I am taking your /r/ e-course right now and have a question for you about a 9-year-old client who was diagnosed as an infant with a tongue tie but parents were advised not to have it clipped at the time. As a result, he had tremendous feeding problems which mom recalls were a “nightmare.” Too bad, his pediatricians were so uninformed…sad. His 2-year-old brother was also born with a tongue-tie but had it clipped at birth and subsequently had no feeding issues. D, I’m seeing so very often a genetic component.
This client has good range of motion with his tongue, (protrusion, retraction, elevation, etc.), Somehow, I can’t imagine that he has a good range of motion, protrusion and elevation based on what you say in the next few sentences. Maybe the mid portion of the body of the tongue is compensating for his other difficulties and it appears that these functions are within normal range, but I truly doubt it. however, I’ve noticed that when he retracts and elevates his tongue to produce a vocalic /r/, he raises his jaw and cannot keep his mouth open. I looked under his tongue and saw that the lingual frenum was anchored close to the floor of the mouth thus making it impossible for him to keep his mouth open while retracting and elevating the tongue. We look at several things here, D. First of all, look at where the frenum inserts into the floor of the mouth. Is it on or right below the lower alveolar ridge? Or is it fairly far back on the floor? Also, look where the frenum inserts into the tongue itself. Is it about midway or is it closer to the tip? Or is it far down at the base of the tongue? Now check and see if it seems to be embedded into the tongue tissue above the place where it appears to attach to the underside of the tongue. Look at the length of it. And check if it is thick or thin, flexible or inflexible. All of these are considerations and how they “come together” is important. Get back with me, being sure to send this portion of our emails since I sometimes get so busy that I mix up one email with another. We are also finding it common for the ankyloglossic person to have a ankylo’d labial frenum. Look under his upper lip and see if the frenum on the underside is too close to the teeth. It should not be tight or causing the upper lip to be pulled at all. He also has a high, narrow palate with a long narrow face. I have found so many /r/ kiddos with high narrow palates that I don’t need a study to tell me the two often go hand in hand.
I advised his mother to speak to an ENT about the tongue tie to see if anything could be done. She hasn’t gone yet so I wanted to ask you if you have any research on clipping the frenum and improving production of vocalic /r/. I don’t know of specific studies since I have worked for so many years on this type of problem that I didn’t care if someone found out that my observations and therapy was provable or not…..it only makes sense that with a restricted tongue AND a high narrow palate that one cannot obtain and maintain the ER sound. It is impossible and a study would probably be very easy to do if you have enough clients…since it is likely that 100% would have difficulties. Any other information you could provide would be very helpful. I am the third SLP he has seen since he was 5 and the first one to point out the high palate and the fact that the tongue tie may be preventing progress on the vocalic /r/. Again, a sad state of affairs that past therapists didn’t bother to look in his mouth before making him feel like he was a loser who couldn’t get the doggone /r/ sound habituated. I truly empathize with the frustration he has experienced in not being able to change this sound error. When I told him that the difficulty he was experiencing may not have to do with his inability to work hard and do what is asked of him but rather something structural beyond his control, he was so relieved he let out a huge sigh. I just consulted with another SLP in South Florida with a 9 year old boy; same story! And last week I saw a 17 year old young man here in Orlando who took therapy for /r/ during his entire elementary, middle school and high school years…to no avail!!! D, trust your “gut” about these things.
Here is what I would do IF he is ankyloglossic (use my criteria above and get back with me):
- I would not torture the young man with therapy if he is tongue tied.
- I would not treat him if he also has the high palate
- Check to see if he can suction flat to his palate and see how much of the sides of the tongue overlap the arch/teeth. If, in a short while, you can get him to fit his tongue within his high narrow palate, you might have a shot at the ER but only IF the tongue tie is taken care of. Otherwise, he will need the palate expanded, if an orthodontist also finds that it is high and narrow.
I think this young man and his family are very fortunate to have found you, D…truly. You will be able to give him the right direction and I will help you…let me know your findings and …good for you for looking deeper than the others did, for seeking information from the online course, for emailing me….we need more SLPs like you!
I wanted to get your thoughts on whether lip incompetence in an adult (in their 30’s) that has an overjet and overbite can be remediated through lip stretching exercises. Is it worth it to try?
Bi lateral linea alba was present and also extended to the inside of her lower lip. She states that she rests her tongue on the mandibular teeth and she closes and bites her tongue – which eventually causes pain and she opens her mouth.
In adult patients with TT, do you find less pain in the post frenectomy rehabilitation phase when a period of pre habilitation is undertaken, in essence conditioning the musculature as much as possible?
Are there exercises in your manual that will help a child who has difficulty in lifting the middle and back of the tongue enough to suction it to the palate?
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?
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.
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?
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?
I used to take kids who could suction flat with the expander, but there are too many other considerations.