MULTIMEDIA

Myofunktional Exercise  Collect ion

Application:

The contents of this chapter does not contain a description of a single exercise but gives a summative comment to the exercises and methods.

The methods applicated can be divided in three classes of  use:

Documentation – A neuro-muscular status (static or kinetic) is registered in a specific way and, thus, is analysable, fileable and reproducible.

Instruction – (Information) The neuro-muscular situation is vividly described to the patient – either to prove a disorder or to demonstrate the correct process.

Motivation – The annotations are used to gain a better therapy acceptance or to design the course of therapy in an interactive program.

LIST OF METHODS

Hand-Mirror

- The most simple and efficient method (see also chapter HANDMIRROR) shows the muscle action to the patient during his practicing. In the initial stage a better instruction about the actions to be carried out and about their realisation can be obtained.

During practicing the effect to be obtained can be compared to the presently reached.

This method is quite sufficient in the Myofunctional aspect, moreover, with the aid of the mirror the patient may be directed to dysfunction caused modifications at the structures in the oral cavity (Information, Motivation).

Pictures   

As described in the chapter MEMO prefabricated or by the patient self drawn pictures may remember of the desired task or inform him through the drawing of essential exercise details. This is offering some mental help (Motivation).

Palatogram

- The manipulated course of movement in combination with the photographic documentation is mainly supporting diagnosis. In connection with the hand-mirror it may as well serve an instruction and motivation (about this also see the special chapter ‚PALATOGRAM’).

Blacklight

- The special form of the method described under ‘Palatogram’ is designed to have its influence through the special procedure. An essential detail is the fact that the colour paste is only visible under UV-light and lights up (requiring a UV-light source).

Plaster Jaw Models

- The plaster casts of the jab bows will show characteristic deformations of the dental arches.

Comparison of models gained in monthly intervals will allow judging the therapy progress.

This may cause some motivation besides a precise documentation of the therapy progress.

Photographs

- Photographic pictures can help to demonstrate the correct features when showing them on a respective model, at the other hand they are, taken from the patient, of use as documentation to show the state in distinct therapy phases.

This, too, will gain a certain motivation effect. Moreover hints are possible on alterations of the structures in the Cavum Oris caused by dysfunctions same as with the hand-mirror.

Instant picture photos

- These images primarily function as documentation of contemporary states. As they are immediately at hand hey may be used as instruction during practicing as “Still wrong” or “Much better”.

Hints towards dysfunction caused alterations in the mouth are possible same as with the ‘Hand-mirror’.

Electronic data recording

-This method may replace all above mentioned imaging methods including the hand-mirror and video-clips and could be preferred. Also animated drawings are included in this chapter as they are, for example, demonstrated in www.myonet.de in the Diagnostic Exercises, Demonstration.

Acoustic recordings

- Here two categories will be considered, those dictated on a sound storage as instructions which may guide the training outside the consultation. Here also special orders can be given as formula for the Mental Training especially in preparation for the night-time habituation.

Moreover acoustic information saved from former sessions, for example articulations   can be referred to and compared with actual ones or they help to avoid mistakes in the present training phase. With defects in the sound formation (as for some exercises with an acoustic effect as TONGUE CLICK, GIDDY-UP' , ,ZIP’-EXERCISE ,  and similar exercises) presently gained recordings may be displayed to induce a sort of feedback effect to the present stage and the aim envisaged. Computer aided evaluations provide a graphic analysis of, for example, different sound frequencies in a correct and the actual articulation for correction or analysing the fault.

Video clips

- The methods described before are static and record a short decisive moment of the muscle action. Saved clips give an insight into a flowing movement. Key sequences can be

analysed in standby mode or Slow Motion. Computer aided evaluations allow a graphical analysing. Simultaneously operated acoustic recordings effect the comparison of muscle

action and sound formation. The method is especially recommendable for research purpose but, is suitable as well for documentation, motivation and instruction. In the latter case

this would gain a didactic clip (information). (About this also see paragraph “Electronic Recording”). This can also be drawn up as:

Animated Drawing.

This can be described as a sketch refined to the essential outlines. The desired course of motion will, then, be demonstrated in the kind of an animated cartoon. The method serves

as a motivating instruction and can be combined with acoustic information (Information, Motivation), (About this also see paragraph  “Electronic Recording” and examples on the

internet page – see below--).

Interactive Programs

 - Some of the methods described above may be used in combination as teaching programs saved on data carriers ands handed out to the patient as they are, for example, are shown in the www.myonet.de , Diagnostic Exercises, Demonstration. They can be used as instruction material for the home training (and as well be played in the training sessions). Such a program is showing actions, asking questions which can be answered with the keyboard our mouse and even allows acoustical comparison with the simultaneous use of a microphone (see above, Information, Motivation).

Intraoral-TV-Camera

(About this also see paragraph “Electronic Recording”). Indications  to dysfunction caused alterations on structures of oral cavity and pharynx as mentioned in paragraph ‘Hand-mirror’ or colour markings as in ‘Palatogram’ can be demonstrated in this manner to the patient.

Glasfiber probe TV  

For example using a nose probe will result in pictures about muscle actions in the pharyngeal space which can be recorded, demonstrated during the training and, thus, regulated through special instruction.

Stationary X-Ray Recording

Especially through the orthodontic methods of copying a photo into an x-ray picture dysfunction caused hard tissue alterations can be recorded and prove positive changes with compared photos.

Digitalized cinematographic X-Ray recordings

With this technique motion sequences can be recorded especially from the mandible in the respective muscle actions.

When moving points get a radio dense marking also in this case the computer aided evaluation a graphic analysis.

Nuclear magnetic resonance tomography recording

The molecular structure of tissues can be polarised under the influence of a magnetic field. Is the polarisation revoked oscillations are sent from the texture which give a picture of the tissue when recorded. This resembles an X-Ray photo but implicates no radiation exposure.

Using contrast medium will gain additional effects so that, for example, the position of the tongue body or of the throat musculature can be depicted under distinct functional conditions.

This method especially suitable for diagnostics.

Sonography

This method resembles in certain aspects the before described in its results. Here, instead, the ultrasonic oscillations, modified through the textures are recorded. Certain difficulties are existent in contrasting tissue borders. On the other hand, with this method it is possible to record cinematographic shootings. In this manner functional or functionally deranged motion sequences of muscle actions can be documented.

Magnetic Field Probe

The fact that magnetic fields are influencing each other resulting in a modification of current and becomes measurable trough this fact is turned to practical use. A mounting frame fixed to the head of the patient mostly holds three coils each representing one space coordinate. A second coil in miniature size with a cable fine as a hair is adapted at the test site in the mouth. The measured values which result from the relation of the coils towards each other again are evaluated computer aided and graphically depicted.

 So also with this method multiple otherwise not visually accessible regions can be inspected in respect of the movement flow.

Sensors

Similar to the above described magnet probes other sensors can be used  which transfer an information received as light, temperature or contact via cable as an electrical change to a recording and –again computer aided – draw up a diagram.

 These finally described method all are quite expensive, diagnostically valuable and especially for research purposes very useful. They can be combined and, thus, provide revealing information abut motion sequences of visually not observable sites.

Motography

This method is known from investigation of fast motion sequences of machines but also of sportsmen. It is suitable for locations which can be inspected with the eye, for example, to record fast happening fine motor actions in the region of the Orbicularis, cheeks and chin or the mandibular movements. When the snapshoot is taken with the instant-picture camera the result is an immediately available way-time-diagram. The system works on the basis of marking several spots at sites to be investigated. These spots are caused to flash simultaneously in a certain precise beat of fractions of a second so that the light pulses follow the motion sequence resulting in a chain of dots on the recording (photo).

Similar diagrams are generated when the respective points are recorded by an electronic camera and computer aided transformed to diagrams. Besides diagrams as well three-dimensional pictures of the body examined can be generated as standing or as moving pictures.

These methods are extremely storage capacity intensive and so might be reserved for hospital or research.

Myo-Scanner

Main part of this instrument is a probe which is transforming the pressure it is exerted to into electrical pulses which are indicated on a meter. The probe is adapted in a way to record the pressure exerted on it by the tongue tip or the Masseter myogaster (MASSETEREXERCISES), the lips in closed Rima Oris or the dental arches set upon each other. Problems are arising at one hand in how to fix the probe, on the other, to classify the measuring unit. The results obtained deliver a vivid comparison to those reported I earlier sessions and will, thus, document a therapeutic progress and, again, prove a motivating capacity.

Spring-Balance

A measurement to be carried out very easily in connection with the exercise TUG-OF-WAR is employing a spring balance with a drag pointer. With this measuring device the force can be identified which is generated to keep hold of a button of defined size with the lips against a force trying to pull it out. As this muscle action does not refer to functional exposure the values measured should be seen in relation to the overall strengthening of the Orbicularis.

The method is easily reproducible, uses a common determinant and has a motivating effect in treatment. The balance can furthermore be used as a training device.

Metric Comparison Measurements

This procedure is well suited for documentation as well as motivation for dysfunction caused alterations of the teeth position. A positive modification of Overjet or Overbite, Diastema formation  and the like can be easily determined – like with plaster jaw models (see there) – with little expenditure and high precision.

Tonometer

Here the air pressure in the oral cavity is determined .A small tube of drinking straw size is held between the lips and connected to a pressure gauge. Readings are taken in the common dimension of Millibar. The quantum of air pressure is caused by the strength of the lips in closing the Rima Oris against air seeping out and the strength of the Velum for the pharyngeal closure against the force of the buccinators and Diaphragma Oris to raise the pressure. Through a drag pointer the measured values can be recorded. Comparison to earlier gained data allows the evaluation of therapy progress. The device is easily handled and may be used as a training device. (See TONOMETER EXERCISES), (See also special chapter on the Website www.myonet.de).

Computer aided Evaluation

As mentioned above in the description of several apparatuses the recorded movements can be presented graphically on a monitor through a computer calculating program as moving diagrams, sketches or 3D pictures.

If moving points are set into relation with static ones many motion sequences can be analysed.

Within this subject the analysis of very fast running fine motor sequences within view or not visual field are of special interest.

Discussion:

If the idiom MEDIA has the meaning ‘means of information’ the hand-mirror might be the most simple and even for children at any time usable equipment. The presently widest spread tool surely is the EDP camera. Generally it is integrated into the treatment unit (dentist, orthodontist) and therefore can record probe shots within the oral and nasal cavity.

The technical progress, indeed, has put quite a number of partly quite costly tools to our disposal with which the qualifications of relevance of documentation, safeness in respect of its application of the measure, accuracy of measurement in the evaluation of results and being based on standard measures or reproducibility are more and more matched.

It must be acknowledged that by this the effectiveness of the therapy has increased.

As the recorded muscle actions can be evaluated with computer aided methods more precise comparisons or more complaint specific therapy prescriptions, case history relevant documentations and moreover diagnostic detail findings are now available. So computer aided movement analysis offer insight into detail processes which have stayed hidden even with speeded up motion picture methods.

It bears, though, some drawback that the new electronic special equipment is quite costly therefore are rather appropriate  as hospital utensils so that in the daily clinic we will have to fall back on more simple methods and means or look for cooperation with those institutions.