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Samenvatting Spraakstoornisen: Myofunctionele stoornissen
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Samenvatting van de cursus en de lessen omtrent Myofunctionele stoornissen
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Hogeschool GentSpraakstoornissen
Myofunctionele stoornissen
2021 -2022
,Inhoud
1.1. Orale myologie ...................................................................................................................................................... 5
1.1.1. Spieren van de faciale expressie ................................................................................................................... 5
1.2. Basiskennis gebit ................................................................................................................................................... 7
1.2.1. De tanden ...................................................................................................................................................... 7
1.2.2. Tandontwikkeling en tandschikking .............................................................................................................. 9
1.2.3. Occlusie ......................................................................................................................................................... 9
1.2.4. Malocclusie ................................................................................................................................................. 10
1.2.5. Op de tand uitgeoefende krachten ............................................................................................................. 11
1.2.6. De orthodontie ............................................................................................................................................ 11
1.3. Oraal-sensomotorische ontwikkeling ...................................................................................................................... 12
1.3.1. Ontwikkeling in de perinatale periode ............................................................................................................. 12
1.3.2. Ontwikkeling in de postnatale periode ............................................................................................................. 14
Orale motoriek – relaties tussen voeding en spraak ...................................................................................................... 16
2.1. Oroffaciale myofunctionele stoornissen.................................................................................................................. 17
2.1.1. Wat zijn OMA / AMG?....................................................................................................................................... 17
2.1.2. Oorzaken van myofunctionele stoornissen ...................................................................................................... 17
2.1.2.1. Centrale stoornissen ........................................................................................................................... 17
Door vernietiging van bepaalde delen in de hersenen kunnen bepaalde functies uitvallen of slecht functioneren
→ diverse oorzaken ................................................................................................................................................ 17
Deze stoornis komt voor bij onder andere: ............................................................................................................ 17
2.1.2.2. Ontwikkelingsstoornissen ................................................................................................................... 17
2.1.2.3. Somatische factoren: .......................................................................................................................... 17
2.1.2.4. Psychische factoren: ........................................................................................................................... 18
2.1.2.5. Erfelijkheid .......................................................................................................................................... 18
2.1.2.6. Orthodontische behandeling .............................................................................................................. 18
2.1.2.7. Andere AMG........................................................................................................................................ 18
2.2. Types van myofunctionele stoornissen ................................................................................................................... 18
2.2.1. Zuiggewoonten ................................................................................................................................................. 18
2.2.1.1. Duim- en/of vingerzuigen .......................................................................................................................... 18
2.2.1.2. Lipzuigen / liplikken.................................................................................................................................... 20
Tongzuigen .............................................................................................................................................................. 20
2.2.1.3. (Fop-)speenzuigen...................................................................................................................................... 20
2.2.1.4. flesvoeding t.o.v. borstvoeding.................................................................................................................. 20
2.2.1.5. gevolgen van zuiggewoonten .................................................................................................................... 21
2.2.2. bijtgewoonten ................................................................................................................................................... 21
2.2.2.1. nagelbijten ................................................................................................................................................. 21
2.2.2.2. bijten op potloden en andere vreemde voorwerpen ................................................................................ 21
1
, 2.2.3. habitueel mondademen.................................................................................................................................... 22
2.2.3.1. oorzaken van mondademen ...................................................................................................................... 23
2.2.3.2. gevolgen van mondademen....................................................................................................................... 23
2.2.4. Afwijkende tongplaatsing in rust ...................................................................................................................... 24
2.2.5. tongpersen = infantiel slikken ........................................................................................................................... 24
2.2.5.1. classificatie van afwijkende slikpatronen................................................................................................... 24
2.2.5.2. oorzaken infantiel slikken .......................................................................................................................... 25
2.2.5.3. prevalentie tongpersen .............................................................................................................................. 25
2.2.5.4. gevolgen van tongpersen ........................................................................................................................... 25
3.1. Myofunctionele stoornissen .................................................................................................................................... 26
3.1.1. Inleiding............................................................................................................................................................. 26
3.1.2. Observatie ......................................................................................................................................................... 26
3.1.3. Anamnese ......................................................................................................................................................... 26
3.1.4. Onderzoek ......................................................................................................................................................... 27
3.1.4.1. Onderzoek op functieniveau (functies en anatomische eigenschappen).................................................. 27
3.1.4.2. Onderzoek op activiteitenniveau ............................................................................................................... 28
Behandeling – oraal myofunctionele therapie: .......................................................................................................... 30
Volgorde van behandelen ........................................................................................................................................... 30
1. Afleren van afwijkende mondgewoonten .............................................................................................................. 30
1.1. Aanpakken zuiggewoonten ............................................................................................................................. 30
Gedragstherapeutische aanpak .............................................................................................................................. 30
Materiaal: ................................................................................................................................................................ 31
Behavioristische benaderingen: .............................................................................................................................. 31
Gebruik van intra-orale apparatuur ........................................................................................................................ 31
1.2. Bijtgewoonten: nagelbijten, bijten op voorwerpen........................................................................................ 32
1.3. Behandeling van (habitueel) mondademen ................................................................................................... 32
OMT (oraal myofunctionele therapie) .................................................................................................................... 32
Gedragstherapeutische aanpak .............................................................................................................................. 32
Gebruik van een oefenagende en reminders ......................................................................................................... 32
Gebruik van technische hulpmiddelen ................................................................................................................... 32
2. Correcte tongpositie in rust aanleren ..................................................................................................................... 34
3. Alveolaire slik aanleren ........................................................................................................................................... 34
3.1. Behandeling van tongpersen .......................................................................................................................... 34
OMFT (orale myofunctionele therapie) .................................................................................................................. 34
De face formertraining ............................................................................................................................................ 37
Het inzetten van myofunctionele trainersystemen ................................................................................................ 37
Specifieke traningsprogramma’s en materialen voor OMFT .................................................................................. 38
4. Verbeteren spraak (alveolaire articulatie) .............................................................................................................. 38
2
,5. Automatiseren van aangeleerde patronen ............................................................................................................. 38
3
, Spraakstoornissen: myofunctionele stoornissen
− SMG = schadelijke mondgewoonten
− AMG = afwijkende mondgewoonten
1. Inleiding
Afwijkende mondgewoonten
Duimen (Habitueel) Mondademen
Infantiel slikken Flesvoeding / fopspenen
Gevolgen
Malocclusies Kaak- en verhemeltestructuurafwijkingen
= open beet = hoog / gotisch verhemelte (smal en hoog)
= opening tussen bovenste en onderste tanden
OMFT (= oraal myofunctionele therapie): effectiviteit?
Doorheen de jaren veel controverses effectiviteit Oraal MyoFunctionele Therapie:
− Ene groep laat zich positief uit over de positieve uitwerking van doelgerichte spieroefeningen in het OFG
− Andere: stellen de myofunctionele therapie in twijfel. Baseren zich op uitspraak van “Joint Committee for
Dental and Speech Pathology uit 1974”.
JCDSP: onvoldoende wetenschappelijke evidentie
− Dat er een causaal verband is tussen tongpersen en open beet
− Dat er onderscheid is tussen normale en abnormale slikpatroon
− Dat er een causaal verband bestaat tussen slikken en occlusie
− Dat myofunctionele therapie effect heeft op slikpatronen en mondvormen
JCO in 1975
− “A speech pathologist may conduct a study on tong thrust with regard to speech, but not with regard to
orthodontic effects. That is only within the orthodontists province and we do well to keep this in mind.”
(Hoofdredacteur Journal of Clinical orthodontics)
o Strijd tussen verschillende disciplines barst los
o Bepaalt de functie de vorm of bepaalt de vorm de functie? → is het bv infantiel slikken het gevolg
van een afwijkende vorm van mond / kaak? Of is de afwijking van mond / kaak het gevolg van een
afwijkende functie?
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