Dear Sarah-

Normal tongue development starts as 50/50 protrusion/retraction. Towards 4 to 6 months the development occurs where the tongue starts being more retracted in anticipation of spoon feeding. Then lateralization occurs in anticipation of solids and the tongue retraction with tip dissociation is stronger. Over time by 24 - 36 months tongue tip elevation for the swallow develops. This sequence occurs simultaneously with the development of speech sounds. As we know in Down syndrome there are many delays and deviations of this pattern.

So to answer your question.....Tongue tip elevation will not occur without retraction and elevation. You have not mentioned the age of your child or feeding skills. So I am not sure if these tools would be a start place as our hierarchies have prerequisites, such as bite block 5.

As for evidenced based practice for this tool, please refer to the blog I wrote on Down syndrome: "Orofacial Myofunctional Disorders in Individuals with a Diagnosis of Down Syndrome."

Also, there's a lot of references and info in these books:

They will give you the normal development of tongue movements with references as well as justification for why you need to work on certain skills. If you need more let me know.

Hello,

I was wondering if you could possibly help me. My six-year-old son has Moebius syndrome and recently had facial reanimation surgery. We have been doing TalkTools therapy for years and love it. We do a lot, from the Z-Vibe to Chewy Tubes to the horns! We have him try to follow the Z-Vibe with his tongue, but I can’t get his tongue to lift up. My question is: how can I help my son improve tongue movement? He has twelfth cranial nerve palsy, and his tongue has become so much stronger with therapy, but tongue tip elevation is still so hard for us. Any tips? Thanks so much for your help.

Danielle

Hi Danielle,

Here are some questions that may help us think about why he may be having difficulty. When we are looking for tongue tip elevation we need to know first if he has jaw stability, tongue retraction and tongue tip lateralization skills first; these are prerequisite movements we look for. If you are unsure of any of the terminology let me know!

1. Does your son get any lateral movement? If so is he getting lateral movement to both sides? What activities do you see this movement in?

2. Can he chew on his back molars and hold the food there? Do you see his tongue move toward the food as he chews? Does this look easy for him?

3. Can he drink from a straw with tongue retraction? (Or does he protrude his tongue forward)

4. Have you done the Jaw Grading Bite Blocks so we know that he has adequate jaw stability as well?

If you’d like to send a quick video clip doing some stimulation of his tongue I may be able to see something.

All questions that may help us get a “why” answer and maybe a plan! Also, if you haven’t already, you should read this article by Sara Rosenfeld-Johnson about Moebius Syndrome. I look forward to hearing from you and helping any way I can!

Renee Roy Hill, MS, CCC-SLP

Renee Roy Hill, MS, CCC-SLP has provided therapeutic assessments and program planning for adults and children with oral placement, feeding and motor speech deficits for over 17 years. She is the owner of Crossroads Therapy Clinic in New Braunfels, TX and a member of the TalkTools® speakers bureau. Renee has been an invited speaker for ASHA state conventions and has received specialized training in speech/oral-motor/feeding therapy, Apraxia, sensory processing disorders, Hanen Courses, NDT training, TAMO therapy and PROMPT. She is the creator of the TalkTools® Schedule Board Kit, co-author of Ice Sticks, and author of the TalkTools® Apraxia Program.

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Hi TalkTools,

 

I have a 6 year old male student who produces /h/ for /k/. He appears to have placement, and is able to produce /g/. However, we have not been successful in nearly a year of therapy with eliciting /k/. His voice is hoarse during conversational speech. His mother is not interested in visiting an Ear, Nose & Throat Doctor. Do you have any suggestions or theories? Thank you.

 

Angela

Hi Angela,

Based on what you have written he just is not associating tongue elevation with his "k" sound and instead is producing the 'h." I would work on "g" repetitively and throw in a whispered "k" in a sequence of sounds (having him repeat). I would try to get him in the right position over and over and over again and then switch quickly to the "k" and see if that works. Work on teaching "k" as the quiet sound. 

Other exercises you can try would be horn blowing, bubble blowing, and straw drinking. This will help to reinforce the back of tongue retraction that is important for that speech sound. Even though it seems he already has the placement with the "g," hopefully the repetition will help get him transitioned to the "k."

I hope these ideas help. Please let me know how it goes and write back with any other questions.

Have a great day.

Thanks,

Liz