Hi, I am interested trialing your tongue tip elevation/lateralization tools with my client, a child with Down syndrome who has significant difficulties with tongue tip separation and production of tongue tip sounds t, d, s, n.
Can you please tell me where tongue tip lateralization is part of the normal speech pattern and why this is recommended prior to elevation. Can you also direct me to any research supporting the use of this tool as although I feel that this would be beneficial for this child I need some evidence that I am working in line with best practice.
Many thanks for your time and support.
Tagged "tongue elevation"
When people need help with therapy or products, we put TalkTools® Instructors to work and then publish the exchange for anyone in the same situation to get help, too. This question is from Danielle, by Facebook message.
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.
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!
Thank you so much for replying, I appreciate it more than you know. My son does have some lateral movement, but it is limited. He uses his fingers so much to move his food to his back molars and has always been a messy eater. When he drinks from a straw his tongue protrudes forward as well. Thank you for taking the time to help us.
He still needs help with tongue retraction and lateral movement before working on elevation. He is not yet ready to work on elevation. Good luck with everything and let us know if you still need our help!
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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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.
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.
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.
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!!!
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!