Tagged "tongue tip tools"


Ask A Therapist: My First Time Doing An Eval

Posted by Deborah Grauzam on

Hi TalkTools, 

 

I have a few questions for the staff SLP. I watched the "3 Part OPT" videos and I can see how it generally walks me through the eval process but the language doesn't seem clear to me on the Assessment Form. Did I miss something?

 

It is my first time doing an eval. Here are my questions regarding how to do the eval:

 

1. For "Jaw Grading Bite Blocks", do I use ALL of the in the A, B, and C positions? Or just some or the last one?

 

2. for "Tongue Tip Lateralization", what does this look like? Do I start with asking them to swipe the inside of their mouth left to right 10 times and if they can't then use the tool? What do I ask the client to do?

 

3. For "Tongue Tip Elevation " I don't understand the criteria of 50 seconds, 1 time. What does this mean?... hold the tongue tip at alveolar ridge for 50 secs? What do I ask the client to do?

 

4. "TT Depression"- Where does the tongue go? What do I ask the client to do?

 

5. Same for "TT Up and Down"  - where does the tongue go? What do I ask the client to do?

 

Sincerely,

 

Carrie 

 

Hi Carrie,

Great question!  The Oral Motor Skills for Feeding and Speech Checklist is not intended to “teach” you each section of the form but a place for you to write results, guide you through an assessment and then provide the information you would need to then develop a program plan for therapy. The form assumes you know each technique, or, have the resources to find the protocol for each exercise. The criteria for success listed is a reminder of what the final goal is to complete that activity or step (this is the part that so many, to include myself have difficulty remembering when you are new to using the protocols). You may want to consider looking into our next course, “Assessment and Program Plan Development” that would follow the 3 Part Treatment Plan. In this course we use this form for several different evaluations to help you become familiar with its use! I will answer your individual questions below, directing you to where the complete instructions for each of them are!  If you have further trouble don’t hesitate to email me!

1. Each Bite Block Height would be assessed at each level. For example, you would not move from Bite Block #2 Exercise A to Bite Block #2 Exercise B unless they have met the criteria for Exercise A and so on. These instructions can be found in the books “OPT for Speech Clarity and Feeding” “Assessment and Treatment of the Jaw” and included with the set of Bite Blocks.

2. There is a specific exercise outlined in “OPT for Speech Clarity and Feeding” using a Bite Block and complete instructions with the Tongue Tip Lateralization Tool. There are many steps to this activity to teach the client to lateralize the tongue tip to the lower back molar.

3. Yes, the final goal is that the client can hold the tongue tip to the alevolar ridge for a full 50 seconds, 1X. You will notice that in therapeutic practice we often request multiple repetitions of practice but it is not always the criteria for success.

4. This is another activity that is in “OPT for Speech Clarity and Feeding” or included in the instructions with the Tongue Tip Elevation Tool. 

5. The tongue tip will go to the same two locations previously practiced individually. These instructions are also in “OPT for Speech Clarity and Feeding” followed by a transition technique to teaching the /s/ sound once you have completed this activity!

Renee Roy Hill, MS, CCC-SLP

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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 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.

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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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