ENDEAVOUR SECTION: TOTs and Speech: What You Need to Know!
Robyn Merkel-Walsh MA, CCC-SLP, COM®

As we have learned from Mills et al. in 2019, frena are dynamic structures comprised of collagen fibers and fascia. When ankyloglossia is present the tethering of these fibers may restrict normal tongue movement resulting in functional implications. Ankyloglossia often referred to as “tethered oral tissues/TOTs” and is often the cause of disruptions to the orofacial complex known as an Orofacial Myofunctional Disorder (OMD).

OMDs are also associated with speech sound errors such as an interdental lisp and /or abnormal lingual dental articulatory placement for /t, d, l, n, ʧ, ʤ, ʃ, ʓ/ (ASHA, n.d.). It seems logical that if a tongue cannot move freely, that the movements required for speech sounds may be impacted resulting in atypical or compensatory oral placements, yet it has been suggested that individuals with a tongue-tie can compensate for limited range and speak with alternative articulatory placements.

Clinicians working with Speech Sound Disorders (SSDs) often note a correlation between tongue-tie and speech errors, but this is controversial, and therapists are left confused on which assessment tools and treatment methods are evidence-based. Robyn will discuss possible correlations between SSDs and ankyloglossia, provide an evidence-based review dating back to the 1950’s, and will discuss SSDs in tongue tied speakers and the clinical implications for assessment and treatment.

Robyn Merkel-Walsh, M.A., CCC-SLP, COM ® is a Licensed Speech Pathologist and Certified Orofacial Myologist® with 29+ years of experience in the state of NJ. She is employed full time by the Ridgefield Board of Education and runs a private practice in Ridgefield, NJ. She is a lecturer and author for TalkTools®. She has been elected NJ Kids Top Doctors in 2012, 2013, 2014, 2018 and 2023. Robyn received both her undergraduate and graduate degrees from Montclair State University, where she was later invited to be an adjunct/clinical supervisor. She also taught classes at Bergen Community College, is a former clinical site coordinator for Seton Hall University and is currently an adjunct at Brescia University. She is the Board Chair of the Oral Motor Institute and serves on the Board of Directors for the International Consortium of oral Ankylofrenula Professionals. She is the proud recipient of four ASHA ACE Awards and the Ridgefield Woman of the Year 2019 in Business. She is on the faculty of The Breathe Institute and is currently a student in the Vocology program at Lamar University.

1 CE credit available to AAPMD members