Tagged "adult client"


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: OPT with Adult suffering from MSA

Posted by Deborah Grauzam on

Adult Speech Therapy

Hi!

I am a trained speech-language pathologist, working in Sweden. I have taken part of the video-based course in the OPT-method and have very positive experiences from using the program with my former clients in a children’s rehabilitation center.

Now I work with elderly patients, primarily suffering from stroke but also with a wide spectra of neurological diseases.

This week, I met with a patient suffering from syndrome MSA, earlier misdiagnosed as Parkinson's. My colleague have worked with his dysarthria inspired by the Lee Silverman-method, which had a mildly effect on his difficulties with controlling the airflow. I proposed that we should try the instruments from OPT as a complement which the patient felt very positive about.

Though the patient recently started to experience difficulties with chewing food I wonder if it would be appropriate to work with the bite-tubes? We are all aware that his condition will continue to progress and that he most likely will suffer from dysphagia, not far from now. What are your thoughts about training when the patient have a progressive disease?

Best regards

Hi, Your email was referred to me for a response as I have been using OPT with adults for many years and have seen significant progress in both stagnate conditions and degenerative conditions such as MSA.  I am so pleased you see the benefits of this work and encourage you to continue to implement the techniques with your adult clients.

As a matter of fact I have just completed my newest book on using OPT with adults and am hoping it will be available for purchase within the next 6 months.    
In the case of a degenerative disease the hierarchy of intervention would remain the same as would the criteria for success to progress to the next level in each activity.  The major change is that your goal will be to maintain function rather than to improve function.  That is not to say in the initial phase of the disease the client will not progress but as the disease progresses the gain will become first minimal, then only maintaining and finally reducing.  
 
As you are working with these clients be aware of their fatigue and do not push them higher than their highest level before failure in each activity during the therapy session or for daily practice.  
 
You mentioned you are using the Bite-Tubes and that is wonderful.  I would also suggest the Horn Blowing Hierarchy and the Straw Drinking Hierarchy if the client is approved for thin liquids such as water or juice.  You can begin the Straw Hierarchy with liquids and if the client develops a pharyngeal phase dysphagia you can continue to use the Straw Hierarchy without liquid.  Instead use twenty 1 inch cubes of paper.  Have the client use the designated straw to pick up the piece of paper, to hold it for 10 seconds and then to rotate the head to drop the paper.  Remember to rotate to alternating sides of the body to ensure symmetrical muscle involvement. This technique has proven to be very beneficial for clients as a maintenance activity as the disease progresses.  
 
I hope this has answered your question but if not please feel free to email me.  
 
PS:  I loved my time in Sweden and hope to return there some day to teach and visit with friends.       
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Ask a Therapist: Therapy Techniques for Adults

Posted by Deborah Grauzam on

Adult Speech Therapy

Hi Sara,

Do you have a course for adults yet? My Dad is 95, has experienced several TIAs, and I would like to be able to assist him in regaining his muscle functioning.

I also notice how many of the seniors have difficulty chewing and swallowing. I am a certified orofacial myofunctional therapist through the IAOM. I have several ideas, but when I saw that you developed a program, I am most interested. I didn't see any program listed as available?

Thanks for your assistance

Hi,

I have just finished my newest book on my work with adults and am in the process of creating a 1-day class on the subject.  It is not on video as yet but I will be offering it "live" at numerous locations this Fall and my book should be coming out within the next six months.  I realize that does not help you now so let me give you a few suggestions of how to work with your dad.

As you mentioned, many of the seniors do have difficulty chewing and swallowing in addition to having speech clarity disorders.  I have developed a program to address the oral phase of feeding and speech clarity which includes improved mobility in the jaw, lips, cheeks and tongue.  The two basic programs are:  Bite-Tube Hierarchy and Straw Drinking Hierarchy.

The straws can be used with or without liquid.  If your dad is able to follow directions then I would also include the Jaw Grading Bite Blocks in your treatment plan.  Each of these therapy tools comes with directions as I developed them with an engineer and have been using them for over 20 years with my adult clients.
If you decide to use these tools, please read the directions first and then contact me with any questions.
I hope this answers your question.  
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Ask a Therapist: SMILE protocol for Severe Diagnosis

Posted by Deborah Grauzam on

Hi,

I would like to know if your SMILE program would help someone who is not a tongue thruster but has other abnormalities like a restricted tongue movement because of extra frenulum material, a malformed tongue, and a cleft (somewhat repaired). In other words I already know that programs can reach a variety of patients. Mine is an adult with not only all of the above problems but has just had teeth implants top and bottom. Her tongue and its relation to the teeth, and cleft (nasality) are her problems. I listened to a recording of her voice before implants and it sounded somewhat more clear but not substantially.

Thank You,

Thank you for your question. If this client does NOT have VPI and the nasality is the result of the tongue tip being poorly elevated then YES. I have treated multiple clients with nasality issues because the tongue was low or the tip was anchored due to restricted frenum. What is very important is that the client has the mobility to execute the program. If there is a severe tongue tie surgery may be needed prior to implementation.

Thanks for your interest,

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