[Modified activators in cerebral palsy patients--a new area of application]

ISMAR: an autotherapeutic device assisting patients from drooling to articulated speech

This overview of three decades of clinical experience with oral therapies complemented by oral devices-vestibular screens (VS) and ISMARs (Innsbruck sensory motor activators and regulators)-tries to put these devices into an oral functional context including postural control of mobile structures both inside and outside the mouth-down to the feet. ISMARs have certain unique features which teach a person not only better postural control of the lower jaw and, hence, hyoid bone and tongue, but also to stimulate movements of lips and tongue to improve salivary control, functions of eating and drinking and the domain of communication, e.g. facial movements and articulation of speech. A review of the relevant postural background is provided and the mechanisms are explained and may serve as models for other oral therapies. The inter-relation and multi-functionality of muscular connections throughout the body explains the uniformity of facial, oral and pharyngeal dysfunctions in different conditions such as cerebral palsy, Moebius syndrome, chronic nasal congestion or developmental retardation and exposes patients with oral dysfunctions to the risks of vicious circles. However, at the same time the opportunity is given to trigger beneficious circles. Three principles of postural control in and for the neck region are postulated. Clinical observations and experiments with volunteers are described and some supporting information is given-hopefully enough to stimulate clinical work and give rise to further experimental work to illuminate this field which is extremely important for both human communication and inter-relation.