Simultaneous rehabilitation of the tongue and breathing: a physiological necessity

Dive into the importance of simultaneous re-education of the tongue and breathing with Dr. Patrick Fellus. Discover how advancements in neuroscience enhance our understanding of functional rehabilitations and why a holistic approach is crucial for dynamic balance.

Dr. Patrick FELLUS

- Founder of the French Society of Pediatric Orthodontics
- Inventor of Froggymouth

THE PROGRESS AND POPULARIZATION OF NEUROSCIENCES ARE CURRENTLY REVOLUTIONIZING ALL THE USUAL PROCESSES WHETHER IT BE NEUROMARKETING, NEUROLEADERSHIP, NEURO-EDUCATION. OUR SPECIALTY ALSO BENEFITS FROM THESE SCIENTIFIC ADVANCES WHICH ALLOW US TO BETTER GRASP THE ISSUE OF FUNCTIONAL RE-EDUCATIONS.

But it is especially important to understand that it is not the re-education of a praxis that should be addressed, swallowing for us orthodontists, breathing for sleep medicine, drainage of the inner ear for ENTs, articulation for speech therapists, but the totality of oro-facial praxes to ensure a global dynamic balance. Fortunately, nature can come to our aid if we respect physiological acquisition processes.

 

FOUR APPROACHES CURRENTLY GOVERN THE PROTOCOLS, HOW TO CHOOSE THE MOST EFFECTIVE THERAPEUTIC?

 

ENGRAMMATION

I) Sixty percent (60%) of children spontaneously discover a new swallowing program around the age of four in a completely natural and unconscious manner that we will call the anoetic path.

Genes and epigenesis intervene spontaneously at the appearance of mastication, and cause an increase in Nerve Growth Factor, producing new neurons and thus new neural circuits.

A brief reminder of some fundamental principles will allow us to better understand the influence of physiology and biochemistry.

MEMORY DOES NOT REST ON THE PROPERTIES OF NERVE CELLS AS SUCH BUT ON THE NATURE OF CONNECTIONS BETWEEN NEURONS AND THEIR WAY OF PROCESSING THE SENSORY INFORMATION RECEIVED.

FUNCTIONAL BALANCE IS NOT A STABLE STATE, BUT A STATE IN PERPETUAL REORGANIZATION.

 

Information is constantly analyzed and is generally quickly ignored, but it can lead to reorganization through the anoetic path if it is relevant.

II) Many practitioners prefer to ignore the correction of oro-facial praxes in their therapeutic schemes, hoping that the normalization of dental occlusion will allow the acquisition of a balanced functional scheme at the end of treatment. This random approach will also be anoetic.

III) But it is increasingly accepted that dysfunctions lead to dysmorphoses and that they must be treated just as much as deformations of the dental arches.

The most used technique concerns a voluntary approach to these acquisitions. Practitioners, speech therapists, physiotherapists, will try to make the patient aware of the movements they usually perform and then of the movements they need to apprehend. We are in a top-down approach (voluntary, noetic) where orders start from the cortical part and descend to the motor effectors.

Eric Kandel, Nobel Prize in Medicine, showed that the effectiveness will depend on the frequency of these stimulations and the daily practice of prescribed exercises. Spaced sessions will modify the messages transmitted at the synapses, but this will only involve short-term memory. However, if the information is repeated regularly, the nucleus will intervene to ensure its passage into long-term memory.

IV) Froggymouth, by activating the emotional system, opens a new mode of immediate recording in long-term memory that researchers call "now print" (imprint the current content of neural activity into memory.) (2)

 

INTERACTION BETWEEN DIFFERENT CIRCUITS

Other neural circuits managing other oro-facial praxes may thus be involved thanks to communication between these different elements called "connectionism", a role assigned to glial cells, 4 to 5 times more numerous than neurons and whose role is essential in learning. (1)

Around the synapse, the glial cells pick up the conversation like a wiretap and will spread the information to all other neural circuits via gliotransmitters as if the information was broadcast by radio to all circuits and allow other circuits that were not involved in the re-education process to benefit from this information to improve their efficiency.

This "connectionist" system resembles the operation of falling dominos and simply controlling the lip posture will activate the swallowing circuit which will activate the control of nasal breathing and so on, allowing the re-education of praxes that are difficult to access.

The tongue will adopt a high posture in its posterior part (lingual dome) which will stimulate the transversal growth of the upper jaw, thus improving its comfort in cases of narrowness.

A return to physiological breathing will promote the inhibition of meta-circuits managing mouth breathing.

These interactions are necessary to establish a permanent balance.

 

AUTOMATION

« It must be recognized that neuro-muscular, labial, functional lingual re-educations frequently relapse.

But is it really a relapse?

This would suggest that there had been healing. It seems rather that the sought-after goal, namely the automation of the function's posture, was not achieved. Yet, that is the real healing.

We are not vigilant enough to meticulously check if automation has been achieved. We often content ourselves with observing the neuro-muscular responses to given orders. On the contrary, it is about obtaining an automatism, thus a praxis without consciousness. » Maryvonne FOURNIER.

That's why it is necessary to pay as much attention to automation as to engrammation, a stage that the work of Björk allows us to better understand.

He described 4 learning protocols:

A.A.A.A. E

A.A.A.T. E

A.A.T.T. E

A.T.T.T. E

A representing for example a classic learning session, T intermediate tests to evaluate the progress made, and E the final evaluation.

He asks participants to choose the best protocol according to them. The majority will choose program 1 whereas the most effective is program 4.

This strategy 4 will be taken up in game programs managed by artificial intelligence.

« Generally, it is only at the end of the game that one knows if it has been won or lost….

The trick that computer scientists have found is to learn two things at the same time: to act and to self-evaluate.

One half of the system, called the critic, learns to predict the final score. At every moment, this neural network evaluates the state of the game and tries to predict the reward: am I rather winning or losing the game?

Thanks to the critiques it forms over trials, the system has an evaluation of its actions at every moment and not only at the end of the game.

The other half of the network, the actor, can then use this evaluation to correct itself. Over trials, the actor and the critic progress together, the former learns to act wisely by focusing on the most effective actions while the latter learns to evaluate the consequences of its actions ».

These control sessions can be entrusted to parents who must three times a day tell the child if their lips are in a correct posture (the correct circuits will be reinforced unconsciously by the release of dopamine) and three times a day correct them if they notice a contraction of the orbicular muscles.

 

 

Under the orders of the premotor and motor cortexes, the motor sequence will be managed by the circuits of the grey matter of the spinal cord and the tegmentum of the brain stem (alpha motoneurons). It will be controlled at the level of the cerebellum, which detects and corrects the difference between executed movement and desired movement, and the basal ganglia which suppress erroneous data and prepare upcoming movements.

A very simple test will allow us to judge if our re-education has been effective: ask the child to count to 60, if you see the tongue between the dental arches, automation has not yet been achieved. If the tongue stays well inside the dental arches, you can increasingly space out your surveillance sessions.

A re-education of breathing is a necessary condition for the re-education of the tongue which is necessary for respiratory re-education. This approach joins the works published by Takashi Ono who even highlights the intervention of the diaphragm muscles and the phrenic nerve.

Only the anoetic path will favor the natural establishment of this approach.

          

Contemporary Bibliography:

1) Yves AGID, Pierre Magistretti. L’homme glial. Éditions Odile Jacob. 2018

2) Stanislas DEHANNE. Apprendre, Éditions Odile Jacob. 2018

3) Francis EUSTACHE. La mémoire entre sciences et société. Éditions le Pommier. 2019

4) Olivier HOUDE. Que sais-je ? Le raisonnement. 2018

5) Olivier HOUDE. L’intelligence humaine n’est pas un algorithme. Éditions Odile Jacob. 2019