The question I had was in regard to the article you have on your website, "Effective Exercises for a Short Frenum” You discuss stretching the frenum by using the Bite-Touch exercise as described in the book Oral-Motor Exercises for Speech Clarity. I have the second edition of the book copyrighted 2001 and cannot find the exercises described.
I was initially confused by this question but in doing further research I realized when I worked on the second edition of that text I changed the name of the exercise from Bite-Touch which I use in my classes to "Tongue Tip Lateralization." Since that time and at the suggestion of Gregory Lof I have changed the name of the book to Oral Placement Therapy for Speech Clarity and Feeding," in the third and fourth editions. Thank you for bringing this to my attention as I will now have to change that information on the online article.
The child I am seeing is 3 years 6 months old. His frenum was clipped a year ago. But there is a remnant of the frenum holding his tongue low in his mouth. His tongue tip cannot reach his alveolar ridge, however he can make acceptable low /s/, dentalized /t/ and /d/ sounds and an acceptable /n/.
This may be true but he is probably using his his jaw to elevate his low position to meet the alveolar ridge during co-articulation. This overuse of the jaw may eventually result in stress to the TMJ and eventually over time can result in TMJ dysfunction.
He can use short 3-4 word sentences fairly clearly, however, His speech becomes more and more unintelligible with longer utterances.
This again may be due to lack of jaw from tongue dissociation and fatigue. Place your tongue at the bottom of your mouth and hold it there while use a few 3-4 word phrases. This lack of tongue from jaw dissociation can result in fatigue and reduction of articulatory accuracy.
He can chew and manage both hard and soft foods. (Eg, pretzel sticks going back on either side of his mouth, chewing gum and moving it from side to side.)
The question here is whether or not he is chewing on his back molars. If not then you will have to identify if that forward placement for chewing on his side teeth is secondary to jaw weakness or to the inability of the tongue tip to place the food on the back molars for "normal" chewing.
His parents have a consultation with the ENT regarding whether a more extensive surgical clip is possible.
I hope the answer is yes as without releasing the tongue tip his issues in speech clarity and feeding safety will continue.
I do not think he is in danger of choking on his food but I do think the limited range of motion may be contributing to the lack of clarity as his sentence length increases. I think he gets fatigued by the effort to use the tongue effectively.
Yes, I agree with that as well.
Thank you for your attention to this. I would appreciate your opinion. I am not sure if stretching will increase the range of motion much but I would try it, if you have found it can make a difference.
The activities entitled "Tongue-Lateralization" and "Tongue Tip Elevation/Depression" are used to stretch the frenum when mobility is a physical option. The stretch is slight as the frenum is not very pliable. We have also developed two tools to assist in the stretch and in developing tongue tip mobility if further surgery is indicated and you need to work on range of motion. They can be purchased on the TalkTools website and come with extensive directions.
I hope this has answered your question.
Sara Rosenfeld-Johnson, MS, CCC-SLP