MRC Myobrace Beginner Course 2014 Part 3

  • 1,125 views
Uploaded on

Myofunctional Research Company presents Myobrace Beginner Course by Dr. Barry Raphael at the Raphael Center for Integrative Education, Clifton, New Jersey, January 2014: Part 3

Myofunctional Research Company presents Myobrace Beginner Course by Dr. Barry Raphael at the Raphael Center for Integrative Education, Clifton, New Jersey, January 2014: Part 3

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to like this
No Downloads

Views

Total Views
1,125
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
39
Comments
1
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. The Myobrace System -A hammer for a houseSat-Sun, January 18-19, 2014 dr. barry raphael the raphael center for integrative education www.alignmine.com drbarry@alignmine.com Day 2 AM Sunday, January 19, 14
  • 2. Airway-focused Orthodontics 1.Airway-focused Diagnostics 2.Prevention 3.Undo the Damage 4.Establish Good Habits 5.Interdisciplinary Treatment Nothing changes unless something changes…. - R. Price Sunday, January 19, 14
  • 3. 4. Ancillary Modalities 1.Education and Motivation 1.The Activity Center and Health Educators 2.Educational materials 1.Activities Book 2.Parent CD 3.Trainerkids.com 4.Myobrace.com 2.Prevention 3.Expansion mechanics 1.BWS/ALF 2.Palatal expanders 3.Biobloc 4.Myofunctional Therapy 5.Ortho-postural Training 6.Nutrition Sunday, January 19, 14
  • 4. It’s NOT about the Trainer Part 1 Sunday, January 19, 14
  • 5. You mean I have to pay $7 for this? Sunday, January 19, 14
  • 6. Now that’s a bowl of oatmeal! Yum! Sunday, January 19, 14
  • 7. It’s about the VALUE you’re adding Habit Training Better Breathing Nutrition Trainer and straight teeth Overall health Sunday, January 19, 14
  • 8. It’s NOT about the Trainer Part 2 Sunday, January 19, 14
  • 9. The Process: The Chip Shot The Goal: To get the ball as near to the cup as possible Sunday, January 19, 14
  • 10. Sunday, January 19, 14
  • 11. Which Hammer should I use? Sunday, January 19, 14
  • 12. Which Trainer should I use? Sunday, January 19, 14
  • 13. It’s not the Trainer It’s the Training Sunday, January 19, 14
  • 14. When should treatment begin? Sunday, January 19, 14
  • 15. A tree brace This is a tree brace. It helps the tree grow straight in the face of environmental forces (ie: wind, waves, trucks, etc.) Sunday, January 19, 14
  • 16. Here is a bent tree. If you had wanted it to grow up straight, when would you have applied the brace? A) Let’s wait for all the branches and leaves to grow in first. B) When the tree was young, before it started to bend C) Will you repeat the question? Sunday, January 19, 14
  • 17. Airway-focused Orthodontics 1.Airway-focused Diagnostics 2.Prevention 3.Undo the Damage 4. Establish Good Habits 5.Interdisciplinary Treatment Our ultimate goal is to keep children from getting sick. By knowing the causes, we can prevent the disease. Sunday, January 19, 14
  • 18. Pre-natal care Sunday, January 19, 14
  • 19. Frenectomy From Paula Fabbie, COM Sunday, January 19, 14
  • 20. Internal Frenectomy From Paula Fabbie, COM Sunday, January 19, 14
  • 21. MUST DO P.T. PRE- AND POST-operative Mobility Exercises • Clucks • Caves • Palate Wipes • Waggle Spots and Waggle Flaps From Paula Fabbie, COM Sunday, January 19, 14
  • 22. Breast-feeding Sunday, January 19, 14
  • 23. ADHD/Breastfeeding/Malocclusion/ dental trauma/SDB Understanding the relationships between breastfeeding, malocclusion, ADHD, sleep-disordered breathing and traumatic dental injuries. Sabuncuoglu O., Med Hypotheses. 2013 Jan 7. pii: S0306-9877(12)00566-X. doi: 10.1016/j.mehy. 2012.12.017. [Epub ahead of print] Sunday, January 19, 14
  • 24. Nutrition •Soft Processed and Pre-cooked foods •Limit muscular exercise and development •Fail to stimulate osseous development •Fail to develop muscular coordination •Sugar over-feed bacteria in the mouth and gut Sunday, January 19, 14
  • 25. Hardening the Diet • start with fiber crackers • then fruits, fresh and dried • then vegetables • then small, cooked meat • progressively over 4 to 12 months, depending on child Sunday, January 19, 14
  • 26. Baby Led Weaning •Starting at 6mo •Give baby real food •Let them explore and choose •Establish Chewing skills naturally Sunday, January 19, 14
  • 27. Oral Habits • Thumb Sucking • Pacifiers • Nail Biting • Tongue Sucking • Object Mouthing • Lip Biting • Chin-Leaning • Trichotillomania Sunday, January 19, 14
  • 28. Thumb sucking For pleasure and comfort... To prop open the airway To relieve a cranial strain Each type needs a different approach Sunday, January 19, 14
  • 29. Adenectomy Sunday, January 19, 14
  • 30. Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome -Clinical Guidelines-Technical Report- Carole L. Marcus, MBBCh, Lee J. Brooks, MD, Sally Davidson Ward, MD,Kari A. Draper, MD, David Gozal, MD, Ann C. Halbower, MD, Jacqueline Jones, MD, Christopher Lehmann, MD, Michael S. Schechter, MD, MPH,Stephen Sheldon, MD, Richard N. Shiffman, MD, MCIS, and Karen Spruyt, PhD American Academy of Pediatrics SUBCOMMITTEE ON OBSTRUCTIVE SLEEP APNEA SYNDROME http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1672 Sunday, January 19, 14
  • 31. Symptoms and Signs of OSAS History •Frequent snoring (≥3 nights/wk) •Labored breathing during sleep •Gasps/snorting noises/observed episodes of apnea •Sleep enuresis (especially secondary enuresis)a •Sleeping in a seated position or with the neck hyperextended •Cyanosis •Headaches on awakening •Daytime sleepiness •Attention-deficit/hyperactivity disorder •Learning problems Sunday, January 19, 14 Physical examination •Underweight or overweight •Tonsillar hypertrophy •Adenoidal facies •Micrognathia/retrognathia •High-arched palate •Failure to thrive •Hypertension
  • 32. The 8 KEY ACTION STATEMENTS 1.Screening for OSAS •As part of routine health maintenance visits, clinicians should inquire whether the child or adolescent snores 2. Referral and Testing •Regular snoring or S&S should be referred for PSG, ENT eval, SM eval, or other tests (video, home study) •sensitivity and specificity of the history and physical examination are poor 3. Tonsiloadenectomy • Has OSAS AND hypertrophy, the T&A is “first line of treatment.” 4.High Risk T&A •Monitor Postoperatively 5.Revaluation •Further treatment is necessary in approx 21% (in obese, 73%) 6.CPAP •If T&A can’t be done or didn’t work •Compliance is a problem 7.Weight Loss •If needed, with everything else 8.Nasal Sprays •intranasal corticosteroids for children with mild OSAS (pre- or post T&A) Sunday, January 19, 14
  • 33. Protocol for Swollen Lymph Exam and History Shrink Tissue Medication Yes Breathing Modification No T&A Breathing Modification Sunday, January 19, 14 Nasal Breathing Reduced Breathing Diaphragmatic
  • 34. Shut you mouth and save your life. Sunday, January 19, 14
  • 35. Dear Barry, You should be at this point at about 9:15. Yours, Roger Sunday, January 19, 14
  • 36. Airway-focused Orthodontics 1.Airway-focused Diagnostics 2. Prevention 3.Undo the Damage 4. Establish Good Habits 5.Interdisciplinary Treatment As much as possible, reverse the condition TOWARD the genetically programmed ideal. Sunday, January 19, 14
  • 37. Undoing the Damage The appropriate treatment for a Collapsed Maxilla… Moves/Grows the Maxilla (up and) forward… AND the Mandible rotates and moves forward Sunday, January 19, 14
  • 38. Treatment Goals Based on Upper Incisor (UI) Sunday, January 19, 14
  • 39. Incisor Goals Type 1 Treatment: Place U1 in ideal position Biobloc Orthotropics, Orthognathic Surgery, Distraction Osteogenesis Sunday, January 19, 14
  • 40. Incisor Goals Type 2 Treatment: Expansion enough to uncrowd Myofunctional Ortho, Myofunctional Therapy, Crozat, ALF, Expansion Orthodontics Sunday, January 19, 14
  • 41. Incisor Goals Type 3 Treatment: Maintain UI Functional Orthodontics, Expansion Orthodontics, Distalization Ortho or No Treatment Sunday, January 19, 14
  • 42. Incisor Goals Type 4 Treatment: Retract/Extrude UI Extraction Orthodontics, Retraction Ortho, Distalization Ortho Sunday, January 19, 14
  • 43. Treatment for Bimaxillary Dysplasia 1. Maxillary Expansion 2. Maxillary Advancement 3. Maxillary Impaction 4. Mandibular Advancement Back B. Hockel 2012 Sunday, January 19, 14
  • 44. Treatment for Bimaxillary Dysplasia 1. Maxillary Expansion Hyrax Haas Niti Exp Sunday, January 19, 14 BioBloc Schwartz ALF Crozat Bent Wire
  • 45. The Farrell BENT WIRE System™ Sunday, January 19, 14
  • 46. Arch Development in conjunction with the TRAINER System™ Recommended Age Group: 10 - 15+ yrs Simultaneous arch development and myofunctional training. Sunday, January 19, 14
  • 47. The Farrell BENT WIRE System™ Arch Lengthening Sunday, January 19, 14
  • 48. The Farrell BENT WIRE System™ Arch Expansion Sunday, January 19, 14
  • 49. The Farrell BENT WIRE System™ Incisor Advancement Sunday, January 19, 14
  • 50. BIOBLOC and BWS System™ ARCH DEVELOPMENT Tongue Position and Function Sunday, January 19, 14
  • 51. BWS : Fabrication Bending the BWS Sunday, January 19, 14
  • 52. The BWS™ - Upper - Fabrication Sunday, January 19, 14
  • 53. BWS : Placement Adapted Wire Sunday, January 19, 14 Ideal Wire
  • 54. BWS : Placement Advanced Lightwire Functional Sunday, January 19, 14
  • 55. BWS : Placement Adapted Wire Sunday, January 19, 14 Ideal Wire
  • 56. BWS: Adjustments Undo Kinks Sunday, January 19, 14
  • 57. Treatment for Bimaxillary Dysplasia 1. Maxillary Expansion 2. Maxillary Advancement BioBloc Sunday, January 19, 14
  • 58. Effects of Maxillary Protraction and Fixed Appliance Therapy on the Pharyngeal Airway Emine Kaygısız et.al., Angel Orthodontist, Volume 79, Issue 4 (July 2009) •25 x 11 year olds •Reverse Pull HG, 350 g, 14h/d for 6 months • Follow-up 4 years post-treatment • 2D analysis only (cephs) “...the maxilla continued to grow forward after treatment, which was maintained in the long-term observation.” “improved the nasopharyngeal and oropharyngeal airway dimensions initially, …. was maintained at long-term follow-up.” Sunday, January 19, 14
  • 59. Expansion and Protraction Biobloc Expander, RPHG, OMT over 24 months Courtesy: Dr. Kevin Boyd Sunday, January 19, 14
  • 60. Expansion and Protraction Expansion and Protraction, 2x4 over 24+ months Courtesy: Dr. Kevin Boyd Sunday, January 19, 14
  • 61. Widen, Advance, Intrude, then 1. Maxillary Expansion 2. Maxillary Advancement 3. Maxillary Impaction 1 3 4 2 B. Hockel 2012 Sunday, January 19, 14
  • 62. ...Extract or Equilibrate Primary Occlusal Stops 1. Maxillary Expansion 2. Maxillary Advancement 3. Maxillary Impaction B. Hockel 2012 Sunday, January 19, 14
  • 63. And Autorotate the mandible closed 1. Maxillary Expansion 2. Maxillary Advancement 3. Maxillary Impaction B. Hockel 2012 Sunday, January 19, 14
  • 64. Treatment for Bimaxillary Dysplasia 1. Maxillary Expansion 2. Maxillary Advancement 3. Maxillary Impaction 4. Mandibular Decompensation Biobloc Fixed Protrusion Sunday, January 19, 14 IMDO
  • 65. Dr. John Mew Sunday, January 19, 14
  • 66. Once that happens we begin the last phase: Walking the lower jaw forward while the remaining adult teeth come in. B. Hockel 2012 Sunday, January 19, 14
  • 67. And THAT is the beauty of Biobloc! B. Hockel 2012 Sunday, January 19, 14
  • 68. And THAT is the beauty of Biobloc! There is currently no other technique in orthodontics except for facial surgery that can change the face in this way. Not only does the face look better, but the lips can close more easily, the tongue can rest on the palate, and the breathing space behind the mouth is more open. All good things! B. Hockel 2012 Sunday, January 19, 14
  • 69. Principles of Biobloc 1.Treat Early (before deciduous molars lost) 2.Over-treat 3.Long Retention 4.Myotherapy to establish neutral posture Sunday, January 19, 14
  • 70. Myobrace or Biobloc? Severity Age and Stage Skills Acceptance Goals Commitment Fee Myobrace Sunday, January 19, 14 Biobloc Myofunctional Therapy
  • 71. Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome -Clinical Guidelines-Technical Report- Carole L. Marcus, MBBCh, Lee J. Brooks, MD, Sally Davidson Ward, MD,Kari A. Draper, MD, David Gozal, MD, Ann C. Halbower, MD, Jacqueline Jones, MD, Christopher Lehmann, MD, Michael S. Schechter, MD, MPH,Stephen Sheldon, MD, Richard N. Shiffman, MD, MCIS, and Karen Spruyt, PhD American Academy of Pediatrics SUBCOMMITTEE ON OBSTRUCTIVE SLEEP APNEA SYNDROME http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1672 Sunday, January 19, 14
  • 72. Rapid Maxillary Expansion Two case studies without controls (level IV) •Study 1 •31 patients •4 months after RME, all patients had normalized AHI •Pirelli P, Saponara M, Guilleminault C., Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep. 2004;27(4):761–766 • Study 2 •14 eligible sleep center patients •a significant improvement in signs and symptoms of OSAS as well as polysomnographic parameters •Villa MP, Malagola C, Pagani J, et al. Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up. Sleep Med. 2007;8(2):128– 134 Data were insufficient to recommend rapid maxillary expansion. Sunday, January 19, 14
  • 73. Rapid Maxillary Expansion Conclusions •“an orthodontic technique that holds promise as an alternative treatment of OSAS in children” •“maxillary expansion may be effective in specially selected patients” •“data are insufficient to recommend its use at this time.” “Biobloc Orthotropics holds great promise for the treatment of OSA is Children - Stephen Sheldon, 2012 Sunday, January 19, 14
  • 74. Dear Barry, It should now be 10:00. Let’s take a break for 15 minutes. Thanks, Tiffanie Sunday, January 19, 14
  • 75. Airway-focused Orthodontics 1.Airway-focused Diagnostics 2. Prevention 3.Undo the Damage 4. Establish Good Habits 5.Interdisciplinary Treatment Retraining Proper Oral-Rest Posture, Oral Function, and other good health habits for a lifetime of stability Sunday, January 19, 14
  • 76. Establish Good Habits STAGE 1 HABIT CORRECTION 4-6 MONTHS Sunday, January 19, 14 STAGE 2 ARCH EXPANSION 4-6 MONTHS STAGE 3 FINAL ALIGNMENT & RETENTION 4-6 MONTHS
  • 77. Trainer Activities • Purpose: To apply Myofunctional Therapy principles on a broad scale. • Assumption: One-on-one MFT is impractical on a large scale. • We can use Myobrace to do MFT and train new habits. • Must be done in conjunction with Myobrace wear. Sunday, January 19, 14
  • 78. Sunday, January 19, 14
  • 79. Sunday, January 19, 14
  • 80. Trainer Activities •MRC Activities Workbook •Groups 1,2,3, extras Sunday, January 19, 14
  • 81. Activity Score Sheet Sunday, January 19, 14
  • 82. COMBINING ORTHODONTICS WITH MYOFUNCTIONAL THERAPY LESS TIME CONSUMING BUT EDUCATION IS STILL NEEDED Sunday, January 19, 14
  • 83. Trainer Activities •MRC Activities Workbook •Groups 1,2,3, extras •www.trainerkids.com Sunday, January 19, 14
  • 84. NEW PATIENT EDUCATION CD MOST USEFUL FOR PARENTS AND DOCTORS Sunday, January 19, 14
  • 85. NEW PATIENT EDUCATION CD MOST USEFUL FOR PARENTS AND DOCTORS Sunday, January 19, 14
  • 86. Orofacial Myofunctional Therapy Oral Myology Myofunctional Therapy Tongue Thrust Therapy Sunday, January 19, 14
  • 87. Myofunctional Therapy • The study of normal function of the muscles of the mouth •Tongue •Masticatory muscles •Facial muscles •Protocols • Group Therapy • Individual Therapy Sunday, January 19, 14
  • 88. Myofunctional Therapy •Neutral Rest Posture •Normalized function •bite, chew, and swallow •Eliminate noxious behaviors •Planning: assessment, examination, diagnosis, treatment planning, implementation of a therapeutic process •Evaluation of outcomes Sunday, January 19, 14
  • 89. Neutral Rest Posture • Tongue rests lightly on palate or slightly away • Dental Freeway space is open • Minimal masticatory muscular tension (contraction) • Minimal pressure or tension within TMJs • Facial muscles relaxed The position from which all functional movement can begin Sunday, January 19, 14
  • 90. Myofunctional Therapy helps OSA Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome Katia C. Guimaraes, et. Al. AM J OF RESP AND CRITIC CARE MED VOL 179 2009, p962-966 • RCT, n=16 adults • 3 months of exercise training reduced the severity of OSAS by 39% (by AHI and lowest O2 sat) • a reduction in snoring, daytime sleepiness, and quality of sleep score • significant reduction in neck circumference • muscle training while awake will reduce upper airway collapsibility during sleep in patients with OSAS. • improvements in several subjective sleep scales Sunday, January 19, 14
  • 91. “It is a sad state of affairs that for every 100 orthodontists in this country there is only one oral myologist when it should be the other way around” - Dr. Bill Hang, 2013 Sunday, January 19, 14
  • 92. Dear Roger, It should be about OK, now it’s your turn. You have 45 minutes for your section, if you will be so kind. Sincerely, Barry Sunday, January 19, 14
  • 93. Ortho-Postural Training • Better breathing • Reduced rate and volume • Restore diaphragmatic function • Better posture •Sitting, standing, sleeping Roger • Better Nutrition Price • Real food • Harden the diet • Better oral rest posture and function • Better sleep habits and breathing Nothing will change if nothing changes. Sunday, January 19, 14
  • 94. 90% OF PEOPLE WITH A SLEEP DISORDER REMAIN UNDIAGNOSED Unaware that such things exist. Unaware that they have such a disorder In denial – when they’re advised of it Fearful of doing anything about it WHAT IS REQUIRED IS A SYSTEM THAT IS: SIMPLE LOW COST EASY TO IMPLEMENT SCIENTIFIC CLEAR AND CONCISE IN THE INFORMATION PROVIDED FREE FROM ANY MEDICAL OR INSURANCE REQUIREMENT INTEGRATIVE SLEEP HEALTH EDUCATION Sunday, January 19, 14
  • 95. + The Facts SECOND ONLY TO HEARTBEAT WE BREATHE MORE TIMES A DAY THAN ANY OTHER FUNCTION IN THE BODY. The average person, living a Western lifestyle, breathes around 28,000 to 30,000 breaths a day. If each breath is just a fraction out of balance the cumulative effect can have a significant impact on health. Sunday, January 19, 14
  • 96. + The Science – Newton and Bohr NEWTON’S THIRD LAW OF MOTION Sir Isaac Newton 1642 - 1727 “Every action has an equal and opposite reaction”. THE BOHR EFFECT Christian Bohr 1855-1911 “As the pressure of CO2 in arterial blood drops so does the bond between O2 and hemoglobin strengthen”. (the reality of this is that O2 flow to the brain and other cells is reduced causing hypoxia, apnea, disturbed sleep, chronic tiredness, memory and attention issues and many more complications.) Sunday, January 19, 14
  • 97. + The Science - Hypocapnia Definition: Noun1. hypocapnia - a state in which the level of carbon dioxide in the blood is lower than normal; can result from deep or rapid breathing. Hypocapnia causes smooth muscle bands around hollow organs to constrict, resulting in multiple dysfunctions in the various smooth muscle systems in the human body. Hypertension Bronchoconstriction, “Asthma” Anxiety/Panic attacks Sunday, January 19, 14
  • 98. + Hypocapnia affects the entire body Sunday, January 19, 14
  • 99. + How efficiently are you functioning? Efficient systems: • last longer • cost less to run • seldom break down • require less maintenance If you are able to get your patient to understand that if: • sleep • posture • breathing are efficient, then the body is in balance and is running as smoothly as it can. Sunday, January 19, 14
  • 100. + How to do this? SLEEP EFFICIENCY: Sleep Image SnoreLab BREATHING EFFICIENCY: Capnometer reading Comparison with standard POSTURE EFFICIENCY: Photographs against grid Highlight anomalies Sunday, January 19, 14 Sleep Breathing Posture
  • 101. +Sleep Efficiency – CPC (Cardiopulmonary Coupling) Spectral Imaging will correlate: Time Breathing Movement Heart Rate REM Sleep Body Position Snoring (graphic) Sleep Spectrogram SQI - Sleep Quality Index HFC - Stable Non-REM Sleep LFC - Unstable Non-REM Sleep Sunday, January 19, 14
  • 102. + Sleep Efficiency – Breathing and Snoring Set relevant parameters such as: • Alcohol • Sedatives • Stimulants • Hot bath • Dental appliance Report will indicate: • Hours slept • Snore score • Time of snoring episodes • Audio of breathing/snoring • Can pinpoint restless movement Sunday, January 19, 14
  • 103. + Breathing Efficiency The Breathing Efficiency Check will highlight the following: Inefficient Breathing • • • • • • • End tidal CO2 Breathing rate Breathing dynamics Breathing mechanics Oxygen release potential Response to external stimuli Effect of posture on breathing Sunday, January 19, 14 Efficient Breathing
  • 104. + Posture Efficiency - daytime Posture photographs will show: • • • • • • • • Lateral balance Midline balance Shoulder position Mouth open or closed Forward head position Kyphosis and Lordosis Compensation mechanisms Foot mechanics – pronation, supination or mixed ascending Sunday, January 19, 14
  • 105. + Posture Efficiency – night time Much night-time restlessness is as a consequence of daytime postural and physical dysfunction. The body is trying to find a place where it is not in distress and that is why people often land up in quite weird positions. This again is manifestation of Newton’s Third Law as often it is the ‘action’ of the day that causes the ‘reaction’ at night. Breathing is severely compromised during night-time acrobatics. Many allergies and night-time asthma attacks are as a consequence of people breathing into their pillows and bedding and inhaling dust, flaked skin particles and other airborne allergy triggers. Sunday, January 19, 14
  • 106. + The greatest amateur anatomist James Weldon Johnson, born 1871 and died 1938, composer and songwriter and creator of “Dem Bones”. Anybody who fails to recognize that the human body is an intricate complex of eleven independent – yet interdependent – systems will fail to achieve a stable and long-lasting outcome. It is simply inefficient to try to treat a comorbid condition by focusing on only one aspect. Sunday, January 19, 14
  • 107. + The Western Medical System John Maynard Keynes, the noted British economist summarized it perfectly. “It is more acceptable to fail conventionally than to succeed unconventionally” The irony of it all is that what we teach IS conventional – it is most of the other stuff that is unconventional. Sunday, January 19, 14
  • 108. + Promote your status as a “Doctor” Patients need to be educated that their dentists are not simply skilled technicians but are also highly trained and experienced Oral Physicians. This can be achieved by setting up your practice to emphasize that you evaluate the entire person, not just the teeth. Sunday, January 19, 14
  • 109. + Education is the key Until dentists realize, and can get their patients to understand, that the teeth are usually not the problem, and that there are numerous underlying factors that have either caused the problem or are getting in the way of correcting them, failures and relapse will continue to happen. This can be achieved by regular information sessions, talks and other community educational activities, for both the public as well as associated health practitioners. Sunday, January 19, 14
  • 110. + Change how they view you For as long as the emphasis of your practice is on: Smile White Teeth Straight Teeth Pearly Whites Laser treatment Pain Free dentistry your patients will regard you as a skilled technician and not expect you to know anything about, or talk to them about anything other than TEETH. Sunday, January 19, 14
  • 111. + Practice Integrative Dental Care By inserting a single word – Integrative – into the name of your practice, you and your team are then in a position to explain to your patients that yours is not just a General Dental Practice. You in fact not only look at the “Teeth attached to the Patient” but also closely look at the “Patient attached to the Teeth” Sunday, January 19, 14
  • 112. + The information trap Thanks to the Internet most people have a vast amount of information on a wide range of topics – especially pertaining to their health. What is often missing however, is the knowledge to make sense of all this information, and the reason we have developed the ‘Berg Education program is to address this issue. By educating your patients you will be able to create an awareness of what they can do for themselves to make your treatment more effective and stable. Sunday, January 19, 14
  • 113. + ‘Berg Education Using the principle of the Iceberg, where only 10% is visible, and the danger lurks in the 90% that can’t be seen, it becomes simple for your patients to understand that the Symptoms they are seeing and feeling are only the “Tip of the Iceberg”. When they see what is going on under the surface they will appreciate that there are other issues to be dealt with in addition to the physical and mechanical adjustments. Sunday, January 19, 14 SYMPTOMS Other underlying issues causing or aggravating the initial problem
  • 114. + The Toothberg People do not catch: • • • • • Open bite Malocclusion Tongue thrust Crooked teeth Forward head position This is a consequence of what they are doing. Unless they change what they are doing they will not change what caused the problem in the first place. Sunday, January 19, 14 Other underlying issues causing or aggravating the initial problem
  • 115. + The Sleepberg People do not catch: • • • • • • • • • Apnea Snoring Grinding Clenching Malocclusion Tongue thrust Crooked teeth TMJ disorders Forward head position These are a consequence of what they are doing, and unless they change what they are doing they will be working against the treatment. Sunday, January 19, 14 Other underlying issues causing or aggravating the initial problem
  • 116. + The Jawberg TMJ disorders are a complex of multiple dysfunctional patterns in day to day life. Included in these can be: • Consequences of previous dental and orthodontic treatment. • Degradation of teeth and jaw integrity. • Severe damage from bruxing and clenching. • Damage done by reflux and medications. Failure to address and treat these issues can seriously affect remedial treatment. Sunday, January 19, 14 Other underlying issues causing or aggravating the initial problem
  • 117. + The Stressberg That Stress is extremely harmful to our health is a well known fact, but Stress is usually regarded by most people as the emotional condition brought about by worries, problems and other life issues. The reality is however that Stress also has other causes, such as postural, dental, environmental, dietary and occupational dysfunction which aggravates the condition. Stress needs to be addressed across all fronts. Sunday, January 19, 14
  • 118. + This is a Dental Team Program Because this is primarily an Educational Program and not Clinical Treatment or Therapy, it is designed to be run almost exclusively by the Dental Team. The dentist’s primary role is chair-side, and his or her only involvement in this program occurs when evaluating the results, doing the case presentation or providing an overview of progress. Sunday, January 19, 14
  • 119. + Flow chart and involvement Patient at Reception Explaining Integrative Dental Care Breathing Efficiency Check Brief greeting by Dentist ( 2-3 minutes) Issue Sleep Image and SnoreLab Result evaluated by Dentist in down time No Problem Dental Team Sunday, January 19, 14 No Action Problem Dentist Further Action
  • 120. + Detailed procedure STEP 1 The purpose is to make a patient aware that this is an Integrative Dental Care practice and that it does things differently. STEP 2 Explain the ‘Berg Education principle and make the patient aware that there is a low cost simple process available to check Sleep and Breathing Efficiency. STEP 3 Invite them to have a complimentary Breathing Efficiency Check while they’re waiting. You will need to get a “consent form” signed on the basis that this is confidential information and subject to Privacy Laws. This will also cover you for taking photographs. Sunday, January 19, 14
  • 121. + Detailed procedure STEP 4 Print out the graph and let them compare it with a functional breathing graph. Let them draw their own conclusions. STEP 5 Explain that the way they sit, stand, walk, talk and function can affect their breathing and offer them a quick Posture Photo session. This will immediately show them that they are out of balance. STEP 6 Explain that dysfunctional breathing and poor posture during the day can carry over to the night and could interfere with their Sleep Efficiency. Offer them the Sleep Image and SnoreLab package. Sunday, January 19, 14
  • 122. + Detailed procedure STEP 7 Tell them that the Dentist will look at the various printouts and decide whether or not they have anything to do with their current symptoms. STEP 8 He/she will then discuss the options available, how they will affect the treatment protocol, when they should be done and will quote an allinclusive fee for the program. Any comment that a lower quotation has been obtained can quickly be countered by asking if that was from an Integrative Dental Care practice. STEP 9 The final step is the Informed Consent and to get started. Sunday, January 19, 14
  • 123. Ortho-Postural Training Home Education Kit •Workbook •Stopwatch •Tongue Tip Tags •Tape Sunday, January 19, 14
  • 124. Ortho-Postural Training • Home Education Kit •Workbook •Stopwatch •Tongue Tip Tags (cellulose) •Tape Sunday, January 19, 14
  • 125. Ortho-Postural Training • 4. Patient and Parent Workshop Dr. John Flutter Sunday, January 19, 14
  • 126. First learn sit-up-straight and stand-up straight in the correct sized chair Sunday, January 19, 14
  • 127. Identify the diaphragm and feel it move. Sunday, January 19, 14
  • 128. When placed in the correct position the can should rock with every breath Sunday, January 19, 14
  • 129. Sunday, January 19, 14
  • 130. Capnotrainer Sunday, January 19, 14
  • 131. Breathing Well App Sunday, January 19, 14
  • 132. More Exercises... • Additional Exercises • From Alfred Rogers • Jaw Stretches • Neck Stretches Sunday, January 19, 14
  • 133. More Exercises... • From Kondo • Tongue Lift (with gum) Sunday, January 19, 14
  • 134. More Exercises... If you show these to anyone, I’ll kill you... • From Flutter/Buteyko • 3M Micropore tape Sunday, January 19, 14
  • 135. More Exercises... • Nasal rinsing Sunday, January 19, 14
  • 136. Game:FACE We teach: PowerUPs: things you do that make you Better Villians : things you do that make you worse Allies: people and things that help you Quests: Challenges to meet Epic Wins: All the Ways in which you get BETTER Sunday, January 19, 14
  • 137. Game:FACE PowerUPs and Rewards Program Parent Worksheet 1. Set Budget 2. Determine Point Values = (2000/3000/4000)/budget 3. Choose Rewards 4. Earning Points 5. Celebrating Epic Wins Points 100 250 500 1000 Sunday, January 19, 14 $/point Prize Value Prize #1 Prize #2
  • 138. Airway-focused Orthodontics 1.Airway-focused Diagnostics 2.Prevention 3.Undo the Damage 4.Establish Good Habits 5. Interdisciplinary Treatment Only by working together will we get to the root of the problem. Sunday, January 19, 14
  • 139. Context: Dentistry is Medicine Big-Picture Issues related to (Mal)Occlusion •Early Feeding, Nutrition and muscular development •Tight Frena and Early Nutrition •Posture, musculo-skeletal-cranial stress and facial growth •Breathing, Airway and Apnea •Soft Tissue Dysfunctions, Habits and malocclusion Sunday, January 19, 14
  • 140. Context: Dentistry is Medicine Big-Picture Issues related to (Mal)Occlusion • Multi-Disciplinary Effort: Various dental, medical, and support specialties will find a common thread in preventing and treating airway issues. GP Oral myologist Ortho Pediatrician Chiropractic/PT Pedo (Pediatric) ENT Hygienist Oral Surg Pain Medicine Educators Prostho Sunday, January 19, 14 Allergist Sleep Medicine Breathing Therapy
  • 141. Context: Dentistry is Medicine •The separation was political and economic, (for good reason) but is now coming to an end •The dentist as oral physician •Broaden your view..... Sunday, January 19, 14
  • 142. My Next Dream Practice • Full Time Staff • Director/Orthodontist • Myofunctional Orthopostural Therapist • 2 Health Educators • Admin • Part Time Staff • Chiropractor/Physical Therapist/Cranio-sacral/AK • ENT with training in Sleep • Allergist with training in nutrition • Nutritionist with training beyond the Pyramid • Referral • Oral Surgeon with training in mid-tongue release • Private practices of parttime staff • Pediatrician with Integrative background Sunday, January 19, 14
  • 143. Airway-focused Orthodontics 1.Airway-focused Diagnostics 2. Prevention 3.Undo the Damage 4. Establish Good Habits 5. Interdisciplinary Treatment When to start? When damage from poor breathing is noticed or when bad habits are discovered. Sunday, January 19, 14
  • 144. The Goals of Airway Orthodontics 1. 2. 3. 4. 5. 6. 7. 8. Sunday, January 19, 14 Breathing through the nose Lips together at rest Correct tongue position No facial muscles moving on swallowing Optimal FORWARD facial development Class I occlusion Straight teeth Better Stability long term
  • 145. Putting it (us) all together Function Nasal clearing Muscle balance and tone Undoing Damage Breathing Dynamics Posture Cranial balance Nutrition Sleep ? Professional ENT, Pulm, OMT, Breathing OMT, Myofunctional Ortho GP, Pedo, Ortho, OMFS OPT, OMT, Breath Phsyio DC, OPT, PT, Osteo Osteopath RDH, Nutritionist, Dietitioan ENT, Sleep Med, Dent ? The Interdisciplinary Center Sunday, January 19, 14
  • 146. Raphael Center for Integrative Education Bodywork Myobrace Activity Center Myofunctional Therapy Ortho-Postural training Sunday, January 19, 14 Medical Public and Professional Education
  • 147. 5. Case presentations and patient demos 1. Case results 2. Clinical Case: Assessment 3. Clinical Case: Myobrace delivery and management Sunday, January 19, 14
  • 148. Francesca (Cessa) Sunday, January 19, 14
  • 149. Mixed Dentition Sunday, January 19, 14
  • 150. Sunday, January 19, 14
  • 151. What to expect. The Dental Model : Getting Perfection The Medical Model: Getting Better i Sunday, January 19, 14
  • 152. Batting Average? Double: Good Trainer Wear. Braces 18mo, Easy Non-X Triple: Good Trainer Wear. Braces 12 mo or aligners to touchup Home Run: Great Trainer Wear. No Braces Needed Sunday, January 19, 14 Single: OK Trainer Wear. Braces 24 mo. Crowding or OJ remain Walk: Tries Trainer. Can’t/Won’t do it. Do Conventional Tx. Strike out: Poor Wear. Case Drags On. Gets nowhere. Braces are a compromise
  • 153. Cases Sunday, January 19, 14
  • 154. Case July 2010 9-10y F Class II div 1 Excess OJ/OB Narrow arches Lip Incompetence STD Mouth breathing Sunday, January 19, 14
  • 155. Soft Tissue Dysfunctions •Lip Incompetence •Lip Entrapment •Hypermentalis •Mouthbreathing Sunday, January 19, 14
  • 156. Symptoms •Deep Bite •Excess Overjet •Low Frenum •Palatal Tissue Trauma •Extruded incisors Sunday, January 19, 14
  • 157. Symptoms •Tapered upper arch •Palatal Tissue Trauma •Rotated first molars •Protrusive Incisors Sunday, January 19, 14
  • 158. Symptoms •Narrow arch •Crowded Incisors Sunday, January 19, 14
  • 159. After Treatment Arch expansion 6 months Muscle Training 12 months Sunday, January 19, 14
  • 160. 12 month progress Sunday, January 19, 14
  • 161. 8 month progress Sunday, January 19, 14
  • 162. 12 month progress Sunday, January 19, 14
  • 163. Case 1 Class II w rotated U6’s Narrow and mild crowding Lower midline to right Crowding at LR4 Tight labial musculature Sunday, January 19, 14
  • 164. Case 1 Upper BWS 4mos T4K Soft, then Hard 9 mos Lower BWS 2 mos • Better arch width and form • No crowding • Molars still rotated Sunday, January 19, 14
  • 165. Case 1 Upper BWS 4mos T4K Soft, then Hard 9 mos Lower BWS 2 mos • Better arch width and form • No crowding • Enough space for LR4 (with leeway and midline shift) • Available space on left to correct midline Sunday, January 19, 14
  • 166. Case 1 Upper BWS 4mos T4K Soft, then Hard 9 mos Lower BWS 2 mos • Reduced overbite • No crowding • Enough space for LR4 (with leeway) Sunday, January 19, 14
  • 167. C.F. 7-6F OJ=7mm, Lost c-space, Open Mouth Posture Sunday, January 19, 14
  • 168. What do you see? Sunday, January 19, 14
  • 169. What do you see? Sunday, January 19, 14
  • 170. What do you see? Sunday, January 19, 14
  • 171. What do you see? Sunday, January 19, 14
  • 172. Clinical Findings • “Severe Soft Tissue Dysfunction” • Anterior Tongue Thrust •Open Mouth Posture •Hyperactive Mentalis •Lower lip entrapment •Lip Incompetence •Lips dry •Large Tonsils •Narrow Arches •7mm overjet •Lost LR c-space •Class II molar •Mom had X4’s and chin implant Sunday, January 19, 14
  • 173. C.F. 8-7yo U-BWS,T4K soft, L-BWS Sunday, January 19, 14
  • 174. Treatment Notes • “is trying to sleep with trainer” •“will really try harder...will try tape” •“doing great with trainer..has started to stay in at night” •“positions tongue between anteriors...reviewed tongue spot” •“still falls out at night” Sunday, January 19, 14
  • 175. C.F. 9.2yo Done w/ BWS, doing neck stretches Sunday, January 19, 14
  • 176. Treatment Sequence Month •6/10 U-BWS •9/10 T4K soft •12/10 T4K hard •2/11 OJ=8mm •4/11 d/c U-BWS, insert L-BWS •9/11 OJ=1mm •12/11 d/c BWS, cont T4K •10/12 d/c trainer •6/13 U/L Fixed (Goal 9/14) Sunday, January 19, 14 0 3 6 8 10 15 18 28
  • 177. C.F. 10-1yoF Perm dentition. Still Class II Right Sunday, January 19, 14
  • 178. Developing the Arch 7-6yo 8-7yo 9-2yo Sunday, January 19, 14 10-1yo
  • 179. Recover Lost c-space 7-6yo 8-7yo 9-2yo Sunday, January 19, 14 10-1yo
  • 180. Recover Lost c-space 10-1yo 7-6yo Sunday, January 19, 14
  • 181. Better Lip Competence 7-6yo Sunday, January 19, 14 10-1yo
  • 182. C. R. 10-8yo F Late Mixed Dent Crowded incisors FaMu active swallow Hypermentalis Sunday, January 19, 14
  • 183. Treatment Sequence Month •9/11 U-BWS, T4K soft •12/11 Trainer Activities •3/12 Microbond U1-1 •7/12 d/c BWS, T4K hard •1/13 Trainer 15min/day •11/13 MB4 Sunday, January 19, 14 0 3 6 10 16 26
  • 184. 10-8yo 11-6yo 12-0yo Sunday, January 19, 14 13-0yo
  • 185. 10-8yo 12-0yo Sunday, January 19, 14 11-6yo 13-0yo
  • 186. .012 Niti Wire Microbond 10-8yo 12-0yo Sunday, January 19, 14 11-6yo Composite Stops 13-0yo
  • 187. Sunday, January 19, 14
  • 188. J.S. 11-8yo F I want braces... Just try it for a coupla’ months... Sunday, January 19, 14
  • 189. Deep Bite Corrected 11-6yo 12-4yo Sunday, January 19, 14
  • 190. Class II Improved 11-6yo 12-4yo Sunday, January 19, 14
  • 191. Treatment Sequence • 1/12 Start MBS1 • 3/12 stays in all night • 4/12 increases daytime wear • 7/12 Occlusion settled. Decide to forgo braces Sunday, January 19, 14 Month 0 2 3 6
  • 192. Still want braces? Sunday, January 19, 14
  • 193. C.G. 9-10yo M Sunday, January 19, 14
  • 194. Lots of cajoling with little success... 9/09 Initial Pix 10/10 DS 1/11 U-BWS 2/11 K1 (FOAN, 2 on coop) 7/11 Group 1 Exercise 8/11 BWS broken, made new 10/11 K2 (good daytime, poor nighttime wear 1/12 d/c U-BWS, place L-BWS 3/12 coop improves 6/12 d/c L-BWS 8/12 still FOAN 1/13 still Class II 3/13 mandibular stretching 9/13 still waiting for e’s Sunday, January 19, 14 Month 0 1 9 12 14 17 24
  • 195. Upper Narrow, Crowded Sunday, January 19, 14
  • 196. Parents wait to see if I’m right about crowding Sunday, January 19, 14
  • 197. BWS Sunday, January 19, 14
  • 198. Crowding resolving Sunday, January 19, 14
  • 199. Arch widening Sunday, January 19, 14
  • 200. Crowded and narrow Sunday, January 19, 14
  • 201. Waiting to start Sunday, January 19, 14
  • 202. Before BWS Sunday, January 19, 14
  • 203. After BWS Sunday, January 19, 14
  • 204. Not bad after all Sunday, January 19, 14
  • 205. Still waiting for e’s to drop Sunday, January 19, 14
  • 206. Deep Bite 9 months Perm Dentition Sunday, January 19, 14
  • 207. Anterior Crossbite Sunday, January 19, 14
  • 208. Patient Name: MYOBRACE K1/BWS - K2 - K3 DOB 20.08.92 RHYS WADE - COOPER 21/04/2010 30 August 2005 Sunday, January 19, 14 21/04/2010 30 August 2005
  • 209. Patient Name: MYOBRACE K1/BWS - K2 - K3 DOB 20.08.92 RHYS WADE - COOPER 21/042010 30 August 2005 Sunday, January 19, 14 21/04/2010 30 August 2005
  • 210. Patient Name: MYOBRACE K1/BWS - K2 - K3 DOB 20.08.92 RHYS WADE - COOPER 26/10/10 30 August 2005 Sunday, January 19, 14 26/10/10 30 August 2005
  • 211. Patient Name: MYOBRACE K1/BWS - K2 - K3 DOB 20.08.92 RHYS WADE - COOPER 21/04/2010 30 August 2005 Sunday, January 19, 14 28/09/2011 30 August 2005
  • 212. T4K - MYOBRACE K1 Patient Name: RHYS WADE - COOPER - DOB 20.08.92 10/11/2008 30 August 2005 Sunday, January 19, 14 10/11/2008 30 August 2005
  • 213. T4K - MYOBRACE K1 Patient Name: RHYS WADE - COOPER - DOB 20.08.92 12/07/10 30 August 2005 Sunday, January 19, 14 12/07/10 30 August 2005
  • 214. T4K - MYOBRACE K1 Patient Name: RHYS WADE - COOPER - DOB 20.08.92 10/11/2008 30 August 2005 Sunday, January 19, 14 12/07/10 30 August 2005
  • 215. Infant WADE Patient Name: RHYSTrainer --I-3 - Myolay DOB 20.08.92 COOPER 02/04/09 30 August 2005 Sunday, January 19, 14 02/04/09 30 August 2005
  • 216. Infant WADE Patient Name: RHYSTrainer --I-3 - Myolay DOB 20.08.92 COOPER 02/04/09 30 August 2005 Sunday, January 19, 14 02/04/09 30 August 2005
  • 217. Infant WADE Patient Name: RHYSTrainer --I-3 - Myolay DOB 20.08.92 COOPER 10/01/12 30 August 2005 Sunday, January 19, 14 10/01/12 30 August 2005
  • 218. Infant WADE Patient Name: RHYSTrainer --I-3 - Myolay DOB 20.08.92 COOPER 10/04/12 30 August 2005 Sunday, January 19, 14 10/04/12 30 August 2005
  • 219. Infant WADE Patient Name: RHYSTrainer --I-3 - Myolay DOB 20.08.92 COOPER 02/04/09 30 August 2005 Sunday, January 19, 14 10/04/12 30 August 2005
  • 220. MYOBRACE K1/BWS COOPER - DOB 20.08.92 Patient Name: RHYS WADE - - K2 - T2 - T3 02/09/09 30 August 2005 Sunday, January 19, 14 02/09/09 30 August 2005
  • 221. MYOBRACE K1/BWS COOPER - DOB 20.08.92 Patient Name: RHYS WADE - - K2 - T2 - T3 02/09/09 30 August 2005 Sunday, January 19, 14 02/09/09 30 August 2005
  • 222. MYOBRACE K1/BWS K2 - T2 Patient Name: RHYS WADE --COOPER--T3 DOB 20.08.92 25/05/2011 30 August 2005 Sunday, January 19, 14 25/05/2011 30 August 2005
  • 223. MYOBRACE K1/BWS K2 - T2 Patient Name: RHYS WADE --COOPER--T3 DOB 20.08.92 31/08/11 30 August 2005 Sunday, January 19, 14 31/08/11 30 August 2005
  • 224. MYOBRACE COOPER - DOB 20.08.92 Patient Name: RHYS WADE -K1-K2 09/11/09 30 August 2005 Sunday, January 19, 14 09/11/09 30 August 2005
  • 225. MYOBRACE COOPER - DOB 20.08.92 Patient Name: RHYS WADE -K1-K2 09/11/09 30 August 2005 Sunday, January 19, 14 09/11/09 30 August 2005
  • 226. MYOBRACE COOPER - DOB 20.08.92 Patient Name: RHYS WADE -K1-K2 09/01/12 30 August 2005 Sunday, January 19, 14 09/01/12 30 August 2005
  • 227. MYOBRACE COOPER - DOB 20.08.92 Patient Name: RHYS WADE -K1-K2 09/01/12 30 August 2005 Sunday, January 19, 14 09/01/12 30 August 2005
  • 228. MYOBRACE K1/BWS - K2 - T2- DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 26/08/09 30 August 2005 Sunday, January 19, 14 26/08/09 30 August 2005
  • 229. MYOBRACE K1/BWS - K2 - T2- DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 26/08/09 30 August 2005 Sunday, January 19, 14 26/08/09 30 August 2005
  • 230. MYOBRACE K1/BWS COOPER T3 Patient Name: RHYS WADE - - K2 - T2-- DOB 20.08.92 05/08/10 30 August 2005 Sunday, January 19, 14 05/08/10 30 August 2005
  • 231. MYOBRACE K1/BWS COOPER T3 Patient Name: RHYS WADE - - K2 - T2-- DOB 20.08.92 26/08/09 30 August 2005 Sunday, January 19, 14 05/08/10 30 August 2005
  • 232. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 08/12/09 30 August 2005 Sunday, January 19, 14 08/12/09 30 August 2005
  • 233. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 08/12/09 30 August 2005 Sunday, January 19, 14 23/12/09 30 August 2005
  • 234. K1/BWS - K2 COOPER Patient Name: RHYS WADE - - T2- T3 - DOB 20.08.92 08/12/09 30 August 2005 Sunday, January 19, 14 10/05/10 30 August 2005
  • 235. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 23/12/09 30 August 2005 Sunday, January 19, 14 10/05/10 30 August 2005
  • 236. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 10/05/10 30 August 2005 Sunday, January 19, 14 10/05/10 30 August 2005
  • 237. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 10/05/10 30 August 2005 Sunday, January 19, 14 19/07/10 30 August 2005
  • 238. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 10/05/10 30 August 2005 Sunday, January 19, 14 19/07/10 30 August 2005
  • 239. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 08/12/09 30 August 2005 Sunday, January 19, 14 19/07/10 30 August 2005
  • 240. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 08/12/09 30 August 2005 Sunday, January 19, 14 06/08/11 30 August 2005
  • 241. BB1/T4K - MYOBRACE K2-T2-T3 07/04/09 Sunday, January 19, 14 07/04/09
  • 242. BB1/T4K WADE - COOPER - DOB 20.08.92 Patient Name: RHYS - MYOBRACE K2-T2-T3 14/09/09 30 August 2005 Sunday, January 19, 14 14/09/09 30 August 2005
  • 243. BB1/T4K WADE - COOPER - DOB 20.08.92 Patient Name: RHYS - MYOBRACE K2-T2-T3 07/04/09 30 August 2005 Sunday, January 19, 14 07/04/09 30 August 2005
  • 244. BB1/T4K WADE - COOPER - DOB 20.08.92 Patient Name: RHYS - MYOBRACE K2-T2-T3 22/04/09 30 August 2005 Sunday, January 19, 14 22/04/09 30 August 2005
  • 245. BB1/T4K WADE - COOPER - DOB 20.08.92 Patient Name: RHYS - MYOBRACE K2-T2-T3 20/07/09 30 August 2005 Sunday, January 19, 14 20/07/09 30 August 2005
  • 246. BB1/T4K WADE - COOPER - DOB 20.08.92 Patient Name: RHYS - MYOBRACE K2-T2-T3 10/01/12 30 August 2005 Sunday, January 19, 14 10/01/12 30 August 2005
  • 247. BB1/T4K MYOBRACE K2-T2-T3 Patient Name: RHYS-WADE - COOPER - DOB 20.08.92 07/04/09 30 August 2005 Sunday, January 19, 14 10/01/12 30 August 2005
  • 248. BB1/T4K WADE - COOPER - DOB 20.08.92 Patient Name: RHYS - MYOBRACE K2-T2-T3 07/04/09 30 August 2005 Sunday, January 19, 14 10/01/12 30 August 2005
  • 249. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 17/03/09 30 August 2005 Sunday, January 19, 14 17/03/09 30 August 2005
  • 250. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 17/03/09 30 August 2005 Sunday, January 19, 14 17/03/09 30 August 2005
  • 251. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 17/01/2010 30 August 2005 Sunday, January 19, 14 17/01/2010 30 August 2005
  • 252. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 25/08/10 30 August 2005 Sunday, January 19, 14 25/08/10 30 August 2005
  • 253. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 06/02/12 30 August 2005 Sunday, January 19, 14 06/02/12 30 August 2005
  • 254. MYOBRACE K1/BWS - K2 - T2 - DOB 20.08.92 Patient Name: RHYS WADE - COOPER -T3 17/03/09 30 August 2005 Sunday, January 19, 14 06/02/12 30 August 2005
  • 255. Demo: Assessment • Roger Price: overview of Ortho-postural Training • Medical and airway history • Photos • Posture photos and analysis • Breathing efficiency analysis • Sleep efficiency • (Models, radiographs) Sunday, January 19, 14
  • 256. Demo: Myobrace Delivery • Welcome patient • Choose color • Describe use and importance • Deliver Myobrace • Instructions •The “two things” • Comfort check • Daytime wearing schedule • Score card • What to expect at night • Cleaning • Next appointment Sunday, January 19, 14