Hi Deb, Thanks for the info. You certainly have a great background! I’ll insert my comments within your email, below: Can you tell me how to train labial not lingual receiving of liquids from cup and straw? With our program/approach, it comes in steps. By the time the patient is ready for drinking from a cup or straw, we have gotten them to where they have passed exercises that teach them how to suction onto the palate; then, later they advance to teeth closed and tongue to spot as they suction a very small amount of liquid and trap it immediately, open mouth while maintaining good suction and tilt head to test the seal capacity, look straight and close teeth but not lips, and swallow. That is just one of the exercises leading up to the liquid swallows. The key is to do basic lingual skills so well right at the beginning of the program that you can then move to swallow mechanics, correct mandible/labial/lingual rest postures, etc.
Should they anchor at the spot or dangle tongue tip just behind teeth? In conjunction with my above info (which I know is difficult to understand since it is out of sync with the rest of the program that leads up to it), the answer is, “Yes, the tongue is suctioned to the palate and the tip will naturally be at or near the back of the spot (IF they are not extreme overjet or Class III occlusion). Currently my clients tongue touches lower lip at oral receipt. You might be able to combat this by having him/her place Neon Exercise Elastic to spot, closing teeth and suction/trap through the teeth during swallowing. Normally, they are experts with the Neon elastics before I tell them to use them in this exercise and some others.
I was training oral suction but client loses it to lower buccal cavity and then either gathers w tongue or does lower lip press and overactivates mentalis. It is important to lead up to the liquid suction. Also, have him use a VERY TEENIE TINY amount of water in the exercise I explained. Prior to giving this exercise, the patients have demonstrated the ability to suction the tongue flat to the palate as well within the arch as possible and maintain that suction for 30 seconds. They have also passed (it’s called Proficiency exam #1) being able to differentiate lingual from mandibular movements in the horizontal, lateral and vertical excursions; at first with “assistance” using a 3Way Mouth Prop, and then with the Prop removed. They also learn some very critical components that set the stage for drinking, eating, natural swallowing, etc. For example, they learn to do something called posterior suction release which separates the anterior and posterior functions of the tongue as are needed for smooth bolus collection and control; they also are given some other exercises that focus on the act of suctioning….that is what I found was missing in other programs over the years; also probably is why other programs are “Solve it all in 12 easy steps, or whatever”….Gotta set the stage with lingual basic skills and gotta do whatever is needed for suctioning prior to moving into chewing, eating, drinking, natural swallows, etc.
I am not sure normal position for this fleeting stage of oral prep. I break oral prep into the tiniest steps I could possibly come up with. I am now trying to train SLPs to think about the benefit of breaking down into these small steps for dysphagia patients rather than always rushing to the back of the tongue and seeing what goes down easiest. I consider orofacial myology as the oral prep stage!!! It just also happens to help with orthodontic, articulation, surgical and other types of disorders! I love it, can you tell??? Hope this helps a bit. I might have sent you part of the table of contents of the Myo Manual, but I’ll attach it again to give you some idea of the varous steps. This is not all inclusive but it will help make sense of some of the info I wrote. Take care, Sandra Holtzman