DIMPLE

Myofunktional Exercise  Collection

Application:

to enlarge click picture

This exercise aims at the controlling or learning of an decidedly fine-motor detail step in the starting-phase of the proceed swallow reflex (see also the exercises in the listing under the SWALLOW- respectively ,1-2-3-EXERCISE’ in the paragraph “DISCUSSION”). This is , why it is used in the reorganization of this reflex after functional problems. (Anatomy: 1.2 , Area II, Page 18, presumably intrinsic muscles). (For further details see paragraph “Discussion”.)

Contents:

The exercise instructs the patient in the self-observation  an in training the respective fine-motor detail step. As a slow-motor exercise it rather belongs to the static exercises.

Materials:

Hand-mirror, small stick (skewer, tooth pick, pencil or the like).

Procedure:

- Previous exercises:

The orientation of the tongue-tip at the POINT should be approved. Subsequently this exercise may be placed in the program for training of the first tongue third. At the other hand the including of this detail-step in the end phase of the comparatively crude-motor swallow training should be considered. The general pre-exercises refer  to the arrangement chosen.

Special pre-exercises are not afforded, associated exercises are hinted at in the paragraph “DISCUSSION”. Worth considering the exercise KEEP-THE-POINT to be positioned in front in the training course. It might be helpful to give the patient a hand-mirror for self-control at the beginning.

-Starting position: POINTPOSTURE .

- Step-by-step-Description:

-1 The mouth opens the tongue stretching forward slightly, resting softly on the incisal edges of the lower front teeth. <all following actions will be monitored in the hand-mirror.

-2 The therapist taps vertically from above on the centre of the first tongue third with a stick.The patient is informed that an indentation is being created at this spot, the DIMPLE.

It might take some time for the dent to appear resulting from a reflex at the taped-on site.

-2b Now the patient will be tapping himselfe, generating the dent (initially hand-mirror monitored).

-2c (In later practicing the sequence will go from step 1 directly to step 2):

After the tongue gas been stretched out, hand-mirror monitored the DIMPLE is created without any help. The dent is , then, carried back- and upwards to the POINT and kept there fpor a short time.

-3 In A following pause the tongue may be loosened with the BAGGY TONGUE and then returned to step 1.

- Timing:

The training sequence is shaped by: “Tongue out” – “form a DIMPLE” – “go to the POINT” and “hold”. With “hold” it may be counted to ten. Recommendable are ten sequences to form one series. The mentioned tapping from step 2a/b is administered in a second beat.

Characteristics:

In the get-going-phase sensory ; surface sensibility, fine-motor, function exercise, motility, motivation, reflex training.

Remarks:

Sometimes quite an amount of patience will be required. Is the exercise needed in the starting phase of the reflex chain, a precise carry-out is requested.

Discussion:

The DIMPLE becomes visible on the surface of the mucosa of the tongue as an indentation of muscular origin . It is situated shortly behind the front rim of the tongue tip and – according to its size – in a regular distance to the rim. It is surrounded by a smooth circular bulge. This configuration can come into being through the special fine anatomy which is characteristic to the tongue surface, the cheek inner lining in the buccinators region and the prolabium of the orbicular region. Fine muscle insertions stream sometimes even hook-shaped into the covering surface distinguishing those from the common skin musculature.

As ALTERNATIVE EXERCISE arrangement the TONGUE CLICK is suitable, which, in contrast to the here discussed exercise is carried out in a rather kinetic mode. Exercises based more on a functional carry-out are: WATER-RETAINER and WATERCARRIER  From this point of view this exercise is recommendable for the latter.