The diagonal straw exercise

Hi Sandra,    Things are going well.  I currently have about 6 myo patients and really love working with them!  I recently asked for the exam, and it came, but I haven’t started it yet . Speaking of questions, I do have this 13-year old girl with a tongue thrust who just can’t seem to get the hang of the diagonal straw exercise.  She inhales instead of sucking.  I think she has some oral apraxia as well as some oral defensiveness.  She can’t stand to have elastics or mouth props in her mouth but is okay with a straw.  She can do the other straw exercises (pops) but does have weak lips.  She just completed a week of lip exercises, and her strength as measured by the lip meter went from 1.0 to 2.0 lbs.  She was very happy to see that.  Do you have any suggestions to help clients understand how to do that diagonal straw exercise?   Hope all is well with you. I miss you!   Fondly, Mary

Hi Mary,  The diagonal straw exercise, when taken down to the smallest basic, is evolved from the posterior suction release.  The posterior suction release must be perfected, then speeded up, then done with the teeth closed/lips open, and then the straw is inserted.  The patient then slowly seals the lips closed and the sound of the suction should be heard through the open end of the straw.  I hope that didn’t sound too confusing, did it? Here it is broken down in to the steps: 1.  Posterior suction release 2.  Faster and faster (with precision) and teeth are closed, lips remain open 3.  Sounds like a giddyup for horsies! 4.  Insert straw into buccal area, not letting it get “stuck” to skin 5.  Close lips and continue suctioning, changing nothing else and sound is heard through straw. Keep those lip exercises going and try to reach 4 lbs, at least.  Try to prove or rule out apraxia as it will help you revise exercises as needed.  She won’t be able to build upon exercises so easily if she is apraxic, and she might be able to do better if given the “whole” idea of exercises instead of breaking it down to the smallest components, which is normally what I do and recommend.  Let me know how it goes…I hope this helps Sandra

Dear Sandra,   A thousand thank you’s for that great idea.  My client can do the posterior tongue click, so I can’t wait to try what you’ve suggested. (She comes tomorrow for her session).   Yes, I plan to continue with the lip exercises.  I will keep you posted as her therapy progresses.  Thanks again for your help with this one.  I don’t know what I’d do without you.   Mary