From Hips to Lips and In Between

Posted on May 19th, 2013 by Denise | No Comments

From Hips to Lips and In Between

By

Denise Koonce OTR

The Neuro-Developmental Treatment Association’s (NDTA) National Conference is currently being held in Houston with a conference title of Focus on Postural Control.  The speaker roster is quite impressive including world recognized instructors, clinicians, and researchers.  The topics being addressed are equally incredible covering feeding to gait but all with a focus on postural control.  Why such an emphasis on postural control, because when you experience the slightest diminishing aspect of postural control you lose optimal function.  Therefore, in treatment alignment and posture should be evaluated and addressed first in order to obtain an optimal functional base of support to engage in and perform activities of daily living.  

We are also recognizing the month of May as Better Hearing and Speech month which provides a wonderful opportunity to discuss and highlight the profession of Speech Therapy.  To celebrate the profession of Speech Therapy while discussing the Neuro-Developmental Treatment approach is golden. The culmination of the two presents a splendid opportunity to discuss and highlight the benefits of what they offer together.   One of the areas most near and dear to the speech therapy world is the area of the neck up.  The mouth is central to daily function and includes activities such as breathing, swallowing, and speaking.  However, in order to produce the best functional outcome at the mouth or lips, you need to look further south to the hips.  The reason for this is you need to have a stable base in order to function properly.  For example, in order to speak a word or chew a bite, literally 100’s of muscles are working simultaneously, coordinating postural systems and movements systems, using concentric and eccentric control, with a multitude of neuro-pathways sending numerous messages back and forth just to carry out such an action.  Remember the old song “The hip bone connected to the backbone, the backbone connected to the rib bone, and rib bone connected to the shoulder bone, the shoulder bone connected to the neck bone…” this is so true in reference to function.  So, while in the seated position, for the best postural alignment you must have shoulders aligned over the pelvis and ears aligned over the shoulders.  This anatomical alignment gives you the best mechanical, functional advantage.  When a stable base of support doesn’t exist you lose the efficient mechanical advantage and function becomes more difficult causing the individual to lose independence or not be able to obtain it. 

For instance, if the rib cage is tight and the rectus abdominis is tight the upper trunk will be pulled forward causing the center of gravity to shift and the base of support will move onto the coccyx away from the ischial tuberosities, creating a curved shaped spine.  The “C” shaped trunk will then cause the scapula to protract and abduct.  The shoulders will roll forward and finally the head will drop.  However, the eyes which drive movement will cause the head to rise and the neck to hyperextend.  The new head placement will cause the lower jaw to drop leaving the mouth in an open position.  These musculoskeletal reactions quickly snowball into a very poor functional position.  Because of the lack of alignment or a stable base of support, the individual’s body changes and adapts its position into a limited functional position negatively affecting the functional activities performed by the mouth.  Subsequently, feeding, breathing and speech are all negatively affected.  It is important for speech therapists, as with all of us who treat individuals with neuromuscular disorders, to remember where our therapeutic starting point needs to be, alignment, posture and vision.

Francie Baxter PhD, OT, FAOTA who is a professor at Texas Woman’s University, Houston, TX and is actively involved, along with our clinic, in research, was also recognized at the NDTA conference as one of this year’s, three, NDTA Scholarship recipients.  During her appreciation speech, she summed up the focus of the conference best by quoting Dr. Karel Bobath “All the symptomatology of brain lesions are caused by interference in normal postural control.”  If you attended the NDTA conference please share your thoughts about the focus on posture.

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