This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Q: I have a teenage client with a reverse swallow pattern and related anterior open bite. I plan to teach him correct oral rest, to swallow in an anterior-to-posterior direction, and to increase his tongue strength. Does this sound right? Is there something I am missing?
Training correct oral rest position and correct swallow movements are the right basic ingredients of this therapy. But remember that oral swallowing entails two types of tongue movements: The tongue movements needed for food preparation (biting, chewing, forming the bolus), and the tongue movements needed for swallowing (transferring the food from the oral cavity to the oropharynx). This therapy should address both.
“Tongue strengthening” is something I do not talk about. In most cases the tongue is strong enough. The tongue movements patterns are off, not its strength.
An analogy to another part of the body helps us understand this–– For example, a child with very poor penmanship might have hands that are plenty strong. He does not need to increase the strength of his hands. He just needs to learn to move them correctly to manipulate a writing utensil.
Likewise, a child with a reverse swallow pattern may have a tongue that is strong enough. He just needs to learn to move it correctly to hold it steady at rest and to move it correctly to manipulate and swallow food.
If you know how the tongue should rest, and how it moves during the oral preparatory stage and oral stage of the swallow, you should be able to do this. If you do not know the basic of correct oral rest position and correct mature swallow, you need to learn that first.
For more information about swallowing: International Association of Orofacial Myology
- Hanson, M. L., & Mason, R. M. (2003) Orofacial Myology: International Perspectives. Springfield: Charles C. Thomas.
- Logemann, J. (1983) Evaluation and Treatment of Swallowing Disorders. San Diego: College-Hill.
- Marshalla, P. (1995) Oral-Motor Techniques in Articulation and Phonological Therapy. Mill Creek: Marshalla Speech and Language.