HOLD-EXERCISE

Myofunktional Exercise  Collect ion

Application:

no illustration

This chapter gives a general description of a collective group of exercises and details which are sharing the here described facts.

The term ‘Hold’-Exercise intends to point out that a definite position has to be assumed and, consciously monitored, frequently maintained unchanged over a specific longer period.

Generally the exercises are prescribed to improve the endurance of the target musculature.

In Myofunctional Therapy they are utilised to practice the Stand-by-Position in the target area. For that reason they will be, in connection with the overall training plan, inserted in a late phase of habituation. One of the best known exercises of this group  should be KEEP-THE-POINT for the tongue tip.

Contents:

With these exercises it utterly is a matter of isometric and isodynamic actions which mostly are coupled with a feed-back stimulus acting as a REMINDER.

Materials:

Materials and methods serve as the control for e correct carry-out.

For the above mentioned feed-back stimulation exercise specific REMINDER are used to gain self-monitoring. Not rarely this will take place in the start phase of the respective exercise while in a later phase a change will take place to the physiologic feed-back stimulus arising by way of the existing sloop sensors as, for example, the surface contact in the above mentioned POINTPOSTURE for the tongue tip (see also remarks in paragraph “Discussion”).

Procedure:

- Previous exercises: Practically every HOLD EXERCISE needs a special pre-exercise. This, of course, will have to generate the textural conditions necessary to take up the particular position; further more demonstrate to the patient precisely which position is expected from him. For the example chosen, the TONGUE-TIP-ORIENTATION the exercise PROVE-THE-POINT would be chosen.

-Starting position: Here parts of or the complete concept of BASIC-POSITION may be prescribed to facilitate the periphery.

Generally the posture requested will be as well starting, as practicing and target position.

- Step-by-step-description:

-1 The patient gets a precise instruction.

     The posture to be taken up generally should be very accurate regarding spatial orientation and Hold-Tonicity. During 

    the joint training session of therapist and patient this will be monitored with meticulous precision to mediate to the

    patient the indispensable accuracy necessary for the at-home training (see “Discussion”).

-2 In an early training phase the patient will now maintain the prescribed position taken up, possibly under hand-mirror

    monitoring while counting up to a given number, mostly increasing during the training course.

-3 The at-home work-out is talked over precisely.

 REMINDERs in the form of self-made signs and prefabricated pictograms are appointed and a continuous monitoring signalized, in our example this would be the KEEP-THE-POINT.

-Timing: For the general timing within the training the total training plan see also notes regarding the exercise succession (“Material”); referring to the application of the exercise at home and over the day compare paragraph “Discussion”.

In respect of the timing for assessing the sequence or the arranging of a series it has been hinted at above that the Sequence length is defined by the counting – for the start short intervals, later on progressive, for example from counting up to fifty then by monitoring with a watch for five, ten, fifteen, thirty minutes (see remarks in “Discussion”).

Characteristics:

(Sensitation), Orientation, Motivation to self-monitoring, Tactile Aesthesis, Myobalance, Feed-back, Stand-by Position, Statics, mostly Fine Motor Skills but variable as well, in cases mode specific tone raising or relaxing (Manipulation).

Remarks:

It has been repeatedly hinted at in the text above that positions worked out through a HOLD-EXERCISE will generally be of a fundamental importance for the physiology of the area trained and, thus, have to be executed and monitored with highest precision.

Discussion:

As already discussed in “Material” the progress in the course of the training should lead away from the usage of materials and preferably towards functional conditions. This development can also be synchronised in the planning of the training through the succession of the respective and coordinated exercises, for example in the context of am INCREASE-ARRANGEMENT as, for example: RING LOCKER > POINTPOSTURE >  ,L’-POSITION. As far as the precision of the carry-out is concerned the therapist simply can not be meticulous enough. The patient will have to note only minimal deviations from the prescribed posture do mean to fail in a venture and the exercise should better have not been carried out at all as, now, a disorder will have been created knowingly.

HOLD-EXERCISEs and the respective Stand-by Position are acting on the textures involved over a long period of time and so have an enormous influence on the physiology or, rather, the pathology.

The HOLD-EXERCISE is not only practiced within a session or worked-out at home; it will be executed -more and more frequently over the day – later on becoming the ‘normal’ physiological posture.

The duration of the training sequence of the here homogenous and uniform training Phase should be extended speedily from the early counting out to ten, twenty, fifty, then over minutes, one, fife, ten up to an hours range. The training position will have to become the body posture! Appropriately the patient should get instructed about the placing of the exercises in the days run as, for example, ‘During the homework for school’, ‘during TV looking’, ‘while reading the news paper’ or the like. More over the REMINDER should be mentioned as helpful and agreed about their application.

A HOLD-EXERCISE is a constantly current task for the overall MFT-Training process. It deserves a constant monitoring, check-over, correction, advancement, admonition and motivating aid.

To increase the training requirements the REMINDER may develop its own significance.

The practicing of the ,M’-POSITION, the relaxed lip closure, may for example be performed using the exercise PLATELET-HOLDER. The platelet, a thin lightweight plastic wafer, rather serves as a REMINDER then as a training device:”You will immediately notice when it is falling down”!

To subsequently reinforce incompetent lip closure the training may be continued using a Jig (wooden spatula, tongue spatula, “ice lolly gripper”) which will advance a tonicity strengthening through its own weight.

An increase of the training intensity may be gained by prescribing an ALTERNATIVE EXERCISE which will have to activate the antagonistic muscle, as well this muscle may be additionally pulled during the practicing of the current exercise.

In our example this would be case with the HOLD-AND-PULL.

HOLD-EXERCISES are wide-range applicable as they are not only suitable for settling in the physiological “regular” posture in the target area but, at the same time, to activate a too weak musculature in its tonicity, to reduce a too strongly acting one as well as to counteract Hyperkinesis and Hypermotility (see  RELAXATION EXERCISES). Simultaneously on the sensory level Orientation and Sensitation will be gained.

When the exercises are pointedly applied for strengthening purposes the already under the viewpoint ‘tone raising’ discussed modi will be applied.

This will mainly be required if the muscular area concerned has to gain its ability to move within its physiological frame but will also be necessary if the stand-by tonicity is not gained.

For the mentioned diminishing solely the effect of habituation under customary training conditions will be sufficient which will also cause an adequate anchoring into the subconscious.

Besides the REMINDERs described for this purpose also additional measures as, or example, the TIMETABLES or MENTAL TRAINING may be used.

While the ‘damping effect’ is reached through the prescription of prolonged training phases strengthening is gained by the regular short sequences each session with the increasing counts.

At this opportunity we must remember that many exercises are executable in the two different modi, static and kinetic which is to say, that, under the special conditions of practicing may be counted to the here discussed ones.

The ensuing list of exercises reflects a selection only; a complete listing would be too extensive and confusing.

To allow an overview in regard to the contents of the exercises enumerated the names are followed by symbols with the following denotation :

K =   designed as Hold-exercise; these exercises are  

         Hold-exercises from their origin and carry-out.

M =   Mode as Hold-exercise; for these exercises are

          existing different execution possibilities one of 

          which is the Hold-exercise.

Mb = May be emphasized in the Hold-mode.

Me = Has an autonomous Hold-mode.

For the rough description of the target area of the different exercises:

N – for the musculature of the neighbouring regions of

       the orofacial area presumably head and neck;

O – for the orofacial region including the radial

       muscle tracks leading in (Perioral musculature);

W – Cheek region;

R – Oropharyngeal area;

S – for the muscles of the original stomatognathic

       system (Masticatory);

Z – for the tongue with its three thirds Z1, Z2, Z3.

LIST OF EXERCISES

OPEN AND CLOSE                              Mb     S

Adductor strengthening                         

ELEVATOR                                           Mb     Z3

Palatal version

BALLOON                                             K      O, W, R

Cheek region tonicity raising

WIDE GRIN                                           K      W

Buccinator

THREE-RING-EXERCISE                    Mb    Z

Palatal version

DRIVING SEAT                                     K      Z1 Motivatory

PODGY TONGUE- SLIM TONGUE  

Slim position                                          Mb    Z

SQUEEZE-A-FLAKE                            K       Z3 Palatal version

DUCKBILL                                            M      O Orbicularis

NECK SIDE STRETCH                        K       N   Head position

HOLD-AND-PULL                               Mb     Z1

oral diaphragm, Frenulum linguae

HOLD A MATCH                           

physiological rest position                   K /O, Z, Z1, S

DOGS GROWL                                      Ne      O Upper lip lifter

CAT’S HUNCHED BACK                     Me      Z catchphrase  

CHERRY MOUTH                                  Me      O Central part

,L’-POSITION                                         K       Z, (Z1)

,L-M’-POSITION                                    K      Z, O, S (physiological rest position)

,M’-POSITION                                        K        O, S (physiological rest position)

MASSETER EXERCISE                         K        S Adductor strengthening

GAPE                                                        K        S Mouth opening, Mobility

NAPE-DIALTOR                                     K        N Stretching

DIMPLE                                                   Mb      Z1 Mobility of the tongue surface

NOSEWRINKLING                                 Me      O Nose opening

,O’-EXERCISE                                         Me      O Central parts

UPPERLIP STRETCHING(active)          K        O    Tissue stretching

PLATELET-HOLDER                             K         O    Rima oris closure

TRUMBONE                                            Mb       W    Buccinator  

KEEP-THE-POINT                                  Mb       Z1

POINTPOSTURE                                     Me       Z1

RING LOCKER                                        K         Z1 Manipulation

LITTLE ROLE                                          Me       Z Transversal musculature

TRUNK-EXERCISE                                 Me       O

RESTPOSITION                                       K         O,S Night time habituation

CROOKED GRIN                                     Mb       O (Zygomaticus)

SLENDER TONGUE                                K Transversal musculature

FROZEN PLOP                                         Me        Z Palatal version

TIED-UP SACK                                        Mb        O Periphere portion

,DRAWER-IN’-EXERCISE                     K           S Mandible Stand-by position

SITTING-POSITION                                K          N   Upper trunk posture

TIP-PRESSURE                                        Me        Z

HOLD-THE STRAW                                K          O   Game exercise

CHEEKBUMP                                           Mb       Z   Sagittal musculature

WATER-RETAINER                                Me       Z1

TONGUE PROP                                        Mb      Z, S

TWO-RING-EXERCISE                           Me      Z1/ 2    

CYNICAL SMILE                                     Me       O  Downwards pull, mouth corners

Instructions: