I came across a question about tongue thrust and how to determine what makes an appropriate therapy client, and I thought maybe I could help address that question here. Below is information regarding remediation of tongue thrust. Click here for further information on prevention and assessment.
Firstly, lets define what exactly is a tongue thrust. A tongue thrust occurs when one’s tongue is pushed against or between the front teeth during a swallow. This should not be confused with a frontal lisp. A frontal lisp can occur with or without a tongue thrust so you must make sure your client, in fact, has a tongue thrust before attempting to remediate it. In addition, your client may only exhibit a tongue thrust in certain situations (e.g. I actually saw someone who ONLY exhibited a tongue thrust when drinking from a straw or soda bottle). So you need to make sure you assess various swallowing situations (at rest, swallowing liquids from a cup, straw, bottle, swallowing solids, etc.) before you determine if a tongue thrust does exist. For more information on the evaluation process and assessment protocol, click here.
Secondly, often times persons with tongue thrust are referred for speech therapy solely because of its effects on their dentition (open bites, overbites, etc.) and we have to ask ourselves if it is ethical to provide speech therapy in these cases? If you are focusing on remediating the tongue thrust you can and should attempt to provide speech therapy to change one’s swallow to a typical pattern prior to or in conjunction with their dental treatments (however, this is much easier to do this prior to dental treatments). Many dentists or orthodontists will prefer their patients to receive speech therapy prior to providing braces and/or performing other surgeries as they want to make sure their patient’s tongue thrust will not negatively impact their treatment plan.
Keep in mind the goal for tongue thrust remediation is NOT to teach placement of articulators for sound production but rather to train a normal swallow pattern as well as encouraging more posterior placement of one’s tongue at rest and while eating. Sometimes, pulling that tongue back into the oral cavity where it belongs will positively impact speech production but don’t be surprised if you still have to train correct placement of articulators for those with frontal lisp and interdental productions of /t, d, n, l/. In my experience, it is much easier to remediate misarticulations that are inconjunction with a tongue thrust AFTER typical swallow pattern is achieved and mastered.
So the big question is how do we remediate a tongue thrust? I have made a tongue thrust remediation program to answer that very question. I have had and used this information over the last decade. It is a combination of previously references tongue thrust programs as well as my own adaptions and modifications of which I have found to work over the years. Therefore, I reference these two programs in general as a resource however, the program itself is my own based on my previous clinical experience.
I cannot stress enough, that if you are NOT an SLP and are reading this information, please understand that this program is NOT meant to be performed without the supervision of a licensed speech-language pathologist.
I also want to explain that although I have separated the exercises into “sessions” (for lack of a better word) your client may require more than 1 therapy session (several in fact) to perform and master exercises in each “session”. Therefore, you should NEVER move on to the next set of exercises unless the previous ones have been mastered (in this case mastery means automatic and effortless). Do NOT have client perform homework exercises until they can perform them in the therapy room with great accuracy in front of you.