Teaching Tongue Lateralization as a Component of Chewing Instruction
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Teaching Tongue Lateralization as a Component of Chewing Instruction Whitney Adams 1 & Keith Williams 1
& Jonathan
Ivy 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract This study evaluated the efficacy of a treatment package which included tongue lateralization as part of chewing instruction. Participants consisted of three children who consumed only pureed food and had no history of chewing. Using the outcome measures, tongue lateralization and chewing, we demonstrated improvements in these outcomes for each of the three children. Prior to the end of treatment, all three transitioned to table food and continued to consume table food in follow-up. In addition to measuring changes in observed outcomes, three speech pathologists not involved with the intervention independently rated video clips taken across the course of treatment for each child. These independent raters reported improvements in both tongue lateralization and chewing. The current study was the first to demonstrate a method of integrating tongue lateralization into an intervention for chewing. Keywords Chewing . Tongue lateralization . Oral motor
Children typically learn to chew when presented with textured food, setting the occasion for them to move from suckling to crushing the food by raising and lowering the lower jaw without a rotary component, a process called munching (Le Révérend et al. 2014). While the jaws, teeth, and connecting muscles are key variables in chewing, they are only part of the process. The lips and tongue are also critically involved in chewing, with the actions of both required for mature chewing (Gisel et al.
* Keith Williams [email protected]; https://orcid.org/ Whitney Adams [email protected] Jonathan Ivy [email protected]
1
Penn State Hershey Medical Center, 905 W. Governor Road, Hershey, PA 17033, USA
2
Penn State Harrisburg, 777 W. Harrisburg Pike, Middletown, PA 17057, USA
Journal of Developmental and Physical Disabilities
1986). Young infants largely limit tongue movements to forward and back since sucking is the initial mechanism for acquiring nutrition. When munching begins to occur, the tongue initially moves up-and-down with the jaw, but over time the tongue becomes more mobile and begins to move independently of the jaw, allowing the location of food in mouth to be better controlled. Researchers have observed tongue lateralization, or the shifting of food to the chewing surfaces, is rare in six-month-olds but consistently observed in ten-month-olds months (Stolovitz and Gisel 1991, Fig. 2). Deficits in chewing, and oral motor functioning more generally, are common among children with developmental disabilities or chronic health issues (Collins et al. 2003; Thommessen et al. 1991). Problems with chewing are also common among children referred for feeding therapy, with one study reporting 26% of children seen at outpatient feeding clinic having difficulty chewing higher textured food (e.g., a slice of apple; Field et al. 2003). Despite the
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