Normal lip patterns:
Three normal lip patterns are lip rounding, lip spreading, and lip closure.
Lip rounding – The lips form a circular shape maintaining muscular tonal balance. This position is attained through easy, nonforceful movement. The amount of rounding can be varied as needed to obtain and maintain a seal around a feeding utensil, or to build up or maintain intra-oral pressure.
Lip spreading – The lips form an expanded horizontal line from the rest position, maintaining normal muscle tone. The position is attained through easy, non-forceful movement. The amount of spreading can be varied as needed to control substances in the front of the mouth, or to aid in drawing substances into the mouth.
Lip closure – The lips meet and touch to seal off the contents of the mouth from the outside. The position is attained through easy, non-forceful movement. The amount of contact and the area of contact can be varied as needed to retain substances in the mouth.
Normal Tongue Patterns:
Tongue movements are an integral part of the eating process. The following six normal patterns (suckling, simple tongue protrusion, sucking, munching, tongue tip elevation and lateral tongue movements) are presented in order from primitive to more mature patterns.
Suckling – The primary movement in suckling is extension – retraction. The tongue does not extend beyond the lips. Lateral movement is not observed. The tongue may show a semi-bowl shape (cupping). The tongue remains flat and thin. The movement is accomplished with normal tonal changes with rhythmical cycles of extension – retraction. Jaw opening and closing occur in conjunction with tongue movement. This is a normal but primitive pattern.
Simple tongue protrusion – This is a primitive, normal movement associated with the suckling pattern. The tongue extends between the teeth or gums. The tongue remains flat and thin with no abnormal tonal changes. (In the normal population, this may be called tongue thrust, especially by speech pathologists.)
Sucking – The tongue is flat and thin, movement is up and down and is contained within the mouth. The tongue tip elevates to the anterior hard palate. The movement is rhythmical, up-down cycles, with normal tonal changes. This is the primary pattern for adults.
The normal rhythm for nutritive sucking is one cycle per second; non-nutritive suck is faster or slower than that rate. A suck occurs with two kinds of pressure: positive pressure and negative pressure. Positive pressure occurs when the jaw elevates, the tongue elevates to the hard palate, and the lips seal. Negative pressure occurs when the jaw drops, the tongue moves away from the hard palate, the posterior cheeks contract, the soft palate elevates, and the lips remained sealed. More coordination is needed for the negative phase of suck.
Tongue tip elevation – This pattern emerges during suck. The anterior one-third of tongue raises upward to contact the upper teeth or alveolar ridge (gums behind upper teeth). It indicates separation of tongue and jaw movement. This movement continues to develop so that the tongue tip can reach the upper lip, even when the jaw is depressed.
Munching – The primary movement of the tongue is up and down with flattening and spreading. Lateral tongue movements are not observed during this pattern. Tongue movements are accompanied by up and down movement of the jaw for chewing and biting. This is a normal tongue pattern observed in early chewing. Food is positioned on the body of the tongue and raised upward to the palate to break up the food prior to swallowing. Soft, lumpy foods, ground meats, and foods that dissolve in saliva (such as crackers), are tolerated with this chewing pattern.
All of these patterns are normal, but do not involve any lateral tongue movement. The person cannot move food between molars for chewing. Since this is needed for chewing more viscous foods, s/he fails to move along the continuum of greater variety and separation of tongue, lip, and jaw patterns. The person is limited to a diet which does not require chewing and grinding, such as a pureed diet.
Lateral tongue movements – The tongue moves to either side, horizontally, to shift food from the center of the mouth to the side. Initially, the tongue may barely shift toward the gum. As skill develops, the tongue will contact the gum or molars. With more control, the tongue will move over the gums or molars. With continued development, the tongue will extend into either cheek. As skills develop, the tongue can move food from one side across the midline to the other side. As movements become more defined, lateral and tongue tip elevations are combined to allow sweeping/cleaning movements of lips, palate, and inside the cheeks. This allows particles of food to be gathered and positioned on the tongue prior to swallowing.
Normal Jaw Patterns:
The following normal jaw patterns are presented from less to more controlled. In normal development, these patterns do not develop linearly. In the same person, more mature patterns may be observed with easy to chew foods, (ex: a cookie) and more primitive patterns may be observed with harder to chew items (ex: steak). The primitive patterns do not disappear. More mature patterns are used with foods requiring grinding, while more primitive patterns are used with less viscous foods.
Close and hold – Jaw stability and strength are adequate to close around the item with normal muscle tone, but not yet strong enough to allow up and down jaw movement around the item. Do not confuse this normal pattern with tonic bite.
Wide jaw excursion – This early pattern is characterized by poor jaw grading in which downward jaw displacement is exaggerated, but not associated with abnormal tone. It is associated with poor internal jaw stability. It may occur during suckling, sucking and chewing. It is often seen during nursing, and then again when cup drinking is introduced. As the jaw gains greater internal stability, better control of jaw movement occurs with improved grading and wide jaw excursions decrease.
Phasic biting – This primitive normal jaw pattern is characterized by rapid rhythmical up and down movement of the jaw. No lateral movement of the jaw is seen. It may occur following stimulation of cheek, gums, or molars. It is usually limited in power.
Nonstereotypic vertical movements – In this beginning chewing pattern, the jaw moves up and down with easy contact and release. Only vertical movement has developed, so that only food coming between the teeth is broken up.
Munching – This early chewing pattern combines phasic biting and some nonstereotypic vertical movements of the jaw with tongue movement to the hard palate.
No lateral jaw movement is observed with these five patterns. A person with these patterns would not be able to grind up fibrous foods. Soft, lumpy foods and ground meats are usually the diet tolerated with these patterns.
Lateral jaw shift – This is a lateral (side to side) movement of the jaw with no downward displacement of the jaw.
Diagonal movement – This is a lateral, downward movement of the jaw to either side with easy contact and release. It aids in the placement of food between molars for chewing. There is no grinding movement, and no movement of the jaw across midline. It occurs in conjunction with vertical jaw movement.
Diagonal rotary movement – There is a lateral, downward movement with upward, horizontal sliding movements for grinding foods between molars. The jaw moves to one side or the other, without crossing midline. It may accompany lateral movement of food from the center of the tongue to the teeth.
Circular rotary movement – This is the most mature chewing pattern, with jaw movement laterally, downward, across the midline to the other side and upward to close. It may occur either clockwise or counter clockwise. It may accompany transfer of food from one side of the mouth across the midline to the other side of the mouth.
Normal Cheek Patterns:Normal cheek patterns include protrusion, retraction, and compression. The cheeks form the walls of the face. The cheek is composed of many layers of muscle tissue, inserting at many different angles. The cheeks assist in repositioning food in the sides of the mouth, in placing food between the teeth for chewing and in moving the food, fluid or saliva to the posterior of the oral cavity for swallowing. The muscles of the cheek assist with lip, jaw, and tongue movement. The receptors for swallowing are located in the posterior area of the cheeks, as well as on the gums, tongue and soft palate. Some of the salivary glands are located in the cheeks.
Hope this was helpful…and thank you again to Beckman Oral Motor!