Episode 288: Screening For Myo with Hallie Bulkin, MA CCC-SLP, CMT®, CPFT™

Hi and welcome to episode 288 of the Untethered Podcast. This is your host, Holly Balkan and we're going to talk about screening for Mayo today because I don't think we've talked about screening for Mayo in a very long time. So let's jump 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 myofunctional therapist, feeding specialist, podcaster, business owner 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, airway, tethered Oral 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. Okay, so I should preface this with I have a free FAST MYO screener. FAST stands for something. I'll explain that in a moment. But you can go to fast myo screening.com and get a copy of the free fast myo screening packet. Basically, it's simple. It's science backed. It'll help you screen your patients for potential orofacial myofunctional disorders. And this is something that, you know, if you're new to myo, you're not really sure where you want to start. This is a great place to start along with this episode because we are opening doors to the MYO membership. In a few weeks, October 21st through 25th, we will open the doors to the MYO membership. You can also join the waitlist there@themyomemembership.com but for now, if you do download the free screening packet, it will also alert you when the doors are open. So if you just want to get all of the above, go to fastmyo screening.com and that will be sufficient to get on the waitlist to know when doors open. But I want to. I want to kind of jump off with the fact that, like I said, as a speech language pathologist, when I was getting started, I really did not know much about Mayo at all. I knew things here and there, but I had no idea that it was called myo. I had no idea what MYO was. I really didn't know much other than doing a quick oral mech exam on my patients. And honestly, I felt like the oral mech exam was the black, like sheep. It was sort of like not really talked much about. Nobody really quite understood fully what they were supposed to do. But I've come to learn it is the most critical part of most evaluations. And so it really breaks my heart that a lot of grad schools still to this day are not teaching from a MYO perspective, an orofacial myofunctional perspective, because it impacts our feeding kiddos and it impacts, really impacts humans across the entire lifespan. And so I can tell you, you're going to encounter these kids over and over and over again in your practice and adults, too, who may have myofunctional disorders. And so, you know, if you might be someone who sort of dipped your tone a little bit, and now you're starting to see patients where you're like, ah, they might, I suspect they might have a MYO disorder. I'm not really sure what to do next. And, you know, you kind of then start to question yourself, as we all do. But here's the thing, right? If you learn how to screen, you can at least identify whether or not they need further assessment, right? And then from there, if you decide you want to really dive into Mayo, that's where you want to get trained on how to assess and, you know, how to provide the proper intervention. And so I do have a course that does that too. But when you download the free packet, you're going to get a comprehensive checklist in that packet that allows you to check off different symptoms and kind of record what you're seeing. Like, super, you know, super easy and straightforward. There's an additional log that is included as well with columns that, like, reflect the information that's on the checklist. And so you can basically carry over what your findings are yours, you know, and kind of give this results form if you want to, any other providers if you want to, or even share it with the patient or their family. And then there's a referral form just to make it easier to refer out when needed. So these, this screening packet is critical to have in your practice because whether or not you treat myo, you need to at least screen for it and know whether or not somebody needs further evaluation. Okay? That is, in my opinion, a mandatory piece of the puzzle. We should know how to screen for MYO feeding whether we treat it or not. Okay. And also this. This is for SLPs, OTs, PTs, RDHs, dentists. Anybody you know under that realm who can assess and treat MYO can download and use this packet in your daily practice. All right? So you can, like I said, go to fastmyo screening.com f a s t myo screening.com and you can download your free copy. If you have any questions, you know, there's ways that you can contact us. Information is always on my pages, but let's talk about what's inside the screener. So I know you're going to go download a copy, but let's say you downloaded it a while ago. Well, when you look inside the packet, as I mentioned, you're going to see a checklist. That checklist is broken down. I call it fast because we have six categories that I've broken the symptoms into. Face. And then I also have, like a dental face section. So face airway is the A. Swallowing is the S. I have speech in there, too. But because not everybody assesses or screens for speech, sound disorders or lisps or whatever, I didn't. I didn't make that a second. S. We just have 1s representing swallowing and speech. And then T is for tongue. Okay. So face, airway, swallowing, tongue, and underneath face, we're going to want to look at whether or not there's any dysfunction. That's very obvious. Is their mouth open wide? Do they have, you know, are they hypotonic? Are they, you know, is there, like, low tone present that we can see in the face? Do they have a potential lip tie? Do they appear to be drooling, having a hard time managing their saliva? Do they have a, like a forward head and neck posture? Right. Is there, is there. Are their ears, when you look at them, do their ears sit in front of their shoulders or is it kind of aligned? Is there a history of ear infections? We can often see history of breathing issues, whether they're related to drainage problems from, like, allergies or ear infections or whatever, like lack of sleep, we can see a lot of that stuff on the face, too. Right. And then long face, you know, aesthetic changes. So if they have a longer face, which tends to happen as the mid face grows a bit wider. And so when some people smile, you'll notice that there is a. A more gummy smile, if you will. Right. And they may have a thinner upper lip. That long, narrow face can be a sign of aesthetic changes. And then from A dental perspective when it comes to face, you know, are there malocclusions present in the teet? Do they have any orthodontic relapse if it's an older kiddo who's already been through expansion? Because we know expansion can start at younger ages, right? So, you know, if they're older, have they had any relapse? Do they have a narrow palate? Do they have a higher vaulted palate? Right. History of cavities or gum disease, Any bruxism or clenching, Any issues with their tmd? Right. These are all things that we can very quickly screen for. And then when it comes to airway, we are already going to have looked at their mouth to know if their lips are open or closed. So if the lips are open, we're probably mouth breathing, right? So, hi, that's an airway hint right there, you know, or are the lips closed? Do they appear to be nasal breathing? Do we know if they have audible breathing at night? Noisy breathing, breathing that we can hear? Are they snoring at night? Do they have audible breathing during the day? Right. It could happen anytime. Tonsils and adenoids, any concerns about those being enlarged? Any known sleep disorders or sleep apnea? Obstructive sleep apnea, right, or uars, Upper airway resistance, Resistance syndrome. That is something that I personally struggled with. Uars, never, never came forward as a OSA case on my sleep studies, but was diagnosed by people who know about uars appropriately. And then I mentioned before, allergies, allergic shiners. You're going to see those on the face. You're going to see, see that, you know, that darker, those darker circles underneath the eyes, or they'll have puffiness under the eyes, like as if they're retaining liquid there. And any, any habits, are they biting on anything or chewing on anything, Sucking their thumb, like chewing their tongue, biting their lip? Anything that you can visibly see or that they report to you. Right. During that screener. And now we know this is a lot of information, right? So bear with me because we still have three more sections to go through. So for swallowing, this is a big one, and then the next two are not as big. Any chewing issues that you're aware of, like watch them have a snack. That's one of the best ways that you can quickly observe some of these skills. Did they have any infant feeding problems? If they're older, do they report any atypical swallowing? Or do you see like that their tongue is coming forward when they swallow? Are they picky or selective in what they eat? Are they Messy or noisy eaters. Any history or current issues with gagging? Uh, do, is there any vomiting surrounding, you know, mealtime or eating snacks? Do they have any, you know, trouble swallowing pills? That's a common one. And then when it comes to speech, you know, there may be some speech sound errors, a lisp or some other things going on. So it's worth noting if it's something that you, you can, you know, screen for SLPs, for example, and then tongue, the TNR fast. Is their tongue low? Is it forward? Do we suspect a tongue tie? Now we can't like diagnose a tongue tie off of a screener. So this is more like, hey, I suspect that this may be present. I'm referring for further assessment. Right. If they have a tongue thrust, is it anterior? Is it, you know, more bilateral? Is it on, like we're seeing it on both sides. Is it something that we think is just not, sorry, not both sides but on the sides bilateral. I read bilateral and said both sides. But a bilateral tongue thrust would be where the tongue is thrusting sideways and versus anterior, where the tongue is coming forward. Do they have macroglossia? A overly large tongue? I will tell you this is not super common. Usually the mouth is too small and then tongue scalloping. Right. Do you see the scalloping around the edges of their tongue? Because that again is going to tell us that their palate is probably too small. So that was a lot. I ran through it super quick. But the point of this is I wanted you to have an idea of what is in the screener. Right. So you get a beautiful checklist with all this information. Now, when you do a screening, are you going to actually go through all of this? No. No, you're not. You're going to go through as much as you can and any symptoms you do see kind of glaringly obviously jumping out at you, you're going to mark down. And if you see anything else, there's space to add other symptoms that you may see as well. Now the next page on the screener allows you to add your findings under each of those sections that we just covered that make up fast. And you know, you can basically check the box if you want further assessment or not. And, and there's another box for specific referrals related to the symptoms that you observed. Um, so it's really just meant to be a super quick, like I'm talking 5 minutes max kind of thing. It's one of those things where if you're doing a speech language feeding screening, you could probably Do a feeding and or myo screening. The last two or three minutes of a 15 minute screening, right? I have them eat a snack, I watch what they do, I have them drink out of a cup. If they're under the age of the four, it's gonna be a feeding screening. If it's over four, it's likely a myo screening because we know that there's that cogn of age level. But really we're looking for a lot of the same things. At least a speech language pathologist who do like swallowing as well. We're looking for a lot of the same things but you know, a little bit more focused on that oral phase of the swallow. So that's really what you want to focus on. And then in terms of, you know, others, so OTs, you know, same thing. You can do this in the last couple of minutes of a screening. RDHs, I know, like I've talked to a lot of RDHs and they'll use this, they'll actually like laminate the screening checklist. So they may not print off and use that checklist for each individual patient, like marking on the checklist, but they'll have it on the wall. So when they turn around to do their notes while you're waiting for the dentist to come in, you know, at the end of a cleaning, for example, they will have it on the wall and they'll kind of glance over it and see like if they observed any of those symptoms. They may ask some questions, you know, based on that. So that's how they're doing it super quick and just adding some notes into their file in case there's something they want to refer them onward for. So again, it's meant to be fast and that is why it's called the fast mile screening. So that's the screener in a nutshell. I have been known to do free trainings on this to teach everybody a bit more about like what these symptoms are and how to look for them. And I've used my own children so we could always do something like that again. But for now that's what you're going to get inside the Fast Myo screening packet. Go to fastmyoscreening.com get your copy. It'll put you on the wait list because again, doors open to the Bio membership on October 21st and it's open for five days only, so make sure you jump in. We cannot wait to see everybody in there that will be joining. This is the last time we're opening the membership for this year. This calendar year 2024. It will not open again until 2025, so if you want in, now's the time. All right everybody, we'll see you in there. Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@hallie balkan.com or pop over to Holly Balkan on Instagram to get all the latest updates.