Episode 60: Use Your Clinical Judgment With Dawn Moore ClinScD., CCC-SLP. COM®

Hi and welcome to episode 60 of the Untethered Podcast. Today we have Dawn Moore joining us. Dawn is a founder of Expression, Speech Language and Myofunctional center in Burlington, North Carolina. Dr. Moore has over 20 years of experience in the field, earning her clinical doctorate in 2018. For 15 years she practiced in the schools of North Carolina as both a clinician and lead SLP specializing in articulation, phonological delays and apraxia. In 2010, she expanded into private practice serving children of all ages. She recently completed the rigorous training and certification process to become a certified orofacial myologist, pursuing this training after struggling to find help for her own daughter with a severe tongue thrust. Through the certification, she has started treating both children and adults and regularly presents for SLPs, Orthodontists, ENTs and Dentists about the impact myofunctional disorders have on speech, feeding, chewing, breathing, dentition and sleep. Quick disclaimer. All information, content and material of this podcast are the opinions 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. Dawn, I'm super excited to have you here to talk about a whole bunch of fun things today. Thank you for joining us.

Hi. Thank you so much. I'm very excited to be here.

So let's just jump on in and find. Share with us how you found Dr. Zaghi in the first place. I know we're going to talk about trmr, but I would love to just hear about how how you came to find him.

So when I was doing my clinical doctorate a couple years ago, I had to have some kind of objective measurement to measure tongue tied because that was one of my exclusionary factors for kids that were enrolling in my R study and I didn't want to put kids that were obviously tied into the study and I couldn't find anything. It was such a hard thing. You know, I had Sandra's information from my class, you know, doing mouth wide open and mouthless suction, but I needed something. I needed a research article to back it up. And I remember when I was in LA at the frenulum workshop, that Dr. Zanghi was there presenting on this information that was coming out of Stanford. And I remember and I'm like, where did that article go? Did that ever get published? And so I did a deep dive on, you know, everything I could find in PubMed and tried to find it and finally came up with it. And I was like, this is it, this is the one I needed. And so that was basically one of the biggest articles that I needed for my research study, just to be able to have some kind of objective measure. But then I had to tweak it and figure out how to do it online because my study was online, so a whole nother level of layer, but at least I had something to back up what I was doing.

Yeah. And so what did you find was the difference? I guess for people who are not familiar with trmr, what is the big difference between TRMR and like the qtt, the quick tongue tie measurement as it's.

So they use the same measurement tool, so they're using the QTT anyway. And then some people, like Irene Marcuson, she uses calipers in her research and whatnot. But again, I was online so I couldn't do that. So I needed something that I could adapt. But the different. There's not a lot of difference other than the fact that they just. There's no subtracting the five. If you do the, you know, the five millimeters from the tongue to spot versus suction, that kind of thing. Any. The original one was always tongue to spot and it was mouth open wide and then tongue to spot. You divide them just like we do. But the big difference was just having it done in over a thousand people. And so then I had something to back up other than, you know, and I asked Sandra way back when, you know, do you have anything, you know, where did this come from? And she didn't have anything to be able to give me for research article that I needed. So that was the big thing. Just having that objective data in over a thousand people was great. I was so thankful it was out there.

I love it. And so obviously you feel it's important that other professionals use standardized measuring systems. So can you speak to that a little bit? You know, why should somebody maybe who's really comfortable with just using the QTT on its own without understanding trmr, why would you recommend they make the switch?

Because if we could all use something standardized that's one of our biggest problems is the definition of ankle glossia, as you know. And that's actually what the article is pretty much called, you know, functional definition of Anglo Gaussia. And we are having a lot of trouble because everybody is using something different. And so if we could all use the same thing. And then any report that goes to these doctors or these other professionals, we're all citing the same research, we're all using the same thing. And Dr. Zaghi even went further because people had asked him, you know, well, can you do it with suction? And then he came out with the next paper, which was add the information on doing it with suction versus just tongue to spot, because he actually makes people do the suction to do the finoplasty. So it made a lot of sense and that that was the next logical progression for him. So it was just awesome. And I think that's the big thing, is for us to have somebody that has the ability to do this, because we don't. We don't have the time, the resources, we don't have the money, nor the patience to be able to do all these things, you know, that he has the ability to do. But the great thing is he's able to share it freely with all of us, which is just awesome.

Yeah. Well, and I know it's really up to us as the clinicians and the people out there doing this work every day, and those of us who might have online platforms to really kind of shout it from the rooftops. Because, you know, while I love my qtt, I recently started to use TRMR myself, and I also am teaching a course, and in one of the modules, we were talking about all the different classification systems that exist out there and the shortfalls of some of them. Right. You know, obviously they're great systems in their intention, the intention behind them. But sometimes you could be totally fine on one classification system but have a posterior tie that gets completely missed, or, you know, or it appears that you have an anterior tie, but, you know, it's. Maybe you don't have all the symptoms on the list that you were handed. So it's. I think, really, in my opinion, it's really great to have something that's functional. Right. That's the whole purpose behind it. Whereas I feel like some of these other ones were not so much based on function, they were just based on insertion point.

And they were great. And I think it's gotten us to this point. It's brought Dr. Zaghi into the fold where he could actually do more of this research and has the funds and the ability to do it. And that's, I don't think without all of the previous ones, we would be where we are today. And I don't think he would have looked into it. So through sleep medicine, of course, you know, that's how we get here. It all goes airway. Right. So I think that's the amazing part of it is everybody has paved the way for us to get to this point and he's even expanded his research even more to help us because we're asking for other things. So I think it's just absolutely amazing.

Yeah, no, I 100% agree. And I think it's our job to help shift people from some of the other systems. Right. So we have a standardized system, as you mentioned before, because obviously the more standardized something is, and if we're all speaking the same language and you send a patient off to a doctor or an ent, a dentist, whoever, and we all know what TRM are grade we're talking about, that's going to be much, much more successful, I think, in continuity of patient care and just understanding what we're talking about, all being on the same page. Because that's one thing I've cautioned my students in my course with is you can use any skill you want. However, if you say it's, you know, this scale, grade four, or this scale with this insertion point or this appearance or whatever skill you're using, if that person receiving the data is not familiar with a scale, it's completely irrelevant. So if you're, you know, just describe what you're seeing, maybe and see if you're going to put a SC in there. So I think this kind of, while we should still describe what we're seeing, this definitely overcomes that issue of not having a standardized system across the board.

And I always include that reference in my reports. So the scale that I'm using in the trmr, the citation is there right after the explanation of what the scale is, what it measures, what grades we're looking at. And so then that way they know that it's something that's in the literature. It's not just something I made up.

Right, right, right. I love that. And that's a really good tip. So anybody who's listening who's either just getting into the myofunctional therapy space and you're doing evaluations, or if you've been doing this for a really long time, I think it's a really great tip to reference your source in a report, because then if it is somebody who's new to it, they can go find that source and read up on it themselves. Exactly. And that's the one thing I love about the breathe institute and Dr. Zaghi and Yoon. They're doing all this. Like you said, they're the ones who are footing the bill on this. They're taking their time, their energy, their money. They're doing their research. They have the patience to do the research, and they're freely sharing it with everybody, which is fantastic. So I think everybody. And we'll definitely link to that research article in the show notes that everybody has access to it. We might even be able to include it in the show notes since it is a free resource. So we'll make sure that that is available to everybody. So you can read up on what we're talking about. But yeah, I'm excited that, you know, I think the more of us that can provide free information and free, legitimate, standardized information, the better. Yeah. But I know as a clinician, it's tough and I've been asked to do research in the past and I'm like, in my spare time. Sure. So I highly appreciate those who do.

And having done a clinical research study with only four people, and I can't even fathom keeping data on the over a thousand that they have used. And that's what you need to have some kind of standardized measurement. So, yes, major props to all of the people that are out there doing the research. But then I also started to understand why we don't have research for everything. Because it's very hard. It's very different than what we do clinically. You know, and standardization that you have to have between clients, it's. It's extremely difficult.

Yeah, well, this is a whole other discussion for another podcast, but it just proves the point. You know, I made a post last week about, like, the cups that I recommend for feeding therapy. And I had one person ask, rightly so, but they said, well, where's the evidence based practice to support your stance against this particular cup or recommending these particular cups? And I'm actually creating a response that will go live this week. And so I have to record it still. But one of them is, look, clinical expertise is a form of evidence based practice. And if you sit there and you drink from one of these cups, and then you observe children drink from these cups, you can feel it, you see it, you'll start to understand the motor patterns required to drink out of some of these cups. And so if you have the Clinical expertise and knowledge to know what normal postures are. Normal drinking, swallowing, resting postures are, you start to realize which tools support that and which don't. Right. And these companies are not going to go out there and do individualized research studies. That's what we're up against. So I think when you have certain people in the field who do this day in and day out, I think you should open up your eyes and ears to be willing to hear what they have to say. Because a bunch of us, for example, used to recommend the 360 cup and now we go, oh, no, that's promoting a tongue forward posture. You have to bite and suck. Or there's like one of three postures that it. And none of them are typical postures that we want a child to be using. So. But yes, that just goes back to that whole discussion of, you know, not everything is going to have a research study to back it. And we have to put on our clinical hats and understand, based on a career experience what is going to be best supporting our long term or even short term goals for a patient or, you know, anyway. So that's my little soapbox on that one. Yeah.

And then even along those lines, then, you know, they could get both of those cups, they could do their own little mini assessment with a kid and they could look and see what you're talking about and say, okay, I see the difference between the two now. Now it's starting to make a little bit more sense. But you've got to have somebody put that thought out there first, you know, and that's, I think, the thing that is so amazing about orifice, Myology and even, you know, with the sleep medicine field, you know, with my own kids, I never knew about all this stuff. You know, I knew about the tongue thrust, I knew about the resting posture. But, you know, sleep medicine has opened up a whole new world for what my daughters are going through and have gone through since birth, which I didn't know. So you don't know it. You don't know what you don't know.

Exactly. And then once you do, you can't unknow it. So then you're really just go down the rabbit hole.

You just drive yourself crazy.

Exactly, exactly. Yeah. And that's funny you say that. I actually had my kids each like take turns drinking from those cups and I took video of them like very close up so I can share it online so people can observe what they look like. You know, obviously it's different than doing it in person, but I think that's a fantastic idea. Go and test it out with one of your kids or your patients and see, you know, the difference between the two because. And I think most people are pretty open to it in our space. Thankfully, most of them are like, wow, I never thought about that. Or, oh, is it okay as a transition thing? Well, I'd rather you not use something like that, but it depends on the case. Right. You know, we always have exceptions to the rule. So again, clinical judgment. I always encourage people use your clinical judgment because even a top tier, Level 1 research study is not always going to hold true for your patient that's sitting in front of you.

It's not. Because they might have six other things going on, like a tongue tie or an airway problem or hip ties or choking, gagging. God knows what they've got going on.

Yeah, there's always a myriad of things, and that's why clinical expertise is part of the EBP model. But anyhow, I know we went off on a little tangent there, but it's okay, you know, it's a good topic. Yeah. So let's pivot back to talking about Dr. Zaghi, because I think he's also come up with a really good term that I'm glad he put a term to it because it's something I've always thought about. But tongue space. Right. He talks about tongue tie versus tongue space and how there is actually similar symptoms for both. So let's go there.

Yeah. He did this at the American Laser Study Club. So this was back in February, and I presented there on the speech side of orificial myology. And then he came in and talked about what he's looking into now, which is basically the difference between tongue space and tongue tie. And, you know, and that we're so hyper focused on tongue tie, which we have all been, you know, and I think we still are. I've backed off on that probably within the last year anyway, because I always want to start with therapy first. Let's see what we can do. If we hit the wall and we can't go forward, then we can say, okay, there's something else going on. There's something else at play we need to look at. But he basically put up his slides for the tongue tie symptoms and then put up his slide for the tongue space issue. And it was exactly the same. There was every. Every bullet point was exactly the same. And it was. That was the lightning rod for myself, for my older daughter, who I've struggled thinking like, she doesn't have a tongue tie. You know, I don't see my younger one. Yes, the older one, I never saw that. But the older one, it was a tongue space issue. So I've got one of each. You know, I've got the tongue tie and I got the tongue space. And I'm thinking, this is insane. How did this happen? You know, But I didn't know back then. You know, I diagnosed her with a tongue thrust at 18 months, but I didn't know you. Everything that was going on with the airway. Just had a sleep study done by Ken Hooks, who does amazing home studies for her. Comes back, mild obstructive sleep apnea, just like the younger one with the tongue tie. So it's like, okay, here we are in the same boat with very different symptoms, different presentations, and different affects to their personality things. They respond differently. One has anxiety, one just is kind of moody. So you see the differences between the sleep issues, too. So it's just been. It's been eye opening for him to put that out there and for me to kind of be able to personalize it and make it make sense for my own kids, then that helps me clinically to be able to help my patients. And that's the best kind.

Absolutely. Yeah. And we've had him on the podcast, too. He's phenomenal. So that's. He's somebody you should definitely look into if you're looking for a home sleep study. Ken Hooks. And you can Google him on our podcast and find our episode. I never remember the numbers off the top of my head, but, you know, it's really interesting.

He did a great, great study presentation at the American Laser Study Club. Oh, my gosh. It was. It was incredible. What a great presentation. Yeah. He is a hands. McGee is his pointer on the. On the screen. And he comes. Oh, he's awesome. He's awesome. He's funny.

He's got a lot of little sayings, and, yeah, he's a great presenter. I highly recommend everybody make sure you. Everybody find Ken. Find Ken. Hunt him down. He's amazing. So, yeah, no, and talking about the tongue space thing, I love how you mentioned you like to start therapy first and if you hit a wall. And I think that's so important because obviously in my evaluations, I do measurements and, you know, they might be. They might appear tied, but sometimes I'm like, huh, we're kind of in this gray area. I'm not really sure if we need to do anything about this, if it's truly a tie or if it's, you know, let's See. And so sometimes I've even from the beginning, I recommended let's start with myofunctional therapy. Let's see what we can achieve. And usually for my patients, I feel like in about three to four weeks, we usually know, like, where we're headed. We usually know, like, if we're starting to hit a wall already or if they might, you know, be able to just kind of push through. And we might not need that tongue tie release or that consult for a tongue tie release. So I don't always send people right away as step two. The thing that I will do immediately is if I feel like there's a tongue space issue and they need some expansion, you better believe I'm going to refer you immediately before, and usually for me at. Before we start the myofunctional program, because I want them to go and get some expansion done first and make sure we've got room for that tongue up there. And so I just, I love how he has made such, what I've made such a complex conversation into such a simple term, tongue space. I'm like, tongue space, yes. It makes so much sense. But reading Dr. Felix Liao's book, you know, what is it? Six foot tiger, three foot cage, that was one of my initial, you know, that's how it introduced me to this concept. And just seeing that title of the book, I was like, oh, that makes so much sense. Like, yeah, duh. I mean, hello, why aren't we talking about this more? So I love how it's becoming a known thing and people are actually starting to look to see, wow, does the tongue actually fit up there? Because, gosh, why release a tongue and try to force it into the palate. If it doesn't fit, you're just going to continue on with the same symptoms even now that the tongue is released, because it has nowhere to go. So, you know, I love that and I love that you are starting mild before release and then also continuing it after, you know, the release is done as well. Because that's extremely important.

Yeah. And pleasantly surprised with some people that I would have initially, you know, over a year ago, something like, oh, yeah, let's, let's look at, you know, getting an evaluation for that frenulum. And they're surprising me at what they're able to accomplish, what they're able to do. And I know that even if we do have to go down that road, that they're going to be so much better off and we're going to have a better outcome because they can Stretch and they can suction and they can do the caves and they can do all these things they couldn't do and they have independent tongue strength now. And so I think it's going to, it's going to be even better. So our outcomes are going to improve because of that too. So it's a win. Win.

Yeah, 100%. I completely agree with that. I had, I made the mistakes of sending people who, you know, in my earlier days, oh, let's send you for a consult. And they, you know, and here, let me just give you a few exercises. And so they would do their little exercises and they'd have their relationship release a couple weeks later and then they'd come back and we would do the post op work. And I will tell you, the people who start myofunctional therapy who are not just given a set of, you know, one sheet of exercises that everybody gets because that's not myofunctional therapy, they are doing phenomenal. Like I, you know, getting that tongue suction, you know, to palate and even if it's shallow, but working through any tension and working through, you know, hey, we don't want to use our whole face, our neck and our shoulders to make that tongue cave or that suction, you know, it's like being able to teach them these things and getting more range of motion and you know, before we send them, if that is what they need. It's. The results afterwards are phenomenal.

It is, it has been much better.

It's making such a difference. So I'm glad to hear that you're seeing that too. Yeah. So I'm very excited about this whole tongue space conversation.

It really made a lot of sense to me. And he is doing, he said he is, this is like their new focus. So this is what he's looking at now especially because he does so, you know, sleep medicine is so big and that's his big thing is, you know, can the tongue fit in the palate? You know, is it a jaw issue? Is it a palate issue? You know, what is it that's affecting? Is it, you know, what's going on in the throat, you know, with the tonsils and the adenoids and so there's so many factors, you know, and again, of course, it all goes back to airway, doesn't it? So just very interesting. But I think it's, it's, it's really cool because we're, we learn something. I think every conference I go to, you know, everybody I talk to, I learn something from them. You know, and it's just one little piece here and there. But, you know, I was. I did, you know, my. We do. I do online MYO evaluations, too, and trying to do the measurements and stuff isn't always easy. So I figured out how to do many of them, but I'm constantly changing those report templates. Everything I learn, you know, I have in there. And, you know, of course, now they're up to like, 14 pages, but a lot of information that's good, but it is. It's overwhelming and all the things that you want to think about and look at, you know, but it is. It's good information and it's all diagnostic. You know, every little piece is diagnostic. And I think that's the great part about it.

Yeah, yeah. And that's part of the puzzle, too, is that it's. It's continuously diagnostic, right? It's dynamic. It's continuously changing. So you go from, you know, I have people who get really hung up, up on, oh, well, I couldn't get the measurements in my, you know, my evaluation. I'm like, that's okay. Because, you know, while it would have been ideal to get them exactly like we'll get the next time, or maybe they couldn't do it yet, and you have to teach them, and then we can get it. And then guess what? The first measurements you take when they're able to do it are probably very different than the measurements you take a couple months down the road. So it's all good. It's dynamic. It's ever changing. Like, we're constantly diagnostic diagnosticians, right? We're constantly gathering data because there's no one cookie. We say, there's not a cookbook recipe. It's not like baking where you go, we need a half a teaspoon of this and one cup of that. No. You're constantly looking at your patient every session and changing what you're doing based on how they present that day. And so it is. I think some people try to oversimplify the myofunctional therapy program, and it's really something. Look, everybody's got to start somewhere, jump in, get your feet wet, take the nose dive. But, you know, until you start, you're not going to be able to continue to mold your program and how you work with your patients.

So I think that's important that people need to understand that this is so fluid. And it's literally the information that comes out is literally changing every day. The more that we learn, the more that the Breathing Institute is putting out the more that all of the, you know, Dr. Siegel and Kotlow and all of them, Gahari, all of them, you know, they're learning too. They learn from every patient they see. So. And then they share that information, say, well, look what I found. I had a five year old that came into my office and could suction better than some of the adults I've worked with. I've never seen a five year old suction like this. Tongue tied release a year ago, you know, and I'm thinking, of course we got the allergic shiners, we've got the whole airway thing going on. But oh my, what a beautiful suction, you know. But still couldn't get a measurement because he wouldn't hold it long enough because of his age to be able to get the measurement. But at that point who cares, right?

Right.

I know his big problem is airway and but look how beautiful it is. And I'm thinking, wow, you're going to be a great myocase. You're going to be a great myofunctional therapy kid. You can already do this at five years of age. It's like awesome. So yeah, you would never expect that. That is the last thing I figured he would ever going to be able to do. And he can suction, but he can't pull air through his lips to make a kiss anymore. We have no lip strength, but we can suction.

Yeah. That's so interesting.

It is awesome to see it and to see that actually happen where you just think I'm never going to see this. And then two people within the last month that I've had that have upper buckle ties barely ever, ever, ever an issue and two back to back. And I'm thinking it's like when you.

Get a new car, right, and you go on the road and you guys, you all of a sudden start seeing that car everywhere and you're like, where.

Did these all come from? Yes. How are they all here? And I'm thinking, oh, there's usually a milk product. Oh, darn it. You know, I mean they're literally wrapping around the gums just like, you know, and I'm like, oh gosh, like here we go. You know, it is, it's like unicorns. The unicorns are here.

Things come in phases, you know, it's.

Like most amazing patients because they know their own body and they know what they're feeling. And so that's been really great. It gives them more buy in because they're not the ones sitting in the corner while I'm Doing all of it. They're the ones that have to feel masseters and they're the ones that got to feel the mentalis, and they've got to do the lip pull and they've got to, you know, they've got to figure all of it out. So I've actually had some better results, I think, online than I've had in person, because everybody's got to be involved and everybody's got to do it. And then, you know, typically in the office, the parents are in the corner trying to do all the things I'm making their kids do, saying, I can't do that. You know, am I supposed to be able to do that? Yes, you are. You know, and so now they're realizing how difficult it is for their kids to do it, you know, because they're feeling like, I don't feel anything on this side. I was like, they're like, I must not be feeling right. But no, you're feeling the right place. There's just no muscle activity on that side, you know, and so then it's like, oh, wow. But then as we go on and we do some exercises and we start to get some strength, they're not, okay, well, let's feel. Let's kind of do a little meaning.

Oh, my God, I felt it.

That popped out, you know, and then it's just amazing to them that they feel that progress and they see it or now the lips are really full, you know, now we see these beautiful lips that we had no lips before. And the parents have commented. I have one. She's like, look at her lips. They're just so beautiful. Every time we get online, she's like, they're so beautiful. I said, they really are. I was like, we need to get her some red lipstick, because that'd just be cool, you know. But it's things like that that you just don't even think about. And as a consequence of doing something like this online, that really changes things and gets people to understand really what you're looking for. Of course, the measurements is, you know, you can't do those, you know, so it's limited. But pictures, I've just grabbed screenshots. I put them in a PD in a PowerPoint, and then I can move them all around and still make my picture arrays, so I can do that. I've send out the cheek retractors so they can do that. You know, we. I've actually used. Have people use spoons, pull back with spoons. I mean, bite blocks. We're using cut up celery sticks, or we're using cucumber, and the kids love it because then they eat it. We can make them any size we need them to. So it's. It's just fun stuff like that that my parents have helped me figure out, you know, and I've had a ball with that. And I write all those things down that they figured out. Like, this worked, and we use these. And the bite blocks weren't working, or we chewed them all up. Now we had to come up with something else. I love that. Yes. It's been super, super fun.

Yeah. I love how you're using, like, celery sticks and just kind of whatever they have on hand. I mean, that's genius. Like, how fun. And that kind of also, I think, getting, like, the creative juices flowing around, like, getting them involved. Right. Like, how much more involved are they when they're like, hey, we've got our celery stick. But that's just fun. It brings, like, a fun little element to it. You don't have to. I mean, look, I always joke I'm the most boring online therapist because I do not pull up the boom cards, and I don't pull up all the fun games. Like, I am like, we are here for mayo. Let's do our mayo. And I need to see their face, so I want to see their face, you know, right in front of me. So I know there's therapists out there who do, like, some really fun, awesome things.

Well, I don't do those for mayo. I do those more for speech. But at the end, we typically play, like, Connect four or play Tic Tac Toe, you know, and that takes, you know, five minutes.

Some of my kids like to, like, write stories, so I'll open up the screen share, and they'll, like, start typing the story, or, you know, we do. We get a little fun, but we're not doing, like, a ton of, like, these games and things during our MYO sessions. And that's all I'm doing is, like, feeding in myo. So it's usually, for me at least, you know, my therapist. Yes. But not so much me.

But there's a lot to fit in in that time.

There is exactly anything. So that. That's why I'm like, wow. To bring in something like a celery stick as a bite blocker, it just. It kind of makes it a little bit more fun.

It does. And then they're like. And then I'm like, did you eat that? Didn't you? All right, where's the next one, you know, and then we make again, you know. Of course I knew they were doing it to do it anyway. But then I'm like, I'm all my like, oh my gosh, I can't believe you ate that.

I love it, I love it.

But it was good.

Well, and the other thing you said too is that you're finding one. It's kind of getting more of the family units buy in because now the parents are more active participant in feeling the face and just getting any measurements that we might be able to gather from them. And then also I've also seen that it's creating faster progress in shorter time. Which was so funny because I've had some patients who kept coming to me week after week after week. And I was kind of at the point where I'm like, all right, we're gonna have to have a conversation because things are not progressing. Are we not doing our homework? What's happening? We're of kind, kind of just. We've now been on repeat for the past three sessions. Like something's up. And then all of a sudden we had, we were forced into do our virtual sessions which I was already doing virtual sessions with other MYO patients. And so, you know, I was comfortable with it on my end. So I was kind of ready to just go, alright, let's go. We're just going to hop right into our next session and start working. You know, there was no really change other than the fact they weren't sitting across the desk for me. They were now across the computer from me. Me. And can I tell you, I dismissed some of these patients faster than I thought humanly possible because all of a sudden it was like, I guess they're focused on my face more even though they were sitting across the desk from me. And now that you know, family buy in and just family unit working together so beautifully. Holy cow, we made such quick progress. I was like, I almost don't feel like I should dismiss you yet because we've gone too fast and I am wondering if I missed something or if we're gonna have a little bit of regression here. So obviously we're gonna be doing our check ins and everything along those lines. But oh my gosh, to see some of them move online versus in person, it propelled them faster than I could have hoped for.

I think them having to stay home for three months, it was like they had to get the work done. Now we don't have extracurriculars, there's no sports, there's no cheerleading, there's no, nothing. You know, so I think that kind of in the grand scheme of things, for Mayo, it really helped.

Yes, that is true. That's a very great point. And you know, some of these kids are on their computers all day, you know, doing schoolwork and they're exhausted. So I. I was fully expecting it just to kind of continue as is because, well, they're still on the computer. They're still, you know, tired. But yeah, you're right, they're. They're not running. Like, they're not, you know, they're not up against all those after school extracurriculars every day. And that's a very valid point because I think that pure level of exhaustion from just everybody being over scheduled after school, you know, now they don't have all that. So that's. Maybe that had something to do with it. But yeah, I was just. I was so excited to see it because so many people are very anti teletherapy. And I was like, oh, no, no, no, no. Like, this is real therapy. We are making some really good progress. And I did a whole episode on it because I was just, even with my feeding therapy patients, so impressed with.

And I think I was impressed with my families and then our staff too. Just the way that they embraced going online and doing just speech and language. I mean, that has just been absolutely phenomenal, you know, that they. It's a learning curve. I mean, when you first do it, you know, it was learning curve for us, learning curve for the parents and, you know, and our families have been amazing and our staff has. And I've told them so often, I was like, I'm just in awe of every single one of them for being able to do what they did in such a short amount of time. It was literally overnight, like, okay, here's our new normal.

Yeah, I mean, it was great. It was so great. Crazy. My staff of my therapist. I have about like 23 therapists. Most of them are doing the online therapy. And only, I think three of us, one of me being one of the three, were previously doing teletherapy. And that was not our whole caseload. It was like a portion of our caseload. So to go from just that to everybody who wants online therapy. No, we did drop about 50% as far as our patient caseload because not everybody wants wanted to do teletherapy, but we have, you know, speech and language and OT and myo and feeding and so to see how all of that can so beautifully be done over the computer. And you know, again, especially with our Little ones. It totally requires more parent hands on, you know, all the things. And so it's been really fun, though, to work with our families and to see how much progress these kids can make. And we've had some. Some of our families are just like, wow, like, I never knew my child was capable of these things. So it's really cool to see that. That side of things too, I think.

I think some of them are gonna really want to stay with us long time.

I agree. Yeah. We did have some parents ask us, they're like, yeah, they're like.

This is really great. I don't have to leave the house, you know, and sit there and everything. And I was like, yeah, I totally get it. Yes, it is nice.

Yeah.

I was the only one in our office that was ever doing. I've been doing television therapy probably for, oh my gosh, 10, 12 years. So it's been a long time. But yeah, nobody else. So it was, it was a learning curve. Everybody was learning at the same time. You know, it was like the entire field of speech language pathology was learning at the same time. So at least there was just tons and tons of resources out there. So that. That was thankful. Yeah.

And, you know, that was one thing I really enjoyed seeing was at least the speech pathology community really pulled together. And I saw a lot of. Of resources come out very quickly on how to train colleagues on, you know, getting online if you're not comfortable with it, and, you know, lots of just free resources, you know, to use in sessions to keep up engagement for like the speech and link those. And I mean, it was pretty cool because I feel like sometimes we're really against a divide in our community. So it's nice to see when people do pull together in a time.

Pull together for the greater good.

Right, Exactly.

But on.

And here's another topic I want to discuss because I know we've kind of gone off on a teletherapy discussion, kind of bringing it back to the. And this obviously goes for anybody, any professional, not just my functional therapist. But how do you. Aside from educating professionals and courses and the podcasts and whatever else, what is your thought or expertise, I should say, on how are you educating professionals in your area on what we're doing and the. Really the information that's going to benefit all of us. Right. Like, how are we sharing information in this space?

And that's the thing we have to get out there because it's in my area in Burlington, North Carolina. It is literally been. I've said it for about five years it's literally been this bubble of like, la la la la la la la. Nobody wants to hear it, nobody cares, and don't say it. You know, I tried with my daughter's first orthodontist. That was a big bust. Tried with my second daughter's orthodontist, which is a new one because I didn't go back to the first one. That was a bust, you know, and then to the, to the east and to the west of me in Chapel Hill and in Greensboro, all kinds of interest, but in my town, no, no interest whatsoever. The baskets, you know, the pamphlets, the. Everything that I have done and just over and over and over again. And right before the world ended in March, I was invited to do a lunch and learn for a dental practice that is literally close enough to my office that I could hit them with a stone. And so I'm thinking, oh my gosh, this has finally opened up, right? And. And then the world ended. And, you know, but I will say it was great, well received. Just, you know, 45 minutes, an hour. And then one of the dentists called me during, like right at the beginning when everything shut down and said, hey, you know, that was really good information. You need to talk to the North Carolina Dental Society and you need to start providing continued education for dentists because they need to know this information. So it was, it was good. And she's like, we referring people to you. But of course, you know, we were shut down and shut down and so it's coming back. But I think the take home message is don't give up because you'll get, you'll open the door crack and when you do, you need to run through it. And so that's kind of what I'm doing now is now our dental practice were all closed down until this past week. And so now it's like, okay, I'm gonna, I'm going back over there and being like, hey, you know, you guys need more sanitizer? Because I had a bunch of that get them, you know, you need some more pamphlets. What do you need? You need cookies? You know, I made them cookies. So, you know, it's just ridiculous, stuff like that. But at least somebody's opened the door and it's taken a long time and I've had such great results, you know, in other areas. But I'm just really excited to be closer to home and start to get people to understand that there is value in all of this, you know, and getting them to understand and teaching them how to do these dental screenings for Airway, you know, that's a big thing, you know, and I give a little pamphlet, little screening tool that they, instead of having it where it's something they fill out, because that was something we got from the rdhs. Like, I don't want anything else to fill out. I've got enough to do. So I made it so they're laminated and they put them up at their station and there's, there's all the things that they can look for and all the signs and symptoms of some airway issues or myofunctional problems that they need to refer to us. So then that way it's always there, they can always see it. And as they see it more and more, it'll become more second nature to them. And it's not something they have to fill out and hand to the parent and all that stuff, but our information is on the bottom. So it's like, take a picture parents, you know, so they can take a picture of that. They've got all that information and then our contact information too. So it's just different ways we're trying to get the information out there. But, yeah, it is. It can be hard. You do run into a lot of brick walls.

Yeah, yeah. No, and I think I'm very fortunate because being in the D.C. metro area, I have my, my dental providers and, and it's been really wonderful working with them. We've had some orthodontists who actually reached out, who basically, admittedly, you know, some of these orthodontists are in their 60s or 70s, are like, well, I've been doing this my whole life this way, and I've never really figured out why, you know, why this happened. Right. Like why the tongue cribs didn't work for some kids and they can get their tongue up in front of it and still shift their teeth. And I'm like, well, that tells you something, right? Or why these, you know, patients are having orthodontic relapse. And so they've started to refer because they recognize, you know, that some, some patients really need myofunctional therapy. And so they reached out. And so it's just, I think you're right, like just about putting yourself out there and not giving up. Like, do not quit just because one no just gets you one no closer to a yes. Right. That's kind of how I look at it. And if you say no, then I'm not going to spend my time maybe right here with you, but I'm going to go find. I'm going to go talk to the next provider. And once I've gone through all the providers, if I'm still getting knows, then I'm gonna cycle back through again, you know.

Well, it's actually funny about that because the first, first orthodontist that I had for my oldest sold his practice to another orthodontist. And the second orthodontist was not neither one of them. The older guy wasn't really interested either, the first one, but the second guy, I was like, okay, some new guys, younger, you know, maybe we'll, you know, can get, get in the door here. Because the tongue crib, you know, way back when, I knew that wasn't gonna work, but they tried it and I was like, and I told you, tongue thrust going on. I do myofunctional therapy. And it was just kind of like, you know, it just felt well. Then, amazingly enough, one of my dentists in Chapel Hill was like, hey, do you know this orthodontist? Because he said he's interested in hearing about myofunctional therapy. It's my daughter's orthodontist, the first one. And I'm thinking, are you kidding me?

I was like, okay, well, it took.

Five years, but yeah, I'll go, we'll go, we'll do it. You know, I think the orthodontist, you know, they're, the dentist are key too, but the orthodontist, you know, and I think that's what I try to tell people. This is their bread and butter. And when they're realizing that something's wrong and starting to question it, thinking that I shouldn't see this kind of relapse or I shouldn't see these kind of problems or nothing's getting better or whatever. That's, that's, that's who I want to see. That's the orthodontist that I want. I want the one that's always questioning why these things are not working out the way they're supposed to. And it's typically, at least the ones we've worked with, it's typically personal. It's usually their own kids or themselves. We had some that had their own issues. And so once they start to realize that there's a connection between the teeth and the mouth and the airway, that's when they call us in. And I love that, and I love being able to go. And it's not like condescending. It's like, you know, colleague to colleague and, you know, let's figure this out together because I can learn so much from them, you know, and I need their information. You know, we were going to have a study group during all this time, you know, was an in person one and it was all going to be about the dental stuff. And then, you know, because we need.

That, you know, you could do it virtually. We're doing our spiritual tomorrow night.

We were going to try, but they, they just, the people that were presenting thought it would be better in person, so. And I agree, you know, I do sometimes, sometimes it's just better in person. So that's what they, they said, let's just wait and we'll, we'll do it. But I need that dental information. I just don't have enough of that, I think. So I love that they're willing to share that information with us as much as, as we are with them. So yeah, you know, we don't, I don't think as SLPs in our world, we collaborate as well as the dentists and the orthos do. Yeah, they have study clubs all the time and I just, we're finally getting one started, but there wasn't a whole lot of SOP study clubs even here.

Yeah, no, I don't even really know of an SLP study club.

That's a common thing in the, in the dental world to have all these study groups and these dinner clubs and all these things where these, these practice owners get together all the time and they're in their private practice, you know, so it's really awesome to see and I think it's a good model.

You make a good point. Because I invited a dentist who's out in California to be on the podcast. And he said, yeah, totally, absolutely. And then he said, hey, can I ask you for a favor exchange? Will you speak to our study club? And I was like, I would love to. And, and it's funny because, you know, my study club, I started it with my dentist locally and so we've got, you know, her, there's three dentists in her practice and they're all very airway centric and holistic. One is also has orthodontia background. And so they do like all. They have a myriad of appliances. They're not like a one stop shop. They're like, we put the appliance on the child or the adult that's right for that child or that adult. And if it doesn't work, we have other options. So. Which is what I love about them. But so she and I were like, we need to get together and like pull together. It was more so like this was one of our strategies for growing our team locally with hey, let's create a study club. Because that's something that people really are interested in. They want to collaborate with others. And so we got the 2pts that are in her office that do like modern counter. Modern counterfacial strain. No, I'm saying wrong counter strain, fascial counter strain. Like my brain is not working. So they do the bodywork on the patients, not just appliance patients, but really anybody who's in there. And they find that like dental work takes better when body work has been done. And it's really cool. And so I am a patient of theirs and so is my four year old. And so I've got my DNA and she's got her alf and we get, you know, I get adjustments every time I'm in there. She doesn't get the adjustments every time she goes in with like the bodywork, but I do. And, and it's just been, I needed it as an adult. Like I don't move anymore unless I have my, my body work appointments, you know, every couple weeks. But it's been so, it's been really cool because we had that. Plus we have an oral surgeon that we refer to, we've got a vision therapist that we invited and we've got some other dentists in the area that have been interested to learn about it. So we've had them come. You know, they may not be at every study club, but they come once in a while. And so, so it's been really interesting and really cool. We've also have our osteopathic couple, their team that they've come to, a couple of them, but they actually travel a lot to Germany to teach. And so they just got back from there. And so, you know, I was kind of, for us it's a little bit social. And then it's also, you know, sometimes we will get permission to discuss a case. So we may not all be on that case, but a couple of us might be. And so we'll bring in the case and we'll pass around like the computer with the pictures and everybody kind of gives their input. Well, hey, have you thought about it it from this perspective? Or hey, have you like what about this? Or wait, look, I'm seeing this like from the osteopath, you know, and then the PT and we're all going, huh, Nope, didn't realize that. You know, and so having all those different eyes with all the backgrounds, you know. And I know I'm leaving people out. We've had some other phenomenal professionals also join in, but me as the SLP feeding specialist, you know, certified orthopolic myologist, like, I bring those eyes. And we've had some other myofunctional therapist. Oh, we do have an RDH who always comes as well, who's an RDH comm as well. And so just having everybody at the table together is such. It's a cool experience. It's really nice to have all of those different eyes to be able to all look at one case together and discuss it together. But then also sometimes we just pick a random topic. Like, we actually had Dr. Liao come to one of our first study clubs, and he spoke to us about his book. And it was just really cool to hear him talk about, you know, how he got to writing that book and talking about some of the things in the book. And, you know, I think it's just study clubs can be. Can operate so many different ways. It could be a study club that reads a book and then you come and you have a book discussion, which is kind of how we started. And then we kind of went. We don't all have time to read an entire book between every time we meet, so let's. Let's pivot. And, you know, maybe once in a while we do that, but let's review cases or. Or if somebody has a topic that they want to discuss, propose the topic, and we can all come to the table and discuss that topic. So ours is kind of. It just changes from. And we haven't even picked our topic for tomorrow night. I'm like, sending out a zoom link, and I'm like, hey, guys, anybody want to propose a topic? I mean, we all just kind of, you know, and I think that's the nice thing because now we know each other, and ours is a smaller study club. It's more of our local team that does it. But it's nice because it's a little bit social and it's a little bit study club of, you know, let's talk about a topic and I'll further our information, you know, our knowledge together. So I kind of. I urge everybody, get out there, start a study club. You might find your team that way. And that's, you know, that was the whole purpose of me even sharing this, because I know just educating professionals can feel like you're hitting a constant wall, but if you pivot a little bit and say, hey, I'm starting a MYO study club, or, hey, I'm doing this, this, and this, you know, they Might be interested because. Because it's not you coming and saying, hey, I want you to change your practice, but hey, let's just talk about this from your perspective, from my perspective, and see where this takes us. So that's been really fun, but I will disclaimer. Everybody who started in our study club was already kind of in this space and was already interested in it. The one missing piece in our study club is an ent. We do not have a local ENT in our study club.

We don't have them in there. But we do have an ENT in my area, area that I actually took my own daughter to. So it was personal and professional as he sleep medicine and he's trained in sleep medicine. So I was like, okay, this is somebody I need to get to know. So went there to get a sleep study for her. And initially he was like, I don't really think we need that, you know, this, that or the other, and I'll go ahead and order it, but I don't really think it's really going to show anything. And well, it did. And he was. He was shocked. I will say he was a little shocked. I think I could tell that even the nurse was shocked. They were all shocked that it was like she was right. Like maybe she doesn't know what she's talking about, you know, but it opened the door, you know. So personally, I did it for that reason. But then I was like, okay. And I. Good Lord. He's probably so sick of seeing my name come across reports, but he's the only one, you know, he's the only one we got here and one that actually understands how important that airway is, you know. So, yeah, we refer people to them all the time. And even in these other areas where I go and we do the study group in Chapel Hill, which is about half an hour, 45 minutes away, I was like, well, there's one in Burlington. If you can't find anybody, you can always go here, you know. And so at least we've got somebody because that is the ENC is the hardest one to find. That is definitely.

We do have someone who's interested and I think is definitely getting on board. But at the point that I took my own daughter, we were basically brushed off. And I was like, he knew what I, you know, he knows this is what I specialize in. He knows I'm an SLP. He actually works with SLPs, and I think that he's well on his way. And I think there's some other people who've Been grooming him. So I, you know, it's time for me to circle back and be like, hey, we need to chat. Because I think, you know, I would love for him to be a part of our study club, be a part of our team. You know, just. It would be nice to have that ENT where we can refer and have that open discussion, because I think not every case is the same where, you know, if we're just looking at how they present five minutes sitting in a chair, that's not. That's not a fair evaluation of whether or not they need ENT intervention or further testing. So, you know, not that I want to send all my kids to the ENT and have them scoped or prodded, but if we're sending them, it's good. We have concerns. Right? Valid concern. And it was interesting because. Who was it?

Gosh.

Somebody recently just said it was on one of the Talk Tools trainings they recommended. Maybe it was Monica Purdy. I could be completely thinking of the wrong training, but she said, I don't send and ask them to look at tonsils and adenoids anymore. I send and I say, I have concerns about upper airway resistance, and I need you to look at. Look into their. Their airway and, you know, figure out where that's coming from. So basically saying, hey, this is there. Can you help me figure out what's causing it? Versus saying, hey, take a look at their tonsils and anoids and see if, you know. Because all the SLPs in the world probably are referring for adenoid assessments, and they're going. They're rolling their eyes when they receive this and going, okay, another tonsil and adenoid assessment from an slp. And so I think, you know, if we can come in with different language. And I was like, that is a genius idea. Yes. I love that. Upper airway resistance. Okay. Because now, you know, we know that not every person with sleep disorder breathing presents with sleep apnea or obstructive sleep apnea. Some of them have uars. And so I think that that is a term that is now starting to.

Come more to the forefront finally.

Yes. Yes. So anyways, I know we went off on various different tangents here. Is there anything.

They're all good.

Yeah. Is there anything that we didn't cover that you want to chat about?

I don't think so.

I think we.

I think we probably pretty much hit it. Although, you know, went off a little bit.

I think we've.

I think we hit all of them, which is. Which is good. But, yeah, the Biggest thing for me is really getting that standardized measurement, you know, and Dr. Zaghi's team and being able to share that information with all of us and anybody that wants to see it. And all the videos that he has online, I use those in my trainings all the time. And they are eye opening, you know, especially to share them with dentists, you know, to. For them to see, you know, people being literally just blown off when they have such severe sleep apnea, you know, and have all the signs and symptoms of all these problems that were obvious because of their dentition and because of their teeth, you know, and they start to start make those connections. It's really, it's really good. So I just love that information that is out there and being able to share that with whoever. And my parents, I give them those links all the time. Like, you know, you don't believe me. You know, here's this information. Go and watch. You want to watch an entire lecture that's like an hour long or two hours, go watch it all, you know, and some of them do, you know, some of them are very interested in that and they will do it. So I'm just so thankful that it's out there because it can open their eyes and even if they don't do something right now, we planted the seed and sometimes that's all we can do. Oh yeah. Many, many people that, it's like you're just, they're just not ready to hear it and that's okay.

Well, and sometimes they come back a year later and they're like, hey, remember that thing you told me about, a thing we discussed? Yeah, we're ready to do that now. And I'm like, okay, great, come on in. So I always say, and hopefully we'll come back now we got a bunch we have to meet our patients, our families, where they're at, and it may not be the right time for them. And it kills us as providers who are sitting here going, oh, but you know what another year might do to your orofacial structures and you're sleeping.

What's gonna happen to your face then? And I was, I was actually in one of the Facebook groups on either the baby's tongue tied support or the adults, I think it was the baby one and talking to a mom. And we went back and forth probably for, oh my gosh, I don't even know how many comments. She's posting pictures of her husband when he was little and posting pictures of her kids and everything. And he had the, you know, the downturn. Kanthi with the cheekbones that weren't. And mouth was open. And I. I said, I'm gonna say he probably either snores or has some pretty serious airway problems or sleep apatomia or has cpap. She's like, oh, my God, he snores like a Bridgewater, you know, so. And it just starting to click for her. And I said, okay. And the way back when in the comments, she said, well, you know, she looks just like her daddy. And I said, well, that's what everybody says. I said, but here's the thing. Dysfunction breeds dysfunction, so let's figure out how to stop it. And that's what I told her. I said, said, you're on the way to stopping this for your daughter. I said, think about that. You could change her life right now, you know, and start working on these problems now. I didn't have that opportunity when my kids were little. Now you do. Now you know what, you know, now that you didn't know 10 minutes ago, and think about the changes you're gonna be able to make. And so it's just. I love being able to get that information out there. And, you know, you can just make a difference in that one kid's life and that mom's life, because now she's thinking about all of her other kids.

Oh, yeah. And then maybe the husband is gonna go in too, next, right?

Yes. That's what I told her.

I was like.

Like, believe it or not, there's help for him too.

That's the beauty of it all. That was the whole reason why I started the podcast. I went to look for it. It didn't exist. I was like, oh, man, now I have to create it. But, you know, it was initially intended to be more of, like, a study club kind of thing. Like, let's get the information out there for providers and see, like, who we, you know. And I've had so many parents listen to it, Moms of babies and local and people who have come to me for treatment. And that wasn't even my goal. I was like, I am. Am busy with a waitlist. Like, I am.

Don't.

You know, my goal is not to gather more patients. My goal is to get information out there, free information for anybody who wants it. And so it's been a beautiful journey because I do think that it is reaching parents, and parents are sharing it. And if it helps, my goal is, like, if I can just help one person, I've done my job, and I've helped way more than that. And so, you know, it makes Me feel really good as a provider, because, like you said, we need to figure out how to get this information out there to professionals, to families. And the more info that's out there that is supporting these positive changes in people's facial structures and their overall health, the better. Starting at birth. I'm excited.

Starting at birth. And that's the trick. I had one family that came in that had a daughter, had a lip tie, and mom showed me the picture in utero, the lips open. Isn't that great? I. And you know, and we know. I mean, we know this stuff starts at birth. We know it starts in utero, but just to have it confirmed and to see it and you're just like, oh, my gosh, there it is. You know, it is. And nobody would help her. Nobody did anything about it. And she tried, you know, and it's just. It's so disheartening, and it's so horrible to hear those stories just time and time again. Although, you know, you do get the families in there and. And you're talking about all the things going on with their child. And then the mom is sitting there, just mouth as a gate, because she's like, oh, my God, that's me. And the husband's looking at her like, that's you. That's you. That's you. That's what they did. They just talked about the whole time, you know, like, that's you. Oh, that's your mom. Oh, that's your mom. You know, and so it's. They start to make the connections. Like those connections are coming. And I love that, because then they start to understand there's a reason for all of this. And they're. They're thinking, well, we went to so many different specialists, and nobody's put it all together because we're not talking about. None of us are talking. And that's what we're trying to change. We're trying to change that dynamic that we all start communicating. So then we don't just go here and here and here and here. We go here in the middle, where all of us communicate and get you the best help that we can get. So. And I think that's the part that's. That's really inspirational to get that information out there for them. So one person at a time.

But, hey, one person's better than none, right?

So here we go. I love it.

Thank you. Dawn, this has been amazing. I am so glad you were able to join us today. Appreciate all of your time and your information and sharing with us your experience. Both as a clinician and a little bit about your daughters too. So thank you.

Thank you. Appreciate it.

Thanks for listening to this podcast. If you want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts or pledge a small amount on patreon.com the Untethered podcast. If you found value, others you know in this space will too. So be sure to share this episode on your social media platforms and join us over on Facebook on my Facebook page at Halibulcan Biz, on Instagram at Alibulcan, and you can head over to theuntetheredpodcast.com to grab a copy of the show Notes and where you can also subscribe to be kept up to date on the latest podcast episodes.