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Nasality, Ankyloglossia and Articulation Protocol

Friday, 01 December 2023 / Published in Dental Hygienist, Dentists, myofunctional therapist, occupational therapists, Orofacial Myologist, Orthodontist, Parents, physical therapists, SLP-A, speech languge pathologist, Teacher, Therapists, Uncategorized

Nasality, Ankyloglossia and Articulation Protocol

orofacial--myology-nasality-ankyloglossia-articulation-protocolr
Q:
I am a SLP.  I watched your tongue tie 101 course for SLPs.  It was very helpful.  I gained valuable information pertaining to assessment and treatment.  Thank you!  I have a question and I would really appreciate your input.  I recently assessed a seven year old girl who previously had surgery to release her tongue tie.  Her lingual range of motion appears good, (although after taking your course I’m going to do further assessment in this area).  She articulates sounds well at the single word level, but has mild errors in conversational speech with s, z, lingual alveolars, th.  The issue that is more noticeable than the articulation errors is hypernasality.  Why does her speech sound hypernasal?  I’m assuming this is related to the tongue tie.

I’d appreciate your insight into this area.  Thank you so much!     L

A:
Hi L,

Thank you for getting in touch and for your question.  Does she sound hypernasal all the time or just when trying to articulate for her therapy?  For example, when I teach /r/ using my program (also on Northern Speech), there is a point where many clients sound hypernasal during their attempts to move forward with the ER sound.

I’m guessing it is during conversation with the young lady you’ve described.  I have seen some clients with ankyloglossia who were hypernasal but after working in therapy for awhile, it subsided.  I don’t know of any studies linking the two but I will check that out, thanks to your observation, L.

Regarding your other observation:

 She articulates sounds well at the single word level, but has mild errors in conversational speech with s, z, lingual alveolars, th.

This sounds like a true orofacial myology “disorder” and is typical of clients seen for orofacial myology (aka myofunctional therapy).  It is important that they be taken from the very basics all the way to habituation.  I don’t know if you are a Myo Manual owner; if not, here are a few basics.

 In short, for articulation:

1.  Eliminate all barriers such as ankyloglossia, airway issues, certain ortho appliances, and most definitely any oral habits.

2.  Maximize the tongue movements, shaping, excursions within the oral cavity.

3.  Based on a thorough assessment, improve function as needed for lips, lingual-mandibular differentiation, other orofacial muscle functions ability to suction, and much more.

4.  Integrate articulation therapy at the appropriate time based on what you found in the eval.  For example, if there is lateralization of sibilants, you have to cover the section on suctioning first or you won’t get them to habituate.

5. For sounds that are interdental or dentalized (“thrusting), you don’t introduce them until the client demonstrates that they can maintain correct resting postures of the tongue, lips, and mandible for increased periods of time.  From that acceptable resting position, the tongue will be in the position to produce crisper precise sounds and will be in a better position to obtain habituation of the target sounds.

I hope this helps.  If you think you might have interest in joining our trained grads around the world, let me know.  Sometimes schools or practices provide help with CEU courses.  You would love our training course.  Everybody does!

Tagged under: hypernasal speech after tongue release

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