MBGR Protocol of Orofacial Myofunctional Evaluation with Scores

Abstract

The MBGR Protocol with scores was first published in 2009. This protocol was widely administered by speech-language pathologists experienced in orofacial myology in different states from Brazil for four months. From the comments and suggestions of these professionals, the protocol was reviewed and modified. A consistent visual training materials program was prepared, and speech-language pathologists, experienced in orofacial myology from different states of Brazil, Venezuela, Peru, and Colombia were trained with the provided materials. These speech-language pathologists administered the protocol for two years. From the data collected by the speech-language pathologists, modifications were made, and a final version was designed. This final version was administered for two-months by the same speech-language pathologists from Brazil, Venezuela, Peru, and Colombia in order to re-test the final version of MBGR protocol. The aim of this study was to demonstrate the efficiency and effectiveness of the protocol to assess orofacial myofunctional alterations. The final version of the MBGR protocol with scores has proven to be efficient and effective in the identification of individuals experiencing orofacial myofunctional disorders.

INTRODUCTION

Protocols are important in the providing parameters for assessment, especially in a specialty area such as orofacial myology (OM). In Brazil, until the 1980s, there was an absence of structured protocols for the identification of orofacial myofunctional disorders (OMD). Since the 1980s short protocols to assess the OM alterations were designed by different speech-language pathologists (Marchesan, 1997; Marchesan, 2003a; Marchesan, 2003b; Marchesan, 2005a; Marchesan, 2005b; Marchesan, 2005c; Cattoni, 2006; Paskay, 2006; Felicio, Ferreira, 2008; Rodrigues, Monção, Moreira, 2008; Cattoni, Fernandes, 2009; Tessitore, Paschoal, Pfeilsticker 2009; Whitaker, Trindade, Genaro, 2009).

During 2007 and 2008, four speech-language pathologists, experienced in OM, decided that it was important to design a structured protocol. From the protocols in existence at that time, a new model protocol was designed and published (Genaro, Berretin-Felix, Redher, Marchesan, 2009).

From the administration of the original 2009 protocol, modifications were made, and a final version was designed. This version consisted of two parts: history and clinical examination. The history section focuses on collecting information about: general health problems; breathing; sleep; previous treatments; feeding; chewing; swallowing; oral and postural habits; communication; education; speech; hearing; and voice. The clinical examination section is composed of eight parts and focues on assessing: body posture; the face, mandibular and occlusion measurements; extra-oral and intra-oral examinations; mobility of lips, tongue, velum and jaw; pain; tone of lips, mentum, tongue and cheeks; orofacial functions including breathing, chewing, swallowing, speech, and voice.

A scoring system was developed for the results obtained from administering the protocol. Because of the different characteristics of each item assessed, the scores range, from the maximum score considered as being reflective of the most deficient results and 0 score considered the best or normal performance. At the end of the MBGR protocol, a summary with scores of all items assessed is provided. Photos and video recording are the types of documentation suggested. This is primarily to compare the first evaluation to the re-evaluations.

The aim of this article is to demonstrate the efficiency and effectiveness of the protocol in identifying orofacial myofunctional alterations.

METHODS

The protocol published in 2009 was widely administered by speech-language pathologists experienced in orofacial myology in different states from Brazil for four months. Following the directions of the authors of the protocol, the speech-language pathologists administering the protocol also photographed and recorded the patients during evaluation. The data was collected and the considerations of the speech-language pathologists were sent to the authors, who analyzed all the cases, including the photographs and recordings. From the comments and suggestions of these professionals, the protocol was reviewed and modified.

Understanding the importance of administering the reviewed protocol, the authors searched for speech-language pathologists from Brazil, as well as Latin America, to test the new version of MBGR protocol. A consistent visual training materials package was prepared, and speech-language pathologists experienced in orofacial myology from different states of Brazil, Venezuela, Peru, and Colombia were trained in the use of the materials, and administered the protocol during the following two years.

From the information collected by the speech-language pathologists, modifications were made, and a final version was designed. This final version was administered for two-months by the same speech-language pathologists from Brazil, Venezuela, Peru, and Colombia who administered the previous version in order to re-test the final version of MBGR protocol.

RESULTS

The final version of MBGR protocol is presented in Appendix A. In an attempt to provide examples of some of the items included in the MBGR protocol, Appendix B provides photographic samples of some of the items included on the MBGR to help the new clinician understand the characteristics important to conducting the clinical assessment.

DISCUSSION

The new protocol permits the identification of individuals experiencing orofacial myofunctional disorders, and also presents information on categories of problems. Insight into the potential causes of an orofacial myofunctional disorder, and potential future difficulties that the individual may experience, is also possible for the properly trained evaluator. When a specific protocol is administered by trained individuals, a systematic and homogeneous analysis of the collected information is possible which may justify the knowledge and beliefs currently held about orofacial myofunctional disorders.

As Hogikyan & Sethuraman (1999) and Gasparini & Behlau (2009) indicate in their studies on voice, subjective judgements may be accurate or inaccurate. Informational data from a specific country on the disease incidence, etiology, prognosis, the most frequent symptoms, for example, can only be obtained from the use of a standard protocol.

When protocols are administered during all the treatment phases including evaluation before and after treatment, the comparison of data reveals whether the therapeutic techniques are effective or not. If professionals from different places administer the same protocol, they can compare data from different patients concerning diagnosis and treatment, and potentially identify specific treatment procedures for the various types of orofacial myofunctional disorders, which could then be provided in an efficient and effective manner.

CONCLUSIONS

The MBGR is a two-part protocol composed of history and clinical examination with scores, which allows the speech-language pathologist to assess, diagnose and establish prognostic information for orofacial myofunctional disorders. In order to be confident in the data collected, it is important to use a protocol which has been developed and reviewed by knowledgeable specialists. The authors feel that this final version of the MBGR protocol is an instrument that will not only help in the identification of individuals with orofacial myofunctional disorders, but also permit individuals interested in conducting future research a protocol which will allow the accurate collection of data.