The author, Debbie Lowsky, MS CCC-SLP gave permission for this article to reposted here. Looking at gross motor skills in relation to oral motor skills is an important concept. Developmentally, a child achieves trunk rotation before lateralization in the mouth. Therefore, It make sense that using exercises that develop rotation can help with the progression toward chewing. I also use rotation exercises in therapy, particularly with children who have linear movement patterns. I have seen this greatly improve a child’s ability to achieve tongue lateralization. – Krisi
Tongue lateralization is the ability to move the tongue side to side inside the mouth. It’s an important skill for feeding therapy and development, as the tongue lateralizes in order to manipulate food to be chewed and formed into a ball (or bolus) before swallowing. It’s also how we go “fishing” for leftover food particles in the cheeks, around the gums and teeth, and on the lips.
There are several ways you can “test” for this. Ask the child to imitate you “wagging” your tongue. Or, place ARK’s Probe or Z-Vibe to the corner of the mouth on each side and prompt the child to touch it with his tongue tip. Or, place the Probe in the middle of the bottom lip and ask the child to touch it with his tongue tip. Then move the Probe in increments to the corner of the mouth, prompting him to touch it with his tongue tip at each increment (this provides a tactile cue for the tongue to follow).
Remember, one does not need to perform this oral motor task for speech sound development. Yes, the sides of the tongue need to make contact with the upper back teeth for such phonemes as r, sh, ch, etc., but no speech sounds are made with the tongue lateralizing. This movement is strictly for feeding. So observe the child eating. Really get in a position for a good view into the oral cavity.
Overemphasize chewing yourself, making a “yum-yum” sound. Is the food being moved side to side? What type of food is it. Puréed? Mechanical soft? Chopped? Regular? Maybe the child isn’t progressing to eat harder-to-chew foods because he cannot lateralize. It has also been my experience (as it was just this past week), that some children may only lateralize to one side. I know this is puzzling, but every now and then this happens in therapy to me. So keep an eye out for tongue lateralization to both sides.
To teach the concept of tongue lateralization, I usually start with trunk turning exercises. The idea here is to start gross motor and teach the child how to reach across the midline, physically moving their arms side to side. Once the child understands this concept of moving side to side, it’s a lot easier for them to understand that concept on a smaller scale inside the mouth. In a few cases, I have observed tongue lateralization beginning to develop after we do trunk turning for three weeks (WITH the parent following through with this exercise at home – very important).
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Cathy Fox, M.S., OTR/L says
Rotation of the trunk is accompanied by stabilization of thoracic extension, including scapula, thus giving the muscles attached to the scapula, base of skull and all other external attachment a movement pattern that requires elongation. Tongue lateralization occurs upon stable structures, which must include core stability with input from muscles coming from all directions. Upon those structures the elongated muscles can move and while others stabilize. This is the principle of rotational movement. Great concept!. Have thought and work on this for years but never took the time to write it down. Congratulation for putting out a significantly important but frequently missed component of treating oral and pharyngeal dysphagia.
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