Tagged "biting"


Ask A Therapist: Chewy Tubes for a one-year-old

Posted by Deborah Grauzam on

Hi!

 

I am working with a little boy who is about a year old, developmentally (orally) is around 8-9 months. I gave the family the yellow chewy tube to practice biting/chewing, in addition to desensitizing gag reflex--instructing them to use with close adult supervision. The caregiver reports to me that his pediatrician told her not to give him the chewy tube as it is "too advanced for him". My question: is there a particular age range for these chewy tubes? Is there any information I can provide this doctor to support the use of chewy tubes in the treatment of feeding for speech therapy?

 

Thank you so much!

 

Sarah

 

Hi Sarah,

I am sorry the child's pediatrician is not as accepting of the chewy tubes.  I have used the chewy tubes with much younger children so I am not sure why the pediatrician is opposed to it.  It might be worth calling and discussing with him.  Maybe giving him the website, blog link, and more information about it would be helpful.  

The only other chewy tube that you could try that would be easier is the red chewy tube.

Please let me know if you have anything else come up or have any other questions. We are always happy to help.

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: A client bites down on baby bottle

Posted by Deborah Grauzam on

Hello! 

 

My name is Yael and I have a patient who is 18 months, has low tone in the oral area, likes a lot of sensory input inside the mouth but won't suck on a straw or drink from a cup. He only drinks from a baby bottle and kind of bites down on it. How can I start working on his suckling skills so I can work with the straws and all the other tools?

 

Thank you!

 

Yael

 

Hi Yael,

I will give you a number of things to try and see what works for your patient.  I would work on providing a good sensory warm up with the Vibrator & Toothette, chewing on gloved finger, using the z-vibe, or red Chewy Tube (depends on where your client is with jaw strength). I would question if your patient has jaw weakness based on your description.  You can also try rocking the bottle in and out of the mouth to encourage more of a front/ back pattern versus the up/ down biting. Then I would try to use the Honey Bear with Flexible Straw to encourage drinking.  You will load the straw for the patient and provide jaw and cheeks support if needed. I hope some of this helps.

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

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: 3 year old with Moebius Syndrome

Posted by Deborah Grauzam on

You all have been amazing when I have asked for help with my students, so I have another question. I have just evaluated a 3 ½ year old who was diagnosed at birth with Moebius Syndrome. Although I have had difficulty finding information about this syndrome, I managed to find an article Sara Rosenfeld-Johnson wrote that was extremely helpful and plan to follow her recommendations. My main concern right now is that a Haberman bottle was used to feed him, so now he clamps his teeth down on the flute and straw when I try to work with him. Is there any tool that is beneficial to inhibiting the teeth biting and promoting the normal suck and swallow and blowing? And if you have any other references for oral motor therapy related to damage to the 7th cranial nerve I would appreciate it. THANK YOU!!!!!!   Thank you for the compliment and the question.  I have worked with Sara and the Moebius population for the past 10 years and hope I can help with your question!

 

The clamping of the teeth is common since the primary problem we are working with is the inability to close the lips.  So this is very common with most of the children and adults we work with.  The key initially is to make the mouthpiece big enough to fit into the current lip opening.  To determine if this is even appropriate to begin, you need to know if the client has paralysis or paresis.  If you have seen any upper facial movement, flutters or twitches then you are looking at paresis and working on these skills may improve lip and cheek function.  Here is a basic outline of what you might do with straw and horn blowing; both a part of a complete oral placement program that would also address any deficits in jaw stability as you are trying to achieve lip from jaw dissociation (I can give you more information on that if you would like):

1st:  Begin by using the TalkTools vibrator and trimmed Toothette (the vibration is the key) under the upper lip and in the cheeks to provide sensation to the muscles. This would be done for 1-2 minutes and therapy activities would then follow.

2nd:  Horn Blowing:  Measure the lip opening when the child is in a resting lip posture, or if possible, trying to close his lips on command.  You may begin with Horn #1 if they have the breath support and skill but also may want to start with the Alex Tub Flute (TalkTools has begun carrying them but you will need to check availability).  This horn is easier to blow and has a wider mouthpiece.  If you use Horn #1, wrap the tip of the horn in medical tape several times until the mouthpiece measures the lip open position.  This will allow you to then support the jaw with your non-dominant hand and place the horn between the lips, rather than the teeth (the pre-requisite is that they know to exhale on command).  Using the TalkTools Progressive Jaw Closure Tubes is also helpful in teaching this skill.  As they meet the criteria, you can unwrap the horn mouthpiece one time and repeat until you have removed all the tape.  The lip, assuming there is the ability to gain movement will follow with practice.

3rd:  Straw drinking:  I would suggest starting with the Honey Bear with Flexible Straw.  There is a program Sara and I wrote several years ago called the Ice Sticks Program that has a technique using a syringe to teach a client to retract the tongue and swallow.  This same program can also be used with Moebius Syndrome with the goal of teaching the child to “slurp and swallow”.  You can use the Honey Bear following the same principles as the syringe technique to place the straw in the buccal cavity, squeeze and then tell the child to slurp.  You would need to ensure he is not biting on the straw (support with your non-dominant hand if needed) and that the tongue is retracted (you will often see the tongue protrude between the central incisors as an additional compensatory strategy if tongue retraction is difficult for them.  As they learn to “slurp” the liquid you have squeezed into the cheek, it activates the cheek, lip and tongue muscles, eventually leading to the child's ability to “slurp” the straw on their own.  There are several steps to teach this and I’m happy to share more detail if you need it as well!

I would also encourage you to visit the Moebius Foundation website.  Our past presentations should be available for you to view and may be helpful as well.

I hope this gets you started!  Clients with Moebius Syndrome are a joy to work with once you have the appropriate tools and starting point!  We’ve had great success with many individuals using these techniques!

Thank you,

Renee Roy Hill, MS, CCC-SLP

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Ask a Therapist: Biting and Feeding Improvement

Posted by Deborah Grauzam on

Hi and Good Morning!

 

I am writing from Israel, I have participated in your course that you have presented in November in Jerusalem. Thank Goodness I have been using many of your techniques to assist my clients and I have seen success.

 

Sara, I have an important question to ask regarding an adorable child, Charlie. I will describe Charlie and my results of oral-motor exam administered as best as possible so that you may answer us accordingly! Thank you for your time!

 

I have been seeing Charlie since mid February. Charlie is 3.5 years old. He is developmentally and cognitively delayed (has seizures). According to exam he is both hyper-hypo sensitive, he enjoyed the toothette (with orange juice) in his mouth- at home he constantly requests for the pink, fluffy toothette. He allowed me to go around his mouth and in the mouth after a lot of work. (The second session he only let the toothettes). Charlie's jaw, tongue and lips are weak, and there is not enough dissociation between jaw, lips and tongue. Little grading of jaw, needs jaw assistance to drink from straw #1.

 

Tongue thrust while drinking. Lip closure, protrusion, rounding is poor. Speech is limited to single syllable words (deletes sounds), or short phrases-he is not so clear. He is being treated by PROMPT therapist since he is 2 years old. I have given them a structured program including many tools you have taught (ice stickchewy tube, etc.). They have been practicing and carrying out exercises every day...he is starting to feel his mouth, they have seen a lot of drooling, sticking hands in mouth constantly and even so more, a lot of biting (siblings, friends). Parents are very concerned, they understand that the exercises will help him feel and strengthen lips, jaw and tongue, better speech and feeding. But, now there is excessive biting and touching of the mouth!

 

Sara, is this a normal occurrence?

Yes I do see this response when a child first identifies the positive sensory feedback from increased jaw movements. It is actually a positive sign but I can see why the family is concerned. I will make the following suggestions:

1. Make sure they are doing the Bite-Tube Hierarchy set with as many of the 4 tubes he can use, 10 times each day and to do them as soon as he makes the move to bite someone or touching his mouth.

2. Add the Bite Block exercise and the gum chewing exercise.

If you do all of these exercises, everyday, he will not need to bite. I hope this answers your question.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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