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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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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Easy “Birthday Cake” Fine Motor Activity

Easy "Birthday Cake" Fine Motor Activity

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The best therapy exercises are the ones where the child doesn’t know it’s an exercise, which is why every pediatric speech and occupational therapist’s “bag of tricks” is mostly full of toys and games and other fun activities.

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Play dough is one of these staple activities.  There are endless possibilities of what you can do with it, one of which is creating a “birthday cake” for imaginary play and to work on fine motor skills.

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So, let’s throw a birthday party!

•   Be enthusiastic and involve the child in every step of the process.  Ask him/her who’s coming to their party, what kinds of games they’ll play, where it will be hosted, etc. Continue reading Easy “Birthday Cake” Fine Motor Activity

Easy Thanksgiving Turkey Craft

Turkey Fine Motor Play-do Craft

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This friendly turkey is a quick and easy craft, both for Thanksgiving and beyond.  You’ll need:

  • Play dough of your choice (funky colors welcome)
  • Two eyeballs
  • Pasta of your choice

If you don’t have eyeballs, you can substitute for beads, etc.  If you don’t have the pasta shown, you can substitute for almost anything you do have.  There’s no “right way” to do this.  The beak we made from a broken shell-shaped pasta piece.
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Have the child pick up each piece individually and place it in the play dough to practice fine motor skills.  Use textured pasta to add a sensory component to the activity.  Give the child one or two step instructions to practice following directions and sequencing.  And of course, this turkey is a great opportunity to practice language skills as well!

How to Decrease Tongue Protrusion & Encourage Retraction

Question: I have a 2 year old on my EI caseload, our program purchased the z-vibe kit for him. He is demonstrating some sensory aversion, drooling, and an open mouth posture with tongue protrusion. His tongue protrusion is beginning to affect production of his speech sounds. Are there any specific exercises I can have him do to decrease tongue protrusion?  Thank you so much for your help!


The issues you mentioned are likely all connected.  Let’s tackle the tongue protrusion first.  In order to help you visualize what he needs to work on:  hold your mouth open, bring your tongue forward between your teeth, and have the tongue tip/blade rest on your lower lip.  Now pull it back into your mouth with your tongue tip and front part of the tongue blade positioned on alveolar ridge (the gum area right behind the upper front teeth).  Commonly known as “SPOT,” this is where the tongue tip should be when we’re not eating, drinking, or speaking.  It’s also where the tongue tip sounds (t,n, d, s, z, l) are made.
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There are many strategies you can use to get the tongue toned, tightened, and retracted so that it’s on SPOT.  The first thing I always recommend is to get him on straws, as these naturally encourage oral motor skills and decrease tongue protrusion.  If he doesn’t drink from a straw yet or if he has a weak suck, our Bear Bottle Straw Cup makes the transition easier.
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Continue reading How to Decrease Tongue Protrusion & Encourage Retraction

Halloween Printables for Fine Motor & Language Play

Frankenstein Printables for Fine Motor & Language Play

We drew up some spooktacular FREE printables for you all!  Introducing: Frankenstein (“Frankie”) and his Bride.  Each character is available in both blank and colored in, all of which can be downloaded here.  Read below for ideas on how to use them for Halloween-themed learning activities:


To encourage speech and language:

  • Print off the blank characters and have the child color them in.  Let them use their imagination, or throw in one or two step prompts to practice following directions (“color his hair first and then his nose”)

Halloween Fine Motor Mr. & Mrs. Frankenstein

  • Put the two characters next to each other and work on pronouns (his versus hers), body parts, etc.
  • Put a blank piece of paper underneath the heads and prompt the child to finish drawing the rest of their bodies (this is called visual closure).
  • Give them names and come up with a story behind them.
  • Talk about what’s silly (their hair, coloring, bolts, etc.).
  • Make them into masks (cut out the faces, punch holes in the ears, and tie a string from ear to ear).


For fine motor fun:

  • Use Mr. & Mrs. Frankenstein for a lacing activity.  Laminate them, punch holes around the edges of the paper, and then have the child lace through the holes with a shoelace.  Lacing is also an excellent bilateral coordination activity.
  • Use wikki stix to outline their eyebrows, the stripes in their hair, lips, blush, etc.


For sensory play:

  • Let the child fill in the faces with various textured objects/items: shells, beads, small crumpled up bits of paper, cotton balls, etc.
  • Use them as a template for food play to help kids with food aversions become more comfortable with different textures.  Put cheerios in their hair.  Cheese doodles for the bolts. Veggie sticks for Frankie’s smile.  Give Mrs. Frankenstein fruit loops or licorice hair or coconut flakes hair.

Have fun and Happy Halloween!

Therapy Quick Tip: Preparing for Halloween

With just over two weeks left before Halloween, now is a good time to help children get ready for trick-or-treating.  Some of my kids say “fick or feet” or “sick uh seat” or “twick or tweet.”  So we’ll spend time practicing how to say “Trick or Treat” correctly (or the best way they can to be understood).

Halloween Therapy Tip

I also role play to help them be better prepared.  We take turns re-enacting how they will walk up to the door, knock or ring the doorbell, say trick or treat, follow directions (such as to pick one or two pieces of candy), AND say thank you with good eye contact.

It takes a while the first session to get it down, but only 2-3 minutes to review it in following sessions.  And it gives the child a sense of accomplishment, decreases any anxiety they may have, and gives them confidence so Halloween can be all about fun!

Happy Halloween!

Debbie

Therapy Quick Tip: How to Hack a Puzzle

How to Hack a Puzzle

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This puzzle wasn’t early-intervention-friendly enough for me – the insets were just a boring tan / wooden color!  So I colored in the insets to give kids more of a visual cue to complete the puzzle.  Now they can match the blue dog puzzle piece to the blue dog picture, the green fish piece to the green fish picture, etc.
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Bear Puzzle Hack

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If the puzzle doesn’t have any images in the insets at all, just take a picture of the puzzle piece, print and cut it out, and tape/glue it in the inset.  In the above picture, for instance, the small beach ball and bear are cut out of paper.

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You can also added velcro for an extra fine motor, tactile, and sensory element.  Simply attach a fuzzy piece of velcro to the back of each puzzle piece, and a corresponding scratchy piece of velcro to the insets.  This way the fingers have to work a bit harder to remove the pieces.  Velcro is also very sensory – both in the sound it makes to pull it off, and in how it feels to the touch.  As an added bonus, the puzzle pieces are less likely to get lost now, too!

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Enjoy!
Debbie