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).
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.
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.
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
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:
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.
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. .
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. .
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 then fast again. We chew to a silent yet steady beat in order to properly break down food. .
In the video below, however, this young man has a very sporadic chewing pattern. In fact, he’ll often try to skip chewing altogether and “wiggle” food toward the back of his tongue where it will then trigger a swallow. This is of course a choking hazard, so we’re working on establishing a rhythmic chewing pattern so that he will consistently and adequately chew the food before attempting to swallow it. .
You may notice that before I do the exercises, I tell the young man what I’m about to do, “I’m going to put this in between your teeth and I want you to chew on it. I’m going to count up to 10.” And so forth. By explaining the exercise beforehand, he knows what’s going to happen and what’s expected of him. This leads to better results as well as less anxiety if the individual is hesitant/unsure. It’s particularly important to do this when the individual doesn’t know you very well yet. .
1. Place the loop of the Z-Grabber (or Grabber) in between the front teeth and have the individual chew 10 times. Provide support/guide the jaw with your opposite hand if necessary for stability.
2. Give him a chance to swallow. Then place the yellow Textured Bite-n-Chew Tip XL (or the extension of the Grabber) in between the molars on the right side. Count to 10 chews.
3. Repeat on the left side.
4. Then repeat the whole set again: 10 chews on the loop at midline, 10 chews on the extension on the right side, 10 chews on the extension on the left side. Then a final 10 more chews on the loop again.
So we’re practicing chewing on both sides of the mouth, as well as in the center of the mouth for symmetry. If the chewing speeds up or slows down in pace, tap out a rhythm with your hand or try chewing to the beat of music. Tapping out the rhythm can be very helpful in the meantime before that silent beat becomes second-nature. .
This exercise also helps build jaw strength and stabilize the jaw if you find it sliding to the right or left during speech (which can make certain speech sounds / phonemes sound “slushy” or unclear). .
As an alternative, you could also do this activity with the Z-Vibe: for step 1 you would place a Bite-n-Chew Tip laterally in front of the mouth instead. Or if using a Y-Chew instead of the Grabber, you would similarly place one of the extensions laterally in front of the mouth for step 1. .
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. .
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. .
I recently completed a Clinical Swallow Evaluation and today a Videofluoroscopic Swallow Study of a 10 yr old boy’s swallow (both revealed a safe swallow that is within normal limits) and observed that his is not an age-appropriate chew pattern. He engages in a Nonstereotypic Vertical Movement during mastication. As a result, oral prep phase is significantly extended and his mother reported that it takes him (at times) up to 1.5 to 2.0 hours to complete a meal. In one case, he informed me that he does not like powder (i.e., flour or powdered sugar) and the meal in question consisted of scrambled eggs and French Toast that had only powdered sugar on it – sans syrup. However, I have found no information regarding immature mastication patterns in older children. Any information or resources you may provide or suggest in this regard will be greatly appreciated.
In a vertical chewing pattern, the jaw moves up and down in a vertical motion. Since the tongue and jaw are connected, the tongue will follow suit, also moving up and down. This is sometimes referred to as a “tongue pump.”
On the other hand, in a mature chewing pattern, the jaw moves in a rotary (circular) motion to grind the food – imagine a cow chewing its cud as an exaggerated example. At the same time, the tongue moves from side to side in order to manipulate the ground food particles into a bolus (ball of food). Without this grinding motion and tongue lateralization, it makes sense that he’s having difficulties breaking down and manipulating his food, and why mealtimes are very long and exhausting. Try chewing your food today without moving your jaw or tongue from side to side – it’s not easy!
So your goal would be to develop a rotary chew so that he can properly chew and manage food. Once his chewing skills improve, he’ll be able to eat different kinds of foods, particularly those requiring good chewing ability. And a rotary chew will drastically decrease the time needed to properly break down food, which is typically no longer than 30 minutes.
I have a client (5-years) who sucks her thumb. She has a lisp and produces most of her consonants while protruding her tongue. I perfectly understand that unless we resolve the thumb sucking, the protrusion will not going to go away, but her parents are not on the same page as me. What techniques would you recommend to decrease the thumb sucking? .
You’re definitely right in that the tongue protrusion/thrust isn’t going to go away until the thumb sucking goes away. And the thumb sucking isn’t going to go away until mom and dad get on board. There are many potential side effects you can discuss with them to help them understand the situation: .
. DENTAL Suggest that she make an appointment with her daughter’s dentist and/or an orthodontist who knows about tongue thrusts. They’ll be able to show that the teeth are being pushed forward or if the palatal arch is high from thumb-sucking. And even if there are no visible side effects yet, they can explain their likelihood and discuss potential dental/orthodontic bills later on. .
SPEECH Explain that similar to the effects of a spouted sippy cup, sucking her thumb has promoted a tongue thrust, which is not a normal tongue position except for in young babies suckling from a bottle. This is why she’s producing certain consonants with her tongue protruding (or against the front teeth), and why she has a lisp. .
FEEDING Explain that in addition to the speech problems already present, tongue protrusion can cause feeding problems. There are a couple ways you can demonstrate how a tongue thrust affects feeding/drinking: .
• Pull the lower lip down with your thumb and ask the child to swallow. She may not be able to because she needs her lips to assist the swallow.
• Ask the child to chew a cracker. Have her open her mouth to show you the chewed food before she swallows. You may see food particles scattered throughout the oral cavity without any bolus formation, as the tongue is not strong enough to manipulate the food into a ball.
• Sometimes individuals with a tongue thrust are not able to drink from a water fountain without making some kind of adjustment to get the water into their mouth (like turning sideways). So have her take a sip of water, lean over a garbage pail, and swallow without turning her head. See if the water falls out of her mouth.
The tongue is the major factor in all of these situations and many more. When you suck your thumb, the tongue often rests forward and low under the thumb, which can allow the tongue to become flaccid and unable to function properly. .
Tongue lateralization is the ability to move the tongue side to side inside the mouth. It’s an important skill for feeding therapy and development, as the tongue lateralizes in order to manipulate food to be chewed and formed into a ball (or bolus) before swallowing. It’s also how we go “fishing” for leftover food particles in the cheeks, around the gums and teeth, and on the lips. .
There are several ways you can “test” for this. Ask the child to imitate you “wagging” your tongue. Or, place ARK’s Probe or Z-Vibe to the corner of the mouth on each side and prompt the child to touch it with his tongue tip (in the picture above, for example, I’m doing this with the Z-Vibe Preefer Tip). Or, place the Probe in the middle of the bottom lip and ask the child to touch it with his tongue tip. Then move the Probe in increments to the corner of the mouth, prompting him to touch it with his tongue tip at each increment (this provides a tactile cue for the tongue to follow). .
Remember, one does not need to perform this oral motor task for speech sound development. Yes, the sides of the tongue need to make contact with the upper back teeth for such phonemes as r, sh, ch, etc., but no speech sounds are made with the tongue lateralizing. This movement is strictly for feeding. So observe the child eating. Really get in a position for a good view into the oral cavity. Overemphasize chewing yourself, making a “yum-yum” sound. Is the food being moved side to side? What type of food is it. Puréed? Mechanical soft? Chopped? Regular? Maybe the child isn’t progressing to eat harder-to-chew foods because he cannot lateralize. It has also been my experience (as it was just this past week), that some children may only lateralize to one side. I know this is puzzling, but every now and then this happens in therapy to me. So keep an eye out for tongue lateralization to both sides. .
“I have a 12 day old infant with diagnosed Down Syndrome. She has moderate tongue protrusion. A friend suggested your products. I was wondering which ones you recommend and any suggestions you might have? Thank you for your help with this!” .
Dear New Mom, although each child is different, there are several goals that I usually work on: .
In my experience, children who have Down Syndrome often develop oral defensiveness and texture aversions, which can significantly impact their diet and ability to eat. So it’s important to work on normalizing these sensitivities if they’re already present. Or even better – to work preventatively before they start. There are several things you can do:
• As early as possible, get into the mouth to provide stimulation and introduce new textures. Use the Oral Motor Probe and proPreefer to stroke and apply gentle pressure to the gums, palate, cheeks, lips, and tongue. Stroke the sides of the tongue, run the tools across the tongue, inside the cheeks, over the lips, etc. For infants and toddlers, the proMini is a smaller version of the Probe designed to fit inside their little mouths. These therapy tools have different textures on them to provide a varied sensory experience. You can also dip them in food to introduce texture into mealtimes and for nutritive stimulation. Sticky foods work well, such as applesauce, yogurt, and stage 2 baby foods.
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 food allergies, the following goodies will sweeten your efforts to improve tongue elevation, tongue lateralization, oral awareness, lip closure, tongue strength, and much more. .
Most brands will do, but Dum Dums are my favorite. They’re not too big, not too small, but just the right size. And as you can see from the list of ideas and activities below – very versatile! I give my kids two flavor options and let them pick one to work with. Too many options can be overwhelming, but two choices is just enough to give them some control over the situation and to let them have a more active role in what we’re doing. .