Ask a Therapist: Physical Therapist Question on Oral Motor

Posted by Deborah Grauzam on

Hi,

 

I am a physical therapist working in Early Intervention in NJ. I have a 12 month child that I suspect has an undiagnosed syndrome. She has very low muscle throughout. Her cognitive level is about 6 months. She cannot sit unsupported. She can imitate a play action. She is making very few sounds. Frequently sticks out her tongue, open mouth posture. She can only eat pureed foods. I called for a speech assessment and was told by the Speech Therapist that there is no evidence that Oral Motor Therapy can help her speech at this age. Is that true?

Thank you for your help!

 

Tal

 

Dear Tal, 

Thank you for your question.  My name is Monica Purdy and I am a speech and language pathologist that also specializes in oral placement therapy and feeding. There is a lot of research on oral motor and the effectiveness and evidenced based information. If you visit this page on the TalkTools website you will find articles that you can print off and give to the speech therapist. Many speech therapists assume when someone mentions "oral motor" that they are referring to exercises such as "tongue wagging" (moving the tongue from side to side outside of the mouth), puffing the cheeks, and/or elevating the tongue to the nose or chin (again outside of the mouth). These activities do not have any support and are not related to speech or feeding and should not be used. However as you know being a physical therapist you can address muscle function by working on stability, dissociation, grading, precision and endurance in order to help a client with feeding and speech intelligibility. At TalkTools we do this by using kinesthetic feedback or tactile cues to help a client achieve these skills. Many times we work on feeding because it is a precursor to speech and we can prevent speech sound distortions from occurring if we address the muscles in feeding.   

I hope this helps, if you have any further questions please do not hesitate to contact me. 

Monica Purdy, M.A., CCC-SLP

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Ask a Therapist: The Child Refuses Tools

Posted by Deborah Grauzam on

Hello,

 

My son was using TalkTools products since he was about 4 months old until he was 2 years old.

 

He is now 3 years and does not like them at all. Gets really mad when I try to use the chewy things, Z-Vibe or straws. He really does not want anything inside his mouth or to get his face massaged. 

 

Any recommendations?

 

Any other tools that are recommended for kids with Down Syndrome?

 

Adriana

Hi Adriana,

These behavior can develop as children get older. In my class on Autism, I describe many factors that can contribute to behavioral challenges, sensory-motor challenges and moving forward in therapy.

First and foremost a predictable schedule with built in rewards is critical. Rewards need to be very frequent.

Secondly many kids need a sensory warm up. Consult with an OT/PT that specializes in sensory integration. Whole body movement, massage, music and sensory methods may be helpful prior to oral exercises.

Finally, without seeing your child myself I cannot recommend specifics; however at TalkTools not only do we support our work, but the work of Pam Marshalla, Debra Beckman and Diane Bahr, all have oral motor programs. I suspect the program may be too routine, so adding some massages, feeding programs and a more reinforcers may do the trick.

Robyn Merkel Walsh, MA, CCC SLP

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Ask A Therapist: My First Time Doing An Eval

Posted by Deborah Grauzam on

Hi TalkTools, 

 

I have a few questions for the staff SLP. I watched the "3 Part OPT" videos and I can see how it generally walks me through the eval process but the language doesn't seem clear to me on the Assessment Form. Did I miss something?

 

It is my first time doing an eval. Here are my questions regarding how to do the eval:

 

1. For "Jaw Grading Bite Blocks", do I use ALL of the in the A, B, and C positions? Or just some or the last one?

 

2. for "Tongue Tip Lateralization", what does this look like? Do I start with asking them to swipe the inside of their mouth left to right 10 times and if they can't then use the tool? What do I ask the client to do?

 

3. For "Tongue Tip Elevation " I don't understand the criteria of 50 seconds, 1 time. What does this mean?... hold the tongue tip at alveolar ridge for 50 secs? What do I ask the client to do?

 

4. "TT Depression"- Where does the tongue go? What do I ask the client to do?

 

5. Same for "TT Up and Down"  - where does the tongue go? What do I ask the client to do?

 

Sincerely,

 

Carrie 

 

Hi Carrie,

Great question!  The Oral Motor Skills for Feeding and Speech Checklist is not intended to “teach” you each section of the form but a place for you to write results, guide you through an assessment and then provide the information you would need to then develop a program plan for therapy. The form assumes you know each technique, or, have the resources to find the protocol for each exercise. The criteria for success listed is a reminder of what the final goal is to complete that activity or step (this is the part that so many, to include myself have difficulty remembering when you are new to using the protocols). You may want to consider looking into our next course, “Assessment and Program Plan Development” that would follow the 3 Part Treatment Plan. In this course we use this form for several different evaluations to help you become familiar with its use! I will answer your individual questions below, directing you to where the complete instructions for each of them are!  If you have further trouble don’t hesitate to email me!

1. Each Bite Block Height would be assessed at each level. For example, you would not move from Bite Block #2 Exercise A to Bite Block #2 Exercise B unless they have met the criteria for Exercise A and so on. These instructions can be found in the books “OPT for Speech Clarity and Feeding” “Assessment and Treatment of the Jaw” and included with the set of Bite Blocks.

2. There is a specific exercise outlined in “OPT for Speech Clarity and Feeding” using a Bite Block and complete instructions with the Tongue Tip Lateralization Tool. There are many steps to this activity to teach the client to lateralize the tongue tip to the lower back molar.

3. Yes, the final goal is that the client can hold the tongue tip to the alevolar ridge for a full 50 seconds, 1X. You will notice that in therapeutic practice we often request multiple repetitions of practice but it is not always the criteria for success.

4. This is another activity that is in “OPT for Speech Clarity and Feeding” or included in the instructions with the Tongue Tip Elevation Tool. 

5. The tongue tip will go to the same two locations previously practiced individually. These instructions are also in “OPT for Speech Clarity and Feeding” followed by a transition technique to teaching the /s/ sound once you have completed this activity!

Renee Roy Hill, MS, CCC-SLP

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Ask A Therapist: 24 Year-Old Male With Severe Stuttering

Posted by Deborah Grauzam on

I am a speech-language pathologist in private practice. One of my clients is a 24 year old male with severe stuttering. He also has a diagnosis of mild cerebral palsy. His most noticeable dysfluent behavior is the inability to initiate speech due to blocks at the vocal fold level. Do you think any of the Talk Tools would help? Thank you!

 

Jody

Hi Jody,

According ASHA, most treatment methods for stuttering are centered around behavior; however there are treatment protocols that focus on breathing. This is true of Dr. Martin Schwartz who wrote Stutter No More in 1991 about the "Passive Airflow Technique". For this method  stutterer is taught to 1. Release air 2. Slow down the first syllable and 3. Intent to rest between verbalizations.

Since the goal of Oral Placement Therapy is to provide tactile cues for speech sound production, we would consider OPT tasks that specifically target phonatory control and diaphragmatic breathing if the client was not using proper airflow to support speech. Phonatory tasks such as the horn kit, spirometer or bubble tube could be tools that would assist improved speech breathing; however we would also be certain that we were using more specific evidenced based therapy techniques for stuttering. These methods alone would not directly facilitate fluent speech but rather assist you in the pre-requisite skills needed to engage in airflow methods.

We would try blowing with horns or bubbles or encouraging airflow of any kind on his hand.  Once we felt like he was able to coordinate his breathing and blowing we would then move to humming or adding the "m" sound. We would work on this very gradually.  

Please keep us posted on how it goes and let us know if you have any other questions.

Thanks,

Robyn Merkel-Walsh, MA, CCC-SLP & Elizabeth Smithson, MSP, CCC-SLP
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Ask a Therapist: Significant Tongue Thrust Swallow Pattern and Tongue Protrusion

Posted by Deborah Grauzam on

Hello!

 

I have a 13 month old with Down syndrome who has a significant tongue thrust swallow pattern and tongue protrusion. Her tongue is ALWAYS out of her mouth, far. Almost as if she is intentionally pushing it all the way out. She retracts her tongue when I place a straw in the corner of her mouth, place a puff on her molar ridge (and will maintain tongue lateralization for a short period), and when I place the elephant jiggler in her mouth. As soon as she attempts to control the puff with her tongue or swallow, her tongue pushes forward again. I can prompt her to retract her tongue at rest but it comes right back out. What else can I do? I only get to see her one time per month at this point. Mom sits in on sessions and carries over at home. Pediatrician and ENT have no concerns about size of tonsils; I have not observed them myself yet.

 

Aubrie

 

Hi Aubrie,

It sounds like you have been working really hard with this patient to address the tongue retraction.  Everything you are already doing sounds great.  I would add bubble blowing, horn blowing and chewing on the back molars (with cubes of food if able, z-vibe and the bite tubes). All of this will encourage tongue retraction in the mouth. The more you can work on the retraction the better.  

I hope this helps.

Please let me know if you have any other questions.

Thanks,

Elizabeth J. Smithson, M.S.P., CCC-SLP 

 

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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