Operant control of pathological tongue thrust in spastic cerebral palsy

Pathological tongue thrust (reverse swallowing) has been associated with neuromuscular disorders and linked to dental malocclusion, articulation problems, difficulty in eating, and excessive drooling. In this study, observable tongue thrust in a 10-year-old retarded male was modified during mealtime using a procedure consisting of differential reinforcement (presentation of food contingent upon tongue in) and punishment (gently pushing the tongue back into the mouth with a spoon). Results of a reversal design showed substantial decreases in tongue thrust and food expulsion, and a large increase in observed chewing. These data compared favorably with data obtained for other retarded persons not judged to be tongue thrusters; in addition, the objective results of the treatment program were substantiated via pre-post evaluations done by occupational and physical therapists. These findings suggest that operant techniques may be an effective means of treating tongue thrust and its associated problems, and that further development and evaluation of behavioral interventions may provide a desirable alternative to more intrusive surgical or mechanical procedures.