In the realm of orthodontics, a profound understanding of the intricate relationship between malocclusion, airway issues, and posture is crucial for comprehensive diagnosis and treatment planning. By utilizing modern posture assessment tools, dental professionals can effectively evaluate patients for potential airway and occlusion-related concerns.

Malocclusion, characterized by misalignment of the teeth and jaws, significantly influences a patient’s posture. Interferences in the bite can strain facial muscles, which, in turn, transmit tension to the muscles at the back of the head, affecting the cervical vertebrae. These imbalances and tensions can contribute to postural issues. To evaluate the symmetry of the face, neck, and shoulders accurately, incorporating a posture grid during orthodontic case photography proves valuable.

II. The Role of Airway in Posture and Malocclusion

Airway issues often go unnoticed in orthodontics despite their impact on posture and malocclusion. Children with airway problems may experience compromised nasal breathing, leading to insufficient oxygen supply to the midface during critical growth periods. This inadequate growth can result in crowding and malocclusion, contributing to alignment issues. Recognizing the correlation between airway obstruction and malocclusion development is vital for dental professionals in understanding subsequent posture abnormalities.

While malocclusion typically affects posture, it is essential to acknowledge that posture can also influence malocclusion. Structural deviations in the spine exert forces that pull the head in specific directions, impacting the masticatory muscles and potentially leading to malocclusion. This bidirectional relationship underscores the need for a comprehensive understanding of the intricate connections between posture, malocclusion, and overall oral health.

To produce reliable images of posture assessment during routine and follow-up dental exams, it’s recommended to procure a posture grid and strategically install it in an accessible area where patients can comfortably stand against it. Placing the grid in a dedicated corner of the examination room or near the photography setup ensures its consistent usage. Dental professionals can document the posture assessment by taking standardized photographs of patients standing against the grid. These photographs capture the symmetry of the face, neck, and shoulders, providing valuable visual evidence for evaluating posture-related concerns and facilitating comprehensive treatment planning.

 Comprehensive Team Approach

Collaboration among dentistry professionals is essential for the comprehensive management of malocclusion, airway concerns, and posture issues. In addition to orthodontists and general dentists, pediatric dentists, oral and maxillofacial surgeons, prosthodontists, periodontists, oral medicine specialists, sleep medicine specialists, ENT specialists, and physical therapists specializing in orofacial, craniofacial and speech therapy play crucial roles in this team approach.

Speech therapists, specializing in communication disorders, including articulation and oral motor skills, often contribute to the collaborative approach in managing these issues. By working closely with dentistry professionals, speech therapists help address speech and swallowing difficulties that may arise as a result of these conditions, ensuring a comprehensive treatment plan that encompasses functional, aesthetic, and communication aspects.

By working together, these professionals provide the necessary expertise, interdisciplinary knowledge, and integrated care to address the multifaceted nature of malocclusion, airway issues, and postural abnormalities. Through this collaborative effort, patients’ oral health and overall well-being can be effectively improved.

Resources:

• Posture grids commonly used with speech language therapy practices are available from BodyZone and PostureZone. These companies work with therapists, pathologists and hospitals worldwide providing posture related supplies.

• Relationships between Malocclusion, Body Posture, and Nasopharyngeal Pathology in Pre-Orthodontic Children
• Associations between Posture, Voice, and Dysphonia: A Systematic Review

Speech Articulation and Phonology as it Relates to Posture

Firstly, in the domain of speech articulation and phonology, we encounter children who struggle with making correct sounds. An articulation disorder occurs when a child consistently produces a sound incorrectly, while a phonological disorder involves errors in sound patterns. By assessing the posture of a child’s oral structures, including the jaw, lips, and tongue, we can identify any misalignments or muscle weaknesses that may contribute to their speech difficulties. For instance, a mispositioned tongue or insufficient lip closure can impede accurate sound production. By conducting a thorough posture assessment, we can pinpoint these specific areas and tailor our therapy interventions accordingly.

Posture and Motor Speech Disorders

Secondly, in motor speech disorders such as Childhood Apraxia of Speech (CAS) and dysarthria, posture assessment plays a vital role. CAS is characterized by difficulties in planning and coordinating the movements necessary for speech production, while dysarthria involves weakness in the muscles of the mouth, face, and respiratory system. By evaluating the overall postural stability and coordination of the child, we can determine if there are any underlying motor control issues affecting their speech. For example, observing any asymmetry, lack of jaw control, or inadequate breath support can provide valuable information for designing targeted treatment plans to improve motor speech skills.

Posture Assessment and Speech Language Therapy

Posture assessment also holds relevance in other areas of speech therapy.

Stutter or Clutter

When working with individuals who stutter or clutter, assessing their posture becomes essential in understanding the physical aspects influencing their fluency. By examining their breathing patterns, tension in the upper body, and overall postural alignment, we can identify any factors that may contribute to disfluencies. A holistic approach that integrates postural analysis with therapy techniques can facilitate improved fluency and overall communication effectiveness.

Voice Disorders

Furthermore, in the domain of voice disorders, evaluating posture is crucial. Voice disorders can arise due to various reasons, and persistent changes in vocal quality may indicate underlying issues. By collaborating with otorhinolaryngologists to rule out structural or functional causes, we can then incorporate posture assessment as part of our speech therapy sessions. Analyzing the alignment of the head, neck, and shoulders can provide insights into potential muscular tension or misalignment that might affect vocal production. By addressing these postural aspects, we can support the restoration and maintenance of a healthy voice.

Pediatric Posture Assessment as Part of Patient Evaluation

For speech language pathologists who may not already be using a grid to capture posture pictures, especially with pediatric patients, incorporating this practice can greatly benefit your therapy sessions and documentation. When working with children, it is essential to track pediatric progress and document posture changes over time to effectively monitor their development. Using a posture grid system to capture posture pictures provides a visual reference that allows you to objectively observe and compare any changes in their posture throughout the course of the intervention. This method not only helps in identifying areas of improvement or areas that require further attention but also enables you to communicate these changes to parents and other healthcare professionals involved in the child’s care. By implementing a consistent grid-based posture assessment, you can enhance the accuracy and reliability of your documentation, leading to better-informed decision-making and improved outcomes for your patients.

SLPs Using Images to Collaborate with Parents

Visual imagery, such as a posture picture, is a powerful tool for relaying findings, successes, and declines to parents in speech therapy. As SLPs, we understand that parents play a crucial role in their child’s progress, and clear communication is vital in keeping them informed and engaged in the therapeutic process. By sharing posture pictures with parents, we can provide a tangible representation of their child’s posture and physical changes over time.

These visual images serve as a concrete evidence of the progress made during sessions, illustrating the effectiveness of interventions and highlighting the milestones achieved. Moreover, in cases where a decline or plateau in progress occurs, posture pictures can help parents understand the specific challenges their child is facing. This visual documentation fosters a deeper understanding and empowers parents to actively participate in their child’s therapy, as they can clearly see the impact of treatment strategies and make more informed decisions regarding their child’s care. By leveraging the power of visual imagery, we create a shared language with parents, facilitating open discussions and collaborative efforts to optimize the speech therapy journey for their child.

Resources:

• Posture grids commonly used with speech language therapy practices are available from BodyZone and PostureZone. These companies work with therapists, pathologists and hospitals worldwide providing posture related supplies.

• Posturographic analysis in patients with dysfunctional dysphonia before and after speech therapy/rehabilitation treatment
• Coordination between Posture and Phonation in Vocal Effort Behavior

*Did you miss Part I? Read it here >>>

From Movement to StrongPosture®

Effective motion is efficient and smooth, or as dancers describe it – graceful. In biomechanics, this smooth linkage of complex motion means nerve pathways are being activated and inhibited in sequence to create what’s called coupled motion.

What’s taken for granted for dancers and just about all humans in everyday life is that we’re also unconsciously doing something very complex: Keeping our balance… on only two feet!

This is significant because every other mammal on the planet uses four feet (or paws) to get around and perform in everyday life.

Why is this important?  From a kinetic energy perspective bipedal humans are more efficient.  We can’t run a fast as our cousins on 4 legs, but we can keep going for far longer (which is how our ancestors ran down creatures like wooly mammoths and saber tooth tigers).

Balanced Thinking?

In addition, as the only primates that live our lives balancing on two feet, we humans have more neurons available and so a greater neurologic potential to train motion control. It also helps with other cognitive activities, like abstract thinking, communicating a story, and choosing what to focus upon.

When learning a new task, the neurologic weighting of our 3 sensory inputs: Visual, Vestibular and Proprioceptive. This is a strong factor in how we manage subtleties of balance and alignment intrinsic in our overall gross motions (that’s the BAM in StrongPosture®).

Balance: Adults vs Children

In “Static Body Balance in Children and Expert Adults Ballroom Dancers: Insights from Spectral Analysis of Shifts”¹ Antonio Cicchella described significant difference in how young vs older dancers learn balance exercises.

For adults, Cicchella found a “dominance of the vestibular system” in the static equilibrium tests and so recommended focused attention on proprioception during balance exercises with eyes closed.

For children, he recommended focusing attention on vision by doing balance exercises with eyes open.

From my perspective observing posture and motion, I have two observations to add…

The first is that unique functional compensation patterns develop from the individual’s structural adaptations over a lifetime. This is relevant for all adults, but especially for professional dancers.

As injuries accumulate over time, and loss of the degrees of freedom of subtle arcs of motion ripple up (and down, and across) the kinetic chain(s), our perception and unthinking movement throughout life veers away from symmetry and accuracy. Which is why for adults, especially those not yet experiencing balance issues, rebalancing those intrinsic errors towards reality by doing balance exercise with eyes closed is a smart strategy to age well.

The second is that the children here are trained dancers, and so atypical. But from humanity’s long-term perspective, all kids today are unique because today’s tech kids spend massive amounts of hours in front of a screen, hands on a device and so engaged in less varied motion patterns. Plus, many, many are grossly sedentary.

Training Balance – Eyes Open, Eyes Closed

Cicchella’s recommendation that dance teachers and coaches “train children in balance exercises with their eyes open, while adults could train with their eyes closed” is not a bad thing, but does not address the fact that the NMS system of today’s tech kids is developing and so being trained differently than any prior generation. That said, the population of trained young dancers in the study are obviously not average kids.

I agree with Cicchella’s recommendation for adults to close eyes for balance exercises, but would opine that correlating eyes open with eyes closed exercises is the better strategy for all dancers to add to their routines.

An important point especially for dancers:  Posture is where all motion begins, but there’s more to any performance than posture. CPEP, Kelli Dorrough, trains dancers, and made a really good point for why she advises adult professionals to use eyes closed training:  “When you’re performing on stage you need to feel motion more, because sometimes you’re blinded by the bright lights”.

Finding and strengthening weak links with posture correction exercise

For dancers and adults of all ages who want to move well and avoid injury, the best strategy is regularly performing balance exercise, sometimes with eyes open, and sometimes with eyes closed.  And, doing so with a cognitive focus on aligning proprioception and vestibular inputs.

Feeling how your body is balancing. Reinforcing our two internal somatic inputs to provide a more accurate base to correlate with our visual input of the outside environment.

Strong Posture Program – Connect Perception to Reality

The StrongPosture® protocols call the process of training vestibular, visual and somatosensory inputs P2R. It’s about  connecting our internal somatic Perception to external Reality (P2R), and so training the CNS towards being more accurate.

Moving the big parts of the body requires rearranging the small things as well. For dancers and the rest of us who want to perform at our best and stay in motion as we age, it’s about connecting subtle movements with large ones to move energy up and down the kinetic chain smoothly.  Connecting core controlled motion so things are more fluid, and less choppy.

In other words, moving well.

—

*Certified Posture Exercise Professional

¹ Cicchella, A. (2021). Static Body Balance in Children and Expert Adults Ballroom Dancers: Insights from Spectral Analysis of Shifts. Biology (Basel), 10(12).

• At-home patient rehab. 7 Steps to StrongPosture® is the online at-home program for patients that integrates education and exercise designed to blend easily into your workflow. Subscribe to offer the program to your patients & clients >>>
• CE Approved online education. Posture and Balance Assessment, Rehabilitation & Motor Control Exercise >>>
• Complete in-office rehab program. Pro Training Manual, Patient Handouts and more >>>

Add the StrongPosture® program to your practice get the Posture Rehab Exercise Set and enroll in the online CE course. Take your practice to the next level with CPEP® Posture Specialist Certification.

I am fascinated by posture and motion, which is why a 2021 study in the journal Biology on ballroom dancing really caught my eye. In “Static Body Balance in Children and Expert Adults Ballroom Dancers: Insights from Spectral Analysis of Shifts” (1) Antonio Cicchella makes some important observations about balance, as well as some suggestions to maximize the effectiveness of motor control training for all people, of all ages.

Cicchella’s observation that “Static balance is related to dynamic balance, and can be assessed with greater objectivity” summarizes my longstanding interest in posture. Plus, his conveying that “static balance is the most studied condition of balance in dancers” opened my eyes to a value of dancing for motor control insights.

From my perspective, ballroom dancing is a natural study of the neurologic differences between how adults and children learn to control precise patterns of how they move.

The researchers compared professional adult ballroom dancers with 8-12 year old children who’ve taken lessons 4 days a week for 4 years, and compete in dance competitions. A force platform with sophisticated computer program analyzed patterns of sway and stabilization to measure the relative neurologic weighting of the 3 neurologic inputs of balance – visual, vestibular and proprioceptive.

The Results: Children really do learn differently than adults. When compared to adults, children gave greater weight to the proprioceptive somatic-sensory system. For adults, the vestibular system dominated centralized and fine balance control.

In my opinion, their study also reinforced an observation about motor control, attentional focus and mindfulness training…

How you learn to do anything, is how you learn to do everything.

The study made specific recommendations on adopting balance exercises differently for kids than adults. But to understand the implications, first lets take a step back and ask:

What is being trained when you learn a new neuromusculoskeletal (or NMS) pattern of motion?

Understand this: The NMS system is a single, profoundly integrated system. Its not neuro + muscle + skeletal bundled together. The NMS system is a unified whole, one of which we’re only occasionally somewhat aware.

Millisecond by millisecond, the brain, spinal cord and peripheral nervous system controls how humans and all other mammals move. However, humans are the only mammals that have the cognitive ability to focus awareness and shift from unconscious to conscious motion.

Also, from Physiology 101: Each of the thousands of muscle fibers in a muscle follows the same all-or-none principle as nerve fibers: An individual muscle fiber contracts fully, or not at all. The combination creates cascading spirals of feedback and feedforward. These loops of cause and effect connect to move the body in a kinetic chain, where the effect of an action or position any link affects other links further down (or up) the chain.

When a single muscle contracts the force, angle and direction of the energy is controlled by recruiting different populations of it’s fibers, with each one following the all-or-one principle. Thousands of active muscle fibers work together to generate kinetic energy, which is directed along the kinetic chain.

Punjabi’s model organized the NMS system into 3 subsystems – Active, Passive and Control.

Communicating clearly to the public as well as other professionals is our goal, which is why the StrongPosture® model re-labels this triad as the mechanical subsystems of Contracting muscles and Connecting tissues being controlled by the neurological Control subsystem.

Mechanically, the “musculoskeletal” part of NMS patterns is the precisely integrated sequencing of varying populations of muscle fibers to fully contract and either move, or resist motion.

Within its mechanical range, a single muscle can actively:

• Contract to shorten and move the attached bone(s) to which it’s connected, or
• Resist lengthening to stabilize the joint(s) where the bones are held together.
• A joint’s arc(s) of motion are passively restricted by ligaments and other elements of the connecting subsystem.
• A combination of both, with some fibers shortening and others contracting to resist lengthening

Within their respective functional ranges, all the muscles of the Contracting subsystem work together to move the body by directing the energy of contraction along each joint’s arc(s) of motion. The Connecting subsystem of the kinetic chain is passive, directing energy with leverage of bones and tendons, along with magnification of the compressive forces by fascia and intramuscular sheaths that focus the energy to generate greater force.

Mechanically, it’s a large but finite system of motors, ropes and pulleys guiding muscular energy. Like water flowing downhill, the mechanics of our motion is kinetic energy flowing down the kinetic chain, following the path of least resistance.

Neurologically is where things gets more complex with the Controlling neuromusculoskeletal subsystem.

We all know muscles strengthen in the way they used. In addition, when nerve pathways are used frequently, they become easier to stimulate, or facilitated to do whatever they’re trained to do.

For motor nerves, trained to move in sync and sequence, or not quite (which is why your golf swing has a hook, or a slice). For sensory nerves, accurately transmitting a message about position, motion… or pain – whether or not the message is true.

Nerves that fire together, wire together.

Performing a motion means directing kinetic energy precisely along the kinetic chain. Training ballroom dance (or any sport) involves focusing attention repetitively to move in desired pattern(s). It’s the moment-by-moment sequence of millions of fibers – muscle and nerve where some populations of muscle fibers contract to move, others contract to stabilize, and most are quiet.

Attentional focus and repetition are the keys to learn new motion patterns. Moment by moment, the nervous system manages the relative weighting of the 3 sources of input:

• The eyes seeing
• The muscles and joints feeling, and
• The vestibular system in the inner ear sensing change in position and acceleration.
  The brain and our unconscious reflexes are constantly shifting the perceived relevance of each source of input to guide energy along our kinetic chains.

This ballroom dancing study compared how kids vs adults learn to balance and so guide motion by weighting the relative importance, or weight, of these 3 inputs.

This is about everyone, not just dancers.

We’re all constantly shifting how much to depend upon the input from our visual perception of the horizon with the inner ear’s vestibular input. The brain weighs these two inputs in ways just now becoming understood, and coordinates them with the input of millions of nerve endings in muscles and joints, as well as nerve receptors which feed proprioceptive and kinesthetic information to sense position and motion… and plan our next step.

This is important because how we weight sensory inputs is not just about dancing, or even motion! The experience of pain, mechanical strain and discomfort are profoundly influenced by how the brain weights and processes visual, vestibular and proprioceptive inputs. Techniques to retrain pain perception by up-weighting and down-weighting of sensory inputs is a hot area of study, and will be the topic of a future blog post.

In next week’s article, find out more on the implications of kids vs adults learning differences for training balance in Part II of Motor Learning in Kids vs Adults – From Movement to StrongPosture®.

• At-home patient rehab. 7 Steps to StrongPosture® is the online at-home program for patients that integrates education and exercise designed to blend easily into your workflow. Subscribe to offer the program to your patients & clients >>>
• CE Approved online education. Posture and Balance Assessment, Rehabilitation & Motor Control Exercise >>>
• Complete in-office rehab program. Pro Training Manual, Patient Handouts and more >>>

Add the StrongPosture® program to your practice get the Posture Rehab Exercise Set and enroll in the online CE course. Take your practice to the next level with CPEP® Posture Specialist Certification.

I’m a certified yoga teacher and a CPEP. I’m also a mother of two athletic daughters who are competitive figure skaters. I’d like to bring the program to younger athletes.

I’m really interested into bringing this [StrongPosture®] program into schools and working with children, who I see sitting with some pretty poor posture, looking over their tablets. So, I’m hoping to bring some information that will help them to improve their posture so that they can grow to be healthy adults – without problems! ~Susan Lamash, Yoga Instructor, CPEP

We want to know what you’re doing to brand yourself as “the Posture Expert” in your community.  You may be featured in our newsletter!  Email rebecca@bodyzone.com for more information.

Read up on CPEP benefits, posture certification requirements, and how we can help you to be the “Posture Expert.”  Learn more>>>

We want to know what you’re doing to brand yourself as “the Posture Expert” in your community.  You may be featured in our newsletter!  Email rebecca@bodyzone.com for more information.

Read up on CPEP benefits, posture certification requirements, and how we can help you to be the certified Posture Expert in your area.  Learn more>>>