UNRAVELING TOT's

FUNCTIONAL ASSESSMENT AND REMEDIATION OF TOT's

(TETHERED ORAL TISSUES)- 

two days workshops,  4-5 march 2022

presenting- LORI OVERLAND (Talk Tools), ZOOM platform

Tethered Oral Tissues (TOTs) is the restriction of the frena or frenulum, which are small
folds of tissue that connect bone to tissue and support or limit movement. While not a new condition, the term TOTs was coined by Kimberly Benkert, RDH and later by Dr.Kevin Boyd in 2014 to describe restriction of the frenula in the tongue (ankyloglossia),lip (lip-tie) or buccal frena.

There are many “hot topics” about treating TOTs ranging
from the need for surgery to whether or not pre- and post-op care is necessary. Lori
and Robyn have done extensive literature review on TOTs and have collected several
years’ worth of clinical data in preparation of this course to explore these controversies and focus on an evidence-based approach to treatment.

This course provides participants with a “task analysis” of TOTs interventions, based on
Robyn and Lori’s theoretical foundation that the oral sensory-motor system cannot be
separated, and therefore when TOTs is diagnosed the impact on movement impedes
the way the person processes sensory information for feeding and speech. Any
movement in the body can be broken down into smaller motor units, and Robyn and
Lori have created a series of neuromuscular re-education techniques ranging from
passive to active to work with patients across the life span with a range of cognitive
skills.

This class will walk through interventions for both pre-feeding and feeding for: breast,
bottle, cup, spoon, solid and straw feeding(s) in addition to the oral placements required for speech clarity. Pre and post- operative considerations as well as surgical procedures will be discussed. Neuromuscular re-education of the cheeks, lips and tongue will be presented and numerous demonstrations, practicums and video slides will teach participants to execute a functional remediation program. Exercises may be executed in the school, hospital or clinic-based settings based on the impact on education or activities of daily living. Finally, Robyn and Lori have added a new section
on toddlers and strategies for success with this challenging population.

Learning Outcomes

Participants will be able to list at least 2 surgical techniques for TOTs.

Participants will be able to identify at least 2 goals of a pre-op TOTs plan of care.

Participants will be able to execute at least 3 neuromuscular education activities for pre and post op TOTs (1 buccal, 1 labial, 1 lingual).