Tongue Thrust Therapy

Question:  I am an SLP seeing a 8 year old student with a tongue thrust.  What products would be the best for addressing the tongue thrust?  How long does it usually take for them to affect a change in a child’s lingual placement?

 


 

Great question.  For tongue thrust therapy, I use the protocol outlined in the book Swallow Right, 2nd edition by Roberta Pierce.  It’s a must and a wonderful reference for therapists working on swallowing / tongue thrust therapy.  It typically takes me about 12-16 weeks to correct a tongue thrust, depending on the child and other factors of course.

 

For some of the exercises in the book I use ARK’s Probe.  Roberta uses a twizzler or stirrer to do them (the Probe wasn’t developed at the time it was written).  But I find it much easier and more effective with the Probe because it provides more input.  It’s also a versatile tool for a variety of related skills such as jaw stability, tongue tip elevation, mid tongue elevation, back of tongue elevation, tongue pops, oral awareness, and more.  I use one Probe in therapy, and my client has one as well for home practice.

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DIY “Talk Back” Auditory Feedback Device

When working on articulation, I often find it best to begin the session with an auditory discrimination activity.  Not only does this help children better hear their own speech, but it also helps them settle into therapy and focus their attention.

 

Auditory discrimination is the ability to tell the difference between correct and incorrect speech sounds.  Some kids struggle with this, especially if there is ambient noise or other distractions around.  A simple (and fun) way to help with this is through an auditory feedback device.

 

DIY Auditory Feedback Device

 

Did you ever try making one of those DIY “telephones” as a kid – the two cups connected via a string to talk to a friend from a distance?  The concept of an auditory feedback device is the same, only instead of sending your voice to your friend, you’ll be sending it up to your own ear.

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Tongue Tip Elevation Exercises

Tongue tip elevation is the ability to lift the tip of one’s tongue up to the alveolar ridge (the spot just behind the upper front teeth).  As a shorthand, we often call this location “on spot,” as in, “get your tongue tip on spot!”

 

Tongue tip elevation is an oral motor skill necessary to say certain speech sounds (t, d, n, l, s, and z).  It’s also where the tongue should rest during normal oral resting posture (when you’re not eating or speaking).

 

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75+ Feeding Therapy Tips & Strategies

For any therapist seeking to specialize in feeding, the best piece of advice I could give you is to become a sponge.  Take courses and workshops, read as many articles as you can, talk to and learn from your colleagues, join special interest groups on Facebook and ASHA etc., follow blogs, observe other therapy sessions, and don’t forget – learn from the children you treat as well.  They will be your best teachers.

 

Feeding issues are complex.  So take in as much information as you can from as many outlets as you can.  But, take it all in with a grain of salt, because not every strategy will work for every child.  Over the past 35 plus years, a number of people have told me that their way was the only way.  Although that certainly would have made my job easier if it were true, I’ve never been able to use any one method “by the book.”  Each child is different, so it will be up to you to evaluate their needs and cater treatment accordingly.

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SPD at the Dentist’s Office

Question:  Hi, I am a dental hygienist looking for ideas on treating patients with SPD in the dental setting.  Can you give me some suggestions?  Thank you!

 


 

If the patient has sensory issues in the mouth, then they may require a lot of desensitizing before they could even go to a dentist and/or tolerate anything in their mouth.  This oral sensitivity is also known as oral defensiveness.  For more background on this plus some ideas to help de-sensitize, click here.  And for some ideas on how to make toothbrushing more comfortable for individuals with oral defensiveness, click here.
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Continue reading SPD at the Dentist’s Office

Straw Drinking Prerequisite – Tongue & Jaw Dissociation

Question:  I’m working with a client who has Down syndrome.  She can’t differentiate her tongue from her bottom lip when drinking from a straw.  I’ve tried having her drink from a straw using a Lip block to see if that helps, but the tongue still just takes over everything.  Any ideas?
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I always recommend getting children on straws (ideally with Lip Bloks) for their oral motor benefit.  The straw + Lip Blok combination can help naturally exercise and fine tune oral motor skills / oral positioning.

 

However, some skills / prerequisites have to be in place first before the child can effectively drink from a straw, such as trunk control, suck-swallow-breathe coordination, tongue and jaw dissociation, etc.  You have to walk before you run so to speak (and you have to have a certain amount of strength, coordination, etc. before you can do either).  Most children start straw drinking around 8-10 months old.  So if she’s not at that age level developmentally yet, she may need time and/or your help to get there.

Continue reading Straw Drinking Prerequisite – Tongue & Jaw Dissociation

Lip Closure & Rounding Exercises

Lip closure (also known as lip seal) is the ability to close one’s lips around a spoon, straw, cup, etc.  It’s also important in order to say certain speech sounds, such as /p/b/m/, and it’s a factor in preventing drooling.

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Lip Closure & Rounding Oral Motor Practice

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Recently I was working with a 9-year-old child who has Angelman syndrome.  The mother was asking if there was anything she could do to decrease drooling. One of the first things I look for with drooling is whether or not the child has lip closure.  The child was not closing her lips and could not do so on command, so I touched the Z-Vibe to her lips for about 2-3 seconds, and voila – immediately her lips closed.  I waited a few minutes and repeated the stimulation, and she closed her lips again.  She just needed that extra sensory input to be aware of her lips to close them.

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Sometimes a simple prompt like that will elicit lip closure.  Other times you may need to do extra practice until the concept “sticks,” or until they have the oral motor skill to do it.  It really just depends on the child. Continue reading Lip Closure & Rounding Exercises

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Practicing a Rhythmic Chewing Pattern Rhythmic chewing is one component of a mature chewing pattern.  There's a tempo to the way we chew - it's not sporadic;  we don't chew fast then slow ...
Assisting Lip Closure . Just like its namesake, lip closure (also known as lip seal) is the ability to close one's lips.  It's important for several different speech/fee...
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The Oral Motor Benefits of Straws

Whenever a parent asks me what they can do to improve their child’s oral motor skills, one of my first questions is usually:  Are they drinking from straws?
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Drinking from a straw is a very simple yet effective way of improving one’s oral motor skills.  It works on lip seal, tongue retraction, cheek strength, correct jaw position, suck-swallow-breathe coordination, consecutive swallows, and more.  Sucking can also help some individuals organize, increase their attention, and soothe/calm themselves.
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Straw drinking usually starts around 8-10 months of age.  An easy way to teach beginners is with the Bear Bottle Kit, which has a special valve that keeps liquids at the top of the straw (so only a small amount of effort is required to drink).  Or, older kids may prefer the Cip-Kup, which functions the same way but has a more ‘grown-up’ design.  For more information on how to teach straw drinking, click here.
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Continue reading The Oral Motor Benefits of Straws

You may also be interested in:

Assisting Lip Closure . Just like its namesake, lip closure (also known as lip seal) is the ability to close one's lips.  It's important for several different speech/fee...
Why Do Babies Put Everything in Their Mouths? At about 5-6 months of age, almost anything within reach makes a beeline straight to the mouth - keys, toys, their feet, etc. This oral exploration ha...
Tongue Pop Therapy Videos – a Great Oral Motor Exercise! Tongue pops are my faaaavorite oral motor exercise.  They're a fun and easy way to work on tongue placement, oral tone, tongue elevation and control, ...
Does the Grabber Work on Different Skills than the Y-Chew? Skill-wise, what would a child gain from using a Grabber vs. a Y-Chew vs. a Tri-Chew?  In other words, does the Tri-Chew works on different skills tha...
Fun, Edible Oral Motor Exercises for Kids Incorporating yummy treats into your oral motor therapy sessions is a great way to spark interest and increase attention.  As long as there are no foo...

Do Chew Tools Increase the Need to Chew?

Question:  My son has ADHD and Anxiety, he spends a lot of time chewing/sucking on clothes, plastic, and other non- edible items. Would your chewies encourage this sensory seeking behavior or will it help him to eventually not need to mouth everything?   My son is 7 years old.  Thank you!
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Do Chew Tools Increase the Sensory Need to Chew?

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Great question.  Although each child is different, having a chew tool typically doesn’t increase the need to chew.  Especially if the chewing is sensory-related, he’s going to have a need to chew whether or not he has a safe outlet to do so.  Using a chew tool just means that he’ll be able to safely and more comfortably meet that need (as opposed to chewing on his fingers, shirts, pencils, etc.).
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Chewing actually has many benefits, and it usually serves an important purpose.  When you’re thirsty, your body tells you to take a drink.  When you’re tired, your body signals that you need sleep.  Similarly, when some kids need to focus, organize, or calm themselves, their body urges them to chew.
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For more background on why some kids need to chew, click here.  And for a list of all of the chew tools we make, click here.  All options are made in the USA (woohoo!) and come in 3 different toughness levels.  As long as he’s not chewing through things or causing any damage to what he’s chewing/sucking on, it sounds like any of our softest chews would be a good fit for him.
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Some kids always have a need to chew.  Others grow out of it.  For some it ebbs and flows – they might go for weeks or months without needing to chew, and then it comes back again and so forth.  Often this is tied to stress (it’s common to see chewing increase during stressful situations like the back to school transition, holidays, if there’s been a lot of change in their life, etc.).  In my experience, for many kids the need to chew decreases over time, especially if they have other calming / sensory strategies in place, which you can learn more about here.
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I hope some of this helps!
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All my best,
Debbie

Isolating Back of Tongue Elevation for K, G, and Y

For the K, G, and Y sounds, the back of the tongue elevates to the palate.  One of my favorite “tricks” to assist back of tongue elevation is to use the Z-Vibe with the Hard Spoon Tip:

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Speech Trick for K, G, and Y

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Place the bowl of the Spoon Tip on the tip of the tongue, and then have the child say the sound (as demonstrated in the video below).  By holding down the tip of the tongue with a tactile cue, you make sure that only the back of the tongue will be able to elevate.  Oftentimes children will have trouble distinguishing between using their tongue tip for /t/d/n/l/ versus the back of the tongue for /k/g/y/.  So this is one way that you can isolate the back of the tongue movement for the /k/g/y/ sounds.

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Remember to explain to the child what you’re about to do and why.  It can work wonders to help them feel more comfortable, understand what’s going on, and have a more productive session.  If necessary, I demonstrate the exercise/skill on a puppet, on my hand (my hand being the “tongue”), and/or on myself.
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Why a Spoon Tip?  Even though the Spoon tip is traditionally used in feeding therapy, it’s also “just the right size” to hold down the tongue tip for this articulation exercise – big/wide enough without being too big.
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For more Z-Vibe exercise ideas, click here.
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Enjoy, and as always, don’t forget to think outside of the box!
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Debbie

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