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The Alimond Show
Bryanna Schwarting: What's Really Happening When You Can't Swallow, Speak, or Sleep
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My name is Brianna Schwarding , I am a speech-language pathologist , I am a feeding and swallowing specialist , I'm a certified lactation professional and I'm a qualified oral facial myologist track candidate . And some people just say alphabet soup . Alphabet soup , yes . After the event , all to say that I am mouth obsessed , which is why I am the owner and founder of the Mouth Rehab in Ashburn , virginia . Okay .
Speaker 2Don't stare at my mouth too
Meet Brianna: Mouth Rehab Specialist
Speaker 2much Now . I'm scared . I'm kidding .
Speaker 1I'm kidding , no , I've had friends that are like do you turn it off ? Like , can you turn it off when you're like speaking and eating with people ? I'm like , yeah , you know , work hours versus play hours .
Speaker 2I can turn it off . I don't know that . Yeah , didn't sound very convincing . I'm just kidding , I'm kidding , I'm kidding , all right . So can you share what you do at the Mouth Rehab and how you help clients improve their overall health through your specialized services ?
Speaker 1So at the Mouth Rehab I work across the lifespan . I work with infants , I work with toddlers , I work with children , teens , adults . I would say that I have always had a love and passion for feeding and swallowing and it's so deeply rooted and cultural and I feel like that's the piece that I try and keep protected . I started in swallowing and swallowing disorders and then slowly moved into tethered oral ties , as my sons were both born with tongue ties , became an oral facial myologist working on how the muscles at the cheeks and the lips and the tongue all work in synchrony or harmony to reduce the risk of breathing out of our mouth or snoring . Or I know you're like , yeah , oral habits like sucking our thumb , biting our nails , finger sucking pacifiers all the fun stuff apparently .
Speaker 1Yeah , all the fun stuff . But yeah , I have a wide range , because even infants breastfeeding , bottle feeding , oral aversions , and then with adults , from anything from speech to language to cognition .
Speaker 2Yeah , so not just the kiddos , right , we've got the adults too . Adults as well . Wow , that's incredible . Now I want to ask you what is a myofunctional therapy for those of us who may not be familiar with ?
Speaker 1that yeah . So myofunctional therapy is working on the muscles of the lips , the tongue , the cheeks . Some people like to say it's like physical therapy for the mouth . I don't know if I like to say physical therapy , because we aren't necessarily quote unquote strengthening musculature . In a way we are , but it's a way of working on the musculature to help us breathe out of our nose , be able to eat and chew and swallow without our tongue moving forward but going up and back For those
Understanding Myofunctional Therapy
Speaker 1tongue thrusters . If you've ever seen littles that continue to move their tongue down and forward , that might look like messy eating and teenagers that might look like orthodontic relapse . I work with a lot of orthodontists that are like you , are the missing puzzle piece to help me preserve my work , because they'll move all of the teeth . But then the tongue is such a strong muscle that the tongue will . Those patterns will just shift the teeth over again .
Speaker 1So for adults that go through a second round of braces or aligners , it's typically the tongue that was the culprit . So now we have orthodontists that will refer to the mouth rehab so that the tongue doesn't mess up their beautiful work .
Speaker 2Absolutely . That's incredible how , like physicians , nurses , doctors , everything they all have like their community because it's all a community where you guys have to work together with different functions and different specialties that when you bring them all together , it's , like you said , that missing piece to help fix or help solve an issue for your clients . So that's incredible .
Speaker 1I would say a large piece of it is there's a barrier . So often we see littles that are in therapy for a long period of time . We're like why can't we get to the root cause of this ? And it's typically one of four things . It's either chronic nasal congestion or a nasal obstruction , it's enlarged adenoids or tonsils . It's mouth breathing from , whether it's a tongue tie or a high and narrow palate . But it's usually one of those four barriers that's getting in the way of us being able to meet our therapeutic goals , whether it's in speech therapy or feeding therapy .
Speaker 2Good to know . And then , what drives you to get to the root cause rather than just compensating for issues in your field ?
Speaker 1What a beautiful question Because , like I mentioned so often , we have littles that move through feeding therapy , are graduated through feeding therapy , and then they're like still , something is missing still , and they'll continue to do services again and same for speech . They'll do speech therapy when they're younger or be in speech therapy for a year or two years . And it's like why aren't we getting to correcting this list ? Why hasn't it taken this long ?
Root Causes and Compassionate Care
Speaker 1And there might be a structural or anatomical reason why there's a barrier there , for why we can't hit those milestones ?
Speaker 2Yeah , absolutely . And then , how do you define compassionate care in a clinical or business setting and how do you bring that to life every day ? What does that look like for you ?
Speaker 1Being a mom . You know , after becoming a mother , my way that , the way that I completely shifted how I am as a clinician , as a Christian I believe that we're all God's children , so every single person that comes through my door is someone that I'm going to put my heart and soul into . And now there's another layer of being a mom where I know that I was also that parent that went to six different specialists before I diagnosed what was going on with my little . So I would say , like the biggest piece is like I'm compassionate because I've been there . But also I know that a mother or a father's intuition , whatever is deep in their will that saying wait , hold on , like this doesn't seem right or this is taking too long , or maybe this isn't the right provider . And I tell that even to the clients that see me . If we do a comprehensive evaluation and something in your will is like it's not what I was thinking , don't ignore it . Tell me , we'll find out what that path is . So , yeah , I think becoming a mother has completely shifted my life .
Speaker 2Yeah , and I love that . I love that you are so open to following your intuition and to speak up , like for your kids and the health of your kids and who's helping your kid with their issues Like that's so important and the fact that you experienced that yourself as a mother . I think that's crucial and I think that probably is so relatable for a lot of people to be heard . And then , why is it important to balance evidence-based practices with individualized , person-centered approaches ?
Speaker 1What a wonderful question , wow . We have to dive into the research . We have to look at what is the evidence-based practice for each therapeutic intervention that we bring in . But it's evidence-based practice , it's also a triangle . You have to bring in clinical or the patient's experience , and you also have to bring in the parent rapport and the client's history too . So research , client history and then also
Evidence-Based Practice and Misconceptions
Speaker 1what's happening within the field because that's how research develops too is the patterns that we see in front of our clients . So I think that it's important to waver between the evidence base but then also truly listening to your clients and what they're experiencing , because there's a lot that's happening right now that's shifting the way that we practice too . Can you give me an example of what is shifting , for example , within the speech field ?
Speaker 1There's sometimes a little bit of a controversy about oral motor exercises , and I believe that you can work on oral motor exercises and pair it with functionality motor exercises and pair it with functionality , as long as if we are working on these small , intricate movements , or if we're working on let's let me give an example blowing bubbles .
Speaker 1If you're blowing bubbles in speech therapy , why are we doing that if we're trying to work on the w sound . So speech therapists might say like you shouldn't be working on oral motor exercises , like blowing bubbles , when what you should do to work on speech is just the speech . But I believe that within oral motor exercises you can quickly shift . If someone is blowing bubbles and I'm finally getting a lip rounding that I didn't get before , with just working on the speech , then I can shape it , blow that bubble with just working on the speech , then I can shape it , blow that bubble , but then give me a sound and then you can pull right back into what your target is . So I feel like with oral motor exercises , whether it is a speech sound or how we're eating and chewing , you take a small movement , bring it quickly back to function .
Speaker 2I love that . It kind of reminds me of like singing lessons almost . Like you know , it's just like work on your vowels and like all that stuff .
Speaker 1So that's , you wouldn't do that in like isolation , but you do different . Another example would be like in physical therapy they may have you hopping on one foot . You came in because you need help with running and you're like why are you having me hopping over here ? It doesn't make any sense . Because you need help with running and you're like why are you having me hopping over here ?
Speaker 2It doesn't make any sense . But how do we run ? You somewhat , hop from foot to foot . It becomes like glad and then you start . Thank you for that example . I love it . That was beautiful . Yeah , I love it . And then , how does a feeding therapist help babies ?
Speaker 1Wonderful question . So with feeding therapy we're also looking at those oral motor skills . How are the lips , the cheek , the tongue working while we're feeding and breastfeeding , with bottle feeding , whether it's oral aversions or tongue tie , we're looking at the musculature and how can we hit these different developmental milestones and reflexes to meet our goals . So with feeding therapy , with working with infants , I work really closely with cranial sacral therapists and IBCLCs to kind of hit that missing piece of the oral motor , the musculature that gets us to our goals .
Speaker 2I love it . And then what's ? I know we talked about this a little bit about misconception , but what's one common misconception about myofunctional disorders and their broader impact on health ?
Speaker 1It's a wonderful question too . Yeah , A common misconception about myofunctional therapy . I think that the common misconception would be that you're doing these exercises to breathe through your nose , which seems simple . You could just tell a kiddo hey , close your mouth , right , it was that simple . But there can be a barrier , like I mentioned earlier , for why it's difficult for us to breathe through our nose . So I feel like the misconception of myofunctional therapy is that we're doing different exercises to get us to breathe through your nose , but truly we're providing a comprehensive evaluation , going through airway health , a sleep screen , how we're eating and chewing our speech sounds and relating it , circling it all back together to find the root cause , before we individualize the musculatures to get us to that goal of just breathing through our nose instead of our mouth .
Speaker 2Yeah , absolutely . And if it was that simple , I don't think you guys would be here . Clearly , it's not simple . You guys need like a whole system to help a team , so it's pretty dense . Yeah , Thanks for talking about that . And then how has your advanced training in areas like TMJ , airway orthodontics or oh my God , I'm going to butcher this dysphagia , Dysphagia , Dysphagia . Okay , see how embarrassing Shaved the way you support clients .
Speaker 1Yes , it all comes back to musculature there's . Sometimes those are all really different . So I'm like , how do I bring those all wrap them all together ? So with swallowing and swallowing disorders , typically there's an etiology , there's a reason why we're having difficulty
Swallowing Disorders and Treatment Approaches
Speaker 1swallowing , coughing , gagging , that sensation of like a lump in our throat . So one providing an assessment to see what it looks like and what I'm hearing , and then always referring out to the right provider to find the root cause . I was going to give a case study but I guess I can .
Speaker 1So I have a friend who is 30 years old and he's gotten multiple swallow assessments because he can't swallow Like the initiation of his swallow . He can't swallow Like the initiation of his swallow , it just gets stuck , wow . So he's had formal swallow assessments where they're trying to find out why and he was given the diagnosis of dry mouth he can't initiate his swallow . That has to be neurological . So coming to a specialist that's able to , okay , let's see what's happening while you're eating and chewing . Let's look at your structure . Let's look in your cheeks , underneath your tongue . Let's see what's your history with breathing and sleeping . Let's find out why and going through even his history of feeling dizzy or his fingertips get numb , going deeper into how come you find that there is a possible neurological or early neurological symptoms , or why we can't initiate that swallow . Yeah , but sorry , that was just for dysphagia .
Speaker 1No that's okay . You also mentioned TMJ . That's another TMJD disorder . So if we are looking at popping or clicking or if our jaw is deviating one side when we're opening , myofunctional therapy would be a way of addressing musculature to get us those balances so that we're able to breathe through our nose versus our mouth . So , sometimes there can be imbalances with TMJ . Often providers will refer to possibly Botox to help with that discomfort , but it is a temporary fix . Botox will wear off , but addressing the musculature does not .
Speaker 2Got to get to the core right , Get to the core is what it's all about .
Speaker 2That is so incredible . The fact like just you saying , like people have a swallow that's stuck , a lot of people probably feel dismissive . It's just like just you saying , like people have a swallow that's stuck , a lot of people probably feel dismissed . It's just like just swallow , like what is wrong with you , like it's easy , but it's something neurological , it's something deeper . So I am so glad that you're here today able to talk about and debunk some of these things , because maybe people , somebody might hear this and maybe they're like oh my gosh , I relate to that , or I have a friend or my kid that is so important , that people don't feel like they're being dismissed and that there are specialists who can help you or somebody that you know and love . So thank you so much for sharing that , and I feel like people don't know that the speech therapist is the swallowing specialist .
Speaker 1Our scope is so broad but to know like I'm looking for a speech therapist that does . When I previously worked at Inova , you know I would go in like , oh , we're going to get you a consult for the speech therapist . I'm like I have no trouble talking Like , but it's for swallowing .
Speaker 2Wait , what ? So ? Yeah , good to know . And then what's a breakthrough moment ? When identifying a root cause that led to a significant improvement for a client or a patient .
Speaker 1I feel like typically we can identify the root cause within the evaluation or within the first session . That mile lens brings us a whole different perspective as a speech or feeding therapist , but an example let's see here . My most excited about right now .
Speaker 2Yeah , you don't have to say any names . Yeah , yeah , yeah , obviously yeah .
Speaker 1Exactly , hippie y'all . I have a nugget who is eight years old and awful sleep . For his whole history , mom's like he's never slept through the night and as an infant he never slept through the night . As a toddler he was always running to the bathroom and now as an elementary school kiddo he snores really loudly and he has these big blue bags underneath his eyes and she's like I just think that he's just I've
Success Story: Sleep, Speech, Swallowing
Speaker 1just been written off as he's the one that just doesn't sleep .
Speaker 1But when he came to see us we noticed that he has a very high and narrow palate and the shape of our dentition , the shape of our mouth , is also a reflection of the shape of our airway . So the first thing I did was talk to him , talk to the family about this , got him in for expansion and once he had expanded his palate we worked on myofunctional therapy to marry all the musculature so that's all working in harmony and worked on speech sounds as well . So now he had a lisp . He no longer has a lisp , he's now breathing , sleeping through the night . He was bedwetting at eight years old but he couldn't breathe . So our body is going to wake us up when we get into that lighter sleep and if we wake up , okay , well , we'll go to the bathroom . And what else we worked on ? His tongue thrust swallow . He was swallowing down and forward . He was always a messy eater eating with his mouth open . He now swallows up and back .
Speaker 2Yeah , Wow , what a difference you've been able to make so many areas in his life , From sleep to eating to breathing like . That's huge . You must feel very , very proud of yourself for that right . Look at the chills on camera here . Y'all , we did not turn the AC down , we promise . I'm just kidding .
Speaker 1It means the world to be able to sleep . That's restorative , that's how we think during the day . I mean , I think about being a postpartum mom and not getting any sleep and waking up every two hours Like we're irritable , we're moody , our attention goes awry More often . Now with these kiddos getting diagnosed with ADHD , there are some people that are saying like no , we need to get a sleep screen first . And there are some people that are saying like no , we need to get a sleep screen first , you need to get a sleep study before we move through the ADH diagnoses . And it's such a good point Like if we're not sleeping , I can't focus .
Speaker 1Yeah , no , absolutely I'm going to be irritable , I'm going to be moody , so to provide another flip of the coin when it comes to sleep , comes back to the mouth , or even I'll go there , because I always go there with my clients too Like one question that I would say every person's thrown off . That I ask is like are you going to the bathroom every day ? Do you poop every day ? Maybe that question goes back to like how are we eating and chewing If these littles are swallowing food whole or you're like you need to slow down ? Something with the musculature is not making it easy for them to break down their food , so they're swallowing things whole and it takes longer to digest and it takes longer to go to the bathroom . Oh my . So sometimes even talking about how often we go to the bathroom infant , child or adult comes back to how are we eating or chewing ? Makes ?
Speaker 2sense Wow , sounds like my cat a little bit . We don't see cats , yeah , no , okay , good to know too . I almost was going to ask All right , so now let's change the topic a little bit . What inspired you to launch your own practice in 2018 ? And what were the biggest lessons learned in the early days ?
Speaker 1Well , I became a speech therapist in 2018 , and what were the biggest lessons learned in the early ?
Speaker 2days .
Speaker 1Well , I became a speech therapist in 2018 , but I actually launched last year , April , and I never thought I was going to open my own business and it's still scary every single day . But it started from being told that my maternity leave I wasn't going to get a maternity leave . I was part of a building associated with Inova and when we got sold , the new company told me that my pregnancy was a pre-existing condition . What , and unfortunately
Building a Practice from Scratch
Speaker 1I mean . We were able to come to an agreement and I did get a maternity leave , but it just leaving anova , which was my dream job .
Speaker 1To where do I go now ? What's my next step ? And I thought about starting a business and I was like , maybe , maybe not . And then I think it was within a month I was like , no , I'm going to do this , I'm going to go off on my own . And all throughout postpartum , I was listening to podcasts and feeding my cherub and I was learning how to create a business . I started my business on the side of my full-time job , seeing people mobily , driving to them , going to their homes . And then I that was April I moved part-time in my job . July , October , I bought a space .
Speaker 2Congratulations . Thank you , it's in Ashburn , okay .
Speaker 1And then in December I left my job and then by February I had a waitlist . How ?
Speaker 2did you feel ? It feels crazy oh my gosh , I'm proud of you . That's not an easy thing . It's scary , it's very scary , oh my God .
Speaker 1Are you a solo ? Yeah , so I'm a solo practitioner . Sorry , you're gonna make me tear up . Oh my God , I've got some tissues girl . So I'm a solo practitioner , but I just hired . Since I had a wait list since February , I hired a clinician . Her name is Carly .
Speaker 1I wasn't planning on hiring a virtual clinician , I wanted somebody in person , but she's just really good , nice that's awesome and she's been having a lot of success and I'm excited to have somebody on my team now success and I'm excited to have somebody on my team now . So yeah , it's me and Carly and my waitlist that gives me anxiety , but it's okay , I can sit in my feelings . It's only been a year . I just very grateful for the I was going to say family , but they are family the clients that come and see me and the progress and the work that we're able to do . I feel a great connection to Northern Virginia and the providers in this area . Even it's a lot to go out on your own , but for other providers to send me all these referrals it shows me that not only do they see my passion in the work and the results that I'm able to provide for this community , northern Virginia providers are just unmatched . Like we are in an area that's able to provide easy conversation , collaborative care , which I'm very grateful for ?
Speaker 2Oh , that's great to hear . I love that . I love that you've built yourself a community and that there's others who are willing to , like you know , give a helping hand and vice versa . So that's beautiful . Thank you so much for coming on the podcast . Thank you for just bringing your smile , your beauty and your knowledge . We so appreciate it . Thank you for inviting me this was awesome .