Decreased Lingual Movement

Hi Sandra,

I am reaching out to see if you have any advice to offer or can steer me in the right direction. I am seeing a student who has difficulty with all vocalic /r/ sounds, but has made decent progress towards all with the exception of /or/ and /rl/ to a lesser degree than /or/. He presents with decreased lingual movement but does not have an obvious anterior tongue tie. He is unable to stick out his tongue without it resting on his teeth and he cannot click his tongue without moving also moving his jaw. I am really at a loss for how to help him. He participates in a variety of oral functional exercises to help with jaw stabilization and increase ROM, but has reached a plateau. He shows a slight improvement when his jaw is retracted during /or/. He previously had a tongue thrust which has been corrected.

I am sure you get many questions, so not to worry if you are unable to answer mine. Just thought I would try!

Thank you


I have an R course online with Northern Speech Services and it is really helpful, and will give you guidance as to the sequential approach to getting a stable /r/ in all contexts; however, I still think that having our orofacial myology intensive course beforehand is a big plus.  It looks from your emails that you are doing the right things, but my guess is that there are several gaps and that you might not be using the ideal sequence to get where you want to be with the patient.

1.  How old is the child you have described?  If he is over 4, which I assume he is since you are working on /r/, can he elevate his tongue with his mouth open fairly widely?  This is an example of a major focus area that should be addressed at the initiation of treatment.

2.  Clicking and suctioning with control are additional primary requirements and that is why I have put that into the proficiency exam #1 of the Myo Manual. This is one of the lingual excursions that necessary to achieve before moving forward with any speech disorder or even accent modification or voice, etc.  If you skip certain aspects of proficiency #1, I find that there are prices to pay later in that habituation is usually not attainable.

3. He should be able to stick his tongue out and in repeatedly;  to move laterally from lip corner to lip corner; to move from incisive papilla (the spot) and drop downward with ease repeatedly;  all of these without involving the mandible or lips.  This excursions are almost always the very first functions addressed.

As far as anterior or posterior tongue tie is concerned, it is not so important to label them with any given patient.  What is important is to see where the frenum attaches “to” the tongue, is it submucosal/embedded beyond that insertion; where does it attach to the floor of the mouth or lower alveolar ridge; how long is the flexible portion; is the tissue taut or not?  and more…..

Get back with me and I will try to give you more direction as to what steps you should “back up and do” before continuing further.

I know you have wanted to take our course for a few years and if there is anything I can do to help you make it happen, please let me know.  Our course relates to many speech disorders, even dysphagia, and I know you will not be sorry you spent the time or money to participate.

I am not trying to push you, honest, just wanting to go deeper into your questions than an email can provide….in the course, I know you’ll get the answers to them!

Sandra R. Holtzman, MS, CCC-SLP, COM

Would you use your digit sucking elimination program with a client to eliminate the noxious habit of lip licking?

He substitutes lingua alveolar sounds for these three (s/f, z/v, l/w). I worked with him for 45 minutes and during the entire session, he chronically licked his lips (predominantly his lower lip). His tongue was deeply scalloped when he was asked to protrude it and he had an abnormal rest posture (since all he was doing was licking his lips! ) He was not able to pucker/move the upper lip at all and the lower lip barely moved. He had a very long philtrum.


How many exercises?

Do you really see the patient two times a week, does once a week work? Is half hour enough time?


I have a really bad problem of sucking on my tongue

Now that I am older I realize that a lot of my nieces and nephews and cousin are doing the same thing too


I’m new at orofacial myology. How can I improve?

Posted by | Jun 30, 2014 | Tags: ,
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All of us have to evaluate from several perspectives


Adult tongue sucker

Posted by | Jun 15, 2014 | Tags:
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There is no easy help for an adult (or child) tongue sucker. That’s where psychology has to be incorporated. As with all noxious oral habits, you want to work first on Awareness…


Building a decent foundation for a patient, even if they move or you move

Posted by | May 30, 2014 | Tags:
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I’ll be leaving these patients within 3-6 months. Do you think it’s fair to start?


TMJ degeneration and LIP SUCKING habit

She desperately wants to stop this habit & I think it would give her a much better feeling about herself. Plus it will be critical to have success with the other treatments she is receiving. What would you suggest that I do to help her stop this habit?


No facial movement bilaterally post CVA

Mid 30s male suffered a small right occipital lobe CVA. Found face down on the floor after undetermined amount of time…SLP consult 2 days later due to ‘no facial movement bilaterally’.


Extremely high narrow palate

He is 28 with an extremely high narrow palate thus cannot breathe well. His tongue has the “macro” appearance due to the palate issues. He’s gone through surgeries, ENT referrals, and I started therapy on him to strengthen his lips and to habituate a correct resting tongue posture. I also referred him for a lingual frenectomy that he followed through with. We only worked together around 5 sessions and he was then out of the country with work.

adenoids alveolar phonemes ankyloglossia ASHA certified orofacial myologists decision to quit Dr. Robert Mason drooling freeway space frenectomy habituation hyoid bone IAOM incisive papilla lack of expressive language lingual frenum lip licking habit lip strength lisp lower alveolar ridge malignant sleep apnea myofunctional therapy Myo Manual narrow palate open bite oral motor orofacial myofunctional disorders orofacial myology orofacial myology treatment palatal expander post frenectomy quick tongue tie assessment restricted lingual frenum sleep apnea speech language pathologist sucking habits suctioning thumb thumb sucking TMJ tongue exercises tongue thrust tongue tie tongue to spot unplugging the thumb