BUST the THRUST: First Five Weeks of My Tongue Thrust Treatment FREE

bust the thrust

I have received  A LOT of calls and e-mails about my tongue thrust program.  I have been working hard on building an app to sell the program for therapists to purchase and use with their clients.  Because of this I haven’t provided my treatment protocol because I was waiting for the app to be completed.  But, because the app is taking longer than I anticipated to be completed, and because I am feeling generous.  I decided I would post the first five weeks of the program for free.

Please keep in mind that this program should only be used by a licensed Speech Language Pathologist – or under the direction of a licensed Speech Language Pathologist.

For more information about tongue thrust please read my posts here and here -where I explain what a tongue thrust is and how to informally assess tongue thrust.

And remember to follow along on the blog – as I will provide updates about the finished Bust the Thrust app, which will include the remainder of the program as well as video demonstrations and data tracking features.

Good luck and here is my program: Bust the Thrust (First Five Weeks FREE)

 

choosing therapy targets

 

I have a very simple and concise form to help determine therapy targets when working with children who have Apraxia of speech. This form is incredibly useful to me.  It helps me track my clients’ progress as well as guides me through choosing therapy targets during each session.  If you have read some of my other posts about Apraxia you will know that I like to focus therapy on specific movement patterns (two pure speech sounds with the movement in-between).  It is my theory that once a child can produce all possible movement patterns – they will be an intelligible communicator!!!

This form is simply a combination of ALL of the possible movement patterns in the English language. So based on my theory – once a child can produce every target on this sheet – they will be an intelligible communicator.

This form allows you to easily view where each child is (in terms of their progress) and how much further they have to go.  It gives you a starting and ending point – which is helpful to keep you from feeling overwhelmed and motivated to push forward.

Total Movement Pattern List

Total Movement Pattern List

This form will take you through the entire scope of therapy targets for children who have Apraxia in a few simple steps.

Informal Assessment:

1.  Informally assess the child’s ability to form each pure speech sound in isolation by producing each sound listed across the top of the document.  Model each sound for the child and circle the sound if the child is able to imitate the sound correctly.

2.  Informally assess the child’s ability to produce Vowel-Vowel movement patterns by completing the yellow portion of the form.  Model each movement pattern highlighted in yellow and circle the movement pattern if the child is able to imitate it correctly.

3.  Repeat step #2 for each section in the form:  Consonant-Vowel (green), Vowel-Consonant (blue), Consonant-Consonant (purple).  Make sure to circle each movement pattern the child is able to imitate correctly.

Choosing Therapy Targets:

Once you have informally assessed the child’s overall abilities you will have a good idea of where to start in therapy.

1.  At the beginning of each session have the child quickly drill through each pure speech sound and movement pattern they were previously successful with (i.e. drill through each circled target at the beginning of each session).

2.  Target a combination of known movement patterns next.  For example: if your client can produce /ui/ and /it/ – try targeting them together to make /uit/ (or “wheat”).  Or another example would be – if your client can produce /mɔ/ and /mi/ – try targeting them together to make /mɔmi/ (or “mommy”).

3.  Target a new pure speech sound.  This is the tricky part – getting the child to produce a sound they have not been able to produce before.  Use other similar sounds (sounds in similar groupings- manner, place, voicing, etc,) that the child can produce to help mold/shape/form them into the new pure speech sound you are teaching.

4.  Target new movement patterns.  If you know the child can produce two pure sounds in isolation – but hasn’t been able to produce them together in a movement pattern – that is where you should start.  This part of therapy just consists of slowing down the movement from one speech sound to another (see my other Apraxia posts for more help on how to do this) and allowing the child to practice and memorize the movement between the two sounds.

Overall:

The overall goal of this form is simple.  You can easily keep track of what the child can do and what they have not been able to do yet.  Start each session reviewing those targets they have been able to do in the past – and follow a slow progression of introducing new targets.  Work on combining known targets together to make more complex targets.

Good luck, and like always let me know if you have any questions.

Alissa

Speech Client Christmas Present Idea

Okay.  I have officially been the worst blogger lately.  Not a single post in all of December.  I have so many excuses for it – we celebrated both of my kiddos birthdays during the holidays which made for lots of planning, preparing, and spending time with family and friends.  We had a great time.

I have also been working hard on the production of a new speech product that is geared toward children with Apraxia.  I AM SO EXCITED FOR IT!!! It is almost finished – so be sure to follow my blog so you won’t miss it.

Other than that – my new year’s resolution is to be more consistent with my posts.  So here is to hoping…

I wanted to share something with you all and decided to showcase one of my favorite client Christmas presents I have made in the past.  I have given this as presents for my private speech clients as well as for all the (100+) kids on my school case load.

client christmas

 

Isn’t it cute?  Anyway – I gave them all this note with a hand held mirror as a present.  Fun and functional – right. I wanted them to feel inspired and motivated, and I wanted something that would help them practice their speech better at home.  I figured a mirror was the way to go.

For my private speech clients I just headed to the dollar store and purchased enough mirrors for all of my clients.  For my 100+ students I couldn’t afford $1 for each child – so I found some cheaper mirrors online that I could order in bulk.  It worked out well and they all turned out really cute.

I know it is after Christmas – but if you wanted a late Christmas present for your students/clients – here is an idea for you.  Or you could just save the idea and use it next year.

Here is a more generic version of the letter that you can just print out and use yourself.

student christmas

 

I hope everyone had a Merry Christmas and a Happy New Year.

-Alissa

8 Tips for Treating Stuttering

I recently had a new client’s mother discuss with me her concerns for some disfluencies (stuttered speech) her son has.  The client’s mother was bothered because other therapists that had worked with her son had said, “We can’t treat it because he never does it around us.”

This frustrates me a little, but I actually understand the therapist’s difficulty.  It is incredibly hard to treat something you don’t hear yourself.  But the truth of the matter is, that just because the therapist doesn’t hear it, doesn’t mean it is not a problem.

It is often common for children with disfluencies to be more aware of their speech around others that they are less familiar with (i.e. a speech teacher).  They might work extra hard (even subconsciously) to appear fluent.  They might talk around the words/sounds that they would typically stutter on and try to avoid them completely.

However, when these same children are in a more relaxed environment where they feel they can let their guard down and be more themselves (i.e. at home), they might produce more disfluencies.  This is because they might not care as much how their stuttering is perceived by close family and friends.  They assume their loved ones will look past it.  Or – they just want to relax when they are at home.  All of these things are understandable.

The problem however, is that sometimes these types of children never receive appropriate treatment because they have a way of hiding their disfluencies from professionals who can help.

I have dealt with this many times in my practice and have come up with a few tips that you can try when working with a client who has disfluencies (whether you hear them or not).

1.  Always trust what the parent is telling you.

It has been my experience that some parents feel like no-one believes them when they say their child stutters.  If a parent is concerned – you (as a therapist) should be too.  Parents don’t tend to make up concerns about their children.  They don’t want their children to struggle.  Why would they pretend their child is stuttering if they aren’t?  I always tell my parents “I am the professional – but you are a professional too when it comes to your child.  You know your child better than anyone – so if you tell me something about your child – I am going to believe you.”

2.  Get as much detailed information from the child’s parent/other family members as you can.

Ask specific questions about the child’s stuttering habits.  Approximately how often do they stutter in a 5 minute conversation?  Do you notice their stuttering habits change in different environments?  Do you notice their stuttering habits change around different people.  Which environments do they speak the best in, or the worst?  Which people do they speak the best around, or the worst?  Can you imitate what your child sounds like when he/she is stuttering?  Are there specific sounds, words, phrases, or sentences that seem to increase your child’s disfluencies?

3.  Try to get a video of the child stuttering.

With cameras built into almost every mobile phone now-a-days, this should be easy.  Just have the parents on alert to try to capture the child’s true stuttering habits.  I prefer for this to be done without the child’s knowledge – if possible.  Children are going to automatically work extra hard to conceal their stuttering habits if they know they are being taped.

4.  Observe the child in their natural environment.

If the only way to observe the child in their natural environment is to view a video taken by the child’s parents – then use it.  However, there are other ways to see the child’s true stuttering habits.  Drop in on the child’s classroom (especially during an activity that requires verbal communication).  Observe the child during lunch time or during recess.  You can begin to see how the child communicates in a variety of settings, and this information will become very beneficial to you as treat the child.

5.  Stress the child out.

I know this sounds harsh – but stuttering is often triggered by stressful situations.  If the child is never stressed around you – it is likely you will never hear any stuttering.  When I say stress the child out – I am not implying that you be mean to the child or make them feel bad.  Just put them in everyday situations that may cause slight panic.  Some ideas are: public speaking (set up some kind of activity that requires the child to speak in front of other people), talking on the phone (have the child call a local pizza shop and ask about the specials), ordering food (take the child out for ice-cream and have them order their own).  Anything that might take the child slightly out of his/her comfort zone – you can use these opportunities to both observe disfluent speech, and work on correcting it.  When observing it – take notes about what type and frequency of stuttering you hear.  When working on correcting it – you can discuss the scenario ahead of time.  Practice what the child will possibly say.  Work on keeping the child calm.  Role play the situation ahead of time.

6.  Help the child become more aware of stuttering by having them keep track of your (pretend) stutters.

Often times children who stutter a lot – don’t even realize when they are doing it.  It is key to increase their awareness of their stuttering habits.  To do this – you (as the therapist or parent) need to model what disfluent speech looks like.  Carry on a conversation with the child, play a game with the child, read a story with the child – during one of these activities – produce random but noticeable disfluent speech (imitate the child’s stuttering habits if possible) and have the child track your disfluencies.  This will not only help make the child more aware of disfluent speech in general, but will help them understand how stuttering can interfere with communication.

7.  Help the child become more aware by keeping track of his/her own stutters.

Complete any one of the activities mentioned in #6 – but track the child’s stutters during the activity.  Both you and the child should track the child’s stutters and then compare your results and the child’s results.  This will help you see how aware the child is of their own stuttering.  This will also help the child realize how aware/unaware they are of their own stuttering.  You can also video record or tape record the child’s speech and them watch/listen to it together later and track the stutters heard.  Then compare your results.

8.  Teach the child how to prevent/correct stuttering by practicing pretend stuttering and specific stuttering techniques to overcome it.

This tip is especially helpful when working with children who don’t stutter around you (the therapist) – but who do in fact stutter.  Model disfluent speech and then model how to fix it using a specific technique (gentle onset, pull-outs, reduced rate of speech, etc.).  Have the child practice pretend stuttering and fix it by using a specific technique.  If they have practiced fixing disfluent speech (even when it is not real) they will have the tools to fix disfluent speech when it is real.

Good Luck and I hope some of these tips help!!!

Tongue Thrust Checklist

Happy Halloween internet friends (or I guess it is officially the day after).  I have had many requests for more information about how I treat tongue thrust.  Unfortunately it has taken me a while to get some of this information posted.  I have been pretty busy the last little while working on costumes, decorations, Halloween crafts and treats.  I had so much fun this Halloween with my kiddos.  They sure kept me busy.  Don’t they make the cutest Superheros…photo (1)

Couldn’t you just eat them up???  Maybe I am biased – but they sure are cute.  And here is one of the whole Super Family…

photoI just love them.  I hope your Halloween was as much fun as ours.  We had a great time.

Anyway… getting back to business.  As I began putting together my tips for treating tongue thrust I realized that I better provide some type of tool to diagnose (at least informally) tongue thrust first.  It doesn’t really matter if you know how to treat tongue thrust if you don’t know who actually has it and who doesn’t.  So, I am providing you with a Tongue Thrust Checklist.  This is an informal tool you can use to help you diagnose tongue thrust.

The first page provides you with the directions for completing the checklist.  You really only need to print one copy of these directions to save for your information.  Pages 2 and 3 need to be printed out and filled out for each student you are assessing.

It was my hope to provide you with a concise form on which you could document all of your finding regarding tongue thrust and make informed treatment and diagnostic decisions.

Like always, please let me know if you have any questions.  And be sure to follow my blog so that you don’t miss future posts containing my “tips and tricks” for treating tongue thrust.

Alissa

tongue thrust checklist

 

Tongue Thrust

TONGUE THRUST PIC

Since I started my private practice I have received a large amount of tongue thrust referrals.  This is mostly due to the limited coverage of tongue thrust therapy through the school district.  Where I come from – therapists are allowed to treat tongue thrust through the school district if the tongue thrust causes an articulation disorder.  But they are not allowed to treat tongue thrust (or reverse swallow as it can be called) alone.  This makes sense I guess – since an atypical swallow pattern doesn’t really affect a child’s ability to access an education like an articulation impairment does.

Anyway… all this exposure to tongue thrust has helped me perfect my techniques and my clients have had AMAZING success.  Seriously.  I love treating tongue thrust.  It is simple, straight forward, and totally possible to fix.

But I would like to back up for a minute and talk about what a tongue thrust is exactly.  I am going to explain it the way I like to explain it to the parents of my clients.  I begin by explaining that a tongue thrust is actually an abnormal or immature swallow.  I use the word immature because a tongue thrust is actually considered “normal” up until a child is about 8 years old (although I prefer for children to have adapted to a more mature swallow much sooner).  A tongue thrust is the type of swallow that a baby uses.  In this type of swallow the back and middle parts of the tongue are fairly lazy.  They just kind of “come along for the ride” while the tongue tip does most of the work.  This type of swallow is critical for a baby because it allows the baby to use their tongue tip to expel liquid from a nipple (breast or bottle).  To understand this type of swallow better I actually filled one of my baby’s bottles and drank from it (are you grossed out yet???).  But seriously – I did.  I wanted to understand the process better so I could explain it to my clients and their families better.  I suggest you try it as well if you are trying to get a better understanding of tongue thrust.  You will notice that the tip of your tongue does most of the work.  The tip of your tongue just has to put pressure on the nipple to allow the liquid to flow from it.  You will also notice that your tongue is almost required to push up and forward to expel the liquid.

Another way to understand a thrusted swallow better is to watch a baby try to eat baby food.  The reason babies are so messy is because they swallow with a tongue thrusted swallow.  Their tongue is so used to pushing up and forward to swallow – that it continues to do so even when it is introduced to more solid food.  However, this type of swallow is much less effective for swallowing solid food – so typically – over a process of years- a more mature and effective swallow pattern will begin to develop.

Instead of a forward/upward scraping motion that occurs in a thrusted swallow, a more mature swallow begins with the tip of your tongue pressing against the bumpy spot behind your top front teeth (your alveolar ridge).  The middle, sides, and back of your tongue then should suck up against the roof of your mouth (while your tongue tip remains on the bumpy spot) to push the food back toward your throat.

You can see now why a thrusted swallow is often referred to as a reverse swallow.  In a thrusted swallow the tongue is pushed up and forward (in a scraping motion), in a mature swallow the tongue is pushed up and back (never pushing against or past your front teeth).

You can see how in a thrusted swallow the back and middle of the tongue are pretty non-active, but in a mature swallow they are working a lot harder.  As a child develops a more mature swallow – the back and sides of their tongue begin growing stronger and gain more control of movement.  This has huge implications for articulation.  If a child fails to transition to a more mature swallow, the back and sides of their tongue fail to mature as well.  This is where we begin to see difficulty producing sounds that use the back and sides of the tongue (/r/, /sh/, /ch/, /j/).  But we also see difficulty with fricative sounds (sounds that require pushing airflow out) that involve the tongue (/s/, /z/, /th/).  This is because the back/sides of the tongue do not have the strength/stamina to hold the tongue in the correct position against the pressure the airflow creates.  I kind of explain it in terms of posture.  Your tongue has a correct posture inside your mouth for these sounds with airflow (s/z/th).  But as soon as you begin blowing your air out, the tongue gets pushed forward as well.  It is not strong enough to resist the airflow and maintain its correct position.

Are you still with me???  I realize this is a lot of information.  I hope it is making sense.

I have had many articulation clients come to me because they needed help producing one/some/all of these sounds (s, z, th, r, sh, ch, j, etc).  I determined they had a thrusted swallow, and I treated their thrusted swallow without ever actually treating the specific sound errors they had.  Many times the sound errors corrected themselves once the swallow was corrected.  This isn’t always the case – sometimes I have to work on the specific sound errors once the swallow is corrected – but the therapy goes much faster once the thrusted swallow has been corrected.

This is why a greater understanding of tongue thrust is so important.  If we don’t know how to diagnose it or treat it – our client’s articulation errors can often be difficult if not impossible to fix – because their abnormal swallow is undoing everything you are doing during therapy.

It is also important to have a greater understanding of tongue thrust because it is so prevalent.  If you haven’t treated tongue thrust as a therapist – I assure you it is just because you haven’t realized that was the problem – not because the problem was never there.  Tongue thrust is very common and I assume – very underdiagnosed.  The reason it is so common in our day is, I believe, because of the introduction of so many “false nipples” in our society.  ”Back in the day” babies would nurse from their mother until a certain point when they were weaned, this allowed the more mature swallow to begin development.  ”Now-a-days” babies have bottles, pacifiers, and sippy cups.  All of these things contribute to babies/toddlers using a thrusted swallow for longer periods of time than they should.  And it almost seems like if a child misses the opportunity to develop a more mature swallow, they lose that ability and never end up developing one.  I have treated many adults as well that have swallowed using a thrusted swallow their entire life.  Sometimes the thrust affected their speech, the way others perceived them, their success in social situations and careers, etc.  A thrusted swallow can have negative life long affects.

So, we as therapists need to do better to understand and treat tongue thrust.  And this is just the first step I am taking.  Now that we have discussed what a tongue thrust is, I am planning on giving tips and pointers as to how to treat it in later blog posts.  For now you can check out my tongue thrust brochure that explains better the signs, symptoms, and causes of tongue thrust.  And like always – let me know if you have any questions.  Thanks.

TONGUE THRUST BROCHURE PG 1 TONGUE THRUST BROCHURE PG2

 

FREE Visual Cue Flip Book

Slide11For those of you who are familiar with my blog – you will know that I LOVE flip books.  I use apraxia flip books all the time in therapy and love the versatility they provide.

I recently put together another flip book – this time focusing on visual cues (or pictures of the mouth as it makes different movements).  The best part about this flip book is that it is as versatile (if not more) than my other flip books.  Using the visual cues in the flip book format allows you to provide visual cues for all phonemes (consonants, vowels, dipthongs) as well as many simple words or word combinations.

At the end of the document I have provided you with some examples of how to use the visual cues flip book - but be sure to experiment and come up with your own sound combinations or words that you want to target.

Be sure to visit my blog post here on how to create a flip book using a printed document. Good luck!!!

FREE Syllabic /l/ worksheet

I’m not sure if anyone despised teaching final /l/ more than I did when I first began working with clients many years ago.  The kids always seemed to mess up the production of /l/ in the final position of words even when they could say it in the beginning and middle position of words.  It drove me crazy.

Then one day as I was teaching the /l/ in the final position – it dawned on me that often the final /l/ is a totally different type of movement than the initial and medial /l/.  This happens when the final /l/ is a syllabic /l/ (something I remember learning while getting my undergraduate degree in speech – but hadn’t really processed what the difference looked like or sounded like).

After thinking a lot about final syllabic /l/ I made this worksheet to help breakdown the movement.  When producing a final syllabic /l/ it is not so much about bringing the tongue tip up to the alveolar ridge – but HOW you bring it up there and the vowel shape of your mouth as you move the tongue up.

For this type of /l/ you don’t push your tongue against the alveolar ridge and then pop it downward.  That would make words like “wheel” sound like “wheela” or words like “snail” sound like “snaila”.  Sound like any of your speech kiddos???

Anyway… when teaching a final syllabic /l/ I make sure to instruct the child to bring the tongue up slowly (almost in a scooping pattern) and then HOLD the tongue against the alveolar ridge.  This usually takes care of the problem beautifully.

Good Luck and I hope it works for you as well!!!

Slide1

Reward Route

REWARD ROUTE

Reward Route

 

** Go to Print Setup and change the Orientation to Landscape before printing the document.

I am excited to share my reward program with you.  There are a few different ways to use this program which makes it versatile to meet your individual needs.

OPTION 1: Print off one copy of the first page for each student. Each time your student works with you (and works hard enough to earn a reward) you can either cross off a space – or put a sticker on it. Each time the student makes it to a yellow space (rXr space) they earn a bigger reward (prize, treat, etc.).

OPTION 2: Print off 5 copies of page #3, 4 copies of pages #4-#8, and 1 copy of pages #9-#12. Mimic the reward layout on page #1 by putting the pages in the right order across a wall with the title (pages 9-12) across the top. Print off and cut out one train on page #13 for each student. Have your students put their names (or initials for confidentiality) on their trains, color their trains, and cut them out. Print out, cut out, and glue together the die on page #14. Each time your student works with you (and works hard enough to earn a reward) the student earns a chance to roll the die and move their train along the reward route. The student moves to the closest space of the color that they rolled (similar to the Candy-land Game). Each time your student lands on a yellow space (rXr space) they earn a bigger reward (prize, treat, etc.). When your student gets to the end they just start over at the beginning again and you have a never ending reward chart.

OTHER NOTES: I actually don’t use the little die on page #14—I made a die out of a medium sized square box and colored each side one of the colors on the reward chart. The students like to roll the bigger die much more. Also – I purchased a small vending machine for under $100 that stores my candy and prizes. When the students land on a yellow space they earn a quarter to put into the machine. I have the key to the machine so I just recycle all of the quarters over and over again. The kids love it!!

Also, instead of using this program to enforce good behavior during therapy, you could opt to use it to enforce your students’ completion of their speech homework.  It works great with my HOMEWORK PROGRAM.

Good Luck and I hope you enjoy it!!!