Breaking Down Barriers

Dilemma

In 1999, I was working on a trauma team in a local hospital outpatient clinic when my first tongue thrust patient landed in my clinic chair. He bore little to no resemblance to the patients I was used to treating that had medical diagnoses like TBI, stroke, Parkinson Disease, ALS etc. This 15-year-old young man was healthy, athletic, and academically talented (that’s the fancy way to say smart!). He had no disease, no paralysis, no articulation errors, no visible oral malformations, no developmental delays.

His orthodontist had referred him to a speech therapist for tongue thrust therapy because he had his braces taken off a year or so earlier and his teeth had moved back where they started. Not something anyone wants to see after that type of time and financial commitment. The orthodontist had determined that he was tongue thrusting and it was contributing to the drift and wanted to have it corrected. Because I was the only in network speech therapist for their insurance plan he ended up coming to me, but honestly I was NOT prepared. I was skilled with disease and disorders…not “normal”. What to do?

Well of course I did what any responsible clinician does when you are faced with a population that is within your scope of practice and related to what you do but not within your skill set. You reach out to the colleagues that do work with that population. You get into the literature and research and find out what is standard practice. What is working?

The results of my collaboration and research revealed a standard practice approach that involved retraining tongue placement by focusing on the “spot”. Traditional tongue thrust therapy took on average a year to retrain the tongue placement and often required “tune ups” as regression was quite common. Very little research was available (and very dated…1970s) and when diving deeper it became very controversial with some experts denouncing the diagnosis of tongue thrust stating that it was a behavior and did not require therapy because it was not a disease or disorder.

I proceeded to treat this young man given the tools and mentoring I had, but quickly realized that he was not going to invest his time in therapy every week for a year, nor was his insurance company going to pay for a year of therapy! Cancelled sessions and poor follow through was looming. If I didn’t get some real results quickly and make it stick the whole thing would be a waste of time and resources. This dilemma and my experience with dysphagia, apraxia, articulation disorders, and dysarthria came together as I added my neurogenic and oral motor experience into the mix. We had success! His tongue thrust was improved.

Expansion

Patients often come in clusters. Once the word gets out that you are a good therapist in a particular area they seem to multiply and suddenly you have quite a few who are looking for the same results. That is what happened, and in 2003 when I started a private practice this reputation followed me and before I knew it we had a reputation for treating tongue thrust. It was in 2005 when I started training my employees to do my technique that we started to realize the consistency with our tongue thrust clients. We realized that they never seemed to need tune ups. We realized they were usually in and out in less than 10 sessions. We realized that their tongue thrust didn’t just improve, it was eliminated. We went back through the clinical data and began following up with previous clients and monitoring current clients and found that indeed, NO regression for up to 5 years (after that we stopped asking!). The average length of treatment was 7 sessions.

Honestly, I was pretty humble and sheepish to share these results because they are so remarkable and NOT standard practice. I was skeptical of my own data, so we kept taking it and kept getting the same results across multiple therapists and multiple years until I was so confident in replicating the process that I published the Stone Tongue Thrust Protocol as an Assessment and Treatment tool for the identification, diagnosis and treatment of tongue thrust in 2008.

Solution

Nearly 10 years after that first 15-year-old came into the clinic I had perfected and systematized the elimination of tongue thrust! So now, almost 20 years later, you would think that there would be more understanding of tongue thrust, more awareness, more effective therapies because we have had so many advances in our scope of practice, research, technology, education…right? Wrong!

I still, on a very regular basis, hear from dentists and patients that nothing can be done (or needs to be done) for tongue thrust; that therapy doesn’t work; that you just need to teach them to put their tongue on their spot. I see patients after they are on their second or third set of braces (and a variety of placement appliances specifically tailored to prevent tongue thrust) with everyone frustrated because the teeth just keep moving. I see patients who are facing major jaw surgeries to address misalignment and TMJ issues. I see patients who have serious TMJ issues that have been treated by a variety of disciplines with no relief. Guess what they all have in common? Yup! They HAD tongue thrust and we eliminated it (as well as the other issues that were being caused or exacerbated by the tongue thrust)!

So no longer am I sheepish and quiet about my technique. You can’t argue with 18 years of clinical refining and outcomes.  In our current climate of transparency, clinical outcomes, and managed care there is no space for 1970s practices that take a year and don’t stick. Poor outcomes have perpetuated the myth that tongue thrust therapy doesn’t work or isn’t needed when in fact it is not the therapy it is the skill set of the clinician. The STTP Training Center was created to train professionals in the Stone Tongue Thrust Protocol so that we can change the face of tongue thrust therapy. Eliminate the misconceptions, take down the barriers and create access to unprecedented outcomes through exceptional training and support.

The STTP Training Center is found online at https://www.openlearning.com/sttptrainingcenter and provides education for the general public about tongue thrust what it is and what can be done. Education for professionals who most often identify tongue thrust, dental and speech language pathologists, about how to recognize and refer to a qualified provider. Education for professionals who treat tongue thrust and want to have an effective skill set to eliminate tongue thrust and build a niche service line in their clinic with exceptional outcomes. Together we are committed to changing the face of tongue thrust therapy and breaking down the barriers of access and outcomes.

 

 

 

About

The Stone Tongue Thrust Protocol (STTP) is a clinically proven effective tool for the elimination of tongue thrust for individuals over the age of 8.  Cally R. Stone MS, CCC-SLP is a state licensed and nationally ASHA certified clinical Speech Language Pathologist who developed and authored the STTP.  Her clinical work with tongue thrust came initially as an outpatient hospital clinician who received referrals for tongue thrust due to the insurance company contract with the hospital providers.  Frustration with traditional tongue thrust resources falling short in the limited time allowed by the payors, as well as poor follow through by patients led to the integration of techniques used with neurogenic patients who demonstrated oral phase dysphagia.

When Cally became a private practice owner in 2003, she was able to further refine her tongue thrust treatment methods and consistently achieved exceptional results in a shorter amount of time that did not require the “tune ups” reported throughout the tongue thrust literature.  Her practice became well known for the Stone Tongue Thrust Protocol (STTP) with patients and practitioners recognizing the value and lasting results of eliminating tongue thrust by training a new resting posture and posterior swallow. The STTP is now available for a second generation of therapists to become certified in the appropriate identification and use of the Protocol for the assessment and treatment of tongue thrust.

Kudos to the Parents!

I am continually amazed that in 2016 we still have these perpetuated myths about tongue thrust, whether it exists, what to do about it and whether it matters. I guess I’m amazed because I’ve been effectively treating and eliminating tongue thrust for almost 15 years so when I hear these reports from clients, friends, or family I just shake my head in disbelief! Once I get done shaking my head, I get busy educating because that’s what I do!

Here’s the situation I’m going to start with because it just happened yesterday! Completing an evaluation with a 15 year old young man who has had speech therapy not once but twice in the past 10 years because of concerns with tongue thrust  by the PARENTS because of mouth breathing and jumbled dentition. He of course sees an orthodontist who uses appliances not only to spread his palate but also hinge his jaw to aid with dental alignment. The orthodontist agrees there is an issue with tongue thrust and refers to a speech therapist that is close by his office.  Unfortunately, this therapist is not trained in the elimination of tongue thrust so she does an articulation approach (understand that this child had no articulation errors) and no one sees any results or understands what is even to be expected.

Fast forward 5 years or so and the speech therapy is long gone, the braces are off and low and behold the teeth are going right back where they started! Maddening!  Kudos to the PARENTS who know this isn’t ok. Their child has had sinus surgeries and massive orthodontia and 10 years later is still breathing through his mouth and thrusting. He is now old enough that he doesn’t want his teeth to go back to an open bite (which it already has) and his parents are concerned that the open mouth posture is indicative of something else. Well yes it is! It’s tongue thrust and if you understand why his palate needed to be spread and his jaw needed hydraulics, you understand that it all has to do with the oral muscles we use to swallow. If you have a reverse swallow the front of the tongue is doing all of the work and not distributing the tongue where it should be as you mature from an infant to a toddler to a child to an adolescent and finally an adult. Yes, these mouths are changing for many years and if the muscles are not working properly you have all sorts of maladies like jumbled dentition, misalignment of the jaw, TMJ, articulation disorders, and now research is pointing to progressive swallowing problems as we age.

It’s kind of like the toddlers who walk on their tip toes and as they get older they receive physical therapy to release the tight tendons and retrain their gait so that it doesn’t throw off their muscles, spine and posture as they grow. Unfortunately, most people don’t “see” the effects of the reverse swallow and certainly don’t equate it to a tongue thrust so nothing gets done until the structures are set and even then they treat the symptoms with appliances and surgeries rather than fixing the underlying muscle and swallowing issues that are causing it all to begin with.

I have decided that these stories can be used to debunk the myths and bring both professionals and consumers into the reality that tongue thrust most definitely does exist, tongue thrust therapy can be done by a variety of professionals but the important thing is that they have specialized practical training in the elimination of tongue thrust as a swallowing disorder not just a tongue placement issue. I treat very few clients these days as I have changed my focus to educating the professionals with effective tongue thrust identification and elimination using the Stone Tongue Thrust Protocol. Because of this I feel confident that the word is spreading and people are getting it…  Then I have experiences like the one I share from YESTERDAY.  Oh boy! We still have a lot of work to do! Thank goodness for parents who are persistent and trust their gut.