Spastic diplegia and orthodontic appliances

Hi, I have a client who is 8 years old, with developmental delay and spastic displegia and was born prematurely. She has one sound error (w for r) and has a tongue thrust habit. Mother is considering a crib appliance to correct the tongue thrust, but wanted my opinion about when to do so with regard to speech development. I don’t know anything about crib appliances or much about tongue thrust so I’d really appreciate your opinion. Thanks very much! T

Dear T, You’ve posed a difficult question.  Usually I can say unequivocably, NOT to use a rake or crib or other “tongue thrust” appliance.  It is less cruel and certainly more beneficial to offer a course of orofacial myology treatment.  However, there are some considerations for your particular client:

• You don’t have experience with orofacial myology therapy so I am putting the following link for you to find someone trained in your location:  https://orofacialmyology.com/myo-therapists/
•  I’m not sure what types of limitations to myofunctional therapy your client might have. It varies from patient to patient with her condition.
  • Can she control her tongue well enough to learn to point it at will, elevate it, suction it to the palate, etc.?
  •  Is the thrusting part of a physical limitation that causes an obligatory “tongue thrust” that may actually be serving a desirable purpose?
• What do her teeth look like?
• Do you know why she is going to get orthodontics?

I suppose there are times, when all else fails, that it is better to consider using an appliance than to do nothing at all. Also, let me know the answer to some of the questions above and I’ll try to help you further. My best, Sandra