Tagged "Apraxia of Speech"


Ask A Therapist: Sound production roadblock

Posted by Deborah Grauzam on

Hello therapists,

 

My daughter has been working on TalkTools program since she was 3 months old. She bites well on chewy tubes (red and yellow), does her straw drinking and cup drinking. Here are my few questions:

 

1) My daughter seems to be drinking well from cup and does horn exercise well, but we have a hard time translating the horn exercise to "m" sound. Do you have any advice to encourage the "m" sound?

 

2) We feel like we are reaching a roadblock with her exercise because we cannot get her to make sounds that we want, i.e.: "mmm," "me," "moo," etc. She would round her lip but has a hard time saying "wooo" or "oooo". Is there any exercise we should work on to help with making those sounds?

 

Thanks a lot, we love your program a lot and hope to hear from you!

 

Jessie

 

Hi Jessie,

Thank you for your questions. I would try the Apraxia Shapes. They are great. They will help you with exactly what you were describing in both your questions. I believe that they will be able to bridge the gap for you. There is a video that you can watch to show you exactly how to use them and instructions that come with the tools.

Please let me know if you have any other questions. I am happy to help anyway I can.

Have a great day.

Thanks,

Liz

 

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: Tongue Retraction

Posted by Deborah Grauzam on

Hi,

 

I'm beginning to work with a 7 year old boy with Down Syndrome and Apraxia. For the straws, he protrudes his tongue under the straw. He also does this with the Honey Bear. His Mom says she has a verbal cue of "fishy kiss" which will help him to round lips, and tongue will retract.

 

He also does the horns. He mastered #1 today :) ! We're also working with chewy tubes. Red is great, compressions become weaker with yellow. Bubbles are still needing cueing with the blue apraxia tube to get the lips rounded. He has a lot of force, but his lower lip protrudes and elevates and all of his air is directed up instead of out. It's getting better.

 

Is there something else I should be doing to get that tongue to the right position for straw drinking?

 

Thank you,

 

Meredith


Hi Meredith,

Great question regarding tongue retraction. The straw kit will work on tongue retraction at different levels of the tongue. It is important to have your patient work through the whole straw kit to achieve the retraction. It is also important to note that he does not have to demonstrate tongue retraction with straw drinking until he reaches straw #5. I do think using the "fishy kiss" verbal prompt before offering the straw is a great idea to set him up for the right movement pattern on the straw.   As far as the bubbles, try using the toothette with vibration as a sensory warm up right before the bubble activity. This should help him to achieve lip rounding more at mid-line without the upward movement he is demonstrating. Then I would transition immediately to using the green bubble tube that comes in the kit for blowing bubbles. Attempt blowing bubbles with this tube and see if that helps. Please let me know if you have any other questions. I hope this all helps. Thanks,

Elizabeth Smithson, MSP, 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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Ask A Therapist: Client with Autism and Apraxia of Speech

Posted by Deborah Grauzam on

Hello TalkTools,

 

I am an SLP working with a four year old boy with autism and apraxia of speech. He has some significant drooling and is non-verbal. I completed the "Three-Part Treatment Plan for Oral Placement Therapy" on-demand course, but was hoping for some guidance from your Instructors.

 

He is the first child I've used Oral Placement Therapy (OPT) with, and we're working on the Drooling Remediation Program. He's progressing really well with the Chewy Tubes and the Straw Hierarchy but is not able to volitionally blow on Step 3 of the Bubble Blowing Hierarchy, nor is he able to blow for Horn #1 or hold a tongue depressor between his lips for any length of time.

 

He is able to produce the /m/ and /b/ sounds, but often not on command. He just recently began to show some lip rounding while producing a /w/ sound.

 

I did purchase the Pre-Hierarchy Horn and have been working on the ball/exhalation activities. Is there anything else I can/should be doing to help him with blowing?

 

Also, when he eats, he sometimes will chew the food, remove the bolus from his mouth, rest for a few seconds and then place the food back in his mouth and finish chewing/swallowing. Do you have suggestions on how to address this?

 

Thank you in advance,

 

Amber

 

Hi Amber,

I'm Robyn, a TalkTools® Instructor, and I will answer your questions the best I can without knowing the child.

I will start with the feeding issue first. This sounds like a self-stimulatory associated with the autism or an issue of bolus mobility. He certainly could have chewing fatigue, or perhaps cannot lateralize the bolus to where it needs to go to swallow it. You will need to assess this, and if needed, implement a pre-feeding program such as, Feeding Therapy: A Sensory-Motor Approach. If all is assessed and nothing is wrong from an oral motor perspective, I would work with the child's behaviorist on a regimented plan to keep his hands down and away from the mouth during feedings.

On to your OPT questions... Phonatory control and volitional blowing can be a very big problem with apraxia. The sounds the child is making can be reflexive in nature but not achievable on command. This is also a defining trait of apraxia. I would consult with OT/PT to start working on rib cage expansion, trunk stability, and core strength as prerequisites for blowing. For now, expose him to the Bubble Program staying on step 2 of the Bubble Hierarchy and practice placing Horn #1 in the mouth and taking it out for the lip closure motor plan. You may also model it for him with your own horn. I often sing, "If you are happy and you know it blow a horn toot toot" and place the horn in the lips when I say 'toot'. I also place children in a prone position on an OT wedge during this task. Immediately after drilling the horn, use the Apraxia Bilabial Shapes to practice the bilabials.

Good luck!

Sincerely,

Robyn Merkel Walsh, MA, CCC-SLP

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