Tagged "tongue tip"


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.
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Ask a Therapist: Proper Tongue Elevation & Retraction

Posted by Deborah Grauzam on

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

 

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