're not even new to dysphasia. And I was like, no, no, this is definitely not what you want. At first I thought they were asking, like, would feed the peds apply? Because I was thinking, like, oh, well, it depends where they are in their journey. It's not really appropriate either, because that's not what we're targeting. But, like, tell me more about these patients and I'll tell you more if it might apply to them, but probably not. But, like, I saw Maya and I was like, no, totally not where we're going here. You know, so it's. It's helpful, I think, to know just, like, what, like, who for what, you know, what background information you need to have. And so that's. I think that's awesome. I have a question for you that actually came up for the first. I think it's like the first or maybe the second time this has ever been asked in my four plus years now of, like, teaching and even talking about, you know, tots inside my course and the whole conversation around rubbing on an open wound following a tongue tie release when there are no sutures in place. Do you have any thoughts or opinions on that? Or does your team have any, you know, protocol around rubbing or not rubbing on an open wound?

I have a lot of thoughts on that. Yeah. So. And I. I talk a lot about this in tots, and I think you. You took it like, gosh, 2018 or something, so.