Tagged "tongue tip elevation"


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: 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.

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Ask a Therapist: Nasal Emission of "sh", "ch", and "j"

Posted by Deborah Grauzam on

Hi Sara,

 

I have a student who is turning four years old next month. I have been seeing her for several months for nasal emission on /sh/, /ch/ and /j/. She never had any anatomical problems and has been seen by an ENT. Oddly, she produces /s/ and /z/ just fine in spontaneous speech. I've been trying to work off the /s/ to /sh/, or /h/ to /sh/ by raising the jaw while producing /h/, the butterfly position, etc. I don't think she is able motorically to follow the instructions but then again it could be she doesn't understand due to her age. I can tell she is trying as she will crunch her nose trying to stop the air from coming out. She is bright and discrimination training has been mastered. She understands oral versus nasal sounds. Do you have any suggestions?

Let me begin by saying there may be a few options for her and without seeing this almost 4 year old I can only give some suggestions. You will have to try each of them to see which is the most beneficial.

To begin, the difference between the /s/ and /z/ and the "sh" "ch" and "j" is the increased use of the lateral margins of the tongue resting against the upper palate.

1. If your client can say "ee" then you might want to work from that position rather than from the ones you tried. Show her a picture of the upper jaw with the sides of the tongue resting against the upper jaw. You can find this graphic in the handout for the class, "A Three-Part Treatment Plan for Oral Placement Therapy" if you have taken that class or if not it is also in the book, "Oral Placement Therapy for Speech Clarity and Feeding". Once this child can feel the sides of the tongue elevated and making contact with the upper palate you can have her freeze in that tongue position and try to say the standard "sh." Sometimes it is easier to get the "ch" from this position so I would try both.

2. If that does not work then I would see if she has the ability to elevate the sides of her tongue. The prerequisite movements for this placement would be the ability to a) lateralize her tongue tip to the back molars on alternating sides of her mouth without sliding her jaw, b) elevate and depress her tongue tip from an "ah" jaw position without moving her jaw. If she cannot do these prerequisites then the Straw Hierarchy would help develop these skills. Again you would refer to the book "Oral Placement Therapy for Speech Clarity and Feeding," for complete instructions.

3. You might also want to try the activity entitled, "Oral-Nasal Contrasts" from "Oral Placement Therapy for Speech Clarity and Feeding," as that activity works directly on mobilizing the velum.

I hope this helps,

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Tongue Tip Position for /s/ and /z/

Posted by Deborah Grauzam on

Hi Sara,

 

My friend Diane told me that you have been exploring alternate tongue positions for sibilants and recommended that I ask you the following question: Assuming there are no airway issues, how important is it to correct the resting posture of the tongue in order to enable correct production of sibilants?

 

I am working with a seven year-old boy with a perpetually low resting posture of his tongue. He keeps his lips closed at rest, but his tongue is quite lax while he speaks, and it affects his /s/ (frontal lisp), /r/ (vowelized), and /l/ (imprecise). We have done the straw program and he is capable of producing a good /s/, but I just have a concern that with his tongue lying around at the bottom of his mouth, he will not conquer the /s/ in his spontaneous speech. In discussing this with Di, she posited that you might have an opinion on my question.

 

I’d appreciate your thoughts when you get a chance.

 

Thank you,

 

Lana

Hi Lana,

I am so pleased Diane suggested you email me as she is correct, I have been very interested in tongue tip position for the standard production of /s/ and /z/.

It is important to teach the tip to elevate and depress in order to move fluidly within the oral cavity. Using the straw hierarchy will result in retraction but will not improve tip mobility. You may want to look at the tongue tip tools which teach lateralization of the tip and tongue tip elevation/depression.

Once a child has those skills he will be able to show you which position is right for him. Do you have a copy of my book Oral Placement Therapy for Speech Clarity and Feeding? In it I list the sequence of activities to ensure the oral skills are adequate to produce the /s/ and /z/ in addition to the other sounds you say this child is having trouble producing.

I hope this answers your question and have a nice day,

Sara Rosenfeld-Johnson, MS, CCC-SLP

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