In tongue tie, tongue motions are constrained in predictable ways - 
there is humping of the posterior tongue, reduced elevation of the 
midtongue (or the entire tongue if it's an anterior tongue tie), reduced 
lateralization of the tongue tip, and sometimes reduced extension of the 
tongue as the mouth opens.

If there is a neurological birth or prenatal environment-related issue 
(neonatal encephalopathy, mechanical issue from nerve compression, etc.) 
the tongue movements are likely to be weak and/or disorganized.

And some babies have both issues.
Catherine Watson Genna, IBCLC NYC

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