Hi, 

I hope I’m not bothering you, but I’m needing help. I have taken many OPT courses, most recently your tongue thrust course. Thank you, it was awesome!!

I have a little boy that I started seeing when he was 7. He presented with open mouth posture and breathing, frontal lisp on /t, d, l, s, z, ʃ, tʃ/. We worked for 10 months. We targeted resting position, went through the bubbles, bite blocks, gum chewing, tongue exercises, nose breathing…

Then they took a 9 month break and just came back for a “refresher” today. He is jutting his jaw to the right in speech (his bite is perfect when asked to smile) and his top lip has a lot of tension for /s/. Is the lip tension because of jaw instability? Would you go back to jaw work? I know this is a silly question, but still confuses me some: if he juts to the right, that indicates jaw instability on the right and we strengthen the right side, or is it the total opposite? Why is my mind playing tricks on me?!?!?!

He still needs to practice resting position and nose breathing. He is suffering with allergies now.  

What would you recommend? Thank you so much for your time.

Meredith 

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Hi Meredith,

I hope I can be of some help! (Although I may have more questions than answers initially.)

If at the end of your therapy he had not fully transitioned his oral placement skills to function (eating and correct production of his sounds), it is possible that he has lost some of the motor planning you originally taught. I would definitely go back to the jaw and see what has happened.

The jaw jut you are observing could be due to asymmetrical skill but you won’t know which side is weaker until you re-assess (some people pull to their stronger side and some people push. You are NOT going crazy  ).

I am guessing the tension you are seeing in his lips and the jutting of the jaw are in direct relationship to what he is trying to do with his tongue.

Here are some questions to consider:

Reassess his movements of the tongue, particularly his straw drinking and swallowing. Has that changed? Did he work through the tongue thrust program? What has the family been doing as part of his discharge? Is there a possibility that he’s learned any of these newly visible movements through incorrect practice?

Is the jaw jut and lip tension only seen with the /s/ sounds? I wonder if that helps open his airway while he is speaking? Just a thought.

I’m happy to help you brainstorm further if you’d like to send a little more information about these skills and the results of your re-assessment!

Sincerely,