Frequenty Asked Questions:
1. What is an orofacial myofunctional disorder (OMD)?
An OMD is a functional disorder of the facial and tongue muscles. Structural deviations may be present such as a short frenulum (the tissue which connects the base of the mouth to the tongue) or other tethered connective oral tissue, such as a posterior tongue-tie. Other areas in the mouth commonly associated with short or tight connective tissue include either sides of the buccal cavities or at the junction of the gums and upper/lower lips. When the tissue is too tight, it may inhibit proper function and range of motion of the affected muscle/tissue. With an OMD, common signs, symptoms, and indicators include the following: Decreased tone/strength of the tongue, decreased range of motion in the tongue, prolonged thumb-sucking or pacifier use, a forward tongue-thrust, obligatory mouth breathing, snoring, a high-narrow palate, poor oral habits, dental alignment issues, breastfeeding or feeding issues in infants, and tethered oral tissue (TOT) impacting normal function of the tongue posture at rest, during swallowing or feeding, and proper tongue or musculature movements. Adults, children, and babies who have a tethered oral tissue release, may continue to experience difficulty with their breathing/feeding/speech musculature movements if they have neglected to re-train the muscles to function properly. After the release or surgery, the motor plan/programs must be addressed as applicable in relation to eating, feeding, drinking, and speaking by establishing correct tongue posture and movements. Working to increase oral discrimination/awareness, lingual tone/strength, and improving range of motion for proper swallowing patterns - both before and after surgery - are all essential for a successful outcome.
Therapy may focus on increasing proper function and integration of the suck-swallow reflex (for infants under 4 months old) or the chewing reflex (for infants over 4 months old), both of which are necessary for proper breastfeeding or bottle feeding before and after tongue-tie surgeries or TOT revisions. Compensatory patterns and tissue abnormalities develop long before birth! Tongue-ties may develop at 7-10 weeks gestation. When TOT's remain undiagnosed, they may negatively impact facial development, breathing patterns (open-mouth posture/primary mouth breathing vs. nasal breathing), tongue function, dentition, sleep patterns (including potential snoring/future sleep apnea), and feeding/swallowing patterns.
I am passionate about helping parents by providing education on how to work with their babies' facial, jaw, palate, and feeding development. Significant growth occurs with your baby's oral musculature during the first three months of life! (See the diagram below).
2. What is myofunctional therapy? What are pre/post frenectomy or tethered oral tissue surgery exercises?
Myofunctional therapy includes exercises and stretches that re-train the tongue/speech muscles to have proper posture, proper strength, adequate range of motion, and correct coordination during eating, speaking, breathing, swallowing, and at rest. Much like physical therapy is indicated to improve muscle strength, tone, and coordination following a musculoskeletal surgery, myofunctional therapy is critically important following a frenectomy or tethered oral tissue procedure. Therapy works to improve tongue/oral musculature strength, tone, and coordination, all of which are necessary for proper breathing, eating, sleeping, and speaking in coordination with correct tongue movements. As humans, we swallow almost a thousand times per day; to function properly, the tongue muscle has to remain strong and not thrusting forward against the teeth! Over time, improper tongue movement can negatively re-shape/re-form the position of the teeth and palate if the tongue is not re-trained.
3. How do I know if I could benefit from speech therapy?
I am able to determine areas of concern by conducting a thorough speech-language assessment in which I evaluate key areas which can impact speech-language, as well as the function, strength, and structures of your speech musculature that is necessary for proper communication, feeding, and language/speech development. Qualifications for speech therapy treatment may vary; clients typically qualify with a private speech therapist at a higher rate compared to most school districts, because qualifying factors include quality of life outside of the client's academic performance. When working with school district students, however, qualification for speech therapy is determined by the Washington or California state standards (as applicable) for speech-language disorders, which focuses primarily upon whether the student's educational performance is adversely impacted in the classroom by their speech/language disorder.
4. Do you offer packages or do you charge per session? How do I pay?
I have packages for the Tongue Tips, Tiny Tips, and Thumbs up! programs, as well as the pre/post tongue-tie or tethered oral tissue surgery programs. Additional sessions may be purchased following completion of programs if needed. All speech-langauge therapy sessions and evaluations will be billed individually. School districts will be billed monthly with an invoice; please contact me for contract bids/information/rates. For private pay clients, please contact me for rates.
5. Do you take insurance? Do you provide superbills?
I am currently a private-pay provider. I may add a limited number of insurance companies in the future, but that is yet to be determined. Currently, I am considered out-of-network with insurance providers, but I am happy to provide a superbill for you to turn into your insurance provider for possible reimbursement of services. Each client is responsible to call, verify, and send all paperwork to their insurance companies.If you have a flexible spending account (FSA), you may be able to use it to pay for speech therapy. An FSA sometimes allows you to set aside a portion of your earnings (before taxes) to pay for eligible medical expenses like speech therapy services. Another option is to look into local grants/scholarships. I do provide superbills for each session with the therapy codes.
6. How do I set up my client profile, schedule, and attend therapy?
Please call for a free 15-minute phone consultation. From the home page, click the pink "Book initial 15-minute phone consult" button. Following our phone consultation, if I determine that an evaluation is needed, I will send a welcome email in which you will set up your username/password in my secure client portal. From there, you will fill out the consent forms/intake form/demographics/and your payment information for Stripe. I will schedule your first evaluation. When it's time for your evaluation, you will log into your client portal and click on the "start meeting" button. Following your evaluation, if you qualify for speech therapy services, I will set up a treatment plan with individualized goals. You will now be able to schedule your treatment sessions through your client portal. At the time of treatment, you will go to your meeting link and enter my virtual waiting room where I will admit you into the session.
7. What about missed appointments/cancellations/technical difficulties?
PLEASE NOTE: It is important to have a good internet connection, working video capability, and proper sound in order to conduct virtual speech therapy. If you experience technical difficulties, please use the chat box or call(509) 998-5015.
Emergency cancellations will be accepted with less than 24 hours notice for the client's illness or illness of an immediate family member (see Sick Policy below), death of a family member, medical emergencies, car accidents, and other emergency situations beyond your control. Please notify Brittany Hageman, MA, CCC-SLP as soon as possible. If requested, please be prepared to provide a note from your doctor for emergency cancellations.
Please notify Brittany Hageman, MA, CCC-SLP with Coastal Myofunctional & Speech Therapy by 9:00 a.m. on the day of your appointment if the client wakes up sick and is not able to participate in the session. Cancellations due to illness after 9:00 am will be considered a missed appointment and will be charged a cancellation fee equal to the full session fee. If requested, please be prepared to provide a note from your doctor for cancellations due to illness.
If you cancel or otherwise miss three sessions in a row, you are required to pay the three sessions missed at the full treatment cost. If you know that you will be away for two weeks or longer, please inform the office at your earliest convenience to avoid discharge from therapy. If the therapist has not heard from the client for 30 days, the client will be dismissed and will have to set up a new evaluation if they wish to return to speech therapy.
Late for Appointments:
If you are late for an appointment your session will conclude at the regularly scheduled time. If you are more than fifteen minutes late for your appointment, it is office policy to consider it a missed appointment (see Missed Appointments above) and it will be cancelled. The full treatment amount will be billed to the client. For technical difficulties due to the client's internet connection, video, or sound lasting longer than 15 minutes, the session will be cancelled and the client will be charged the full treatment amount. If the technical difficulties are on the therapist's end, the therapist will make-up the missed time at no additional charge to the client.
If the therapist is not able to attend the session, you will be contacted as soon as possible. Please be sure that the therapist knows the best way to reach you. Every effort will be made to reschedule your appointment in a timely manner at no additional charge to the client. If the therapist is late for your appointment, you will be given the full session time or the therapist will schedule another time to make up the lost minutes, at no additional charge to the client. Brittany Hageman, MA, CCC-SLP with Coastal Myofunctional & Speech Therapy regrets any inconvenience to your personal schedule that may arise.
8. What are the benefits of teletherapy?
Teletherapy can be highly effective and it is a lot of fun! I have nearly a decade of experience working virtually with clients from preschool through high school. Teletherapy creates opportunities otherwise not available to many people seeking speach/language or myofunctional therapy. This is especially true for clients living in a rural setting for whom an extended, long distance commute, could create an undue burden. For those with a packed daily schedule, the ability to conduct sessions from the comfort of their own home, can make a huge difference. I work with clients of all ages via teletherapy and my clients enjoy the video feedback/virtual activities. As a professional, I have personally noticed that clients are motivated by the interactive activities and clinical games that I use to target their goals. I also use videos for visual cues and feedback. Having the video feature in therapy, has been beneficial to my students due to the visual cues that it provides with certain goals that are being addressed.
Children learn more effectively when they are engaged and are having fun! My goal is to provide treatment that carries over into a variety of settings, as I teach your child how to develop self-awareness skills with their therapy goals.
9. How long will I be in speech therapy?
The length of time depends on how motivated the child or adult is, the severity/type of the disorder the client has, how consistent the client attends therapy, and how often homework or skills are being addressed at home. I will be happy to provide feedback to you regarding ways to implement therapy strategies at home. The length of the client's treatment plan varies according to their individualized needs.
10. What ages do you work with?
I work with clients of all ages, from babies to adults. I enjoy all ages and we can discuss if teletherapy is right for you!
11. What if you determine that speech therapy is not needed or appropriate?
I will refer you to a provider who may be more appropriate (If applicable). I love transparency and I will give you my professional opinion about what recommendations are best for your individual case.
12. Do you give homework and how do I help my child/teen if they have a speech-language disorder?
I love giving simple, functional, and creative homework or stretches to help with your progress. I have listed a number of at-home strategies, beneficial tips, and resources for specific speech-language concerns (see "Further Education & Resources" below).
FURTHER EDUCATION & RESOURCES
Articulation/sound disorders (how children make the sounds):The following chart contains the age at which children aquire speech sounds in the majority of the population: https://www.asha.org/siteassets/practice-portal/speech-sound-disorders-articulation-and-phonology/consonant-age-of-acquisition.pdf*See below for a visual chart showing when children typically master specific sounds.Phonological processing disorders (patterns of sound errors that children exhibit during speech acquisition):Typically, speech sound pattern errors are eliminated by age 3. For example, children who make the back sounds in the front of their mouths such as /k/ and /g/ will turn into /t/ and /d/. All children will most likely produce these errors as they acquire speech/language, but they will eliminate the patterns as they learn the correct sound patterns. See the following chart from ASHA:https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/selected-phonological-processes/Tips for Artciulation and Phonological disorders:Be positive with their progress! You can hang up pictures with the target sound/s in the bathroom and practice each time they brush their teeth by saying their words with the sound/s as they watch their tongue and lips in the mirror. Model the sound correctly when the child makes the error by having them watch your mouth as you say the sound. Use a mirror as they brush their teeth to talk about how the sounds are made in the mouth. Play games such as "I spy" or a sound scavenger hunt with the target sounds/words/sound patterns (back or front sounds), starting with the target sound or a certain speech pattern first. Once the child masters the sound, work on words with the sound in it, followed by phrases, then sentences, and finally at the conversation level to encourage carry-over in all speaking environments. For phonological patterns, target sound patterns such as /k/ and /g/ for the back sounds, /t/ and /d/ for the front sounds, /l/ for liquidization errors, and fricative sounds such as /s/ and /f/ or affricates such as /ch/ and /j/ if the child is stopping the airflow. Sound error patterns occur when the child substitutes the sound for a different sound. During a speech evaluation, I am able to determine if the disorder is a sound pattern issue or if it is a sound production issue. I can inform you with what sound pattern errors occured if applicable.
Voice disorders (Vocal pitch, quality, flexability, tone, and loudness):
Voice disorders can occur as a result of a pathology or vocal abuse. Regarding pathology (Example: vocal nodules, etc.), a doctor or an Ear Nose and Throat (ENT) doctor will be able to assess the condition. If the child has a voice issue, such as vocal hoarseness, it could be due to poor vocal hygiene. Encourage the child to stay hydrated!
Encourage an extended period of vocal rest (have the child read a book, etc.) each day. Have the child avoid yelling, clearing the throat, making loud play sounds, whispering loudly, or excessive coughing. Address possible underlying environmental exposures or factors such as allergies, chemical/smoke exposure, and dust or allergen exposure.
Model correct "inside voices" during play and encourage the child to close the gap with anyone they wish to speak to. If the child is older, have a day when the child rests their voice using written communication.
Practice deep breathing and ease into speech using "inside voices".
Stuttering/Fluency:Stay positive and supportive when children are speaking. They have many thoughts and feelings they wish to communicate.
Avoid interrupting your child; let the child finish speaking before answering. Do not complete the sentence, even if there are stuttering events or intermittent silence. I suggest not putting them on the spot, because this can cause stuttering events to increase. Try to encourage your child during a relaxed time at home (fluency time) to stretch out difficult words using "stretchy slow speech" like a slinky toy. Encourage the child to take a deep breath and ease into speech with relaxed lips/jaw/speech muscles. Try practicing short phrases and taking a breath after 3-4 words with reduced speed. Model relaxed speech when you notice the child is speaking too fast or having a hard time with fluency. When the child is in the middle of stuttering, refrain from correcting them. Instead, try re-phrasing what they said by modeling smooth or relaxed speech. When the child is nervous or feels put-on-the-spot, stuttering can increase with increased tension.
Be patient when they are speaking and give them time to communicate in a relaxed or non-pressured setting.
How to help your child speak or communicate at home:
Go to this ASHA page on their website, click on your child's age, and ASHA will give you a free resource that will explain what is typical speech-language development with the appropriate speech-language milestones: https://www.asha.org/public/speech/development/chart/
Keep your language simple and label everyday actions during routines at home. For example, during bathtime you can say or model words or phrases such as "Pour water", "Water in", "Water out", and "duck is swimming". Try to use a variety of nouns and verbs to increase exposure to the words. Introduce baby-signs to increase communication and decrease frustration when the child has a hard time saying the words. Research indicates that using baby-sign language increases their knowledge of vocabulary words and how to use them in sentences. Start with functional baby signs such as: "More", "All done", "Milk"/"Drink", "Please", "help", "Thank you", and different food options that you can work on during snack time or meals. As you go through your daily routines, speak to your child about what action you are doing and the names of objects so that your child can hear the vocabulary word. For example, "I am pouring the water." "I am stirring the soup." "Shirt goes on." "Wipe...Wipe...wipe". Using simple phrases as you describe what you are doing will help increase their vocabulary knowledge and will model the use of the word in English (or other languages as applicable).
Use music and play for words that describe color, texture, actions, prepositions, and nouns. Tape pictures of common nouns/objects around the house onto the items using pictures with the written word on the picture, to increase the beginning of learning early literacy skills. Play music with children's songs to help teach inflection/pitch/prosody, because it engages the right-side of the brain.
During play, use a toy which requires the child to request additional pieces. Begin with signing "More" or the first part of the word "m" and reward/praise them for each verbal or signing attempt to communicate. You can add choices that describe attributes such as: "big/little", "blue/red", "cold/warm", and "soft/hard". Make play-time fun!
Give a choice of two items during play or daily routines. Hold up the two choices and have the child either say the item or the first sound. Reward the child immediately when they attempt to speak or sign. You can start with having two pictures of the items and have the child hand you the picture of the requested item. As they hand the picture or say the first sound of the word, you can expand their vocabulary by adding simple words. (For example: "Ma" for more, you can say: "You want more______. More ______ please.")
When reading to your child, verbally point out nouns or verbs in the picture. Ask open-ended questions about each page, including a variety of who, what, where, when, and why questions.
Receptive (how language is understood) and Expressive (how language is used in spoken or written language) disorders:
Work on re-telling stories after reading to your child by using a visual graphic organizer likethis one from Presto Plans
or this one from Simplified Speechie for WH (Who, what, where, and why) questions. You can find both for free on Teachers Pay Teachers (please do not sell or copy any copyrighted material, but can find free material). To sequence a story and increase comprehension, encourage your child to write simple sentences using a journal or sentence strip to increase the use of correct grammar. Role-play social situations to increase pragmatic langauge skills and make a social story book about difficult social situations.
Myofunctional therapy/Tongue-ties or tethered tissues:
Complete the myofunctional home exercises that are given when you sign-up for the programs that address OMDs. Also, talk to your dentist or orthodontist about treatment options for remediation of tethered-oral tissue. The stretches done before and after a frenectomy, may help improve the healing outcomes/function of the speech musculature. I recommend a book calledTongue-Tied: How a Tiny String Under the Tongue Impacts Nursing, speech, feeding and more by Richard Baxter, DMD, MS and team. I also would recommend the personal kit for myofunctional therapy called MYOwn Tool Kit https://orofacialmyology.com/product/myown-tool-kit/
See also https://myomunchee.com/Feeding difficulties:
I offer suggestions for breastfeeding strategies and feeding strategies based on the child's specific needs. If there is a sensory concern, please talk to an occupational therapist for further resources. There are many feeding strategies that I use from my favorite feeding book called:Feed Your Baby and Toddler Right: Early eating and drinking skills encourage the best development Paperback – Illustrated, May 31, 2018 by Diane Bahr MS CCC-SLP CIMI (Author). I also love using the Chewy Tubes by Talk Tools to help integrate chewing reflexes. You can find them and other resources at the website for Talk Tools: https://talktools.com/collections/feeding-tools
*For all other disorders and adult concerns, go to: https://ashacertified.org/
I have experience working in skilled-nursing facilities with a variety of disorders including: Brain injuries, dementia, dysphagia, voice disorders, and aphasia.
The below sound chart is from The American Speech-Language-Hearing Association (ASHA) and it shows the average age of acquisition for each specific sound (where the bar starts), as well as the age of 90% of kids who have mastered the sound (where the bar ends on the line). For example, the average client masters the /t/ sound at age two, and 90% of clients have mastered that sound by age six.
Below are pictures of the different classes of tongue-ties. The picture on the right is after a tongue-tie laser revision surgery. The diamond-shaped wound will appear and performing stretches may prevent scar tissue or re-attachment. It is imperative to follow through with the after-care following laser tongue/tissue revision surgery to promote proper healing the first time. Speech therapy can help with re-training the tongue or tissue to gain the correct posture and function when at rest, during breathing, speaking, swallowing, when latching for breastfeeding, and during bottle-feeding. We swallow approximately 1,000 times per day, and the tongue can push 4-8 pounds of weight against the teeth. If a tongue-thrust is present, the pressure over time may move teeth or can cause maloclussions/issues with the shape of the mouth. Therapy can also help a baby to learn the correct suck-swallow or chewing pattern needed for proper feeding. Symptoms of a tongue- or lip-tie during feeding include: Frequent feeding, colic, nipple pain, shallow latch, milk on the back portion of the tongue, clicking sounds during breatfeeding or bottle feeding, frustration during feedings, a weak suck-swallow, poor lateralization or protrusion, and decreased cupping/coordination of the tongue. Sometimes, weight loss may occur with a baby if the tongue-tie is impacting the movement of the tongue during feeding sessions or if there are other feeding issues/latch issues that are preventing effective feedings.
For further questions, please book a 15-minute consultation.