The Castillo Morales® concept for doctors and therapists

is a comprehensive therapeutic concept for children and adults with communicative, sensorimotoric or orofacial defects.

On the basis of a differentiated way of considering the sensomotoric development in its influence on the functions and activity in the orofacial area Doctor Castillo Morales developed a treatment concept, which was received favourably here in Germany too and became well known – primarily in connection with the term “orofacial regulation therapy” (Castillo Morales, 1991). In this concept, emphasis was given in particular to the effects of posture and bodily movement on the head, neck and jaw positions and also on the activities of the mimic, oral and pharyngeal muscular system.

Mimic expressive ability and articulation as the most subtle and differentiated sensomotoric performance of our oralfacial muscular system is extremely important for our communication. A non-defective co-ordination of the oral and pharyngeal muscular system is essential to be able to eat and drink without difficulty. Also in the case of people with neurological or anatomically based functional defects these abilities are often adversely affected. In his concept of treatment Castillo Morales therefore focused in particular on the following therapeutic aspects:

  • Supporting the ability of the patients to communicate.
  • Enabling the patients to take part in normal life, even when eating and drinking.

Castillo Morales developed his concept of treatment primarily for people with muscular hypotonia and sensomotoric impairments. Nowadays it is used mainly for children and adults with one or more of a wide range of sensorimotor defects in the region of the face, mouth and throat, as for example

  • children with congenital, anatomically-based malformations in the region of the mouth (e.g. Pierre Robin Sequence (PRS), cleft lip-jaw-palate)
  • children with hypotonia, e.g. trisomy 21 (Down’s syndrome) and other symptoms genetically  determined
  • prematurely born children having difficulties when drinking and eating
  • patients of all ages with neurological diseases accompanied by orofacial symptoms, e.g. neuromuscular diseases, cerebral palsy, resulting from skull-brain trauma or a stroke
Foto © Susanne Magin

This therapy requires exact knowledge of the functional anatomy, the sensomotoric development – in particular that of the  orofacial complex – and the interactions between these systems. Furthermore, conditions of the emotional, communicative and social development must be considered as well as criteria of the autonomous development.

Proprioceptive experience is clarified by treatment techniques like manual vibration, pulling and pressing. The aim is to support the attention given by the child to what it undergoes and does, and also to provide it with trust and security in order to reinforce motivation to rise to new challenges. Motoric activities in the mouth and at the tongue can also be favourably influenced by activating the hands or feet. The supporting function of feet and hands as well as the child’s visual orientation within its surroundings are used to stabilise its posture.

According to the principle “function and form interact upon each other” it is necessary to correct malformations as soon as possible, for example secondary malformations of the hard palate or tooth and jaw misalignments caused by primary orofacial functional defects. For his therapeutic methods of helping a patient to cope with or overcome a malformation or other form of handicap Castillo Morales originally used approaches learnt during his training as a rehabilitation specialist in Madrid when carrying out neurological examinations of children and newly born babies in the French school of André-Thomas and his students, when Castillo Morales modified these approaches in particular in their application to the orofacial region. His differentiated talent for observation, his highly concentrated manner and attentiveness when engaging his patients in a dialogue, which enabled him also to notice and interpret non-verbal signals made by the children, made him an exemplary investigator, therapist and teacher. For many years he maintained intensive contact with medical colleagues and therapists of different specialisms. He was always prepared to allow colleagues to observe his methods and to answer any questions they micht have. Furthermore , he was always ready to consider new therapeutic approaches and experience, the effects of which he could detect or observe. Instructional therapists feel they must emulate this attitude. The shared aim is to comprehend the personality of an individual and to match the treatment to the requirements of the patient and his attachment figure.

Author: Dr. Angelika Enders, Munich