Facilitating Tongue-Tip Elevation

By Pam Marshalla

Q: How can I get my client to elevate the tongue-tip instead of the blade to produce lingua-alveolar phonemes?

Following my 22 Fundamental Methods of Facilitating Jaw, Lip, and Tongue Movements, I would do one or more of the following:

  1. Assist – Lift the tip with a tongue depressor.
  2. Associate – Find one phoneme in which the client elevates the tip, and use that phoneme movement to teach the others.
  3. Contrast – Contrast tongue-tip elevation with tongue-back elevation.
  4. Cue – Point your finger upward to cue the tip to lift.
  5. Describe – Use appropriate vocabulary to describe tongue-tip elevation.
  6. Develop sensory awareness and discrimination – Brush the tip with a toothbrush or toothette.
  7. Direct – Press above the upper lip with your finger and tell the client to push the tongue tip up in that direction against the alveolar ridge.
  8. Dissociate – Brush the tip and then the blade to help the client begin to dissociate the two.
  9. Exaggerate – Open your mouth very wide, and exaggerate your own tip elevation so the client can perceive the movement.
  10. Increase/decrease muscle tone – Put a tiny candy (like a cake decorator dot) on the tongue-tip and have the client press the candy up to the alveolus and hold it there for a count to ten.
  11. Increase range of motion – Have the client stretch his tongue up, down, left, right, in circular motions, and back from alveolar ridge to velum in order to develop gross tongue-tip movement before refined tongue-tip control.
  12. Inhibit – Stretch a long thin tool (swizzle stick, straw) across the mouth from the left side of the lips to the right side. Have the client use the tongue tip to reach out and under the stick and curl the tip up and back to hold the stick in place. This will force the blade down (or inhibit blade movement) and the tip up. (This is a technique from Van Riper.)
  13. Maintain positions – Once the client can lift the tip, have him lift it to the alveolus and hold it for a count to ten in order to build awareness, strength, and endurance for the position.
  14. Mark the target – Touch the alveolar ridge with a Toothette, toothbrush, or Nuk stimulator in order to give the client a tactile sense of his articulation target..
  15. Model – Demonstrate to the client what to do. Use your own mouth, your hands, a model, a puppet, drawings, and so forth to enhance this visual input.
  16. Normalize tactile sensitivity – Have the client suck on an ice cube for a few seconds between trials.
  17. Practice – Once he can lift the tip, have the client do it ten times in a row to build awareness, control, and habituation.
  18. Resist – Press down on the tip and have the client push the tip up against the downward pressure.
  19. Speed up / Slow down – Once the client can elevate the tip, have him practice the movement quickly in sequence.
  20. Stabilize – Have the client bite down with his molars on a stick (Infant tongue depressor, Toothette handle, swizzle stick, bite block) in order to stabilize the jaw while the tip activities take place.
  21. Stimulate reflexes – Brush down the midline of the tongue from tip to half-way back. The tip should be stimulated to elevate over time.
  22. Vivify – Have the client move the tongue in a wide variety of directions to break up old habits and introduce new movement.

For more about the 22 ways to facilitate jaw, lip, and tongue movement, please see this article I wrote for the Oral Motor Institute.

2 thoughts on “Facilitating Tongue-Tip Elevation”

  1. Hi! I just found your page by accident thru googling keywords This is not an area of relative expertise for me but much of what you wrote is in my clinical toolbox. I’m wondering if you have any suggestions for a specific client of mine. Peds, tween, severe flaccid-spastic dysarthria, significant oral/verbal apraxia that for some reason no one has ever diagnosed but me. We have been working on oromotor movements for quite some time and improvement is very slow. We work mainly to overcome the apraxia although her spontaneous movements are hard to measure because of the intermittent spasticity. Using a flavored stimulus on the alveolar ridge usually causes her to raise her tongue blade with the tip continuing to be depressed. attempting to lift the tip from underneath is a battle and require frequent breaks. Lateralization is improving with a lemon stimulus, although I don’t use those much because of the surface dehydration risks.

    She eats everything – food is cut into pieces so she doesn’t have to bite/tear but she can, but mastication can be messy if her mouth spasms mid-chew. The tongue work is helping to improve her bolus mgmt bit by bit, though.

    Of ocurse this isn’t her whole history but any thoughts you might have would be appreciated. Thanks!

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