Tongue Thrust and Treatment of Subsequent Articulation Disorders

What is tongue thrust?

Tongue thrust (also called “reverse” or “immature” swallow) is the common name given to orofacial muscular imbalance, a human behavioral pattern in which the tongue protrudes through the anterior incisors during swallowing, speech and while the tongue is at rest. Nearly all young children exhibit a swallowing pattern involving tongue protrusion, but by the age of 6 most have automatically switched to a normal swallowing pattern. (Wikipedia).

Why is it a concern?

Dentists and orthodontists are concerned with the effects of the tongue and facial muscles on the occlusion (how teeth fit together) of teeth because of the evidence proving that too much tongue pressure against the teeth on the inside and an unequal amount of facial muscle pressure from the outside – as is the case with a tongue thrust swallow and/or incorrect tongue resting posture – may result in a malocclusion or misalignment of the teeth – the resting posture of the tongue and facial muscles play an even more vital role: If the tongue is constantly resting against the front teeth and the upper lip in short or flaccid (weak and flabby), the front teeth will be pushed forward.

Thus, correcting this tongue thrust using special speech techniques will play a crucial role in any good orthodontic treatment, making the treatment’s results long lasting and much easier to achieve.

What are some signs of having a tongue thrust problem?

One or more of the following conditions may clearly indicate tongue thrust disorder and should be investigated further with an evaluation of speech pathologist:

  1. Tongue protruding between or against the upper and/or lower “front teeth” when forming /s/, /z/, /t/, /d/, /n/, /l/, or /sh/
  2. Frequent open-mouth resting posture with the lips parted and/or the tongue resting against the upper and/or lower teeth
  3. Lips that is often cracked, chapped, and sore from frequent licking
  4. Frequent mouth breathing in the absence of allergies or nasal congestion

Treatment of tongue thrust and subsequent articulation disorders

To correct tongue thrust, speech pathologists prescribe exercises designed to promote a normal swallowing pattern, as well as correct speech production. In the evaluation session the patient will be given swallowing and articulation inventory tests. If only “pure” tongue thrust is found without any articulation errors then usually three sessions are enough.

At this evaluation session the patient will be given the main set of drills against tongue thrust that he has to do on a daily basis for 60 days following this session. A second session will be scheduled 4 weeks later to follow up on the results of this oral physiotherapy and consider adding another set of drills for the next 4 weeks after which the third session is scheduled with follow up on the results.

If the patient has misarticulated consonants (usually the high pitched ones: /s/ , /z/ , /sh/ , /ch/ , /ts/) – then each sound will have to be corrected in a 8-session weekly speech therapy while doing the same oral physiotherapy for 60 days – as well as specially designated speech drills to correct each sound…The good news are that by successful correction of one sound we may correct another (for example: correcting the /s/ may solve the problem with the /ts/ sound).

Gal Levy M.Sc. CCC-SLP, has more than 21 years of experience in clinical treatments of Voice, Fluency, Articulation and Language. Gal is working as a school based SLP, Home health SLP and in his private practice at Frisco, TX. He also writes professional articles on various speech disorders and state of the art treatments on Google’s new Encyclopedia, Helium and AC writers websites. Gal participated on Community Focus radio monthly shows with Dr. Griffin advising KEOM 88.5 FM listeners on voice, fluency and tongue thrust clinical issues.

The King’s Speech

(This post originally appeared on the Living Successfully With Aphasia blog)

You must see this film.


Years ago, I met Jung on lower Broadway in NYC. Not actually, of course. What I mean is that the concept of syncronicity rose up and hit me in the face that day. Details are not very important. What is important is that I had to acknowledge that things sometimes conspire to connect you to a larger truth, for which you may not even be aware you are searching.

Having seen The King’s Speech this week, I am struck by the relational and reflective aspect of the practice of speech therapy – the very thing we are now exploring in a deeper and more meaningful way. The character of Lionel Logue, played adeptly by Geoffrey Rush, succeeds with The King only because he establishes the relationship that forms a bond of trust and respect between them. And so it is in our therapy as well.

I am so happy to find a film like this that supports my own personal journey, and confirms what I know to be true.

Shirley Morganstein and Marilyn Certner Smith co-founded Speaking of Aphasia, a Life Participation practice in Montclair, NJ where people with aphasia instruct her daily in their journey. Recently, Shirley began a blog focused more on her personal thoughts about the people she has met and her own process as a therapist.

Meeting the Extreme Makeover Challenge Part 2

This post is the second part of The Extreme Makeover Challenge Room Re-Design

Before and after images of student workstation

Link Visual Strategies To Support Expressive Communication with Alternative-Augmentative Communication ( AAC )

As consultants, we meet these extreme makeover challenges every day by assisting caregivers and professionals to physically re-structure living and learning environments, and by implementing and linking tailored visual strategies to support expressive communication with Alternative-Augmentative Communication ( AAC ).

We define AAC as the use of materials, techniques and equipment to compensate for expressive communication limitations individuals may exhibit, and to provide varied methods that allow for success in the communication process. AAC methods are tailored for individuals based on cognitive level, physical abilities, academic needs and communication settings, and include the following most common methods:

  • Speech Generating Devices (SGD)– SGDs are electronic equipment with speech output capabilities, that may be programmed,
    and offer the individual with increased communication opportunities. In Rising, we discuss various uses of SGDs such as in this device which allows children to communicate information between school and home. Other applications include communicating messages to answer questions, participate in academic lessons, offer social greetings, relay information, exchange thoughts, and interact with significant members in their lives at home, school, and in the community.\
  • Picture Exchange Communication System ( PECS )– PECS is an augmentative communication system designed to facilitate quick, effective, functional communication. It is a concrete visual-based program that encourages communication. Although speech emerges with some individuals and verbal speech is indirectly encouraged, PECS is not specifically designed to teach speech. Its primary objective is to establish an understanding about the purpose and method of communication exchanges, and to facilitate communication by providing the opportunity to relay messages through pictures. We have found a number of our students have been very successful communicating via PECS.S
  • Symbolic Language System–We define symbolic language systems as any method of communication that utilizes
    an action or material, assigns specific messages to it, and relies upon it consistently to relay meaning to the listener. A symbolic language system provides a consistent and easy-to-interpret method of relaying messages when a verbal message cannot be presented intelligibly. Pictures of items or places, labels of products, objects, gestures, and vocalizations are most commonly used to depict representations of desired messages. Rising illustrates many types of symbolic language systems to relay messages for many communication situations such as communication boards, eye gaze charts, and communication binders.

These are some of the elements required to meet the challenge of a successful re-design. We have observed children with autism, other PDDs, and AAC , achieve organization and success, improved behavior, social skills, and communication success when adults implement the strategies we’ve shared.

Carol L. Spears and Dr. Vicki L. Turner are Speech Language Pathologists, Assistive Technologists, and Alternative/Augmentative Communication Specialists. They utilize extensive professional experience, continuing education, and personal perspectives when working with students with autism and other pervasive developmental disorders to provide evidence based interventions. They are co-authors of the book, Rising to new heights of communication and learning for children autism. They are partners in the private consultation practice, Communication by Design Specialists, LLC (CoDeS). CoDeS, located in Northeast Ohio, provide caregivers and professionals with compassionate support and training in homes, educational institutions, and workshop settings. You can follow then on Twitter at @autismplus and find them on Facebook at Communication-by-Design-Specialists-LLC.

So you want to be a Pediatric Speech Language Pathologist? Making Sense of (and Choosing) the Best Settings and Terms for You – Part One of Two

kids holding hands walking in the street

Photo by fiskfisk

When we were at the ASHA convention in Philadelphia this past fall, our team met many enthusiastic clinicians who are excited to use their education and training in Communication Disorders to work with children. I was struck, however, by the fact that there is a fair amount of confusion with the terminology describing both the settings and the terms of employment for SLPs that work with young people. This post will be the first of a two-part article where I will clarify some of the basic terms, and then in the next part I will review some of the practical issues to consider as you choose a position as a pediatric or school-based SLP.

The biggest area of confusion is what the term “pediatric” means in the field of therapy. Most of the healthcare community considers the “pediatric” population to be the group of patients who are under the age of 21. In general, the medical settings (hospitals, rehab centers and outpatient clinics) use this broad-based definition.

When school and government subsidized therapy organizations talk about “pediatric,” however, they are talking about a different population – namely children aged ‘birth to five.’ These kiddos are actually separated into two additional sub-categories, Early Intervention and Pre-K.

Early-Intervention (also called EI) is the term used for home-based (or “natural setting”) services for the birth to five population. The employer of record for an SLP wanting to provide EI speech services varies widely by state. In most states independently contracted SLPs are hired directly by the government EI agencies themselves and through clinics that contract with the state. In a few states, EI services are provided by the public schools.

“Pre-School” or “Pre-K” are campus or clinic based services for children aged three-five. This one makes sense to pretty much everyone!

“School-Based” or “Education Based” services are those for children ages 6 to 18 taking place in a Kindergarten through twelfth grade setting. Of course, within the schools market there are public and private as well as charter schools – public schools with independence that feel more like private schools.

We also field a lot of questions about the different “terms” of employment – especially the difference between “travel” and “contract.” Lately too, the term “direct hire” has replaced the expression “permanent position.” So let’s sort it out.

  • Direct hire is the traditional employment situation where you work ‘directly’ for a hospital, school or pediatric clinic. Historically, this type of employment has also been called ‘permanent’ employment.
  • A “contractor” is generally a therapist who lives locally to the organization that is hiring but is compensated hourly and paid through a staffing agency or back office payroll company.
  • A “traveler,” like a contractor, is also paid hourly and paid by an agency or back office but has arrived from out of town for the duration of the assignment and usually qualifies for a tax-free per-diem to pay for the expenses associated with living out of town while maintaining a residence back home while on assignment.

Therapists living away from their permanent residence (defined as where you are currently paying rent or mortgage) are eligible for “per-diem.” The spirit of this allowance is to exempt from taxation any duplicate expenses affiliated with work that would not be necessary were you living at home. A traveler working for an agency will generally be a W-2 employee of the agency, not for the client where he or she works.

Contractors, because they are local, do not have these additional expenses and are not eligible for per-diem or housing. Contractors may be W-2 or if they are self-employed may receive a 1099 at tax time. IRS rules and regulations regarding 1099 employment are very tricky. This could be a whole different blog article. Suffice it to say, tread carefully if you are asked to work for someone else on a 1099.

Whether you are a seasoned therapist and are familiar with all these terms, or a new grad that is overwhelmed with all your options, there is a lot to think about before you choose a new position. Here are just a fraction of the questions you should ask yourself:

  • What type of kiddos with what types of diagnoses and issues are you looking to work with?
  • Are you a new graduate that needs to complete your CFY, or are you a seasoned practitioner?
  • What is more important to you right now in your situation: cash money or benefits?
  • Can you relocate?
  • Do you want to stay close to home or do you want to live somewhere else for a while?
  • Are you looking to do hands-on therapy or do you want to use or learn management skills?
  • Reward vs. Frustration: If you think a direct hire school-based position is your preference, are you willing to put up with some of the challenges that come with working for a government entity in exchange for the rewards of working with public school children?

In our next post we will talk about some of the practical issues to consider before deciding on a position. Relax! This really is a fun and exciting journey if you take your time and think about it.

Heidi Kay is one of the founding partners of PediaStaff and is the editor-in-chief of the PediaStaff Blog, which delivers the latest news, articles, research updates, therapy ideas, and resources from the world of pediatric and school-based therapy. PediaStaff is a nationwide, niche oriented company focused on the placement and staffing of pediatric therapists including speech-language pathologists.

Apps for Bilingual SLPs and English-speaking speech therapists working with Spanish-speaking children.

I am a bilingual speech pathologist, and for those of you who work with Spanish-speaking children you know how frustrating it can be trying to get ready for therapy. Most of the time we are limited to two options: live translation of English materials or spending hours creating our own Spanish materials. The limited resources in Spanish pushes us to creating our own materials on a daily basis. This can be very difficult for us with an already very limited time on our hands to serve so many children. Thanks to the iPad and the iPhone, developers all around the world are creating apps. This allows us to take advantage of the apps produced in Spanish that can be purchased anywhere. The number of apps in Spanish is still very limited in comparison to apps in English. However, the ease of development of the apps makes it a lot easier for us therapists to access products in other languages. Here are my top 5 apps in Spanish that can be used in therapy:

1. Spanish Articulation Probes

Bilingual slp app logoThis app allows therapists and parents to work on specific sounds. It works like flashcards. It contains over 500 flashcards in it separated by specific phonemes, mode of articulation, and phonological processes. This is a very useful app not only for bilingual therapists, but also for English-speaking clinicians who should work on speech errors in both languages when treating children with articulation delays.

2. Learn Spanish and Play

Learn and play app logoThis is an app for working on basic vocabulary and even categorization. Choose from one of (the) 8 scenes: “granja, Zoologico, Insectos, Mar, Frutas, Hortalizas, Colores and Familia”. There is a teaching and a testing component to this application. Once you have worked on the vocabulary you can go to play game mode and test for learning of vocabulary.

3. Play2learn

Play2learn app logoThis Spanish app is part of a family of apps in several languages, including Russian, Italian, French and other languages. It is very useful if your caseload comprises of students coming from several countries and you want to work on some basic vocabulary on their first language. Play2learn is also an app for basic vocabulary, but with a few more options than Learn Spanish and Play. It contains concepts such as body parts, clothing items, toys, colors, technology vocabulary and many more. It also has a component for verifying learning with coloring activities.

4. Conjugation Nation

conjugation nation logo
This is an app for more advanced learners working on subject-verb agreement in Spanish. The user is given a verb and a pronoun and must type the correct verb conjugation. This is a basic app but is one of the best tools I have ever seen for working on subject-verb agreement: a very prominent feature of Spanish grammar.

5. Spanish Grammar: Ser/Estar

Spanish grammar app logoThis app, despite being a bit difficult to set up is very useful for teaching the differences between “ser/estar” both translated as “to be”(“to/be”) in English but used differently in Spanish. This app gives users lots of ways in which each can be used.

I hope you enjoyed this post. If you have any suggestions of apps in Spanish please send me an e-mail to I would love to post it on my blog. Also keep in mind that any of these apps can also be very useful for English-speaking clinicians trying to brush up or start up on their Spanish skills.

Barbara Fernandes is a trilingual speech and language pathologist. She is the director of Smarty Ears and the face behind GeekSLP TV, a blog and video podcast focusing on the use of technology in speech therapy. Barbara has also been a practicing speech therapist both in Brazil and in the United States. She is a an active participant of the Texas Speech and Hearing Association as a member of the TSHA Culturally and linguistically diverse issues task force. Barbara has created over 15 applications for speech therapists.