I thought the reference below might of interest to the group for a couple of
reasons:
1. Strength only improved for some of the participants and this is a
population for whom there is documented muscle weakness (not necessarily the
case with children with SSD).
2. They suggest no carryover to speech which supports what many of us
have been saying – if you want to improve speech, work on speech.
- Peter Flipsen Jr
===================================
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The effect of lip strengthening exercises in children and adolescents with
myotonic dystrophy type 1
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Lotta Sjögreen
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Corresponding Author Contact Information,
<mailto:lotta.sjogreen@vgregion.se> E-mail The Corresponding Author, Már
Tulinius
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_userid=489297&md5=0631bd58a3fba09f0fc02c609b42cbd1&searchtype=a#aff2> b,
Stavros Kiliaridis
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Anette Lohmander
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_userid=489297&md5=0631bd58a3fba09f0fc02c609b42cbd1&searchtype=a#aff4> d
a Mun-H-Center Orofacial Resource Centre for Rare Diseases and Division of
Speech and Language Pathology, Institute of Neuroscience and Physiology,
Sahlgrenska Academy at the University of Gothenburg, Box 7163, SE-402 33
Gothenburg, Sweden
b Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska
Academy at the University of Gothenburg, Sweden
c Department of Orthodontics, Dental School, University of Geneva,
Switzerland
d Division of Speech and Language Pathology, CLINTEC, Karolinska Institute,
Stockholm, and Institute of Neuroscience and Physiology, Sahlgrenska Academy
at the University of Gothenburg, Sweden
Received 1 March 2010;
revised 21 June 2010;
accepted 23 June 2010.
Available online 16 July 2010.
Abstract
Objective
Myotonic dystrophy type 1 (DM1) is a slowly progressive neuromuscular
disease. Most children and adolescents with DM1 have weak lips and impaired
lip function. The primary aim of the present study was to investigate if
regular training with an oral screen could strengthen the lip muscles in
children and adolescents with DM1. If lip strength improved, a secondary aim
would be to see if this could have an immediate effect on lip functions such
as lip mobility, eating and drinking ability, saliva control, and lip
articulation.
Methods
Eight school aged children and adolescents (7–19 years) with DM1 were
enrolled in an intervention study with a single group counterbalanced
design. After three baseline measurements four children (Subgroup A) were
randomly chosen to start 16 weeks therapy while the others (Subgroup B)
acted as controls without therapy. After 16 weeks the subgroups changed
roles. During treatment the participants exercised lip strength with an oral
screen for 16 min, 5 days/week. Lip force, grip force (control variable),
and lip articulation were followed-up every fourth week. At baseline, after
treatment, and after maintenance, the assessment protocol was completed with
measurements of lip mobility using 3D motion analysis and parental reports
concerning eating ability and saliva control.
Results
Seven of eight participants improved maximal lip strength and endurance but
only four showed significant change. Increased lip strength did not
automatically lead to improved function. There was a wide intra-individual
variation concerning speech and eating ability within and between
assessments. The treatment programme could be carried out without major
problems but the frequency and the effect of training were affected by
recurrent infections in some.
Conclusions
Maximal lip force and lip force endurance can improve in school aged
children and adolescents with DM1. Improved lip strength alone cannot be
expected to have an effect on lip articulation, saliva control, or eating
and drinking ability in this population. Lip strengthening exercises can be
a complement but not a replacement for speech therapy and dysphagia
treatment. A prefabricated oral screen is an easy to use tool suitable for
strengthening lip exercises.
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