ORP: The Missing Piece to Remediating Speech & Facilitating Habituation with Tricia H. Rogers

Okay, all righty. Well, here we go. Hello, hello everybody. Welcome to the speech link podcast. Today we're talking about the oral resting posture, the ORP, the missing piece to remediating speech and facilitating habituation. Better known as carryover in generalization. Happens to be one of my favorite subjects. It looks pretty simple on the surface, but there's actually some complexity to the oral resting posture. However, there's a great deal of benefit in therapy, as I think that we'll soon discover. And before we begin, let's cover some disclosures regarding financial disclosures. In addition to receiving an honorarium for this podcast, Trisha receives revenue from the sale of her well-received books. Personally, I too receive an honorarium for this podcast, and I'm a regular seminar presenter for speechtherapypd.com and I own speech dynamics. Inc, neither of us have any non-financial disclosures. Okay, so happy that you are here, everybody, for our speech link podcast sponsored, of course, by speechtherapypd.com. I'm Shar Bochart, your speech language pathologist host. And, and just so you know, this is Trisha's second time as a guest on the speech link. And she's become a friend and a colleague through the years here. So Trisha H Rogers, MSCC, SLP, is an ASHA certified speech language pathologist with three decades of experience in more than 20 years of specializing in oral facial, myofunctional disorders. She received her master's degree in speech pathology from the University of South Carolina. Then immediately started working in a neighborhood, or a neighboring school district. She's worked with preschoolers and elementary age children and started her own private practice in Portland, Oregon. Currently, she works directly with clients of all ages, supports fellow SLPs through mentorship and consultation, and shares her expertise through print through presentations. Very importantly, she's the creator and author of Miss Time and Friends, a playful children's book series designed to help clinicians during therapy and support parents at home by playfully teaching healthy oral functions. Welcome to the speech link, Trisha. Thank you, Shar. Thank you for having me tonight. I'm so excited to be here. Me too. It is my pleasure. I'm just so excited to be doing this with you. Me too. Holy fun. Thank you. Thank you. Now, I do have a first question to kind of set the stage. Yes. Just second here. You do have a depth and breadth, I would say, of knowledge and expertise with a variety of client ages and populations, right? Right. So what point of your career did you actually realize that the oral resting posture was significant? Oh, I love this question. I love this question coming from you. So your audience is going to hear this. It was in the late 90s. So after I moved to Portland and I started working in private practice at in a clinic and also in my own private practice, I was very interested in the motor parts of the speech and the sensory pieces. And so I discovered your book, the Omar. Oh, my. Oh, yes. Yes. Your second edition. So so that and so I applied that because I was like, I knew something was kind of looked a bit off or the with the motor like once I got some of the intelligibility better, but I could just still the tongue just wasn't working right or just wasn't. It wasn't clear and crisp in the speech. So I found that book, which is, you know, your pre swallow works, right? And I am just like, and honestly, I found my notes that I took from reading the book when I was now back off to find the year it was, right? So I really, because I put that together and then after that, I soon after I found discovered your book, I did, I took all the training oral facial and my functional therapy. And it just like all came together for me and that, but it and I'm not looked back. It has just been such an important, uh, that knowledge has been so important to me and my clients, especially in my private practice. Okay. And in the schools, it's perfectly helpful too. It's just that with anybody, anybody, but I just really, it helped me be able to be successful in my private practice. Well, good, good, good. Now you said Omar, it's oral motor analysis and remediation techniques. And I am not going to say that any, any, you know, I'm not going to say it more than once, and I wrote that in 1995 and when I thought I knew something, you know, and I, yeah, you know, and it was a good start, but I certainly learned a lot since then. And fortunately, there has been a lot of research. I know people say, oh, there's no research. Yeah, there is. Oh, there's a lot of research out there. There's a lot and this, you know, the start right and you, we learn and you learned and, and all of your work is, and there's so much research. Thank you. Yeah. There really is. There really is. And I'm going to say most of it's, you know, it has positive results. Yeah. You know, indicates positive results. Yeah. Yeah. Yeah. So, yeah, well, thank you. Good. Good. Is this the true? Is this the true? All right. Good. Um, let's, let's just talk about what, what is the oral resting posture? How would you describe it for us? Yeah. And then also, I'd like you to describe it as you would tell a parent because it's going to be different. Yeah. And then I'd like you to describe it like if you were actually talking to, you know, a first or second grader, let's say, okay, love this. We're going to be here. You know, I can be similar, but a little bit, a little bit different. So, okay, oral resting posture. Yes. And I love, because it is one thing. It's not oral resting postures. It is the oral resting posture. It is one. It's what the lips do, what the jaw does and the tongue when the, when we're not talking, chewing or speaking. And so, as, as you know, it's like the tongue going also out and swallowing. Yes. Yes. And that's what you're not doing. And you're right. Thank you. Yes. Um, it needs, it's for the swallows to be right. It needs to be in this position. But yes, not when we're drink, we're not drinking. We're, when we're not swallowing, we're not drinking. We're not chewing and we're not talking. We're not just not moving. Best that posture. So, the tongue is is connected and elevated and resting on the, on palette, okay. And the tongue tip needs to be right behind the top front teeth, not touching it. So, it's right up there. There's a little piece of tissue that you can sometimes feel is kind of like a bumpy, o-piece is called your incisive papella. And, um, everybody try and see if you can feel it. It's right when the tissue starts right. Perfect. We all know about teeth. Yeah. Yeah. Yeah. And then, um, and then you tell the parents that, right? Yes. We tell the parents this. Right. And then, um, and then the teeth do not need to be, they're not together. They're about a little two to three millimeters apart. So, they're not clenched and they're not wide because the lips have to be together. So, the jaw has to be resting. Teeth close, but not together. Lips closed. And, um, tongue in that position. And then, for eight through your nose. There you go. Okay. Yeah. Well, yes, you're right with the parents. I would describe that place. Let them feel it. If they hadn't heard of the term incisive papella, I would use that. Um, and then I would explain, typically, explain to the parents the reason why we are working on this with your child is because the tongue needs to be positioned at rest in a very efficient place for it to move and go into the sounds that for the tongue to change shape and, and I tell them all the consonants are made with the tongue making contact with the palate or the roof of the mouth. And so, it needs to be close. The tongue needs to be close to that space so that the sounds all will be crisper and clearer when we're practicing them. Okay. Okay. All right. Yeah. And, and I agree. I agree. Um, I would, I would use the terminology that the tongue is up within the, where the teeth are. Yes, within this, what's not touching the palate, but it's certainly up within that dental arch. Exactly. That is the operating zone. That's where all the speech sounds are made. And so, yeah. Yeah. Okay. It's up there and it's resting. Um, and you don't want it to be in between the teeth. You don't want it, you know, the, if structurally now, if there's a structural issue and the tongue is too wide, the palate is narrow, it might have to be, you know, a little bit outside of that space that you're talking about the dental arch, but typically. Okay. Okay. All right. Do you ever say to the parent, um, you know, I'm just wondering where your tongue rests. Go ahead and close your eyes. Think about where your tongue is sitting. Is it on the bottom? Is on the middle? Is it on the top? Where's your tongue resting? Right. And nine times out of 10. Yeah. Going to be in the correct place. And then I'll usually follow up and say. Yeah. Johnny's tongue is not resting there. Right. Yes. Yeah. Yeah. And helper. Oh, it absolutely does. And it also helps if the parent's tongue is also not resting in that position. And you're having to teach the child because the first thing I do with the kids, oh, yeah. Right. I'll ask them. I'll say, what is your tongue touching inside your mouth? What is your tongue touching? And so I will ask them that in nine times out of 10, they'll be able to tell me what because when they look in there, like you said, feel it. And the most challenging times is when the parent's like, well, my tongue does the same thing as here. And it's like, okay, all right. So and then you definitely go into the reasons and explanation for the parent to, um, at the same time. So yeah, but you're right. It's okay. Yeah. Okay. Yeah. Okay. All right. Good. So the lips are closed. The time is up. The jaws gently relaxed. Okay. All right. Good. Good. All right. So that's kind of a description. It's in the speech zone. It's in the swallowing zone. So if it's resting down, it doesn't have to go, whoa, I'm going to go up and because we know it's not going to, it's just going to stay there and do its stuff. So it needs to be in that elevated position to really move consistently and comfortably and into the speech production and the swallowing production and that kind of thing. Okay. All right. Good. Good. Good. And as you call it that operating zone, the operating zone. Yeah. And we're not like operating, but we don't move. We're not going inside anywhere. Yeah. But zone. It's not great. It's an operator. Yeah. Yeah. Okay. All right. Good. Good. Um, let's see here. Okay. Hopefully things here. Tele therapy. All right. Somebody has a book. Yeah. Okay. Tele therapy. Good. Let's see if we can't cover some of that. Okay. All right. Okay. As we move along. All right. Are there any slides through this episode? No, there are not. No. There's no visuals. And you know what? I try not to actually because when it goes on like Apple podcasts and so on, then, you know, people don't have the visual. So, but I can say that Trisha has visuals in her books. And then also I have done a course or two on the oral resting posture for speech therapy PD.com myself. And there's always, you know, some handouts and things that go along with it. Yeah. All right. Good. Good. Good. All righty. Okay. I do have a quote here for you. And it is an oldie, but a goalie. And it's actually from 1998. Okay. And one of the points that I want to make, I was, I don't know. I was strolling through Instagram maybe a week or two ago. It was over Christmas break. And someone was saying that, you know, we're working on resting postures because, you know, people, you know, they didn't do resting postures, you know, a long time ago. And I'm saying, uh, yeah, they did because I, I, I did it a long time ago. I'm an old timer. Right. And resting postures has been around in long time. And, um, in fact, Dr. Fletcher, Tar, I'm going to divert just a little bit. Yes. But Dr. Fletcher, Tar, in 19, it had to be 1969, 1970, was when I was in college. Yeah. Well, nobody can do math. So never mind. It doesn't matter. I can state that. Nobody is going to understand how old I am. Sure. Um, but a rate, Dr. Tar had written a little book on the oral resting posture. And so I learned about the oral resting posture back in 1969, 1970. Oh, that's even before the IAM was formed. Right. Okay. And so that's when I learned about the oral resting posture. Oh, and I've, they go, why this is, you know, it was kind of interesting. And I delved in. There was a few articles and things on it, but not much at that time. So that I went off to Western Michigan University. And I was telling everybody and, you know, talking about the oral resting posture. And everybody's going, "Huh, what's the oral resting posture?" So even at Western Michigan University, with Charles Van Riper, they had never heard of the oral resting posture. So, but anyway, I have a quote here. And then, um, Trisha, I'd like you to sort of bounce your ideas off of it. If you agree, if you disagree, but it's from Landess in 1998. Okay. All right. Helping an individual optimize their static, which is an interesting way of putting it, their static oral resting posture facilitates achievement of fluid, efficient, and economic movement patterns needed for accurate and fluent speech. I love that quote. Did you get it? You got it? Yes, I got it. Okay. Static, achievement of fluid, efficient, economic movement. All of those things. Yeah. Yeah. What do you think? What makes me think is that when the time is resting, it's really not just at rest. It's not, not doing anything. And one of the things that I would hear from parents and could then explain what happens with the resting, because there's this like the muscles of the tongue are keeping themselves, they're like actually working even though they're at rest at that time. And so I would explain, so the parents would say, say to me, well, their tongue is too big for their mouth, or their tongue is lazy, or it's floppy or something like that. And I would explain how having the tongue resting and having the muscle contracting the little tiny contractions that happen, that that actually helps with that little bit of toning or endurance ability with the tongue. And I said, trust me, you're going to see that after they habituate and get the tongue resting posture, the way the tongue position that we want it to be for the rest posture, then what you're seeing is not going to be so apparent anymore because it's going to have more tone. And it's really cool to see that. So that sticks out of me with that quote. What do you think sticks out for you or the other gut I didn't mention? Economic movement. Because of the sides touching the little bit, the edge, yeah, the edge of the hard palate, but mostly it's touching the sides, the insides of the top back teeth to one degree or another. And that economic movement comes from primarily comes from a couple of different things. But primarily the sides of the tongue anchor to the side teeth as the front part of the tongue moves. And then as it moves to the back, the back of the tongue elevates. Speech is vertical, the front part of the tongue moves vertically, the back part of the tongue moves vertically. And it moves in refined small manners according to landis and according to you and me, Trisha, right? Ignorantly. Small, 80-bitty movements, we can only have to because you have to fit it all in, go articulated speech, via the points of stabilization. So the one thing that we didn't mention regarding the positioning and the, I'm going to say anchorage and bracing. Yeah, I was just thinking about this. Yeah, tell us. So what the bracing, the gik, is that you think about that stuff? Dr. Jek. Yeah, yeah, yeah. Jek, yeah. And on active tongues are braced. And it's that lateral, the back lateral, I do the stabilization for mobilization because if it's not stable, stabilize like that, then the tongue's just going to go like this. There's no vertical. And it just, it's going to, does refined movements and efficiency. It plays for both of those. Right, exactly. You've got to have the lateral margin stabilization, which in research, they call it bracing. And this has been around for a long, long time. Right. It's been, you know, the the palatography. Oh, is this going to lead it telegrams? Yeah, yeah, the palatography. All of that, excuse me, all of that has been happening for decades. And there comes Dr. Jek. And he has done some amazing research. And he is saying that exactly what he is, what you said, that when the tongue is moving during connected speech, that the sides of the tongue are primarily braced against the top side teeth. To one degree or another. Right. For tees, there's more anchorage. Right. And then, yeah, are for an SH, there's more movement. Right. And so you get less anchorage and less bracing. Right. But that bracing is that positioning is acquired by generating what? Trisha, the rest posture. Got it. I mean, that that's why it's so important to speech. Exactly. It's huge. Huge. And I'll be all of because and thankfully we have written words to prove that to us and studies to prove that to us because it yes, it is the it's everything. It is. It totally is. And, um, you know, I'm sure that there are a lot of people that think and, you know, I did for a while that think that, hey, I'm just going to get a get a tongue depressor. And I'm going to touch the sides of the teeth. I'm going to touch the sides of the tongue both sides. Then I'm going to have the match. And then they're going to just figure out, you know, the tongue is going to go there. And they're going to be able to make their, you know, teas and teas as an SHs and CHs and and all of that. And then the back side with the Ks and the Gs and the R all of that. Yeah. But you know what? If the tongue doesn't live in that operating zone, it's not going to do it. It's not going to elevate to get its bracing. Right. Free and absolutely. And it also makes me think to the piece about, they haven't talked about the child yet. Yes. And except for the resting part, but like the ability, you know, for that stabilization and and to happen, there has to be the jaw has to be able to differentiate from the tongue as well. So go, oh, so the tongue has to be able to and the jaw has to be out separate. But the tongue can't separate from the jaw, then you're going to have a problem as well with the way that the sounds work. And that's when the tongue just stays low in the mouth instead. And you're trying desperately to get it to come up just for the sounds. No, that's not going to work. It has to be bracing up there from a place to start for that. Right. Yeah. And familiar with that elevated zone. And you know, I've told my kids that hey, that tongue is going to learn to live in a whole new room. And if the tongue is down, you know, you want it up here. And I say, look at that space up in there. That's a good space to park your tongue. You know, it's just waiting for your tongue to elevate and to get up in the top there and and to sit kind of out of the way, waiting for speech to happen. And it's right in that zone. Yes. Yes. Yeah. When I was explaining this to the little one. So, and my private practice that would have kids that would be on my caseload and then the moms would bring the little siblings. And so I would like, we could tell that the siblings were also very interested in what their older siblings were doing. And also maybe had the same open mouth posture, mouth breathing as their older sibling had. And so I started trying to help the the kids, the little younger kids to help the even younger children. And in my books, I did these visuals of a mistone putting your head on the pillow to get that vertical or elevation. And then snuggling up like you talked about it being a new home. It's like I talked about it kind of like being the little place where she would snuggle to rest. So yeah, all the different ways we can describe this to kids and to make it click for them is super part of therapy. And we're taking them totally, totally. There's something I'd like to move into now. And then I do want to come back to the therapy techniques and so on that you use with preschoolers. And then therapy techniques that you use with the older kids and so on. But I also want to fit analysis in there. Analysis and therapy methods with the preschoolers. Can we move into that for a while. And you know, that's you've worked with a lot of preschoolers. I've worked with many, but not as a lot as as many as you have probably. Because I've done a lot with the in the schools elementary junior high, et cetera. Yeah. So what's your technique or strategies? Because sometimes you have to just strategize rather than just use your technique in in generating awareness of the resting posture and the positions of the lipsticks and jaw with your younger children. Yeah, it is it is challenging. It's you know, each age group has their challenges, right? Adults maybe not as challenging because their motivation is extremely different like they've got a lot of pain and they need to want to motivate. And they're in and out of therapy quickly if they're just trying to get new habits of what their tongue and lips and jaws are doing and nasal breathing. With the little ones, it's very easy to talk about what the lips are doing. Okay, so starting with the very visual with the lips and getting their mouth to close if they've done an open mouth posture getting their mouth to close. And then like one little strategy with that, they get their own little lip balm. And they get to like put it on their lips and then put their lips together. So in that way, you're working on two things. One is like the closing of the lips. And then as you talk about the endurance, the ability to keep them closed. So closing the lips and the competence of being able to keep them that way and endure it. So the little kids kind of like that because they especially the little girls they're like put on their lip balm, that kind of make it fun for the guy, the little boys too. That was one of the ones I was thinking of. And then with the preschoolers, a lot of young age, I really a lot of them maybe are still sucking their thumb or their fingers. And so talking about that with the parents or with the kids to like explain to the parents that anything in the mouth for a long period of time keeps the tongue down and it's going to stay down there because it's not going if the tongue's down most of the time if not going to just elevate and become resting on itself. So you have to so eliminating the oral habits if there are, which there are a lot. And one of my favorite, I pulled this out because one of the favorites books is that remember this oldie, but goodie, it's some helping the thumb sucking child. So I would have with my preschoolers, all of the parents, I would have them get this book and from the library or whatever and read it and start to kind of implement a little bit that. So I find that that's really helpful and then you can start moving into the part of like putting mistong on her pillow as I talked about before. Use a lot of visual aids, which is where my books came out of from this is using the visual aids with the kids because you have to make it fun and playful because they don't understand or like why do I even care about this? I don't even understand why should I even care and it's like, you know, rather than nagging, keep your lips together, keep your lips together, you have to make little fun activities for them. Even the school-aged kids too. Let's see what else would I? About analysis. I mean obviously we can see if if lips are open or closed, if it's chronically open or if they are chronically closed or if they're actually doing both, sometimes I'm gonna say it's 50/50. So lips are pretty easy as far as analysis. Also though sometimes you, you know, there are like four-year-old kids that have been then, you know, lowering their jaw for a long period of time and that generates, you know, the lack of use of the upper lip and so you get that sort of attention of the upper lip, lip and competency. So you can kind of see that and just see if they can actually get their lips together. But tongue, how do you do that with the kids? I mean if the tongue is sitting and it's forward, their jaw is lowered, hello, okay, that's a dead giveaway. But what if their lips are closed? I know that we cannot assume that just because lips are closed that the tongue is up. No, no, no. Right. So between watching what their tongue is doing during an articulation assessment. So when I would assess them, watching them, even if I was doing a phonology test, a Goldman Fristo or any of the articulation tests that you can do videotaping and watching back or watching men to see what the tongue is doing because you can, if we use, when I, we're taught to use our ears during evaluation as speech language pathologists. But a lot of it is about using your eyes, like what do you see? Do you see the jaw scooting around sideways when the kiddos are talking? Do you see the tongue moving like this? And so using your eyes and videotaping. Now it used to be a big deal to try to videotape and then, you know, record it and then play it back and now you just have the phone and you just, and yeah, so just like having the kids see what their tongue is doing. When they watch their own tongue on the video, they're like, I said, see, you know, did you see that? And so I think that's a good part of analysis and, and like I have this little sheet that I put together and I've talked about it with, with carolins about what I kind of do these notations about what I see the tongue doing. If it's coming forward, if it's coming down, and then honest going to, even the four year olds, you ask them, what is your tongue doing right now? When your mouth is closed, they'll tell you, they'll say, it's on my bottom tea, it's down in my mouth, it's against my top tea, or they'll say, it's not touching anything. And so that thing is just kind of hanging in the middle. Just, I call it the floating tongue, where it's just like, it's not little, it's not, where is supposed to be? It's just kind of hanging out. Yeah, yeah. So then, I mean, I asked that question to every, every three year olds, and I shortly, I will use like the visuals with them, like I'll have this, and where the tongue is like, show me, you know, show me where you're tough, close and feel, and I get them to like, like you said, close your eyes, tell me, because you can't see if their lips are closed. And they'll tell, and they'll tell you, they really will be able to tell you if you just, yeah, if they have the cognition, yeah, or they'll indicate or, yeah, or if you get a model and, yeah, maybe they can show you with their hand, yeah, kind of thing, yeah. Play dough, doing it with play dough. There we go. That is, they will, yeah, all of that. Like, you know, so that's, that's really with the preschoolers. Okay. Okay, good, good, good, good. Yeah, and the jaws of dead give away. Yeah, you know, if it's, it's, I mean, the position of it. And, um, you know, if it's lowered, and usually if it's lowered, then usually obviously the, the lips are going to be a part of the tongue is probably going to be down, and maybe forward, just due to gravity. So, yeah, so the, the tricky one is when the lips are closed is the tongue up. And I'm going to say chances are that it's not. And I do know that between the age of two and five, there is a great deal of development going on as far as awareness of the tongue being on top, because we are told in the pre-feeding book. Right. That, um, you know, that swallowing happens on the roof of the mouth at two. And so, you know, there's, there's some elevation there, some vertical movement of the tongue. Is it consistent? It is it consistently in resting posture by the age of three? We don't know. And that's kind of a concern of mine, is that we really don't know. But my guess is that there is a developmental period that happens, that it kind of accumulates over time as speech develops. And I'm going to say if you had that three-year-old that hasn't earned, that chances are really good that that tongue is on top. Right. Not all way at all. Did you have a three-year-old with great articulation? And I would love to, you know, to do this research on it. But, um, you know, find out if that tongue is in a good resting position, I would suspect that it is. I have a feeling that the low-tongued resting posture kind of goes along with that articulation development or our tick that doesn't develop. Not always. Not always. I think that it's cognition. There's other stuff that I'm going to say in general. What do you think about that? Well, I think that's absolutely spot on. It really, it makes sense. And isn't I'm thinking about some part of like the jaw development and the separation of the tongue and the jaw in there and when it's like, yeah, that's so it completely makes sense. And honestly, like my books, what, how my mistone book came to be, because I was working with a very bright three-and-a-half-year-old, almost four-year-old. And, and in the session, we were talking about the tongue and, and a little bit. And, um, when I talked about her putting her head on the pillow and just trying to rest, just starting with the tip for, because he's like, young, right? And, uh, because he was, the tongue was tighter and needed to rest. The mom was like, this really hit it and she kept texting me. Like, I've been talking about the tongue on the pillow and he loves that and he's like, the stomach of me and he'll be like, so I was like, okay, you know, just like, and I kind of drew it out for him and I showed on me and like, I think. And he went quickly with it because he was just on the cusp of like, being able to do that developmentally. So that makes a lot of sense. Makes sense. Yeah. It was a little sibling, right? You know, of, yeah. Yeah. I love that. And I love your books and, and, you know, I'm, I'm a proponent. I mean, it's just nice visuals for young children. And, and I'm going to say even like kindergarten first grade. Oh, yeah. You know, definitely. I mean, cause like, yeah, I have the, like the sooner we can get the kiddos to be having healthy oral functions, the better it's going to be for them. It really is. Of course. Yeah. No, that, and you have, so you have one, um, you know, tell me which books you, I know you have one for the nose. Yeah. So there's, I have it right here. So there's Mr. Knows learns, learns to breathe. And that's like, he has a secret suture power that helps him breathe because he does breathing better than the mouth. It's, it's, it's better for, um, so the lips asked the mouth to close. And then the lips learned to stay together. So that's just these two literally go hand in hand. And then so does then this time, learns to rest in this. And, um, let me show you a visual of the, this is one of the pictures. So I had a, a colleague, she's, um, well, she's a speech language pathologist. She was in grad school when she was drawing these for me, but I love this little one about the lips looking at the lips and the mirror. And then look, the kids get to try it themselves. You know, what is your, what are your lips doing? So, um, and then another one about Mr. Knows to dance. And this one is about the tongue kind of being stuck in a range of motion with the tongue, but it's also great for jaw and tongue differentiation work. So Hannah, towards though, like tongue release and tongue, um, stop tongues, but also is just movement of the tongue. It has a little, she does a little dances. So that's kind of fun. The kids really like this one. Yeah. Yeah. Fine. I love it. Good for you. Good for you. And, and I am going to say, um, oh, okay, my children's book, um, that you work on a tongue thrust. Yeah. So a tongue thrust is a tongue thrust swallow. I really call it that now. Sure. What do you call the tongue thrust? It's kind of a, yeah, I, you know, and I, and I don't, I'm thinking maybe Peggy means, you know, for a tongue thrust swallow, but typically when you have a tongue thrust swallow, it's moving on the horizontal plane. And the tongue isn't elevated. So I would say that probably, I mean, if they're breathing through their mouth and they can breathe through their nose, then I would say that the nose when it's important, that the tongue when it's important, right? Um, just to provide a nice foundation, right? And that's the function of swallowing. Yeah. They all, they all kind of, it's interesting that you would ask this because like the tongue resting, you know, where, where the tongue rests is where it does its job or its function. So if it's resting forward or not, right, then you're going to have that tongue thrust swallow. So mistongling seroths would be great for that. Um, and then, but if the lips are open, like you said, I want to do the lips in the nose book. Um, so yeah, so that's, and there's another one that goes this e-book that goes with mistong wounds to rest. It's mistong's resting adventures. So it talks about all the activities that the kids can do. Um, while they're doing those, they can keep their tongue resting. So okay, and there's a question. Did you see the question? Because you just mentioned, Shelley is asking, is there, and is the new e-book going to be in French as well? You know, thank you for asking that. It will be because there is Mr. Nose resting, well, Mr. Nose adventures and the lips adventures. So when those, yeah, when that's all together, we've, we've thought about doing to front for that. So yes, um, thank you for asking that. Yeah. Um, we did most of the e-books were for, um, international customers, but that one just, yeah, got started and I just need to have them drawn. Okay. Okay. All right. Good, good, good, excellent, excellent. Okay. Well, you know, and we really haven't talked about the nose and working on the closure and all of that, but, um, you know, this will kind of transition us, especially into oral, oral resting posture and analysis and all of that. But let's focus a little bit on the nose and the importance of the nose and then therapy with your older kids and you're okay. Okay. Yeah, great. Because the analysis I think of it's, it's interesting because like nasal breathing is a function and it's, it's like it's part of the rest posture because if you have correct rest posture, then your nose is able to be the main breathing apparatus, right? Hopefully, hopefully, otherwise you're in trouble. Okay. Otherwise you're in trouble. Yeah. I'm not going to do the lip closure unless I know for sure that they have good nasal patency. Absolutely. So here and as the analysis, one of the first things to do is see if the kiddos can sit with their lips closed and breathe through their nose, try 90 seconds, then time to time. Right. And then try three minutes. Whoa. Whoa. You're tough. You're tough. Yeah. Yeah. I would, I would try and get him to go for 30 seconds. Yes. That's, that's that's good. I mean, it's starting. Yeah, for 10, 10, 10 seconds. Oh yeah. It's hard for some kids. Yeah. Yeah. Yeah. You're exactly right. And here's the thing. If they can do this, if they're mouth breathing and they can go for the 30 seconds, then this is just a habit. Most likely it's just a habit that you could help shake and change if they can't for after five to 10 seconds and they're panicky and they just can't and they just can't do it. That is red flag. We need to, you know, talk to the parents, talk to the however in the schools that you can do. It's like there might be something got structurally or blockage could be allergies, right? Could be don't try this analysis when the kids comes in with a stuffing nose because that's not, you know, that's not going to work. Yeah. It's not going to work. Yeah. Yeah. But if they're stuffing nose all the time and they do have allergies, then you're not, if that can't change without possibly intervention, then you're kind of, you can work on tongue posture for the sounds, but habitual nasal. Yeah. And you know, I always tried to determine kind of on my own. I mean, I don't have a scope and I don't look up noses. But, you know, I, I, I have been kind of surprised with the number of kids that just have no clue how to blow their nose. Oh my gosh. I used to, I had to teach this. Me too. I know. I'm like, I didn't sign up for that. But yeah, what was your method? Oh my goodness. I looked at, I had this video of these kids doing it online. It was a little video to write. And I just sat here. I'd literally, would this send this video to the parents and have them watch it. And it was like, oh god, what was it? Like, um, I can't remember now how what the first step was. It's been so long since I've done it. What was yours? Um, well, if it's an, you know, like a, you know, kindergarten or older child that will sit relatively still. Um, and then I know I give them a tissue and they just go and throw the tissue away and nothing happens. Right. Um, it's then basically, you know, I like to have a nice big mirror on the wall so that we can have two chairs looking. Yes. And then I will, you know, side by side. And then I'll put my arm around that child. I'll have gloves on. Yes. Okay. And have a tissue over here. And then, um, I mean, we talk about this first and whatever. But with this hand, I have this going this way so they can't open because they want to try and open their jaw to blow through here. Blow through their mouth. And so I want to try as best as I can, you know, to keep that jaw elevated, closed, you know, that kind of so that we are getting some, um, exertion there, you know, going through the nose. Yeah. So, I mean, I would blow my nose in front of them. Oh, yeah. We talked about it. And, you know, all of that kind of stuff when the rubber meets the road, then we would go through that process. And yeah. And it's not like, oh, yeah, I know how to blow my nose now. No, no, you have to, it's a process. It's a, it's a, it's a learning process. Um, I mean, it's so worth it because if the kid can breathe through the nose, then you can close lips and you can get the tongue up and you can get bracing. And hey, you're often running. Otherwise, you're just sort of dead in the water. Yeah. Yeah. Most of my situations and the, in the private practice too, when I was doing this was like, like allergy related and you need to be able to blow your nose and, you know, help with that because it would help to do that before you try to do some work in the session, just to kind of get at least the, the immediate out and then throughout the session. But yeah. Yeah. Yeah. Yeah. You know, and it's, it's, um, well, let me start with this as far as therapy for the older child and just kind of go through what I did to, um, to begin to establish some kind of awareness of air going through the nose. And what I noticed with some kids was that not always did, did they have this extreme nasal blockage and so on, but they were so used to breathing through their mouth. Right. And when you breathe through your mouth, you are getting a larger volume of air. Then you do with your lips are closed and you're breathing through your nose. There's, there's, um, you know, you could, and you're getting a lot of air in at a short period of time. When you're breathing through your nose, it kind of just sort of wafes through and you have this little, I call it a ribbon of air, little ribbon of air that goes through your nose and it's much more relaxed. Okay. And so I think sometimes the kids are like, yeah, because it's not relaxing for them because it's new and different and new and different. That big space. Exactly. Right. They're still trying to get that volume of air that they can get through their mouth. They're trying to get it through their nose. Right. And so you end up with that Bernoulli effect. Remember that's that Bernoulli effect? Yeah. And so I would, you know, kind of act, try to acclimate them, close the lips, picture in your mind, even close your eyes, picture in your mind, just a little ribbon of air going through your nose, and just try and put a, put the break on that volume of air trying to get through it once. So that I would actually train nasal breathing. Yeah. And that's, yeah. I mean, it, again, it's a, it's a learning process that's not immediate, but I'm going to say it happens pretty quickly. Yeah. And I agree. When it's, when it's possible, it does. And, and like using the humming as the activity of humming, and you do like three to, you know, three to five seconds of humming, and then repeat it. And like, if you like do, I would do twinkle, take a little star, and you know, you have to, yeah, yeah. And then blowing bubbles, blowing bubbles. If you, I have my straw, so I can talk about this. If you have the kids, blowing bubbles in a cup of water. So not blowing bubbles like the other, but blowing bubbles with the straw. Okay. If they keep their lips closed around the straw, blow out, you have to use your nose to blow them up the next time. All right, we're using it to breathe in through your nose, then out through the mouth. Exactly. And so they get the end, so they get used to breathing in through the nose, because, but if they're not, if they're not keeping their lips closed around the straw, then they'll just go, they're cheating. Exactly. Yeah. Okay. Yeah. Okay. Can you do it? Yeah. Yeah. Okay. So that's, that's, that's one of the ones. And they, you know, they love to blow bubbles. You did a little bit of soap in a glass and just do that and just keep your teeth on the straw. And then, yeah. Yeah. You know, I could see in the real, the old, you know, stuff that we all used to do with cotton balls. Oh my gosh. Yeah. Yeah. You know, even with a straw, maybe a larger one or whatever, so they'd have to blow a little more firmly. And, and keeping the lips wrapped around. Otherwise, if lips come off to breathe in, up, then I win. Yes. Yeah. That may be. And the one thing, as far as analysis to with the, the nasal breathing that's super easy, I was forgetting to talk about this. You take a little cosmetic mirror or something and you put it underneath the nose and have them blow out and you, I think, the people call them the frosties. You see, right? And you can also see if it's even or not. And yes, like if there's one side that completely isn't showing any frosties, you're like, okay, we've got a lot exactly. And the kids kind of, but also just to use that analysis, but also during so nasal breathing. And they can see them. Exactly. There you go. The yours and then they, you know, your own little mirror and their mirror. Right. Right. So yeah. Yeah. You know, that's a nice visual of nasal airflow. Right. Right. The frosties. Yeah. That makes a little sense to me. In the Mr. nose book, I tried to get different pictures of the nasal breathing, like talk about their little ribbons, right? There's a little ribbons. And then I think there's another one where I had more. Oh, yeah. This one has it where it goes in and out. I don't know if you can see, but it says in and out for it to teach the in and out, because I separate breathe in good job, breathe out, and then in and out. Okay. Okay. Good. Good. All right. So talk with me about therapy. Okay. So do you want to hear about like the school age? Yeah. Let's do school age. Let's do elementary junior. Really? Yeah. Middle school. Yeah. So all right. High school. A lot of times with like the junior high, it's really the it's easy for them to conceptualize what you're talking about. And as far as what to do with the tongue, what to do with the lips, what to do with the nose, use very inexpensive props to like like a popsicle stick to have them put between their lips. This is too wide, but between your lips to help them when they're doing a quiet activity. Remember, but just by tactily feeling the lips closed and just adding more times that they would do that. The most important thing is just fitting it into their life. Like say you've got a group of kids and that you're working with in the therapy session. And we want them all several of them to work on tongue rest posture position, tongue position, lip position, nasal breathing, whatever. While they're taking turns, everybody when they're quiet can have that popsicle stick between their lips and then you're working with one child on the sound and everyone else is resting there doing their oral rest posture. That works great in a group. Yeah. And you might want to consider using a twisty tie, you know, like, you know, for, and you can get them by the thousand bite Amazon for, you know, for just, you know, short, just a little bit of money. That's what I like. I like the twisty tie because if lips do open and you have a craft stick or popsicle stick or a small size tongue depressor and it falls on the floor or whatever. I'm not big on sticking it back in the. Yeah. And so that twisty tie will stick on the lips. Yeah. And it's thinner and on is visible. Yeah. So that I kind of like kind of like doing that. That's like the breadcabs. Exactly. Well, as far as taking out the twisties. Yeah, the smaller, the longer ones, yeah, that you twist around. Yeah. Yeah. Um, what about, um, if you have someone that just cannot elevate their tongue up to the roof of the mouth and, and the alveolar ridge, what if you just can't get them to do that? What are some ways to, to generate that position? I kind of like to, to do, to divide therapy into, let's get the position and nail that at the position. And then we'll work on the, the transferring of it, the carryover piece. What about the positioning? Okay. So about tongue position. All right. So you're saying they can't do it. Uh, correct. They can't get there. Yeah. And they'll do, I've, I've had a gazillion kids like, Oh, but you're done up here. And take a look. There you go. Yep. And you know, it's up there on top. And they go, Oh, okay. Yeah. Yeah. Yeah. Yeah. Mm-hmm. Yeah. Okay. So, uh, assuming that physically, it can stretch up to that point, right? We're assuming we just physically can't. Okay. Right. All right. So I, one of my, I like to use, um, I like to use, uh, cues like physical cues, or cues. Um, some of the time I would have, um, saw a tiny little, uh, piece of, uh, cake decoration or little tiny, um, I'll see you, uh, last sticks that you can get the dental elastics. You can get those for, um, little money, right? And you hang it on the tip of the tongue and have them like try to put that there, lift it up and hold it up there. If they can't do, the lifting, once you have that, um, it's on there, I would put, uh, a little bit of, um, marshmallow cream on the part of their mouth where the, the alveolar ridge for you would like them to go and have some sticks up there. Does it stick up there? Yes. I never use that. I'm not saying it's not good. I'm just, no, it's sick. It's amazing. It's like, you used it like peanut butter used to be like, but so many people are allergic to peanut butter. So yes. Yeah. So it didn't really couldn't even have it in my, my room. Um, so, um, marshmallow cream, it is like the stickiest stuff. Okay. It is so sticky. Okay. And I would have that, I would put it up there, um, and have them, um, try to put their tongue on that. That is like one of the easiest cheapest, most fun. Um, okay. So, but oftentimes like we need to tell us stabilize the jaw for or put something to, I keep the jaw so that they can let their tongue up because trying to do the tongue and the jaw at the same time. So I would put, again, those, um, food grade popsicle sticks, tape them together, put them between the teeth to hold the jaw and, uh, just have to focus on just the tongue tip. Ah, a Cheerio. Um, yes. A Cheerio is right. Um, start with a Cheerio because it has a little hole in it. And then then move to something smaller because there's a little bit of height to that Cheerio, right? You're still losing a few millimeters of having it in that spot. And sometimes I would throw some kids off, but Cheerio's great for like put it on the tip and go, right? Yeah. Yeah. And I would say, or maybe on the blade because we want that whole tongue to go up, right? We don't got tippy tap or is this, or you're starting off with just the front tongue elevation and then you're going to elevate. Is it? Yes. Are you producing? Because it's so difficult. Well, I was thinking of the most difficult kid of just getting the tip up there is very hard and then because you're having to hold something or press or you put a little bit like the Cheerio be good for that or put more of the, the little bit of the marshmallow cream and then do it a little bit further back and say they have to or just okay, press and hold it and then you're going to have a little more of the blade. But I'm thinking like literally there is no ability to even get the tip up. Yeah. And then okay, great. Good. Good. Good. Yeah. Oh, lie. Okay. Yeah. I think that was our last question. What about a Cheerio? Yeah. I hate to say this. Where did our time go? Gosh. Oh, yeah. I know. It's the top of the hour. I just, you know, I thank you everybody for being here. I just appreciate you being here. Thank you so much, Trisha. Very informative, very practical. Thank you so much. And in closing, I just, I want to thank everybody for being here and continuing to get the word out about the speech link podcast and you'll be able to access this course again through speech therapy PD. You know, because there are a lot of ideas here, if you weren't able to take notes, you know, fast enough, you can watch it again. And also, if you desire, you can access the audio only version on most of the popular podcast apps. And thank you so much for your supportive comments and your good reviews. And Trisha, again, I just want to thank you so much. And to all of you, I hope that you realize, I hope hope hope that you realize how appreciated and how important you are or how important you are. Thank you for all that you do for your therapy clients. And we'll see you soon. Bye-bye.