RE: [phono-tx] lip strengthening exercises and speech

The effect of lip strengthening exercises in children and adolescents with
myotonic dystrophy type 1
Lotta Sjögreena, , Már Tuliniusb, Stavros Kiliaridisc and Anette
LohmanderdAbstract
International Journal of Pediatric Otorhinolaryngology
Volume 74, Issue 10, October 2010, Pages 1126-1134

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.

Keywords: Oral motor treatment; Lip force; Myotonic dystrophy type 1;
Dysarthria

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