Tagged "straw 8"

Ask a Therapist: Tongue Protrusion When Drinking From A Cup

Posted by Deborah Grauzam on

Dear Sir/Madam,


I am a speech and language therapist working in the UK. I had the TalkTools training a couple of years back.I assessed a child last week taking over from another therapist who has just left. This child was advised to drink thick and thin fluids from a thick straw (McDonald's thickness). The child can drink thin fluids easily from straw #7 but has not had any success with straw #8. I observed the child with the thick fluid from a thick straw and they managed really well. When drinking from a cup with no straw there was still notable tongue protrusion. I am not quite sure where to move this child on? Should we move to straw #8 (thin fluids) and continue with thick fluids from a thicker straw? Should you be continuing on the straw hierarchy until there is efficient tongue retraction when drinking from an open cup? I would appreciate some guidance.


Best wishes,



Hi Melissa, 

I would continue on the next straw if she is drinking at ease with tongue retraction as you said. I would want to use the straws for all drinking attempts and minimize the use of the cup. I would work on activities that promote tongue retraction before working on the cup. This will reinforce the motor plan.  I would then make sure to place the cup under her tongue and prevent her from using her tongue as her lower lip.  If this is not working you may want to remove the cup for a short time and work only with the straw and then revisit the cup.  Giving the child a break and only reinforcing the tongue retraction may help.

It is possible for a child to continue demonstrating tongue protrusion with cup drinking after the straw protocol but I would consider that atypical.

Keep me posted and let me know if you have any other questions.


Elizabeth Smithson, MSP, CCC-SLP


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: Thickened Textures, Straws & Horns

Posted by Deborah Grauzam on

Hello, I have some questions regarding your therapy tools/techniques:


1. Why is the goal to have 1/4 inch of the straw in the mouth for the straw hierarchy? Why does the length matter?


2. Do you work on the thickened textures program with the hierarchy straw program simultaneously or should they be done subsequently to the completion of one of the programs?


3. Where can you obtain nectar?


4. Many of the horns have the same type of mouth openings. What is the purpose of having multiple horns with the same type of openings - do they really target different sounds and oral motor postures?


Thanks for your help!




Dear Devorah,

Hi my name is Monica Purdy and I am a TalkTools® Instructor. I wanted to answer some of your questions.

1. The goal for having the straw 1/4 of an inch in the mouth is due to working on lip dissociation from jaw, and tongue dissociation from jaw. If clients are putting the straw on their tongue and are using 1/2 of an inch or an inch, they are probably suckling instead of using tongue retraction. Tongue retraction - especially back of tongue side spread (which is what straw #8 works on) - is important for co-articulation.

2. Once you get to straw #5, you can then begin to use the second straw hierarchy with thickened puree. Often you will be using both of these hierarchies simultaneously.

3. Nectar is the consistency of the puree. For example, use tomato juice. Remember you do not have to use tomato juice, but the consistency of tomato juice. You can also thicken any liquid using nectar packets.

4. The horns really do target different sounds. Some of the horns are flat mouthed horns but the child starts to work on lip dissociation, because the mouth piece becomes smaller and requires more lip tension to make the sound and an increase in tongue tension.

I hope this helps, if you have any additional questions please let me know.

Monica Purdy

Monica Purdy, MA, CCC-SLP has more than 14 years of professional experience specializing in helping children with special needs to communicate. Monica is PROMPT and SOS trained, familiar with sign language, and well-versed in the use of augmentative devices. She is the owner of Kids Abilities Pediatric Therapy Clinic in Indianapolis, IN. In addition to her private practice, Monica is a member of the TalkTools® speakers bureau and has been invited to speak at numerous conventions and seminars across the U.S. and internationally. She is a graduate of Ball State University.

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January 29 - 30, 2016 - Oral Placement Therapy: Assessment & Program Plan Development - Middlesex, NJ

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