Resources 

 


Various commercial treatment protocols and resources are available to the SLP. Most popular among the therapists serving the school aged population are :

1- The Tongue Thrust Book: Oral Myofunctional Therapy and Articulation Correction, by Marcelle Richardson (published by Pro-ed)

2- Tongue Thrust Therapy An oral motor approach to diagnosis and treatment, by Robyn Merkel, distributed by Innovative Therapists International and is accompanied with a DVD.  
                                         

  3- 

S-M-I-L-E: Systematic Intervention for Lingual Elevation: A fun therapy program for tongue thrust remediation.

This program utilizes a combination of traditional myofunctional programs and oral-
motor therapy focusing on speech sound production Articulation drills are specifically used to complement the oral-motor structures and function in the lesson.  The drills are not designed to achieve articulatory accuracy. It is based on the unique feeding techniques of Sara Rosenfeld Johnson and Lori Overland. It is accompanied by a DVD.  

The following are candidates for the program: 

1. Post-frenumectomy patients. The program helps improve lingual resting posture,lingual tone, tongue/jaw dissociation, and tongue/lip dissociation.  In cases of a restrictive frenulum, then the child often does not swallow with correct tongue
positioning, the program will help improve this weakness.


 
2. Children with moderately weak muscle tone will benefit from the program, but children with dysarthria are not good candidates.
 

3. Children with poor dissociation skills, chewing difficulties, myofunctional disorder and/or dyspraxia should benefit since the program targets dissociation, coordination, strengthening and swallowing. 

                                       


After carefully reviewing these resources, however,  it is the view of this group that a special tongue thrust program, Tongue Thrust: A diagnostic and treatment program, first published over 3 decades ago, by Dr. Donald Rampp and Dr. Mary Pannbacker, ( Louisiana State University Medical Center New Orleans), is the gold standard of treatment. It presents the tongue thrust problem in its proper perspective, and is designed to be utilized by dentists as well as by SLPs. It   can even be used in conjunction with ongoing orthodontic treatment. Moreover, this home program is cost effective because it requires less than four hours of professional time and less than nine weeks of total time. The first 6 lessons are presented below:

 

Specific Six Week Program

Lesson 1

There is only one exercise to do this week, but it is important that it be done exactly as you were shown. Place a raisin, life saver, elastic or small rubber band on the tip of your tongue. Then lift your tongue slowly and press it against the “spot” (the gum ridge directly behind the upper front teeth, but no touching the teeth). Let someone check to be sure your tongue is in the right place. Now you are ready for the “tongue tip swallow”.

                To do this, put your teeth together hard; keep your lips apart; place your tongue tip up against the “spot”; suck in gently, then swallow without moving your tongue.

Bite you teeth together HARD

Keep your lips APART

Place you tongue tip up against the “spot”.

Suck air in gently, as you would “slurp” soup.

Swallow, without moving your tongue from the “spot”.

 

TAKE TIME TO THINK OF EACH STEP, FOR EACH ONE MUST BE CORRECT.

NOTE-    When your child has the correct position, have him look in the mirror, explaining that

this is the way he should look when he is practicing this first exercise.

 

PRACTICE SCHEDULE:

                On the first day, do six of these swallows in one practice session.

                On the second day, do six swallows slowly, morning and night.

                After that do twelve swallows three times a day.

 

The following are additional exercises that will help to strengthen your correct swallow. Each of these should be done for one full minute when you are practicing your swallow.

Tongue Strengthener:

Place a tongue blade between your back teeth to hold them open. Place a second tongue blade on top of your tongue with pressure and try to push your tongue to the top of your mouth.

10 in a row; 10 more.

Upper-lip Strengthener:

Put the end of a tongue blade up under you lip and push your lip outward. Then tighten your lip against the blade so that the lip pulls in against the teeth. Put the tongue blade flat under your lip and push the lip.

10 in a row; 10 more

Jaw-muscle Strengthener:

Chew a large wad of wax or sugarless gum, working it hard and moving it from side to side in your mouth.  (Do this for one half hour each day).

Other Exercises:

Try to smile with your lips tensed.

Practice drawing your tongue from the “spot” backward along the roof of your mouth.

 

 

Lesson 2

This week we have three exercises to practice:

Tongue pop strengthener:

Put your teeth together. Place the front one-half of your tongue up behind your front teeth and against the roof of your mouth. Suck up on your tongue, and then pull it down HARD to make a popping sound. You need to do this loudly, not rapidly.

CHA swallow:

With your tongue tip on the “spot”, say CHA with some force. Hold a lighted candle directly in front of your mouth and note that it is possible to bow out the candle simply by saying CHA hard enough. Do this a number of times until you can do it easily. Note that when you say CHA this hard, the front one-third of your tongue is again against the roof of your mouth, as when you popped your tongue.

Now we are going to get your tongue to stay in the CHA position when you swallow. Whith your fingers expanded, starting with your little finger, say CHA hard and fast on three consecutive fingers. The space between the second and index fingers allows for a short period of rest, to be followed by a CHA on the index finger. Then, “slurp” and swallow on your thumb.

Jaw muscle strengthener:

Put your finger tips on your jaw and bit down until you can feel your jaw muscle jump out. Keep your teeth clamped tightly together and say CHOO hard.

 

PRACTICE SCHEDULE:

                Do each of the above exercises twelve times during each of your three daily practice sessions.

In addition, pop your tongue as often as you think about it during the day.

REVIEW:

Do the tongue tip swallow as you were taught last time. Remember to do six of these swallows three times a day.

Remember to practice your tongue strengthener exercise for one minute during each practice session.

Continue to do your upper lip strengthener exercise for one minute at every practice period.

Other helpful exercises:

Stretch your upper lip down over your teeth as often as possible, leaving your lower lip motionless.

Stick your tongue out and try to make a long groove down the middle of it by folding the sides up- place the tongue blade in the middle to help at first. Gently blow air through the groove. While blowing, slowly draw your tongue back inside your mouth and end up making a kind of /s/ sound.



  Lesson 3

This week you have a new swallow to learn and practice.

Back of tongue or “Kick” swallow:

Open your mouth until you can insert three of your fingers between your teeth; make the /k/ sound until you can identify the area of its origin.

Use a mirror to observe the position of your tongue while producing the /k/ sound. While watching yourself in the mirror, say “kick” to place your tongue in the correct position. Keep your tongue exactly in that position while you swallow.

Your tongue should not have moved from the “kick” position when you swallowed. Did it?

If you are having trouble, “kick” swallows can be easily made if you lie on your back, keep your mouth open and relax.

Whistle:

Practice whistling by pursing your lips. Also, whistle through your lips. This exercise will help you gain control of your tongue muscles.

PRACTICE SCHEDULE:

      Do ten “Kick” swallows three times a day.

      During the day, whistle often.

REVIEW:

Do three tongue-tip swallows three times a day.

Practice your tongue pop strengthener exercise nine times at each session.

Do your CHA swallow six times during each of your three daily practice sessions.

Practice your jaw muscle strengthener (CHOO) six times at each practice session.

Practice your tongue gooving exercise.

Practice stretching your upper lip down over your teeth.

The night before your next visit to the therapist try your complete NEW swallow. To do this:

Keep your teeth together like in CHOO.

Keep your lips apart.

Put the front of your tongue up like in CHA.

Remember the feel of your KICK swallow, and pull the back of your tongue into that position.

Suck up on your tongue as you did when you popped your tongue.

SWALLOW!

Warning-your lips must not go together and your tongue must not peek out. Do not “slurp”, but suck up and back on your tongue.

Lesson 4

This week you are to begin to use your NEW Swallow!

Drink all liquids sip by sip. Remember to trap the water or juice in the CHA position; close your teeth; keep your lips apart; think how you say /k/. Now, complete the swallow.

Use your NEW swallow when eating solid foods. Take a small bite of food; chew the food thoroughly; collect the chewed bite in the CHA position; close your teeth; keep your lips open; think how you say the /k/ sound. Now, swallow the food with a sucking action.

Practice the following groups of sounds and words, while your parents listen. Say each word slowly, and feel what your tongue does.

This first group of words will strengthen your “CHA” muscles:

treat lit             neat         did

tight                light         net           dote

trot                   load         note         dot

toad  lad

Say these words to strengthen the “kick” muscles:

Ka            ache         kick         gay          agg

ke            eek           cake         guy          ugh

ki             ike           coke         go            hog

ko            oak                          egg          hag

ku            ickey                       igg           heg

                                                                        

PRACTICE SCHEDULE:

During the day drink all fluids sip by sip, using your NEW swallow.

Eat at least one meal each day with your NEW swallow.

Read the word lists once each practice session.

Additional Exercises:

Practice yawning; notice how it feels in your throat. Watch yourself in the mirror. Yawn at least six times each day.

Gargle every day when your brush your teeth. Make this a habit.

Review the following exercises at each of your three daily practice sessions:

Do three tongue-tip swallows.

Do six tongue pop strengtheners.

Do three “cha” swallows.

Practice your jaw muscle strengthener (CHOO) six times.

Practice your tongue grooving exercise.

Practice stretching your upper lip down over your teeth.

Do ten “kick” swallows.

 

Lesson 5

This week try to eat every bite with your NEW swallow! Make a reminder sign. After you make it, USE it, WATCH it, and THINK about it. Remember, keep your lips apart for each swallow.

Every bite you eat, every drop you drink, and even the saliva you collect in your mouth MUST be swallowed the new way you have been taught. Be careful that your head does not move or thrust forward when your swallow.

You are now ready for “continuous drinking”. This is not sip by sip as you did before. You must still remember, however, to keep your teeth closed tightly and to hold your tongue up in the “cha” position. Have Mom or Dad watch your lower lip while your drink. If you are swallowing properly there will be no lower lip movement.

PRACTICE SCHEDULE:

Drink all fluids and eat all solid foods with your NEW swallow!

VIEW WORK:

Continue to gargle each time your brush your teeth.

Once each day practice reading the word lists on Lesson 4.

LESSON 6

 

The following exercises will make your NEW swallow automatic.

1. Continue to GARGLE every time you brush your teeth, until you return for a final     check.

2. For one more week, keep your LIPS APART each time you swallow, except when you are away from home. The second week, keep your lips apart for only one meal each day. From then on your lips should always be closed when you swallow.

3. For 30 minutes each day of one week, hold your tongue up flat against the roof of your mouth, keep your lips closed, and let your teeth touch lightly.  The second week, do this one hour each day. Thereafter, your lips should never be open when you are at rest.

Do six NEW swallows just before you go to sleep at night. Following your six swallows, place your tongue in the CHA position and go to sleep holding it there. Was your tongue still on the “spot” when you woke up in the morning? Do this exercise every night for two weeks.

 

ADDITIONAL SUGGESTIONS:

                Once a day for the next week eat a light snack or sip water while you are reading or watching television.  Be sure to give enough attention to your swallow so that you do it correctly. This practice will help you establish unconscious use of the NEW swallow.

                During the day be sure to keep your tongue up high in the CHA position. Your teeth should be TOGETHER and your lips CLOSED.

 

WARNINGS:

You may have to review the exercises given in these lessons from time to time if you forget and make one of your old swallows.

Watch yourself in the mirror to see if you are using your NEW swallow. There should be NO movement around your mouth, but lots of movement of your neck muscles.

Keep your reminder sign where you can easily see it for a couple of weeks. Have someone occasionally remind you at meal times to use your NEW swallow.

It will be easy to lose your NEW swallow if you do not keep your teeth together and your tongue high while swallowing.