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Debbie's Blog - oral motor

Tongue Thrust Therapy

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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?


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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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Tongue Thrust Therapy

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As a heads up: I've never been able to use the protocol exactly as it's written.  Each case is different and so treatment must be catered accordingly.  But Swallow Right does provide an excellent groundwork to which I add things, subtract things, adjust the timeline, etc. as needed.

Tongue thrust therapy falls under the umbrella of orofacial myofunctional therapy.  I started doing myofunctional therapy back in the early 70s, that's when I had my first case.  At the time there were very few resources on the topic, so I had to figure it out on my own along with the Swallow Right book.  Luckily today there are many more courses and seminars you can take.  The IAOM (International Association of Orofacial Myology) is a good place to learn more about continuing education opportunities.  You can also consult with fellow SLPs in your area trained in tongue thrust / myofunctional therapy.

Keep in mind that not everyone who has a tongue thrust needs to have it corrected.  There are plenty of children and adults who have a tongue thrust and their speech is within functional limits.  But if it affects one's speech, dentition, breathing, etc. beyond functional limits, then therapy should be considered.

In addition to the Swallow Right program, I also recommend drinking from a straw, ideally with a Lip Blok.  Lip Bloks are mouthpieces that you press into the top of a straw.  They naturally exercise the mouth muscles as you drink and encourage the cheeks to tense, the lips to close, and most importantly in this case - the tongue to retract.

Specifically I’d recommend the 3 size hierarchy (combo).  The goal is to start with the yellow one (which has the longest mouthpiece), then once drinking from that is comfortable, progress to the shorter blue one, and eventually the shortest turquoise one.  This helps gradually teach the tongue to tighten and retract more and more.

For more information on the Lip Bloks, click here.  And for a related article on tongue protrusion / retraction, click here.

I hope you enjoy tongue thrust therapy as much as I do.  It's very challenging and rewarding and is one of my favorite types of therapy to work on!

Debbie

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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? . . I always recommend getting children on straws (ideally with [...]

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Lip Closure & Rounding Exercises

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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 yet? 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 [...]

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

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Thumb / Finger Sucking Alternatives

Question:   My sensory child is more of a sucker than chewer.  She usually sucks on her thumb and fingers, but I am wanting to get her some other options for school and transitions.  She's 5.  What do you recommend? Thumb/finger sucking can be a very hard habit to break - what works for one person may not work for [...]

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Food Pocketing in the Lips, Cheeks, and/or Gums

Question:  My four year old daughter pockets food in her lower gums.  Foods like pizza, chicken, egg whites, etc. (that do not melt like crackers or cookies).  She will simply let it stay in her gum pockets until she looks like a chipmunk and eventually we will have to remove it with our fingers.  She is not able [...]

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