Ask A Therapist: Exercises to remediate speech lateralization

Posted by Deborah Grauzam on

Hi TalkTools,

What would you recommend for a 12 month old who is talking and lateralizes many of her sounds? Currently, she is drinking from cups, not sippy cups, she does nurse 1 time a day and is eating solids. She is using straw #1, and the lateralizations decreased, but when she moved to straw #2 they increased. She is also using the maroon spoon for the spoon feeding exercise. She is not on the horns or bubbles at this point. 

Thank you, 

Sandi

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Hi Sandi,

I would move her back to straw #1 where you felt like you were seeing more improvement on the lateralization. I would stay on that straw for a good amount of time and introduce the bubbles and horns while on this straw. Then work on transitioning to straw #2 once you are consistently using the bubbles and horns. I would also work on the apraxia shapes to try to get /m/, /b/ and /p/ sounds. See if this helps. Please let me know if you have any other questions. 

We are always here and happy to help.

Thanks,

Liz

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Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 11 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy.  She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask A Therapist: Bite Block & Tongue Depressor Questions

Posted by Deborah Grauzam on

I have a student who is using the red bite blocks. He just started. When I put the bite block #2 between his teeth he slides them over. Is this normal or should I reposition them?

I have another student who is having a very hard time holding the tongue depressor between his lips. He has a hard time dissociating between his lips and his tongue and jaw. His tongue is retroflex for l. He is currently working in l in the final positing of words and is having a hard time bringing the tongue forward and not back. Any advice?

Thanks

Rebecca

 

Hi Rebecca

I would definitely reposition. I often have to have the patient bite a couple of times until it is positioned correctly especially with patients with severe weakness. You may even want to practice the biting without the bite block for correct position first and then go in with the bite block. Sometimes that helps as well. 

As far as the second part of the question, I would make sure that I have addressed any jaw weakness first. That is typically the foundation of the issue. As far as the tongue placement I would work on stimulating with the toothette the forward placement of the tongue. I would touch with the toothette on the alveolar ridge where you want the tongue tip to touch and then I would touch the tip of the tongue with the toothette. You can use vibration with the toothette if your client will accept that. This has helped many patients I have worked with find the appropriate placement. 

Please let me know if you have any other questions. We are always here and happy to help.

Thanks, 

Liz

 

Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 11 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy.  She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask A Therapist: Persons with DS have larger tongues?

Posted by Deborah Grauzam on

Hi,

I work for a not for profit helping connect families to community resources. I just attended an appointment with a mother and 3 month old infant with Down Syndrome at the child's Family Physician's office. When the mother made the statement that she feels like her child is choking on its tongue and asked if this would change, the doctor told the mother that persons with DS have larger tongues and hopefully as her child grows his mouth would grow. 

​***This is just not true. Low muscle tone may make the tongue appear to be enlarged but tongues of people with a diagnosis of DS are not larger than the typical population. If this child is choking it may be secondary to low muscle tone, the insertion of the tongue, or inability to coordinate suck, swallow and breath. Starting a muscle based program from birth will make a difference. Feel free to look at the resources on the TalkTools website, particularly the DS feeding class, at this point.***​

The mother also raised a question about her child's head shape and if it would change (there has been a referral for a helmet consult and a request for referral for PT that the PCP does not want to make until after the helmet consult). The PCP told the mother that it may or may not change and the PCP associated the child's head shape with the child's diagnosis of DS. How can I better educate this mother about this? I am beside myself. Is there not information that states otherwise?

​***I am not an expert in head shape...however some babies with DS do have some asymmetry or a flat back of the head. I have had a number of babies on my caseload that have successfully worn helmets.***​

Lisa

Lori Overland, MS, CCC-SLP, C/NDT

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Ask A Therapist: Does Straw Therapy Help Accelerate Speech?

Posted by Deborah Grauzam on

My 2 year old (almost 3 year old) daughter with Down Syndrome is still having difficulty with speech. She has many signs, but her words are limited to ones such as "ball" and "book." I have asked her speech therapist about the Straw Kit. Her therapist does not seem to be in favor of anything other than traditional speech therapy. Does the straw kit help accelerate speech?

Also, her OT would like her to drink out of a cup. Which cup would be best, or is it best to continue with straws for now? Thank you!

Ana

Hi Ana,

Sorry to hear that your daughter is having difficulty with speech. I do believe that the straw kit is something worth pursuing.  I often work with children with another therapist in a situation like this.  One can work on traditional speech techniques and the other oral placement for speech production and feeding.  That might be something to think about.  The straws work on different levels of tongue retraction and lip rounding which are both movements used in speech production. I do find with my patients that speech comes faster with oral placement therapy.  As far as a cup I would recommend starting with the pink cut out cup.

Please let me know if you have any other questions.  We are always here to help.

Thanks,

Liz Smithson

Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy.  She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask A Therapist: Task Analyzing Oral Sensory Motor Skills

Posted by Deborah Grauzam on

Hi Lori,

I have a 7 months old client who is a breast feeder. When trying to give her new things like applesauce, yogurt, etc. She makes the bolus but she doesn't swallow. What can I do for her to swallow, besides achieving lip closure? Specifically for swallowing. I hope you can help me. Thank you.

Rosy

Hi Rosy,

I wish it was as easy as just making recommendations for treatment ... but your treatment needs to be based upon assessment. You need to look at this child's medical issues (does this baby have respiratory issues, gut issues, allergies, etc? What is the primary diagnosis?), tone, posture and alignment issues (what you see in the body is what you get in the mouth), sensory system (is this a baby who has modulation, regulation or sensory discrimination issues?), oral structures (have you looked at the shape of the palate, the labial frenum, lingual frenulum, etc?) and then do a task analysis of oral sensory motor skills (you can task analyze any motor skill) to support safe nutritive feeding. Once you can target WHY this child is having difficulty managing purees, it will be appropriate to plan a program or to ask for suggestions for program planning. The two-day sensory motor class or the sensory motor feeding book may be helpful. Best,

Lori Overland, MS, CCC-SLP, C/NDT

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