International Journal of Physical Medicine & Rehabilitation
Open Access

Sensorimotor Rehabilitation as a Functional Approach to Ankyloglossia Management

Cassie Robert^{* *}Correspondence: Cassie Robert, Department of Rehabilitation Sciences, University of Toronto, Toronto, Canada, Email:

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Description

Sensorimotor rehabilitation in ankyloglossia occupies a crucial yet frequently underestimated role in the comprehensive management of tongue-tie. Ankyloglossia, defined by a restrictive lingual frenulum that limits tongue mobility, has traditionally been approached as a primarily anatomical concern. Surgical interventions such as frenotomy or frenuloplasty are often viewed as definitive solutions. However, growing clinical experience and functional research indicate that restoring anatomical freedom alone does not guarantee normalization of tongue function. Sensorimotor rehabilitation addresses the functional and neurological dimensions of ankyloglossia, recognizing that effective tongue movement depends not only on structural capacity but also on sensory feedback, motor planning and learned movement patterns.

The tongue is a highly specialized organ with dense sensory innervation and intricate motor control, playing a central role in speech, swallowing and oral posture. In individuals with ankyloglossia, restricted movement during critical developmental periods alters the typical sensory experiences of the tongue. Limited elevation, lateralization, and protrusion reduce tactile exploration within the oral cavity, leading to diminished proprioceptive input. Over time, the nervous system adapts to this constrained environment, establishing alternative motor strategies that allow basic function but deviate from typical movement patterns. These adaptations often persist even when anatomical restrictions are removed, underscoring the need for rehabilitation that targets the sensorimotor system rather than focusing solely on mechanical range of motion.

Sensorimotor rehabilitation aims to restore the bidirectional relationship between sensory input and motor output. In ankyloglossia, this relationship is frequently disrupted, resulting in inefficient or poorly coordinated tongue movements. Individuals may demonstrate excessive jaw involvement, asymmetrical tongue motion, or delayed initiation of lingual movements during speech and swallowing. Rehabilitation begins by reawakening sensory awareness within the oral cavity. Tactile stimulation, graded resistance, and guided movement exercises help reintroduce the tongue to a wider range of sensory experiences. These inputs enhance cortical representation of the tongue, allowing the brain to more accurately perceive position, pressure, and movement.

Restoring accurate sensory mapping is foundational for effective motor retraining. Without clear internal feedback, attempts to modify tongue movement often rely on visual or external cues, which are insufficient for the rapid, automatic demands of speech. Sensorimotor rehabilitation emphasizes internal awareness, encouraging individuals to recognize subtle changes in tongue position and contact. As sensory discrimination improves, motor output becomes more precise, reducing reliance on compensatory behaviors that have developed in response to restriction. This process is particularly important in individuals who exhibit paradoxical articulation or atypical swallowing patterns, as these behaviors are deeply rooted in altered sensorimotor integration.

Tongue posture at rest is a critical yet often overlooked aspect of sensorimotor rehabilitation. Many individuals with ankyloglossia develop a low resting tongue posture due to chronic restriction, which influences muscle tone and movement patterns throughout the oral and facial complex. A low resting posture can perpetuate inefficient swallowing, imprecise articulation, and orofacial imbalance. Sensorimotor rehabilitation addresses this by gradually retraining the tongue to adopt a relaxed, elevated resting position against the palate. This shift not only improves muscle tone but also provides continuous sensory input that reinforces proper tongue placement even outside structured therapy sessions.

Motor planning and sequencing are central targets in sensorimotor rehabilitation. The tongue must execute rapid, finely timed movements during speech, often transitioning between complex shapes and positions within milliseconds. In ankyloglossia, these sequences are frequently disrupted, leading to delayed or poorly coordinated movements. Rehabilitation strategies focus on slow, deliberate practice that breaks complex tasks into manageable components.