Tagged "Tongue Protrusion"


Ask a Therapist: Tongue Tip Lateralization & Elevation Tools

Posted by Deborah Grauzam on

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.

 

Sarah

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.
Read more →

Ask A Therapist: Tongue Tip Elevation in Moebius syndrome

Posted by Deborah Grauzam on

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.

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

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.

Danielle

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

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.

Meet her!

  • February 10-11, 2017 in Pasadena, CA
  • February 23-25, 2017 in Austin, TX
  • March 3-4, 2017 in Mobile, AL
  • March 18-24, 2017 in the Caribbean
  • April 7, 2017 in Charlotte, NC
  • April 28-29, 2017 in New Orleans, LA
  • March 6-7, 2017 in Springfield, VA

For more details, visit TalkTools Event Calendar

 

Read more →

Ask A Therapist: Sensory Friendly Bite Blocks

Posted by Deborah Grauzam on

Hi, 

 

I have two questions for you.

 

1. I have lost some pieces of my Sensory Friendly Bite Blocks set and would like to purchase another set. Since the purple sticks are softer than the red ones, many students chewed them thin so that their bite marks are visible in the stick. My question is: should I purchase the red set to avoid that problem or purchase another purple set so that in the event that should any stick get lost, I may have the replacement?

 

2. There are students on my caseload who simply have lingual protrusion for the all alveolar sounds. My question is: if I purchase the Straw Kit for these articulation students, will that help them eliminate their tongue thrust along with standard articulation therapy? Do the straws truly help train the retraction of tongues?

 

Thanks so much,

 

Chayie

 

Hi Chayie,

1. As far as the red and purple bite blocks go I have a set of both. I always try to use the red first because they are more durable and then use the purple if the client does not tolerate them. Many of my clients prefer the texture of the purple so I just know I have to replace those more frequently.

2. Yes, the straws do work on tongue retraction orally. They work on different levels of tongue retraction.  There is a diagram that will come in the straw kit and is also in the book that shows exactly where the retraction takes place with each individual straw. The Horn Kit and the Bubble Kit are two other activities that I often do while working on the straws for tongue retraction. These are all great!

Let me know if you have any other questions.

Always happy to help.

Thanks,

Liz

 

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.

Read more →

Ask A Therapist: Tongue Lateralization

Posted by Deborah Grauzam on

Hi TalkTools,

 

I completed your training a little over a year ago, but still would like some support when making therapeutic decisions.

 

I am working with a 12 year old boy who has both language and speech issues (the /r/ and vocalic /r/ phonemes). I just completed a screening and the oral-motor portion of the screening revealed that: a. he could not protrude his tongue straight out of his mouth (it would lateralize), b. his tongue seemed to have a little tremor, c. he had difficulty dissociating his lips/tongue.

 

I would like to add some Oral Placement Therapy exercises to his therapeutic program. Can you please make some suggestions?

 

Many thanks,

 

Wendy

 

Hi Wendy,

I have your question and will try to give you some pointer on things to try. If you haven't worked on the Bite Tubes with this client yet, I would if you identify jaw weakness. The jaw is the foundation for everything else to work properly. Next, I feel he probably has tongue weakness and increased weakness on one side based on your report. I would work on tongue lateralization exercises to the Z-Vibe tip and with the Tongue Tip Lateralization & Elevation Tools bilaterally. You will have to work twice on the weaker side depending on what you see with your assessment. You could also work on straws and horns to help with tongue retraction for the /r/ sound.

Please let me know how this goes or email back any other questions.

Thanks so much,

Liz

 

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.

Read more →

Ask A Therapist: Oral motor therapy for an adult with Down syndrome

Posted by Deborah Grauzam on

Hello TalkTools,

I appreciate the opportunity to have my question regarding the potential benefit of securing oral motor therapy for an Down Syndrome adult being answered by a group of therapists who has exhibited such an understanding of the progression of the oral motor appearance of Down Syndrome children.

In regards to a Down Syndrome mature adult with a very protruding (and getting more protruding) tongue, is it possible to reduce the appearance of the size of his tongue and the degree of protrusion, even in an adult via oral motor therapy? Might such oral motor therapy prevent future swallowing issues from arising?

Conversely could a current failure to provide oral motor therapy to reduce the individual's tongue protrusion and/or enlarging size of tongue at rest, hasten/lead to future swallow problems?

Have you had personal experience of dealing with an Down Syndrome adult? And if so, what degree of improvement was obtained?

In addition to the potential swallow deficits that I am mostly concerned about, my heart breaks for the individual, as he is stared out everywhere when he is out in the community due to his very protruding tongue at rest.

I read with great interest the article by Sara Rosenfeld-Johnson on the development of oral-motor issues in the Down Syndrome population. I wish I would have seen this many years ago. In our case, it is way too late to prevent the Down Syndrome oral motor myths.

The question to you is this: Is it still possible to correct some of the oral motor manifestations seen by Down Syndrome individuals in an adult? In a mature adult? Can doing so prevent future deterioration? Have you personally attempted to do so? With what success level?

If you recommend oral motor therapy in such an instance which I cited: Are there any medical diagnoses that are legitimately available that would make the therapy coverable by Medicare/Medicaid?

Very truly yours,

Rachel

 

Hi Rachel,

I have received your questions and will do the best I can to answer them all.  I hope I am not missing anything. Yes, you can change the oral motor patterns and therefore tongue retraction in adults with Down Syndrome. I have worked with adults with Down Syndrome and have seen the patterns change and have had success with this program. The main thing that determines their success is the amount of practice that they are able to do between my sessions. It is recommended that they practice their home program a minimum of four times a week. The more work they do at home, the more progress I see. You will not decrease the size of the tongue but you will increase the strength and retraction and therefore change the pattern of the swallow.  This can decrease swallowing issues. I would think that the therapy by a Speech Language Pathologist should be covered. The parents I work with bill their own insurance so that would be determined based on the individual policies.

I hope this helps. Please let me know if you have other questions.

Thank you,

Liz Smithson

 

Hi Liz,

Thank you for the promptness and depth of your response. I was amazed. Thank you. I really appreciate this opportunity to hear your answers.

To make sure you haven't missed anything, I will expound. I am referring to a 54 year old. His tongue can protrude way below his chin at rest. I believe that this condition however truly only got worse recently. To my knowledge, he has not received therapy for this condition, certainly not within the past 15 years. He has a severe reverse swallow.

I would be willing to commit to practicing with him twice a week and can try to bring his direct care worker, who is exceptional on board. What are we talking about here: how many sessions? Over what period of time? What is the range of number of lessons?

1) Do you know any qualified therapists personally in the NYC area who have experience and a positive track record with the Down Syndrome adult population? Do any of them do evaluations/therapy? Do they permit family member or direct care taker to sit in during speech sessions so that they could learn how to work with this individual in house?

2) I have focused on the oral motor aspect because that is what everyone sees first and what I fear can cause him swallowing problems, medical issues, moving forward if it is not addressed now. I would love, however, to see him receiving some therapy to increase his expressive communication, perhaps via a prescribed device i.e. an iPad or some similar devices.

3) What speech/tongue conditions/diagnosis are reimbursable in your experience? Is a swallow test a mandatory prerequisite to making oral motor therapy that is covered by insurance? 

I am constantly told by those that advocate for him that success is not possible for him. Have you, or anyone you know, had success with adults of this age bracket? Longevity actually runs in our family. So we are hopefully talking about many years of benefit and prevention of further issues for the Down Syndrome individual.

To me, 54 is still young. But I am told such is not the case with Down Syndrome individuals as they have much shorter life spans. Have you found this to be true based on your experiences?

You are providing me with very pertinent information and strength on his behalf. I need to hear from someone experienced that his conditions can potentially improve with therapy. I can see no other choice but to try. The previous speech pathologist I informally spoke to (on a train) also shared with me that improvements can be secured, even in his population.

Thank you.

Respectfully yours, 

Rachel

 

Hi Rachel,

I am happy I can help.  I am going to try to answer everything without leaving anything out but if I do please let me know.

As far as how often to have the direct care worker work with him, I would recommend a minimum of two times a week in addition to your two, but anything she could do in addition would just increase the progress.

I do not personally know any therapist in NYC, but check the TalkTools "Find a Therapist" page. It lists Therapists Trained in Level 3 or higher levels in TalkTools Therapy. I would try to do an evaluation with one of them, if you can, and then you could do the follow up treatment. Typically, TalkTools Therapists encourage anyone else implementing the plan to be present for the evaluation, if possible, and often encourage you to video it if you can.

As far as reimbursement goes, that would depend on the individual plans and I would assume it would vary from state to state.  I do not currently do any insurance billing, so unfortunately am not able to answer that question.  

I have not worked with any clients with Down Syndrome that are that age. I have worked with adults but all were younger. I would recommend that you try and see if he is making progress. That is how I have always approached new patients in the past. We give it our best shot and see how they do.  

I hope this has helped. Please feel free to write me back if you need to. I wish you the best of luck and please keep me posted on how it is going.

Have a great day.

Thanks,

Liz Smithson

 

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.

Read more →