DIAGNOSTIC EXERCISES

Myofunktional Exercise  Collect ion

Application:

list/catalogue

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

DIAGNOSTIC EXERCISES are applied in the diagnostic routines such as in the entry examination.

For this purpose common exercises from the catalogue are employed which are summarised in the schema further down. These are especially suitable to evaluate during an admission and assessment of new patients which muscles might be capable to fill their frame of action, and up to which degree.

From the results gained should depend the resultant planning, focal points and applications of exercises.

Contents:

The DIAGNOSTIC EXERCISES are largely as well applied as MFT-exercises which are described in the respective chapters of this exercise catalogue. Some of the muscle actions which are not suitable as exercises will be described in the annotations to the LIST OF EXERCISES.

The exercises reflect common physiological skills which in posture and function have to be controlled by the fit patient.

Incompetence and failure, subsumed on a questionary will allow a limiting down and diagnosing the kind of the disorder.

Materials:

Exercise specific (for the exercise descriptions also see paragraph “Discussion”).

Procedure:

- Previous exercises:

For this occasion no pre-exercises are practiced; the respective muscle action is described or shown to the patient (through animated pictures i8n the special chapter of this website or) by the therapist or auxiliary personnel.

-Starting position: Exercise specific but commonly not required. It is recommendable to induce an acceptable sitting posture on a Swiss ball or stools.

- Step-by-step-Description:

-1 The patient receives a hand-mirror and, following the questionary part 1, gets instructed to immediately imitate the very movements demonstrated with hand-mirror monitoring.

This self control by mirror is not mandatory.

In respect of the reactivity it is irrelevant whether the patient carries out the required muscle action spontaneously or under mirror monitoring.

If a mirror is used this should be recorded in the examination protocol.

-2 Success or failure should be noted down on a prepared questioner (see illustration). In a respective column an ordinary evaluation of the muscle action is recorded in terms of

Posture, Mobility, Motility or strength of the performance. Only the respective rubric is filled in being of importance for the very action. For a posture evaluation for example the Motility is insignificant while for the evaluation of the Motility the strength in performing is irrelevant.

The evaluation is not accomplished in a graded way but solely under the viewpoint of the muscle action being:

excessive (hyper’+’)

normal      (norm’0’) or

too faint    (hypo’-‘).

The next column in the preset questionary leaves room for annotations.

-3 Part 2 of the questionary, the evaluation of the tongue, lips and masticatory muscles is not carried out according to the above scheme. Here a more descriptive assessment is required.

-4  Part 3, the evaluation of the dental arches is directed by orthodontic view points.

-5 Part 4: The last for issues are to convey aids for the general feasibility of the therapy.

- Timing:

It is of material significance that the patient immediately after the instruction will try to imitate the muscle action as the validation will be deduced directly from the resulting performance.

Characteristics:

Documentation, diagnostic.

Remarks:

The results obtained are in any way relative in relation to the respective patient which means that they do not represent an absolute assessment.

Discussion:

The muscle actions / exercises are labelled by their usual common name as to make it easier for the therapist to convey the movement to be accomplished to the patient.

The exercises may be applied separately or in combination with diagnostic inquiries.

The questionary is a supplement to those report sheets discussed in:

Thiele,E.: Myofunktionelle Therapie in der Anwendung, Heidelberg 1992, Hüthig Buch Verlag, ISBN 3830401841 Band 2. There also measurements are applied and documented. It is left to the therapist – especially in part 1 – to compile documenting photos or video clips.

In the MFT the compiling of diagnostic information especially by measurements is quite limited. With the systematic acting out of the here described exercises and the diagnostic evaluation of their performance, though, it can be determined which muscles in what a dimension are involved in the disorder.

In this connection it shall be repeated and again pointed out that data measured in dyn erg or pond really are quite useless for diagnostic and therapeutic purpose as in our case not win and place are assigned to athletes but instead the harmonious, physiological and individual functioning of organ parts, subsystems or reflex chains or their partial steps have to be rated for their functionability.

The rating has to comply with physiology not with peak performance.

For the notorious tongue thrust it is quite irrelevant which muscular pressure in Kg it is carried out. Relevant will be solely the fact that the tongue tip, after a successful therapy, with the first step of deglutition goes to the POINT and further that the antagonistic control loop tongue versus lip pressure is balanced in equilibrium.

As already mentioned the repertoire of common MFT exercises has available a series of executions which address certain muscle tracks of the orofacial system in a characteristic functional manner.

These are listed up in the following scheme according to the muscle groups and explained with a short comment.

Annotations with the symbol ‘*’ are described in detail further down.

To give the therapist a basic version at hand this is saved and may be recalled over a Link.

Short description of Diagnostic exercises not being listed in the main catalogue as Myofunctional exercises:

-Blowing The Nostrils

This muscle action may further be of some use for promoting nose breathing. Quite often through continuated mouth breathing the Ala Nasi are narrow and seem shrunken.

Through a cognitive training the organ feeling and the attention of the patient are directed towards the breathing passage through the nose. It may be commented as an instruction that the nose should take up a position as if sniffing in an especially delicious smell.

Demonstrating and hand-mirror monitoring are recommendable.

– Nibble Rabbit

This muscle action especially aims at the muscle track leading in radially in the Filtrum region. It is commonly described as Musculus incisivus and lifts up just the very middle of the upper lip. This exercise is not described particularly as it has less relevance as a functional exercise. The patient gets the order to move the upper lip just a bit and pointedly so as if to imitate a rabbit.

With this muscle action which will support the Motility of the Orbicularis the lip is lifted slightly in a way that a very small opening of the Rima Oris will result exactly in the middle under the nose. This movement is repeated in its Up and Down frequently and repeatedly

- Aristocratic Smile

With this workout the part of the radial musculature of the Orbicularis is activated which is pulling solely outwards. The muscle action also may be applied for the Motility training. During the motion exclusively the incisors will get visible (not till the canines). The exercise is practiced in a similar way as the one described before.

-Dimple

The “cute little dimple” laterally from the mouth corners. The muscle action reveals the reagibility of the Risorius, the connection link in the chain of the “belt” muscles between Orbicularis and Buccinator.

Not rarely this muscle track is tensed too much and thereby not only forms the dimple – through the prominence bulging up in the inside of the cheek wall

as well the underlying premolars get under pressure and shifted or it leads to a gnawing at or tucking in of the cheek mucosa what as well has a negative influence upon the occlusion.

As an exercise it may perhaps be used if cheek or lip tonicity is to weekly assessed.

In this case also the movement is demonstrated by the therapist and imitated under hand-mirror monitoring.

It may be carried out as well in the Hold as in the Kinetic Mode.

- Contempt

To let hang or pull down the corners of the mouth.

This exercise, too, 9is less suitable as a therapeutic exercise as it rather appears in dysfunctions. To improve the Motility in the mouth corner region it may be applied in ALTERNATIVE EXERCISE in combination with exercises for lifting the mouth corners as for example the DOGS GROWL. In the carry-out the mouth corner is moved as far as possible solely down without straining the “belt muscles” Risorius and Buccinator.

- Defiance

This action demonstrates the ability of the Mentalis to lift up the chin tip propping up the tissues on top. This, then, lends the region a defiant appearance. This action, again, is quite frequently performed as a dysfunction (Grimacing  Swallow) and, so, does not appear in the exercise catalogue. In its physiologic posture the chin tip has to be lowered the chin skin on top smooth and without longitudinal or diagonal skin folds.

Regarding the Mobility both extremes, the down pulled, flat chin and the upwards protruded chin tip must be workable.

The motility is assessed in a fluent change between both positions, the general strength by the decisiveness the movement can be performed with.

- Taut Neck

This muscle action can be observed frequently with sudden strength demanding tasks as sporting feats. In order to stabilise the skull the Platysma is jointly strained, thus tensioning the skin of the neck between clavicle and bone margin of the Mandibula making the neck appear stout in the front.

In its physiological frame the muscle supports the frontal stabilisation of the head in the close state of the mouth posture which means in a synergism strung together with the Orbicularis (while the Mandibula adductors not necessarily get involved).

A straining should well be possible but generally the region should stay discreet.

- Lower Lip Moistener

Generally the patient should be made give up lip licking as a dysfunction. In cases of restricted Mobility the tongue tip can be caused to run around the lip margin or, as in this exercise, to slip to and fro from corner to corner of the mouth or, in the static mode, just dwell on the middle of the lower lip.

- Foot Mat

Here again is a muscle test which is not appropriate as an MFT exercise as the tongue low position represents a malposition.  An exception would be the tendency to push the tongue in protrusion between the rows of the teeth. In those cases the exercises could be used as a relaxation method.

In this case the patient would be asked to, as far as possible, keep off  from straining any muscle of the tongue but put it as flat as possible down on the mouth floor just like a foot mat.

Here quite well fibre tracks get tensed – the vertical – creating the impression of not tensioning.