Tagged "SMILE Program"

Ask A Therapist: Oral Placement Therapy for Teachers

Posted by Deborah Grauzam on



I work in an inner city school with significant deprivation.


Many of the children have speech and language difficulties and when I wander into snack and lunchtime, many have immature eating patterns. Many have immature jaw and tongue movements, quiet voices and poor breath control.


I cannot hope to work with all the children directly.


I have keen K/1 teachers who would like to help.


I am pulling together some activities for the teachers to do with the class - songs, movements, etc., taken from voice TalkTools® and other sources. I want to include activities for respiration, phonation, resonation and articulation.


Has anyone tried to do this already?


Any pitfalls you can anticipate for me and the teachers? Any pointers?


I do use TalkTools® already with some students and I am finding an increasing need.


I am planning on doing a short pre- and post-screening possibly based on the SMILE book.


Many thanks,



Hi Sarah,

First of all I admire you attempt to help so many children in need.  It is so difficult to not have availability to work with everyone one-on-one.  I think if I had to pick on thing to work on, it would be jaw strength with bite tubes because it will help in all the areas you mentioned. Horns would also be a fun rewarding task which would focus on respiration.  The challenge that I see would be not being able to monitor where they are placing the tools in their mouths, which is what makes it therapeutic. I would try to work with a different child each time to make sure they could feel where the tool needed to be and how they needed to breath or chew. Placement and form is very important.  You could watch the group as they perform the task and give verbal feedback.

That being said, I encourage you to consult your school's Speech-Language Pathologist first for advice and mention the procedure above, and only then follow their recommendations. You could work with them as a facilitator but are not licensed to practice Speech-Language Pathology yourself, as a teacher. If there is no Speech-Language Pathologist on duty at your school, consult your state association for support.

Looking forward to hearing back.



Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy.  She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask a Therapist: SMILE protocol for Severe Diagnosis

Posted by Deborah Grauzam on


I would like to know if your SMILE program would help someone who is not a tongue thruster but has other abnormalities like a restricted tongue movement because of extra frenulum material, a malformed tongue, and a cleft (somewhat repaired). In other words I already know that programs can reach a variety of patients. Mine is an adult with not only all of the above problems but has just had teeth implants top and bottom. Her tongue and its relation to the teeth, and cleft (nasality) are her problems. I listened to a recording of her voice before implants and it sounded somewhat more clear but not substantially.

Thank You,

Thank you for your question. If this client does NOT have VPI and the nasality is the result of the tongue tip being poorly elevated then YES. I have treated multiple clients with nasality issues because the tongue was low or the tip was anchored due to restricted frenum. What is very important is that the client has the mobility to execute the program. If there is a severe tongue tie surgery may be needed prior to implementation.

Thanks for your interest,

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Ask a Therapist: Tongue Thrust Therapy versus Appliance use

Posted by Deborah Grauzam on


I am a speech language pathologist who has attended one of your presentations. I see an 8 year old girl who has a tongue thrust.  She has had a habit breaker that she has been wearing for a few years (the device that she wears on her front teeth and it stops the tongue from coming out of the mouth).  Lately though she reverted back to her habit of having her tongue come out of her mouth  even though the orthodontist tried to make the habit breaker a bit sharper so that the it would stop the tongue from sticking out of the front of the mouth.

When I assessed the child, she had perfect motor strength and movement of her tongue, and neither was her tongue inordinately large as not to fit inside her mouth.   Also when she speaks she is able to say her /s/ and /h/ sounds in words and sentences.  However the mother states that once the child has to work very hard and be very mindful to keep her tongue from sticking out.  The mother states at night she sticks her tongue out and does the suckling movements like she is trying to lick something off her lips.  It seems to me that since the child has no motor issues in her tongue muscles, this problem a habitual one that she has developed over the years and into the present.

Do you have any recommendations or suggestions on what techniques I could utilize with this client to help her with the frontal tongue thrust (the child is able to carry on a conversation without having a tongue thrust as long as she is extremely mindful of each word she says).

Thank you so much for all you help.

I am just receiving this email and will be happy to help. Appliances do not correct the tongue thrust, they just change where the thrust occurs. Most kids that wear these appliances develop lateral thrusts as opposed to interdental ones, and the interdental returns when the appliance is removed. There was a great article written years ago on this topic and here is the link.
My suggestion is that this child be engaged in a myofunctional therapy program which will correct the root of the speech issues. There are 3 I like:
2- Roberta Pierce Swallow Right
3- Swalloworks
The difference with my program is you work on speech, OPT and swallowing simultaneously.
Hope this helps and thanks for your interest in TalkTools!
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