Broaden and narrow tongue difficulties for adult

Hello Sandra, I hope you don’t mind another question about a patient – I have been using your program with some additions. I am continuing therapy with a 40 yo female – that I am slowly working with and seeing signs of progress.  But I am not sure about one concern.    This week she can demonstrate pointing the tongue very well in the anterior area and the lateral borders tend to flare or possibly not have any tone.   Although she tends to have a rounded tongue in the mid portion. I would like to see the tongue have more of flat table appearance I believe. I suspect she is gaining control of some of the intrinsic muscles but not all.  I have had her working on pencil pulls  taught be another trainer – rounding the tongue over and under a pencil and alternating with tongue push ups  a different trainer uses having a pointed tongue pushing against a tongue blade.  This week I showed her the use of the tongue depressor in the mid portion of the tongue and saying “EEE” to have her feel this area.   In the past weeks we did the light stroking on the sides and down the center with a coffee straw and we have used a tooth brush in the same fashion.  She is having difficulty with the bowl and trapping which I am sure is all related to this issue. Just as a side note she also has sleep apnea and uses a c pap machine at times.   Am I correct that she needs to develop a ”flatness” for better success with therapy? Should I have her focus on tapping down the middle of the tongue to make a point?  Will this help to ease the rounding?  Maybe with my lack of experience I failed to notice that she was not succeeding with complete contraction of the intrinsic muscles after doing the stroking exercises.  I would appreciate any ideas that you might have for me.      I check out your blogs regularly which are helpful.  I appreciate your time.    Hope you are doing well. Regards, M

Hi , I’ll try to provide you with some helpful input… How long have you been working with her? The broadening and narrowing of the tongue should not take more than one lesson in most cases.   My first concern based on some of your comments is that she might have a restricted lingual frenum.  You state that the “rounded tongue in the mid portion” and “the lateral borders tend to flare or possibly not have any tone” and these might be red flags to look more closely at the lingual frenum.  You must rule that out first.  Do you know how to do that?  If not, check our blog for suggestions, see our video using the QTT Tongue Tie Quick Assessment Tool, and also email me back if needed and ask me more about how to rule it out. You can view the video at:  https://orofacialmyology.com/blog/products/ It’s very important to think sequentially under most circumstances and not select exercises out of sequence.  If she has not maximized or passed Proficiency exam #1, then it is usually futile to move ahead, other than to offer lip exercises or other exercises unrelated to the tongue (buccinators, mentalis, masseter….these would be ok to offer anytime). Also, other than post frenectomy, I see no reason to ever do exercises that cause the tongue to be “outside” of the mouth.  Thus, I would definitely not be doing anything where the tongue is being pushed against an object outside of the mouth or where the tongue is being pushed forward against an object, period.  That serves to involve the glossopharyngeal muscle, which is the main culprit in “tongue thrust” and we don’t want to do that!   As far as the bowl is concerned, I don’t give that emphasis when I’m giving exercises related to narrowing the tongue as it is too confusing for virtually everyone.  Get the narrow/broaden skills down first…and as I said that should take her only a few days of practice.  Use, for example, the Myo Manual exercise where she begins in one lip corner and maintains that pointed tip as she slowly moves to the other side to a count of 10, following a coffee straw; thus, it should take a full 5 seconds to get to the middle/front of the mouth area, proving control of the “skinny” tongue side-to-side.  The “football hold” is the second incredibly effective exercise for teaching the skinny tongue. Do those two exercises and have her practice them and your problem will be solved IF she doesn’t have a restricted frenum or other unknown serious problem. Then introduce the bowl, within the oral cavity and be sure the front and sides are all “bowled” and have her practice that for stability.  That should only take a couple of days of practice, also. Once you master these basics, then you can think about moving ahead to “trapping” and other much higher level skills. Look at the suggested sequences in the Myo Manual and don’t “jump the gun” but rather build the strong foundation first. Hope this helps. Sandra