Tagged "tongue weakness"

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,




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,



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: Feeding Suggestions

Posted by Deborah Grauzam on

Hi TalkTools,


I was at the Feeding Therapy: A Sensory Motor Approach course Lori Overland taught in Manhattan this past January. I've been in love with using what I've learned and have even become a go-to feeding person at my school.  


I have a low-toned girl who has tongue protrusion at resting but can keep her mouth closed at times.  During all speech sounds, she produces with her tongue forward, and I am working on getting it back (have suggested use of straws).  Her teacher recently brought to my attention her difficulty with feeding.  


When observed eating eggs, fish, rice-softer foods with less crunch-her tongue weakness definitely shows. The food just pools in the front of her mouth until she eventually spits it out, because she can't swallow it. She turns her head to the side when chewing, which I'm assuming is her inability to dissociate her tongue from her head. With crunchier and longer foods, her teachers have done well teaching her to put it on the side. 


I would like to implement some of the tongue lateralization exercises as well as the chewing hierarchy for her. It seems she has so much trouble even just initiating a swallow. I appreciate any further suggestions you have, and if you have any idea how to explain why she's having difficulty with these softer foods. 


All the Best,




Hi Lisa,

Thank you for your kind words about the feeding class. It sounds like you are doing a great job. Here are a few suggestions for you:

  • Check under her tongue to make sure she doesn't have a posterior tongue tie
  • Work on lateral tongue movement and the chewing hierarchy
  • Work on cheek mobility to help stabilize food
  • Use therapeutic feeding techniques at mealtime - she may be better able to swallow foods presented on the lateral molars
  • Work with her PT to establish a good seating position for feeding

Good luck!

Lori Overland, MS, CCC-SLP, C/NDT

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