CVA with noted aphasia

Hi Sandra, I’m back working in Florida on the west coast. I just screened a new resident post CVA with noted aphasia in her record and some dysarthria. On exam, her tongue had a fairly significant fissure at midline. Any recommendations for healing? I’m pushing water but nursing said she is resistant. I’m sending a second email with a picture to show what I tried to describe. Hi K,

I would be curious if your patient had the fissuring prior to the stroke. Many times, it is within the normal range to have a fissure or fissures. You ask about healing….is there something other than the fissure that should heal? I don’t think that fissures are symptoms of tissue that should be healed. I also noticed that her tongue deviates to her right in the photo.

I wasn’t sure if you were asking for some ideas about the fissure, about lingual training, or about the dysphagia. Let me know so I can respond more specifically.

Hope all is well :-)

Could an improper oral rest postures/enlarged tonsils/inconsistent mouth breathing completely inhibit the ability to produce /k,g/?

I recently picked up a six year old boy who has been in speech therapy for years for production of velars. He consistently fronts /k,g/ and is not stimulable for the sounds.


Nine years old, forward tongue thrust

Posted by | Mar 15, 2015 | No Comments

I had a patient yesterday. Nine years old, forward tongue thrust. Severe allergies and asthma. These are under control as much as they are going to be. Age 9. To see orthodontist soon. So, is this one that I take as far as possible knowing it will not correct totally?


Swallow Right manual

Posted by | Feb 28, 2015 | Tags:
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I just ordered the Swallow Right manual. Do you think it will help with this feeling that I have that I do not know how frequent and long to have the patients work each exercise?


Must I wait until a palatal expander is taken out to begin therapy?

Posted by | Feb 15, 2015 | No Comments

I used to take kids who could suction flat with the expander, but there are too many other considerations.


RDH Not Too Sure About Charges

Posted by | Jan 30, 2015 | No Comments

My two biggest all time failures were the kids of my two best friends


Can adult undergo expansion?

For adult expansion, longer periods of retention are needed to maintain the expansion.



at times her tongue was in and her lisp were together (which suggests to me that there are no nasal breathing issues). Her tonsils were not visible (small???). She seemed to easily be able to breathe through her nose. Parents report that she does snore a little. Her cheeks were pretty “puffy” looking, but she is a young child so it seemed like it could be just a baby face. On the inside of her mouth, her cheeks seemed really “thick”.


It is fair to start patients when I will be leaving in 3-6 months.

Posted by | Dec 15, 2014 | Tags:
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“Because you know Phase One, most especially proficiency exam #1, you can build a decent foundation for a patient and then, even if they move or you move, they have the most important basic skills.


When apraxia rules all… it explains many of the OM symptoms we see

Hi Sandra, So glad that you were able to meet with my patient. I have been perplexed about him. His OM issues seem to be compounded by his difficulty with nasal breathing (polyps), poor motor planning, and weak sensation around his lips and tongue. For sure…at the very least! My basic results from exam: 1. […]

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