Thank you for sharing! This is awesome information! I have a question for you: How do you address carryover of correct resting posture? I find many of my tongue thrusters have difficulty incorporating what they learn in treatment to their every day activities.
That's a great questions Pam! Thanks for asking. In "session 1" step 4 (where your client is holding the cheerio/elastic, whatever on their aveolar ridge with closed teeth) encourages tongue placement for resting position. I explain to the client that THIS is their resting postion and their tongue should ALWAYS go to "home base" when they are not talking! After I take away the "cheerio" their tongue should go right back to this place. And we pracitce this several times. Once I feel they can place there tongue in the correct resting position part of their "homework" or job at home is to "fix" their tongue placement everytime they notice their tonuge is NOT in correct resting position. I usually recommend that they set a timer, beginning every 2-5 mins or so, while they are watching a 1/2 hr tv show (great way to distract them from what their mouth is doing)...and every time the timer goes off, assess where their tongue is and if they need to put it back into correct resting position, to do so (only 1/2 hr a night for a week I start off with). (Most people hate the timer going off every 2 mins but 5 mins is more acceptable so you may get better results with spreading out time...PLUS you want to see if they are able to hold that resting position for longer periods of time without focusing specifically on it). This is a technique I use throughout the program. Once they master resting position during tv watching, I have them "check" their tongue positions various times a day throughout the week (its the honor code, but you can tell if they have practiced or not by the way they come back the next week....espeically for children, you might need to make a specific practice chart if you feel there is little follow up on this task). Once the client can say to me, I only had to fix my tongue a few times all week, and I can personally tell their tongue is in correct resting postion during sessions, that tells me they are most often using correct resting position in other settings as well. If they are struggling with this skill, I revert BACK to Session 1 steps 3 and 4 for further practice. I've also went out of order sometimes (mostly for children who are struggling) and practiced A LOT of /k, g/ words (first lying on their back on the floor to "feel" the posterior tongue position, then sitting up...ALWAYS with their mouth as wide open as possible...to encourage posterior lingual strength and position in mouth. Rarely, I have used drinking thicker substances out of a straw to encourage more lingual strength (this is GREAT technique for transitioning kids from sippy cups but for those with a tongue thrust already you have to be careful with this technique b/c it could backfire on you and your client could just be using their tongue thrust over and over again while drinking...so I usually don't go with that technique if I can get posterior lingual strength a differernt way). Yikes! That was a long response, but I hope this helps! Anyone else have other ideas or techniques please share so we can all benefit! Thanks!
Thanks for your detailed reply! I just now stumbled across it, all these months later! I've been doing what I call "interval training" as well: using a timer to self-monitor during daily tasks such as homework and tv. I'm also finding that placing a small sticker on their cell phones works well as a reminder to check their tongue placement as cell phones seem to be ever-present.
Pam, I LOVE the idea of the sticker on the cell phone! Brilliant! I am definitely using that in the future. Thanks for your follow up comment. I love your ideas...and I also like the term "interval training"...I might just use that in the future as well! :)
This is amazing! I am just picking up a tongue thrust client and I knew NOTHING! Thank you so much!
So glad you can use it Rebecca!
Hi there. I stumbled onto your page and thank God I did because I knew nothing about tongue thrust. I just recently got a 14 year old client who was just referred to me by her orthodontist (yes, just referred at 14.) She's had braces for about a year, so her teeth look really good. The ortho referred her based on what they saw: her upper teeth were flared out and they could see her tongue protrude during a swallow at rest. I completed an oral motor assessment along with a dysphagia evaluation and followed some of your assessment procedures. She passed both of these assessments with flying colors. I even did different consistencies paired with a variety of using a straw, bottle, cup etc. She keeps her tongue in her mouth at all times, not a mouth breather. She wasn't able to answer whether or not she felt her tongue push against her teeth during swallows. She has a slight frontal lisp on /s/ but has been receiving speech therapy for articulation since kindergarten. I did have her swallow while smiling and from what I could see through a TEENY TINY hole, was her tongue. So, I recommended therapy based on what I saw during swallow at rest and the slight frontal lisp. I'm just clueless as to what to do from here. Could I still follow the remediation program you have outlined here? Some of these exercise seem too easy for her, maybe? What if she still has a tongue thrust/lisp after the remediation program is done since it's only 5 sessions? Any other suggestions would be greatly appreciated!
Well firstly let me say kudos to the orthodontist who realized braces will not help unless tongue thrust is remediated. Ok there are few things I am thinking that might help. Firstly remember that each "session" above is not necessarily a therapy session. You may go as quickly or as slowly as needed for each client. With that said, each exercise is there not just to improve awareness but to improve strength of lingual musculature. So yes I would recommend you beginning at session 1 and moving through the program just modify it as you need to for your client. Make sure before you move on to additional exercises: 1) your client is actually practicing at home (b/c if she isn't there will be little or NO progress) and 2) that she can do ALL exercises with automaticity (so she shouldn't be thinking for a split second how to do something, she should just be able to do it as quickly as you and I can).Your client is exactly why tongue trusting is so difficult to see or determine sometimes. However her flaring teeth are a clear indication of trusting. B/c they flare it may be that she is actually pushing against the ridge at the very top of her teeth (so she could be making some contact with the alveolar ridge and some contact with the very top of her teeth causing them to flare out which is different than open or overbite as that typically occurs b/c tongue is pushed right on the teeth). The truth is your client needs to understand there is NO FORWARD pushing during swallows. If her tongue is anchored correctly all movement is propelled BACK...NOT FORWARD! It also means that it may be difficult for your client to truly realize that her tongue is NOT far enough back so you may have to really some education to explain the differences. Also it sounds like your client is not fully knowledgeable of where her tongue is at rest which is a MUST for remediation of thrust. So education and lots of practice and checking and accountability for that as well will need to happen. The truth is that your client's tongue may in fact be sitting further forward at rest than what is typical however b/c we don't see her tongue she things her tongue is "in her mouth". It's not enough to be in her mouth but must be pulled back so that at rest her tongue is settled along the roof of her mouth with her tip anchored at the posterior portion of the alveolar ridge (furthest point away from the teeth). You know her tongue is sitting along the roof of her mouth b/c her top teeth are the teeth in question, correct? So you will probably have to work on moving that tongue further back in her mouth. Sidebar: another indicator that tongue is placed too far forward is when k/g made by mid portion of tongue contacting mid palate. That tongue needs to be back as far as possible. So doing LOTS of k/g and even long e exercises with mouth open as wide as possible will help get the needed strength in the base of the tongue to pull her tongue back. Also if at rest swallow is the issue, go through the program but spend most time on remediating and having her take accountability for correct swallow function at rest! This is the hardest part of generalization and may need more time. I hope this helped! Let me know how it all works out!
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Thank you very much!