Tagged "tactile cueing"

Ask a Therapist: Physical Therapist Question on Oral Motor

Posted by Deborah Grauzam on



I am a physical therapist working in Early Intervention in NJ. I have a 12 month child that I suspect has an undiagnosed syndrome. She has very low muscle throughout. Her cognitive level is about 6 months. She cannot sit unsupported. She can imitate a play action. She is making very few sounds. Frequently sticks out her tongue, open mouth posture. She can only eat pureed foods. I called for a speech assessment and was told by the Speech Therapist that there is no evidence that Oral Motor Therapy can help her speech at this age. Is that true?

Thank you for your help!




Dear Tal, 

Thank you for your question.  My name is Monica Purdy and I am a speech and language pathologist that also specializes in oral placement therapy and feeding. There is a lot of research on oral motor and the effectiveness and evidenced based information. If you visit this page on the TalkTools website you will find articles that you can print off and give to the speech therapist. Many speech therapists assume when someone mentions "oral motor" that they are referring to exercises such as "tongue wagging" (moving the tongue from side to side outside of the mouth), puffing the cheeks, and/or elevating the tongue to the nose or chin (again outside of the mouth). These activities do not have any support and are not related to speech or feeding and should not be used. However as you know being a physical therapist you can address muscle function by working on stability, dissociation, grading, precision and endurance in order to help a client with feeding and speech intelligibility. At TalkTools we do this by using kinesthetic feedback or tactile cues to help a client achieve these skills. Many times we work on feeding because it is a precursor to speech and we can prevent speech sound distortions from occurring if we address the muscles in feeding.   

I hope this helps, if you have any further questions please do not hesitate to contact me. 

Monica Purdy, M.A., CCC-SLP

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Ask a Therapist: “Fixing” During Horn Hierarchy Exercises

Posted by Deborah Grauzam on

I use the horn hierarchy and really love the results. One of my clients, a young girl, tenses her muscles - shoulder, stomach, facial, etc, to blow and make the appropriate sound for appropriate duration. How do I stop this compensation?

The client is “fixing” – using a compensatory pattern that lets the SLP know the client does not have adequate grading skills in her abdominal muscles. Without seeing the child, there are several possibilities based on the description above:

1. The horn is too difficult for the client. Go back to the previous horn on the hierarchy.

2. The horn is not too difficult, but she does not understand how to use duration of oral airflow without clavicular breathing. In this situation, use the Duration Tube Kit to teach her duration using abdominal grading.

3. Fixing could be a habit the client has developed. Use an easier horn on the hierarchy. Explain to the client she should blow the horn while keeping her shoulders down. Once she understands the feel of the "acceptable" body posture, begin progressing through the hierarchy.

4. Tactile cueing during the exercise may help. Push down on the client's shoulders as she is blowing -- the tactile pressure inhibiting her compensatory posturing may help her understand “acceptable” body posture.

5. The client's jaw is weak and she cannot perform the jaw from lip dissociation movement needed to blow the horn. In this case, stop the Horn Blowing Hierarchy and work on jaw stability. Each week, retry the horns to see if improved jaw skills enable the client to blow the horn without the compensatory postures.

The Horn Hierarchy is a small part of the TalkTools offerings to improve speech clarity. See our website for more information on live workshops in your area or Educational self-study courses (we offer continuing education credits for workshops and self-study courses), and learn about other TalkTools therapy techniques.

Sara Rosenfeld-Johnson

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