Bryanna Schwarting: What's Really Happening When You Can't Swallow, Speak, or Sleep

Episode Transcript

Speaker 1 (00:00):
My name is Brianna Schwarding, I am a
speech-language pathologist, Iam a feeding and swallowing
specialist, I'm a certifiedlactation professional and I'm a
qualified oral facial myologisttrack candidate.
And some people just sayalphabet soup.
Alphabet soup, yes.
After the event, all to saythat I am mouth obsessed, which

(00:23):
is why I am the owner andfounder of the Mouth Rehab in
Ashburn, virginia.
Okay.

Speaker 2 (00:29):
Don't stare at my mouth too much Now.
I'm scared.
I'm kidding.

Speaker 1 (00:32):
I'm kidding, no, I've had friends that are like do
you turn it off?
Like, can you turn it off whenyou're like speaking and eating
with people?
I'm like, yeah, you know, workhours versus play hours.

Speaker 2 (00:48):
I can turn it off.
I don't know that.
Yeah, didn't sound veryconvincing.
I'm just kidding, I'm kidding,I'm kidding, all right.
So can you share what you do atthe Mouth Rehab and how you
help clients improve theiroverall health through your
specialized services?

Speaker 1 (00:56):
So at the Mouth Rehab I work across the lifespan.
I work with infants, I workwith toddlers, I work with
children, teens, adults.
I would say that I have alwayshad a love and passion for
feeding and swallowing and it'sso deeply rooted and cultural
and I feel like that's the piecethat I try and keep protected.

(01:16):
I started in swallowing andswallowing disorders and then
slowly moved into tethered oralties, as my sons were both born
with tongue ties, became an oralfacial myologist working on how
the muscles at the cheeks andthe lips and the tongue all work

(01:37):
in synchrony or harmony toreduce 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, fingersucking pacifiers all the fun
stuff apparently.
Yeah, all the fun stuff.
But yeah, I have a wide range,because even infants

(01:57):
breastfeeding, bottle feeding,oral aversions, and then with
adults, from anything fromspeech to language to cognition.

Speaker 2 (02:08):
Yeah, 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 amyofunctional therapy for those
of us who may not be familiarwith?

Speaker 1 (02:18):
that yeah.
So myofunctional therapy isworking on the muscles of the
lips, the tongue, the cheeks.
Some people like to say it'slike physical therapy for the
mouth.
I don't know if I like to sayphysical therapy, because we
aren't necessarily quote unquotestrengthening musculature.
In a way we are, but it's a wayof working on the musculature

(02:40):
to help us breathe out of ournose, be able to eat and chew
and swallow without our tonguemoving forward but going up and
back For those tongue thrusters.
If you've ever seen littlesthat continue to move their
tongue down and forward, thatmight look like messy eating and
teenagers that might look likeorthodontic relapse.
I work with a lot oforthodontists that are like you,

(03:03):
are the missing puzzle piece tohelp me preserve my work,
because they'll move all of theteeth.
But then the tongue is such astrong muscle that the tongue
will.
Those patterns will just shiftthe teeth over again.
So for adults that go through asecond round of braces or
aligners, it's typically thetongue that was the culprit.

(03:24):
So now we have orthodontiststhat will refer to the mouth
rehab so that the tongue doesn'tmess up their beautiful work.

Speaker 2 (03:32):
Absolutely.
That's incredible how, likephysicians, nurses, doctors,
everything they all have liketheir community because it's all
a community where you guys haveto work together with different
functions and differentspecialties that when you bring
them all together, it's, likeyou said, that missing piece to
help fix or help solve an issuefor your clients.

(03:53):
So that's incredible.

Speaker 1 (03:55):
I would say a large piece of it is there's a barrier
.
So often we see littles thatare in therapy for a long period
of time.
We're like why can't we get tothe root cause of this?
And it's typically one of fourthings.
It's either chronic nasalcongestion or a nasal
obstruction, it's enlargedadenoids or tonsils.

(04:15):
It's mouth breathing from,whether it's a tongue tie or a
high and narrow palate.
But it's usually one of thosefour barriers that's getting in
the way of us being able to meetour therapeutic goals, whether
it's in speech therapy orfeeding therapy.

Speaker 2 (04:29):
Good to know.
And then, what drives you toget to the root cause rather
than just compensating forissues in your field?

Speaker 1 (04:38):
What a beautiful question Because, like I
mentioned so often, we havelittles that move through
feeding therapy, are graduatedthrough feeding therapy, and
then they're like still,something is missing still, and
they'll continue to do servicesagain and same for speech.
They'll do speech therapy whenthey're younger or be in speech

(04:59):
therapy for a year or two years.
And it's like why aren't wegetting to correcting this list?
Why hasn't it taken this long?
And there might be a structuralor anatomical reason why
there's a barrier there, for whywe can't hit those milestones?

Speaker 2 (05:18):
Yeah, absolutely.
And then, how do you definecompassionate care in a clinical
or business setting and how doyou bring that to life every day
?
What does that look like foryou?

Speaker 1 (05:30):
Being a mom.
You know, after becoming amother, my way that, the way
that I completely shifted how Iam as a clinician, as a
Christian I believe that we'reall God's children, so every
single person that comes throughmy door is someone that I'm
going to put my heart and soulinto.

(05:50):
And now there's another layerof being a mom where I know that
I was also that parent thatwent to six different
specialists before I diagnosedwhat was going on with my little
.
So I would say, like thebiggest piece is like I'm
compassionate because I've beenthere.
But also I know that a motheror a father's intuition,

(06:20):
whatever is deep in their willthat saying wait, hold on, like
this doesn't seem right or thisis taking too long, or maybe
this isn't the right provider.
And I tell that even to theclients that see me.
If we do a comprehensiveevaluation and something in your
will is like it's not what Iwas thinking, don't ignore it.
Tell me, we'll find out whatthat path is.
So, yeah, I think becoming amother has completely shifted my

(06:43):
life.

Speaker 2 (06:43):
Yeah, and I love that .
I love that you are so open tofollowing your intuition and to
speak up, like for your kids andthe health of your kids and
who's helping your kid withtheir issues Like that's so
important and the fact that youexperienced that yourself as a
mother.
I think that's crucial and Ithink that probably is so
relatable for a lot of people tobe heard.

(07:04):
And then, why is it importantto balance evidence-based
practices with individualized,person-centered approaches?

Speaker 1 (07:11):
What a wonderful question, wow.
We have to dive into theresearch.
We have to look at what is theevidence-based practice for each
therapeutic intervention thatwe bring in.
But it's evidence-basedpractice, it's also a triangle.
You have to bring in clinicalor the patient's experience, and

(07:32):
you also have to bring in theparent rapport and the client's
history too.
So research, client history andthen also what's happening
within the field because that'show research develops too is the
patterns that we see in frontof our clients.
So I think that it's importantto waver between the evidence

(07:54):
base but then also trulylistening to your clients and
what they're experiencing,because there's a lot that's
happening right now that'sshifting the way that we
practice too.
Can you give me an example ofwhat is shifting, for example,
within the speech field?
There's sometimes a little bitof a controversy about oral

(08:15):
motor exercises, and I believethat you can work on oral motor
exercises and pair it withfunctionality 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 blowingbubbles.
If you're blowing bubbles inspeech therapy, why are we doing
that if we're trying to work onthe w sound.

(08:37):
So speech therapists might saylike you shouldn't be working on
oral motor exercises, likeblowing bubbles, when what you
should do to work on speech isjust the speech.
But I believe that within oralmotor exercises you can quickly
shift.
If someone is blowing bubblesand I'm finally getting a lip

(08:58):
rounding that I didn't getbefore, with just working on the
speech, then I can shape it,blow that bubble with just
working on the speech, then Ican shape it, blow that bubble,
but then give me a sound andthen you can pull right back
into what your target is.
So I feel like with oral motorexercises, whether it is a
speech sound or how we're eatingand chewing, you take a small

(09:19):
movement, bring it quickly backto function.

Speaker 2 (09:22):
I love that.
It kind of reminds me of likesinging lessons almost.
Like you know, it's just likework on your vowels and like all
that stuff.

Speaker 1 (09:30):
So that's, you wouldn't do that in like
isolation, but you do different.
Another example would be likein physical therapy they may
have you hopping on one foot.
You came in because you needhelp with running and you're
like why are you having mehopping over here?
It doesn't make any sense.
Because you need help withrunning and you're like why are
you having me hopping over here?

Speaker 2 (09:49):
It doesn't make any sense.
But how do we run?
You somewhat, hop from foot tofoot.
It becomes like glad and thenyou start.
Thank you for that example.
I love it.
That was beautiful.
Yeah, I love it.
And then, how does a feedingtherapist help babies?

Speaker 1 (10:00):
Wonderful question.
So with feeding therapy we'realso looking at those oral motor
skills.
How are the lips, the cheek,the tongue working while we're
feeding and breastfeeding, withbottle feeding, whether it's
oral aversions or tongue tie,we're looking at the musculature
and how can we hit thesedifferent developmental
milestones and reflexes to meetour goals.

(10:22):
So with feeding therapy, withworking with infants, I work
really closely with cranialsacral therapists and IBCLCs to
kind of hit that missing pieceof the oral motor, the
musculature that gets us to ourgoals.

Speaker 2 (10:37):
I love it.
And then what's?
I know we talked about this alittle bit about misconception,
but what's one commonmisconception about
myofunctional disorders andtheir broader impact on health?

Speaker 1 (10:48):
It's a wonderful question too.
Yeah, A common misconceptionabout myofunctional therapy.
I think that the commonmisconception would be that
you're doing these exercises tobreathe through your nose, which
seems simple.
You could just tell a kiddo hey, close your mouth, right, it

(11:13):
was that simple.
But there can be a barrier,like I mentioned earlier, for
why it's difficult for us tobreathe through our nose.
So I feel like themisconception of myofunctional
therapy is that we're doingdifferent exercises to get us to
breathe through your nose, buttruly we're providing a
comprehensive evaluation, goingthrough airway health, a sleep

(11:34):
screen, how we're eating andchewing our speech sounds and
relating it, circling it allback together to find the root
cause, before we individualizethe musculatures to get us to
that goal of just breathingthrough our nose instead of our
mouth.

Speaker 2 (11:50):
Yeah, absolutely.
And if it was that simple, Idon't think you guys would be
here.
Clearly, it's not simple.
You guys need like a wholesystem to help a team, so it's
pretty dense.
Yeah, Thanks for talking aboutthat.
And then how has your advancedtraining in areas like TMJ,
airway orthodontics or oh my God, I'm going to butcher this
dysphagia, Dysphagia, Dysphagia.

(12:11):
Okay, see how embarrassingShaved the way you support
clients.

Speaker 1 (12:15):
Yes, it all comes back to musculature there's.
Sometimes those are all reallydifferent.
So I'm like, how do I bringthose all wrap them all together
?
So with swallowing andswallowing disorders, typically
there's an etiology, there's areason why we're having
difficulty swallowing, coughing,gagging, that sensation of like

(12:35):
a lump in our throat.
So one providing an assessmentto see what it looks like and
what I'm hearing, and thenalways referring out to the
right provider to find the rootcause.
I was going to give a casestudy but I guess I can.
So I have a friend who is 30years old and he's gotten
multiple swallow assessmentsbecause he can't swallow Like

(12:59):
the initiation of his swallow.
He can't swallow Like theinitiation of his swallow, it
just gets stuck, wow.
So he's had formal swallowassessments where they're trying
to find out why and he wasgiven the diagnosis of dry mouth
he can't initiate his swallow.
That has to be neurological.
So coming to a specialistthat's able to, okay, let's see

(13:23):
what's happening while you'reeating and chewing.
Let's look at your structure.
Let's look in your cheeks,underneath your tongue.
Let's see what's your historywith breathing and sleeping.
Let's find out why and goingthrough even his history of
feeling dizzy or his fingertipsget numb, going deeper into how
come you find that there is apossible neurological or early

(13:47):
neurological symptoms, or why wecan't initiate that swallow.
Yeah, but sorry, that was justfor dysphagia.
No that's okay.
You also mentioned TMJ.
That's another TMJD disorder.
So if we are looking at poppingor clicking or if our jaw is
deviating one side when we'reopening, myofunctional therapy

(14:08):
would be a way of addressingmusculature to get us those
balances so that we're able tobreathe through our nose versus
our mouth.
So, sometimes there can beimbalances with TMJ.
Often providers will refer topossibly Botox to help with that
discomfort, but it is atemporary fix.
Botox will wear off, butaddressing the musculature does

(14:32):
not.

Speaker 2 (14:33):
Got to get to the core right, Get to the core is
what it's all about.
That is so incredible.
The fact like just you saying,like people have a swallow
that's stuck, a lot of peopleprobably feel dismissive.
It's just like just you saying,like people have a swallow
that's stuck, a lot of peopleprobably feel dismissed.
It's just like just swallow,like what is wrong with you,
like it's easy, but it'ssomething neurological, it's
something deeper.
So I am so glad that you'rehere today able to talk about
and debunk some of these things,because maybe people, somebody
might hear this and maybethey're like oh my gosh, I

(14:53):
relate to that, or I have afriend or my kid that is so
important, that people don'tfeel like they're being
dismissed and that there arespecialists who can help you or
somebody that you know and love.
So thank you so much forsharing that, and I feel like
people don't know that thespeech therapist is the
swallowing specialist.

Speaker 1 (15:11):
Our scope is so broad but to know like I'm looking
for a speech therapist that does.
When I previously worked atInova, you know I would go in
like, oh, we're going to get youa consult for the speech
therapist.
I'm like I have no troubletalking Like, but it's for
swallowing.

Speaker 2 (15:26):
Wait, what?
So?
Yeah, good to know.
And then what's a breakthroughmoment?
When identifying a root causethat led to a significant
improvement for a client or apatient.

Speaker 1 (15:41):
I feel like typically we can identify the root cause
within the evaluation or withinthe first session.
That mile lens brings us awhole different perspective as a
speech or feeding therapist,but an example let's see here.
My most excited about right now.

Speaker 2 (16:01):
Yeah, you don't have to say any names.
Yeah, yeah, yeah, obviouslyyeah.

Speaker 1 (16:05):
Exactly, hippie y'all .
I have a nugget who is eightyears old and awful sleep.
For his whole history, mom'slike he's never slept through
the night and as an infant henever slept through the night.
As a toddler he was alwaysrunning to the bathroom and now
as an elementary school kiddo hesnores really loudly and he has

(16:27):
these big blue bags underneathhis eyes and she's like I just
think that he's just I've justbeen written off as he's the one
that just doesn't sleep.
But when he came to see us wenoticed that he has a very high
and narrow palate and the shapeof our dentition, the shape of
our mouth, is also a reflectionof the shape of our airway.

(16:47):
So the first thing I did wastalk to him, talk to the family
about this, got him in forexpansion and once he had
expanded his palate we worked onmyofunctional therapy to marry
all the musculature so that'sall working in harmony and
worked on speech sounds as well.
So now he had a lisp.
He no longer has a lisp, he'snow breathing, sleeping through

(17:10):
the night.
He was bedwetting at eightyears old but he couldn't
breathe.
So our body is going to wake usup 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 andforward.
He was always a messy eatereating with his mouth open.

(17:31):
He now swallows up and back.

Speaker 2 (17:34):
Yeah, 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 proudof yourself for that right.
Look at the chills on camerahere.
Y'all, we did not turn the ACdown, we promise.
I'm just kidding.

Speaker 1 (17:51):
It means the world to be able to sleep.
That's restorative, that's howwe think during the day.
I mean, I think about being apostpartum mom and not getting
any sleep and waking up everytwo hours Like we're irritable,
we're moody, our attention goesawry More often.

(18:11):
Now with these kiddos gettingdiagnosed with ADHD, there are
some people that are saying likeno, we need to get a sleep
screen first.
And there are some people thatare saying like no, we need to
get a sleep screen first, youneed to get a sleep study before
we move through the ADHdiagnoses.
And it's such a good point Likeif we're not sleeping, I can't
focus.
Yeah, no, absolutely I'm goingto be irritable, I'm going to be

(18:33):
moody, so to provide anotherflip of the coin when it comes
to sleep, comes back to themouth, or even I'll go there,
because I always go there withmy clients too Like one question
that I would say every person'sthrown off.
That I ask is like are yougoing to the bathroom every day?
Do you poop every day?
Maybe that question goes backto like how are we eating and

(18:56):
chewing If these littles areswallowing food whole or you're
like you need to slow down?
Something with the musculatureis not making it easy for them
to break down their food, sothey're swallowing things whole
and it takes longer to digestand it takes longer to go to the
bathroom.
Oh my.
So sometimes even talking abouthow often we go to the bathroom

(19:18):
infant, child or adult comesback to how are we eating or
chewing?
Makes?

Speaker 2 (19:23):
sense 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 Allright, so now let's change the
topic a little bit.
What inspired you to launchyour own practice in 2018?
And what were the biggestlessons learned in the early
days?

Speaker 1 (19:41):
Well, I became a speech therapist in 2018, and
what were the biggest lessonslearned in the early?

Speaker 2 (19:44):
days.

Speaker 1 (19:49):
Well, 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 businessand it's still scary every
single day.
But it started from being toldthat my maternity leave I wasn't
going to get a maternity leave.
I was part of a buildingassociated with Inova and when
we got sold, the new companytold me that my pregnancy was a

(20:15):
pre-existing condition.
What, and unfortunately I mean.
We were able to come to anagreement and I did get a
maternity leave, but it justleaving anova, which was my
dream job.
To where do I go now?
What's my next step?
And I thought about starting abusiness and I was like, maybe,

(20:37):
maybe not.
And then I think it was withina month I was like, no, I'm
going to do this, I'm going togo off on my own.
And all throughout postpartum,I was listening to podcasts and
feeding my cherub and I waslearning how to create a
business.
I started my business on theside of my full-time job, seeing

(20:57):
people mobily, driving to them,going to their homes.
And then I that was April Imoved part-time in my job.
July, October, I bought a space.

Speaker 2 (21:10):
Congratulations.
Thank you, it's in Ashburn,okay.

Speaker 1 (21:13):
And then in December I left my job and then by
February I had a waitlist.
How?

Speaker 2 (21:20):
did you feel?
It feels crazy oh my gosh, I'mproud of you.
That's not an easy thing.
It's scary, it's very scary, ohmy God.

Speaker 1 (21:29):
Are you a solo?
Yeah, so I'm a solopractitioner.
Sorry, you're gonna make metear up.
Oh my God, I've got sometissues girl.
So I'm a solo practitioner, butI just hired.
Since I had a wait list sinceFebruary, I hired a clinician.
Her name is Carly.
I wasn't planning on hiring avirtual clinician, I wanted
somebody in person, but she'sjust really good, nice that's

(21:50):
awesome and she's been having alot of success and I'm excited
to have somebody on my team nowsuccess and I'm excited to have
somebody on my team now.
So yeah, it's me and Carly andmy waitlist that gives me
anxiety, but it's okay, I cansit in my feelings.
It's only been a year.
I just very grateful for the Iwas going to say family, but
they are family the clients thatcome and see me and the
progress and the work that we'reable to do.

(22:12):
I feel a great connection toNorthern Virginia and the
providers in this area.
Even it's a lot to go out onyour own, but for other
providers to send me all thesereferrals it shows me that not
only do they see my passion inthe work and the results that
I'm able to provide for thiscommunity, northern Virginia

(22:34):
providers are just unmatched.
Like we are in an area that'sable to provide easy
conversation, collaborative care, which I'm very grateful for?

Speaker 2 (22:45):
Oh, that's great to hear.
I love that.
I love that you've builtyourself a community and that
there's others who are willingto, like you know, give a
helping hand and vice versa.
So that's beautiful.
Thank you so much for coming onthe podcast.
Thank you for just bringingyour smile, your beauty and your
knowledge.
We so appreciate it.
Thank you for inviting me thiswas awesome.