TalkTools | Ask a Therapist – Tagged "Tongue"

Ask A Therapist: Feeding Therapy for a Medically Fragile Client

Posted by Deborah Grauzam on July 13, 2015

Hello Talktools,

First of all, I cannot tell you how much I enjoyed Lori Overland's conference on Feeding Therapy: A Sensory Motor Approach in Savannah! I learned so much and have been able to apply the new (to me) strategies with many of my clients.

I have a question for Lori about a challenging client. My overall question is: how long after a frenectomy can we begin working on oral-motor therapy?

The client is medically fragile. He has 1/3 of his brain (brain stem, parts of occipital, visual cortex is present). He also suffers from CP and diabetes insipidus among other things. He is adopted, and his parents are EXTREMELY dedicated.

He is surprising us all with what he is able to do so far. He will be one year old in a couple of weeks, but he presents like a 3-4 month old right now.

He is able to consume liquids with a bottle, but his tongue tie is preventing him from being able to efficiently nurse, and he is gagging on pureed solids. His tongue tie is being corrected by an ENT surgeon this week. However, his mother is concerned because the doctor indicated the "easiest" thing to do would be to put in a peg tube.

While this baby is medically fragile, he is making progress in all developmental domains. His mother is realistic about him potentially needing a tube, but wants to make sure he truly has the opportunities to reach his maximum potential.

Any suggestions or insights would be welcome! He is very complex, and I know that without your class, I may not have been as prepared for him!

Thank YOU!

Amy

Hi Amy,

Thank you for taking the time to tell me how much you enjoyed the course!

You should be able to begin working on oral-motor therapy with your client within a few days after his frenectomy, but I usually do a two week follow-up, so I can see what the spontaneous results of the surgery will be vs. the impact of the therapy.

It is EXCELLENT to hear that he is surprising you with his abilities and how dedicated his mother is. Reach for the stars, it is nice to be surprised!

In regards to the tongue tie, releasing the tongue will not be a miracle for this little guy, but it will allow you to work on the oral sensory motor skills he needs for feeding. Even if at some point he does need a tube for adequate nutrition, it would be nice for him to do some safe recreational feeding. So...a week to two post-op, start to work on the lateral borders of the tongue, tongue blade stability, and tongue retraction.

I AGREE completely with making sure he has the opportunity to reach his maximum potential!

Good luck and feel free to check in with me if I can help!

Lori Overland, MS, CCC-SLP, C/NDT

Ask a Therapist: Proper Tongue Elevation & Retraction

Posted by Deborah Grauzam on February 18, 2015

Dear Therapists

I need advice please! I am seeing a 5 year old child with severe childhood apraxia of speech together with dysarthria (specifically weakness of tongue and lips). So far his lip strength and movement has improved a lot, but I am really struggling with his tongue. He can protrude his tongue beautifully, retraction we are working on, but he is doing ok so far. Lateral movements we are also working on, but tongue elevation seems impossible! Both posterior and anterior tongue movements just aren't happening! Any advice will be appreciated!!!

Kind Regards

Denise

Hi Denise,

Thank you for your email. I understand your frustration! I can tell you in looking at motor development, tongue tip elevation does not occur if you do not yet have retraction and stability along with lateral border stability which all allow the tongue tip to develop so it may just be a matter of continuing to work on the underlying skills necessary for tongue tip dissociation. Often, children who have motor planning deficits in conjunction with oral motor weakness can progress at a rather slow pace and therapy can be difficult when compared to children who only have dysarthria. I'm happy to help you sort out what might be missing! I often find that the order I do treatment in can be as important as the exercise itself. For example, many children with CAS and Dysarthria have difficulty isolating the motor skill I'm looking for, thus a good sensory-motor program may be useful immediately before targeting the motor task I have as a goal.

I'm not sure what education you have in TalkTools but the Three Part Treatment Plan teaches of our systematic approach to motor speech disorders based on normal development. I look forward to hearing from you!

Renee Roy Hill, MS, CCC-SLP

Ask a Therapist: Tongue Placement

Posted by Deborah Grauzam on March 11, 2013

Hi, I am hoping you can offer a suggestion.

I am an SLP and see a 2 YO child who began sucking on his tongue and had a forward tongue posture before I started seeing him. Once I started working with him I had the family switch to straws only and eliminated the sippy cup. They did that and he continued to have tongue sucking behaviors. Now, he has switched to twisting/turning his tongue around his mouth and it is interfering with his speech sound productions.

I tried to introduce vibration to provide sensory stimulation, but he does not tolerate that in his mouth. I also gave him a chewy tube as a substitution and he will tolerate it, but it is not eliminating the problem.

Do you have any product suggestions? I would greatly appreciate it. He has no drooling, no muscle weakness, and no feeding difficulties. I have never seen a child do this before.

Thank you in advance for any suggestions or product recommendations!

I have a few thoughts on this to help you:

1. Make sure there is not a structural or physiological problem, for example enlarged tonsils and adenoids. If the tongue must be displaced forward for breathing for example it could start these odd habits. Look for a tongue tie.

2. The sensory-motor systems cannot be separated. Though you say there are no feeding issues, I suspect there may be some breakdown in oral-motor development. Look carefully at developmental norms. This will soon be available in the feeding book Lori and I wrote, or you can look into taking Lori's feeding class if you have not already. If this child sucks his tongue at rest, there may be similar patterns on the straw.

3. Use of chewy tubes and sensory motor activities are most useful when you work from the outside of the mouth to the inside of the mouth and the therapy is led by the therapist. So I would not recommend handing the chewy tube to the child, but rather follow Lori's pre-feeding Chewing Hierarchy.

4. Finally, for the tongue sucking, I would recommend tasks that work on tongue retraction. The TalkTools Straw program and TalkTools Horn program, when executed by the directions on the tools kits would be excellent, as would TalkTools Bubble Kit. If you wanted to learn more, we have self-study courses for each of these kits!

Thanks for your interest in TalkTools!

Robyn Merkel-Walsh