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Mira Rządzka

PhD in health sciences, speech and language pathologist, myofunctional therapist. She specializes in early interventions for newborns and infants with oral disorders, dysphagic disorders in children and adults, communication development disorders in children with ASD or genetic disorders, and disorders of oral system function. She is a therapist of L. Mathieson’s Manual Throat Therapy, Manual Dysphagia Therapy, ETTHNO Method in Esther de Ru’s approach, Shantala Special Care trainer, international instructor of the Buteyko Method, feeding therapist, Functional Orthodontics MFS Therapist. Long-time academic lecturer in speech and language therapy and pathology subjects.

Author of many specialized publications for speech therapists, including in academic textbooks, reviewer of numerous publications on early speech therapy interventions and speech therapy aids. Author of the book “Odruchy oralne u noworodków i niemowląt. Diagnoza i stymulacja” (the most popular publication of the Impuls Publishing House in 2019 and 2020), the concept of myotherapeutic support for the development of oral functions in newborns and infants, and preparation of the patient for frenulotomy procedure (FRENULOTOMY Project. Child support, parental support), co-author of the book “Profilaktyka i terapia dysfunkcji oddechowych u dzieci”. Co-founder of the Polish Speech Therapists Association and initiator of the social action of speech therapists Free Speech Therapy Diagnosis Day (DBDL), owner of the Prophylactic-Therapeutic Clinic in Zielona Góra.

Oficyna Wydawnicza "Impuls"

1. Introduction   

1.1. The importance of speech pathologist neurodiagnosis     
1.2. Development of reflexive oral responses in the prenatal period    
1.3. Normative oral reflexes and their evolution    
1.3.1. The reflex reaction of sucking and swallowing     
1.3.2. The rooting reflex (Rittig reflex)     
1.3.3. The phasic bite reflex reaction    
1.3.4. The reflexive reaction of opening, protruding, and closing the lips  
1.3.5. The reflex vomit reaction (retching, pharyngeal)  
1.3.6. The pushing reflex 
1.3.7. The jaw reflex     
1.3.8. Licking/protrusion reflex reaction    
1.3.9. Lateral reflex reaction   
1.4. Anatomical and resting conditions of the oral system in newborns and infants  
1.4.1. Breathing and resting postures of the oral system  
1.4.2. Feeding position  
1.5. Specifics of oral reflexes in newborns and infants with Down Syndrome and cytomegalovirus   
1.5.1. Down Syndrome   
1.5.2. Cytomegalovirus  

2. The aim of the study     

3. Research methods and material     

3.1. Characteristics of the group of studied newborns and infants     
3.2. Group of children with Down Syndrome and a group of children with CMV   
3.3. Research methods    
3.3.1. Evaluation of anatomical conditions and resting postures of the oral system     
3.4. Methods and stimulation techniques used  
3.4.1. Myotherapy 
3.4.2. N.A.P. Manual Therapy 
3.4.3. Feeding Position Control     
3.4.4. Shantala Massage  
3.4.5. R. Castillo Morales’ Method     
3.4.6. Kinesiology Taping    

4. Results   

4.1. Pathologies in primitive neonatal oral reflexes   
 4.1.1. Sucking and swallowing reflexes    
 4.1.2. Gag reflex   
 4.1.3. Biting reflex   
 4.1.4. Lips’ reflexes   
 4.1.5. Jaw reflex    
 4.1.6. Licking reflex    
 4.1.7. Pushing reflex   
 4.1.8. Lateral reflex     
 4.1.9. Rooting reflex     
4.1.10. Resting postures of the tongue, lips, and jaw    
4.2. Abnormalities in the execution of reflex oral reactions caused by anatomical defects  
4.2.1. Difficulties with oral function in children with Down Syndrome    
4.2.2. Oral difficulties in a child with cytomegalovirus   
4.3. Effects of stimulation of disrupted reflex oral reactions   
4.3.1. Therapeutic approach in tongue-tie (ankyloglossia)     
4.3.2. Sucking and swallowing reflexes    
4.3.3. Phasic bite reflex    
4.3.4. Gag reflex    
4.3.5. Lips reflexes: opening, protrusion, opening and closing     
4.3.6. Resting postures of the oral area: lips, jaw and tongue     
4.3.7. Rooting reflex      
4.4. Selected issues of oral difficulties in children with Down Syndrome and cytomegalovirus     
4.4.1. Disorders of oral reflexes in children with Down Syndrome    
4.4.2. Disorders of oral reflexes in children with CMV     

5. Discussion   

5.1. From diagnosis through stimulation to feeding   
5.2. The importance of the pre-oral phase and the sequential execution of reflexes and food intake   
5.3. The essence and maturation of sucking and swallowing  
5.4. Sucking and alternative feeding    
5.5. Resting postures of the jaw, tongue, and lips as an introduction to proper air intake    
5.6. Other oral reactions: examination and oral responses   
5.6.1. The rooting reflex     
5.6.2. Phasic bite reflex   
5.6.3. Gag reflex     
5.6.4. The pushing reflex     
5.7. Feeding positions     
5.8. The importance of ankyloglossia in food intake as the most common anatomical defect    
5.9. Compensation and reflex dependencies    
5.10. Disorders of oral reflexes in children with Down Syndrome       
5.11. Oral reflex disorders in children with CMV     

6. Conclusions       

7. Final words     

Appendix. Primitive neonatal oral reaction examination chart     

Reference    

List of tables and graphs  

Abstract

Abstract

Early speech therapy intervention involves implementing interventions to effectively assist newborns and infants in shaping normative feeding behaviour. Sucking, as one of the essential elements of feeding skills, is conditioned by the maturity of the central nervous system, the motor skills of the oral system, and the sequential performance of newborn reflexes. The increasing number of newborns with feeding disorders raises the need to develop a system for diagnosing and modifying the disturbed primitive neonatal oral reflexes (PNRs). This study aimed to demonstrate the existence of constant compensatory-defensive mechanisms based on reflexive oral reactions in cases of feeding disorders and to analyze the effects of myotherapeutic interventions.

This required prior determination and description of the most common PNR disorders in the study group, developing a precise sequential method for their examination, and establishing correlations and dependencies between oral reflex disorders and feeding disorders. The study group consisted of 95 children (54 male and 41 female), including 36 newborns and 59 infants with abnormal reflexive oral reactions that disrupted feeding functions. It included both children with typical development but only with sucking and swallowing disorders (n = 70), as well as children with developmental disorders: genetic syndrome (Down syndrome: n = 16) and viral infection (CMV: n = 9). The examination included external oral reflexes (search reflex, lip reflexes) and internal reflexes (licking, pushing, lateral, sucking and swallowing pharyngeal reflexes). The resting position of the jaw, tongue, and lips, breathing method (mouth or nose), and anatomical structure of the speech organs were also crucial for diagnosing oral apparatus functioning.

It has been found that a precise diagnosis of disturbed oral reflexes, the resting state of the oral apparatus, and its anatomical conditions determine the therapeutic areas for speech therapy intervention.

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