Client can’t slurp, suction, problem with “dry” swallows

I am working with my first tongue thrusting client and had been doing quite well until we hit slurping.  He is having a terrible time mastering this or even being able to do it all. He is 8 1/2 years old. He was referred by the orthodontist to fix the tongue thrust before braces were pursued. He actually has very good movement of the tongue and lips. He was able to pass the proficiency exam easily. He did tend to keep an open mouth posture at rest (had both adenoids and tonsils removed as a toddler) and therefore I did some tongue and lip exercises to help build better awareness and had him also do activities, such as sitting with a tongue depressor between the lips while reading or watching TV at home.    I did the Knotty Straw exercise with him and he was able to do it successfully. He initially had some difficulty finding the spot and I needed to put peanut butter there to help him find it, but now that’s no problem. He is able to complete a dry swallow with his tongue to the spot and the teeth and lips open He is also able to suction the tongue to the palate with the tongue to the spot and make a loud “pop” sound when he releases. He can do this numerous times in a row without difficulty. Once we moved to slurping swallows however we encountered difficulty. I don’t know if I moved him too quickly or I should have taken more steps in between. If I spray water on top of his tongue and he suctions his tongue to the palate he is able to do the Water Trap Swallow exercise with no leakage of water. So, I assume he is able to obtain and maintain suction. But, he can’t slurp. We have tried numerous ways. I’ve tried to show him what my tongue does, and showed him placement in the mirror. I’ve tried to have him use more of his cheek muscles to slurp. He seems to be straining a lot in the laryngeal area and I’ve tried to point this out to him. I don’t know if he’s suctioning the tongue too tightly initially – I’ve also tried to explain that to him and we worked on trying to have him lighten the suction and bring the sides of his tongue down some to help the water move through. Needless to say, he is quite frustrated by it, as am I, and I know that he cannot move much further in the program if he cannot slurp. I will say that we have tried some of the other exercises such as to and fro swish and goldfish bowl. However, he is doing them without really slurping. Any suggestions?  If you need more info I can give you more if you let me know what else might be helpful. Thank you so much for your time and help – I really appreciate it.

A: I don’t use a “dry swallow”…from the way you described it, it sounds like something that should come later.  In reality, if he isn’t suctioning well, any swallow is incorrect and inefficient.  Therefore, a step back is needed before attempting any type of true swallow.  Even if it appears to be right, it simply can’t be…if suctioning is weak or incorrect. I think more steps in between, tinier ones, are needed…. I think you might be confusing two different exercises.  Do you have the Myo Manual? Let me know if you do NOT have it, so I can describe the exercises thoroughly, etc.  If you do have the Myo Manual, go to Water Slurp Swallow.  This should be introduced before the water trap.   With the Water Slurp Swallows, the water is sprayed UNDER the tongue, not on top of it.  Let me know if you need more details and I’ll get them to you.  After the water slurp swallow, introduce the saliva slurp swallows.  THEN the water trap swallows are introduced, and it requires the client to take the water from the glass/cup, trap it in a smooth easy way, open widely as it is maintained in a trap, tilt head downward to assure a good seal, straighten head, close teeth and swallow.  This may take some time for some kids and a towel should be used when first introducing it as spills may occur when testing the seal.  He should only take a small sip, very small one, for this exercise.  Afterwards, the To & Fro is used.  The Goldfish requires good suctioning power of the sides and middle of the tongue and to be truly doing it well, most of the time the prior exercises need to be mastered. I would suggest going back to Squeaky Swallows, and trying that; then Long Smooches, being sure tongue is to spot and cheeks are being pulled against cheeks; AND MOST IMPORTANT  OF ALL is the Diagonal Straw Exercise.  I would definitely make sure it is good before any of the above is attempted.  If you need guidance for anything I’ve written, email me for details.  If you don’t have the edition two of the manual, I’ll walk you through each exercise or you can phone me at a pre-arranged time.  It will be my pleasure, Laura! Keep me posted, Sandra