Q: I currently have a female client age 2;5 who cannot lateralize or elevate her tongue. Would you have any suggestions for me?

When a client has the type of limited tongue movement you describe, I think we have to follow Charlie Van Riper’s most basic advice, which is to get the tongue to move in any and all new directions. He called it “vivifying” tongue movement.

To vivify means to enlighten or animate. This means that at first we simply want to get the tongue to move in any and all new directions–– up, down, left, right, forward, back, up in the front, up in the back, up on the sides, etc.

We are helping the tongue move in gross ways. Van Riper said this was to break up habits and to teach the client that his tongue can move in many more ways then he thinks it can.

We can vivify tongue movements in many ways. The following ideas have been lifted from my next book entitled The Marshalla Guide. Not all of this would be appropriate for a two-year-old…

• Use creative Imagery: For example, many therapists use the image of Tongue who is always busy around his house. He “cleans the house… dusts off the roof… sweeps the floor… washes the walls… shakes out the mop… walks around the block… [and] rests behind the teeth” (Berry and Eisenson, 1956, p. 140). Mr. Tongue also opens and closes his dental door, window, or gate. He paints the interior and exterior walls of his house, and he dances, wiggles, and hops. Mr. Tongue taps on the roof to communicate with the people who live upstairs, and he searches every corner of his house for his lost sock.
• Palmer et al (2008) found that increasing tongue-to-palate pressure coincided with increased muscle activity in the whole tongue. They suggested that exercises in which the tongue presses against the palate could strengthen floor-of-mouth muscles, tongue muscles, and jaw closing muscles.
• Weber and Smith (1987) found that stimulation to the jaw causes movement in the lips and tongue. Ishiwata (1997) demonstrated that tongue position is reflexively controlled by jaw position. Therapeutically these studies suggest that one of the first ways to stimulate gross early tongue movement is to stimulate gross early jaw movement.
• Traditional therapists understood that the tongue works in concert with the lips and that improvements in lip function would have a positive affect on movements of the tongue. This means that one can vivify tongue movements by increasing lip mobility. “Labial agility has a tendency to produce lingua agility” (Berry and Eisenson, 1956, 139).
• Therapists often get little children to move the head more as a way to encourage movement in all the oral structures including the tongue. Van Riper encouraged head movement to stimulate tongue protrusion: “Protrude tongue as far as possible… Allow head and jaw movements at first but end with head and jaw fixed” (Van Riper, 1947, p. 171).
• Westbury (1988) demonstrated that more hyoid bone movement occurred than did jaw movement during adult speech, suggesting that moving the hyoid bone might stimulate tongue movements while the jaw stays relatively stationary. In therapy we can use hands-on techniques to encourage the client to move the hyoid bone up and down while stabilizing the jaw on a bite block. Have the client place his fingers on his throat at the crook of the neck so he can feel the muscles move. Teach him to push the body of the tongue and hyoid up and down with the throat muscles, and to use his hands to feel the actions.
• According to a review of the literature by Rochet-Capellan, Laboissière, Galván, and Schwartz (2012) research has shown that hand and mouth movements are interrelated. Hand and mouth movements co-occur right after birth, they mutually entrain at 6-8 months during manual and oral babbling, they are produced sequentially at 9-14 months, and they are synchronized by 16-18 months of age. Therapists who work with infants, toddlers, and preschool children often take advantage of this hand-mouth relationship and vivify oral movements by stimulating hand movements. Hand movements should be of the gross motor type like squeezing clay or rummaging the hands through textured substances (sand, beans, or rice). Hand-to-mouth exploration also is encouraged with very young children through finger-feeding activities with pudding, yogurt, and other purees. With older children and adults one can rub the hands with lotions or towels, and stimulate the hands with deep pressure or vibration.
• Motor therapists often use cold stimuli to inhibit hypertonicity and to facilitate muscle contraction, depending upon how it is used (Farber, 1982). SLPs use cold stimuli to vivify mouth movements by having clients suck on ice, ice pops, frozen bananas, and ice cream, and by using cold metal spoons during lip and tongue movement activities. Cold stimuli must be used cautiously. A little bit of cold stimuli seems to cause more movement, a lot of cold stimuli seems to slow and eliminate movement, and of course too much cold stimuli on the whole body can lead to hypothermia and death. It should be noted that there has been no research to verify that cold stimuli will improve tongue function for speech. In fact one study demonstrated that scheduled applications of cold stimuli on the tongue did not improve its swallowing movements in adults with dysphagia following stroke (Rosenbek, Robbins, Fishback, and Levine, 1991).

References

1. Berry, M. F., & Eisenson, J. (1956) Speech Disorders: Principles and Practices of Therapy. NY: Appleton-Century-Crofts.
2. Farber, S. D. (1982). Neurorehabilitation: A Multisensory Approach. Philadelphia: Saunders.
3. Ishiwata, Y., & Hiyama, S., & Igarashi, K, & Ono, T, & Kuroda, T. (1997). Human jaw- tongue reflex as revealed by intraoral surface recording. J Oral Rehabilitation, 24, 857–862.
4. Rosenbek, J. C., & Robbins, J., & Fishback, B., & Levine, R. L. (1991). Effects of thermal application on dysphagia after stroke. Journal of Speech and Hearing Research, 34, 1257-1268.
5. Palmer, P. M., & Jaffe, D. M., &McCulloch, T. M., & Finnegan, E. M., & Van Daele, D. J., & Luschei, E. S., (2008). Quantitative contributions of the muscles of the tongue, floor-of-mouth, jaw, and velum to tongue-to-palate pressure generation. Journal of Speech and Hearing Research, 51, 828-835.
6. Rochet-Capellan, A., & Laboissière, R., & Galván, A., & Schwartz, J. (2008). The speech focus position effect on jaw finger coordination in a pointing task. Journal of Speech, Language, and Hearing Research, 51, 1507-1521.
7. Van Riper, C. (1947). Speech Correction: Principles and Methods. New York and Englewood Cliffs: Prentice-Hall.
8. Weber, C. M., & Smith, A. (1987). Reflex responses in human jaw, lip, and tongue muscles elicited by mechanical stimulation. Journal of Speech and Hearing Research, 30, 70-79.
9. Westbury, J. R. (1988). Mandible and hyoid bone movements during speech. Journal of Speech and Hearing Research, 31, 405-416.