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.

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.

Hi Karen,

I would advise that you work on the Bite Tube Set starting with the Red Bite Tube. This will work on your client's jaw strength and as you work through the bite tubes you can revisit the bite blocks. You would look to see if he is later able to achieve the "natural bite" and "bite hold" required with the bite blocks. Please let me know if you have any other questions.

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.

Hi TalkTools,

I am working with a child with a very small mouth, and the Yellow Chewy Tube is still too big and too hard for him. What would you recommend I use with him instead until he can use that? Thanks.

Jennifer

Hi Jennifer,

I received your question regarding your patient with the very small mouth. There are two things that I would try. You could do the gum chewing exercise that is explained in detail in Sara Rosenfeld-Johnson's book Assessment and Treatment of the Jaw, page 115.  I would just use a small enough piece of gum to fit in your client's mouth.  I would also try to work on the Sensory Friendly Bite Blocks (Purple) and gradually work up from the smallest and see if this would eventually increase the oral range of motion for your client. I would then revisit the chewy tube and see if he is able after working on the other exercises.  I hope these ideas help.  Please let us know if you have any other questions.

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.

Hello,

 

I work in an inner city school with significant deprivation.

 

Many of the children have speech and language difficulties and when I wander into snack and lunchtime, many have immature eating patterns. Many have immature jaw and tongue movements, quiet voices and poor breath control.

 

I cannot hope to work with all the children directly.

 

I have keen K/1 teachers who would like to help.

 

I am pulling together some activities for the teachers to do with the class - songs, movements, etc., taken from voice TalkTools® and other sources. I want to include activities for respiration, phonation, resonation and articulation.

 

Has anyone tried to do this already?

 

Any pitfalls you can anticipate for me and the teachers? Any pointers?

 

I do use TalkTools® already with some students and I am finding an increasing need.

 

I am planning on doing a short pre- and post-screening possibly based on the SMILE book.

 

Many thanks,

 

Sarah

 
Hi Sarah,

First of all I admire you attempt to help so many children in need.  It is so difficult to not have availability to work with everyone one-on-one.  I think if I had to pick on thing to work on, it would be jaw strength with bite tubes because it will help in all the areas you mentioned. Horns would also be a fun rewarding task which would focus on respiration.  The challenge that I see would be not being able to monitor where they are placing the tools in their mouths, which is what makes it therapeutic. I would try to work with a different child each time to make sure they could feel where the tool needed to be and how they needed to breath or chew. Placement and form is very important.  You could watch the group as they perform the task and give verbal feedback.

That being said, I encourage you to consult your school's Speech-Language Pathologist first for advice and mention the procedure above, and only then follow their recommendations. You could work with them as a facilitator but are not licensed to practice Speech-Language Pathology yourself, as a teacher. If there is no Speech-Language Pathologist on duty at your school, consult your state association for support.

Looking forward to hearing back.

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.