Specialist helps children improve their speech

BLUE SPRINGS, Mo. -- Christine Keele needed help for her son. The 10-year-old had a lisp that wouldn't go away. The word "see" would have a "th" sound to it.

He underwent seven years of speech therapy, but the lisp didn't improve.

The boy was referred to Mary Billings, a speech-language pathologist in Blue Springs. Since February, Billings has helped him make great improvement in his speech, Keele said.

"Mary is a true blessing to have in our lives," Keele said.

Billings quickly diagnosed the boy as having an orofacial myofunctional disorder. It's a condition related to the normal and abnormal use of the muscles of the lips, tongue, jaw and cheeks and palate.

Orofacial myology is a condition that the public rarely hears about.

"There are not a lot of people in the area who know we exist," said Billings, who is the owner of Billings Speech Pathology Services in Blue Springs. She is a state licensed speech-language pathologist with 27 years of experience. "There is not a wealth of information regarding this issue like other well-documented conditions."

She went through training to teach the program and now is wrapping up her certification that requires extensive research and writing and on-site observation. When she earns certification, Billings will be the only speech pathologist in Missouri to be specialized in orofacial myology.

In some cases, dentists or speech pathologists not trained extensively in orofacial myology believe they can treat the problems. Dentists and orthodontists commonly will refer a person to a professional like Billings because they have noticed structural facial problems during examinations.

The disorder is usually caused by incorrect moving of the tongue, as was the case with Keele's son. It's called tongue thrust, when the tongue moves between the teeth.

Recent research examining the disorders in various populations have found a prevalence of anywhere from 38 percent in the general population to 81 percent in children exhibiting speech/articulation problems, according to the International Association of Orofacial Myology.

In order to treat orofacial disorders, Billings has the patient perform oromuscular exercises to strengthen facial muscles, she said. She calls it "oral muscle motor training program." There are 75 oromuscular exercises and each patient requires different exercises and treatment method.

Billings also works with adults who have gone through life with myology who didn't know they had it. They experience problems like difficulty swallowing and choking on food and drink and slurred speech. One patient she's treating has a problem with orofacial muscle problems and wakes up regularly gagging and coughing.

"We have to reteach them how to properly swallow," she said.

Billings said people with orofacial myology continually breathe through their mouths. When you breathe through your mouth, the tongue rests downward in the mouth instead of on the roof of the mouth, where it's supposed to be positioned. The downward position of the tongue over time may cause orofacial problems.

The tongue is the strongest muscle in the body per square inch. Every time you swallow, you're pushing 6 to 8 pounds of pressure on your teeth. You swallow an average of 2,000 times a day. The pressure alters orofacial muscles that can lead the condition.

"Some people can get by (breathing through the mouth) and it's never an issue (with the condition)," she said.

During proper swallowing, the tongue should be touching the roof of the mouth to relieve pressure on jaw and lips and lower gum line, all which are strained when the tongue is incorrectly positioned.

Being an orofacial myologist is an integral part of Billings' job as a speech pathologist but it isn't a separate profession. She underwent extensive additional training to become specialized in orofacial myology.

Treatment is covered by insurance coverage on a case-by-case basis. If there's a medical procedure like removal of tonsils and myology is needed afterward, coverage is usually provided, Billings said.

But to prevent treatment, parents can take steps to reduce the risk of their children acquiring the condition. Billings said children should be off the bottle after 1 year old. Eliminate the use of sippy cups and straws. Rather, have the child drink from a normal glass. Prevent the child from sucking his or her thumb.

Usually, Billings has to work with the child and adults for numerous treatments before speech patterns improve. Keele's son is progressing and demonstrating carry-over from the treatment into conversational speech, but has a way to go, Billings said.

"Elimination of lisps is a long-term project for all children, but especially so for older children and adults because their neural motor pathways for speech have already been set," she said.

Keele's son, whose name she didn't want to reveal, said he has made "tremendous progress" in the six months of therapy with Billings.

"Spoken from a mother's heart, when your child isn't making progress any longer and his feelings get hurt or he feels degraded from not being able to do something, you feel that pain with your child," Keele wrote in an e-mail.