Tagged "chewing hierarchy"


Ask A Therapist: Jaw Jutting

Posted by Deborah Grauzam on

Hi TalkTools,

 

How can I inhibit jaw jutting for Horn #1? We are working on the Bite Tube Set and establishing the natural bite with Bite Blocks but this child presents with frequent jaw slide or jaw jutting. Thanks,

 

Anne

 

Hi Anne,

I would provide firm jaw support to inhibit the jaw jutting. You can use jaw support for Horn #1 and Horn #2. Beginning with Horn #3 you would no longer provide jaw assistance.  I would be using the jaw support and gradually try to decrease use as the patient will tolerate. I hope this helps. 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.

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Ask A Therapist: Feeding Suggestions

Posted by Deborah Grauzam on

Hi TalkTools,

 

I was at the Feeding Therapy: A Sensory Motor Approach course Lori Overland taught in Manhattan this past January. I've been in love with using what I've learned and have even become a go-to feeding person at my school.  

 

I have a low-toned girl who has tongue protrusion at resting but can keep her mouth closed at times.  During all speech sounds, she produces with her tongue forward, and I am working on getting it back (have suggested use of straws).  Her teacher recently brought to my attention her difficulty with feeding.  

 

When observed eating eggs, fish, rice-softer foods with less crunch-her tongue weakness definitely shows. The food just pools in the front of her mouth until she eventually spits it out, because she can't swallow it. She turns her head to the side when chewing, which I'm assuming is her inability to dissociate her tongue from her head. With crunchier and longer foods, her teachers have done well teaching her to put it on the side. 

 

I would like to implement some of the tongue lateralization exercises as well as the chewing hierarchy for her. It seems she has so much trouble even just initiating a swallow. I appreciate any further suggestions you have, and if you have any idea how to explain why she's having difficulty with these softer foods. 

 

All the Best,

 

Lisa

 

Hi Lisa,

Thank you for your kind words about the feeding class. It sounds like you are doing a great job. Here are a few suggestions for you:

  • Check under her tongue to make sure she doesn't have a posterior tongue tie
  • Work on lateral tongue movement and the chewing hierarchy
  • Work on cheek mobility to help stabilize food
  • Use therapeutic feeding techniques at mealtime - she may be better able to swallow foods presented on the lateral molars
  • Work with her PT to establish a good seating position for feeding

Good luck!

Lori Overland, MS, CCC-SLP, C/NDT

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Ask a Therapist: Feeding Therapy Self-Study Follow-Up

Posted by Deborah Grauzam on

Dear Lori,

I just completed your "Feeding Therapy: A Sensory-Motor Approach" DVD. What an amazing course! It certainly gave me a great deal of confidence in working with children with feeding disorders. While it was extremely thorough and informative, I do have several questions for you. I would love your input!

1. When would you typically recommend an OT evaluation?  Or perhaps I should say,  in which cases would you not refer a child (with an apparent feeding disorder) to an OT?  ***Great question! I look at the whole child and ask a lot of questions about how the child moves through life. In my case history form I ask questions like: does your child get upset easily, does your child have difficulty calming, does your child have difficulty in new situations, transitions, separation etc, does your child have complicated routines for bed, bath, daily living activities, etc... During the evaluation I watch how the child responds to input in the environment. If I observe underlying sensory concerns (sometimes parents just think their child is challenging, or high maintenance and do not realize the behaviors they observe are secondary to sensory issues) I immediately refer to an OT. If the child seems to be able to self regulate, modulate incoming information (for everything but feeding) ....I would not necessarily refer to an OT immediately. I might start an oral sensory motor pre-feeding program and see how the child progresses.***

2. You spoke a bit about breastfeeding, and I was wondering, what role would a lactation consultant play in breastfeeding support if you are working with a nursing mother?  Would our job be the same as a lactation consultant's or would you ever refer the family to one?***I work with great lactation consultants. They are often the first ones to see the baby. They call me in when they observe oral sensory motor issues which are not related to the mothers milk production, bonding, positioning etc. If it is a mom issue...it is definitely the lactation consultants role to consult. If the baby has oral sensory motor issues....that is our role.***

I would also like to order some tools from your website for my practice.  I want to add the Mickey Mouse attachment, but I am not sure if I should buy the hard or soft one.  ***It depends on your child's sensory system...but overall I prefer the soft mouse*** When would you use one vs the other? ***If a child needs more input I would recommend the hard one*** And what about the cat?  I don't think you talked about it in the video, but I am curious to know when it should be used. ***I use the cat ears to get tongue tip pointing. For example, I may present the cat ear at the lateral incisor for chewing hierarchy level #3, and then alternate lateral incisors!!!!***

I really wish I was able to physically attend your course and get to meet you in person!  You are such an inspiration to me!!  Thank you for all of your incredible work. ***Thank you for taking the class on video, and I hope one day we will meet in person. I am doing a one-hour seminar at ASHA this year!!!! If you are there, please come and introduce yourself!!!!

My very best,

Lori***

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Ask a Therapist: Sensory Processing assistance with a client that has Down syndrome

Posted by Deborah Grauzam on

Hi Lori,
 
I am a speech pathologist working with Toddlers. A few years ago I attended your conference on feeding therapy. I haven’t had to use a lot of the techniques up until now, so I am a little rusty.  I currently have a little guy with Down syndrome who is not chewing a great deal. His mom told me that at home she is noticing a great deal of gagging and sometimes vomiting because of this. We have been trying different textures; however, nothing seems to be working. He is also pretty resistant to chewy tubes and allows them in his mouth for only a short time. He either lets go or will bite down and not let go. I have been looking at the chewing hierarchy, but tools are listed (e.g., z-vibe, etc.) that I can’t remember exactly what I am supposed to do with. Do you have any suggestions on how to target this or where to start? Thank you so much for your help. I appreciate it!
 

Hello and thank you for the questions.

As often occurs, I have a bunch of questions to start.

Does this little one have other sensory issues?  Is there an OT who specializes in sensory processing involved?  Have you made observations about what this little one is doing with his lips, cheeks and tongue (for purees, and for solids).

I would assume (based on the diagnosis) that you should probably be working on cheek mobility and bilabial closure for spoon, cup etc.  If a protrusion/retraction is the primary tongue movement, work on tongue lateralization.  Does the child tolerate vibration?  If so, use the vibe fine tip for the lateral tongue massage.  Try the vibe bite and chew XL head (looks like a yellow chewy tube) if he will not tolerate chewy tubes.  You may want to go outside the box and roll the tool from the lateral incisor to the first molar if this child does not like the tool on the molar ridge. By the way, I have just written a book which should be out in June if you need a review of the class (and updated exercises!!!!).

Best,

Lori Overland

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Ask a Therapist: Tongue Placement

Posted by Deborah Grauzam on

Hi, I am hoping you can offer a suggestion.

I am an SLP and see a 2 YO child who began sucking on his tongue and had a forward tongue posture before I started seeing him. Once I started working with him I had the family switch to straws only and eliminated the sippy cup. They did that and he continued to have tongue sucking behaviors. Now, he has switched to twisting/turning his tongue around his mouth and it is interfering with his speech sound productions.

I tried to introduce vibration to provide sensory stimulation, but he does not tolerate that in his mouth. I also gave him a chewy tube as a substitution and he will tolerate it, but it is not eliminating the problem.

Do you have any product suggestions? I would greatly appreciate it. He has no drooling, no muscle weakness, and no feeding difficulties. I have never seen a child do this before.

Thank you in advance for any suggestions or product recommendations!

I have a few thoughts on this to help you:

1. Make sure there is not a structural or physiological problem, for example enlarged tonsils and adenoids. If the tongue must be displaced forward for breathing for example it could start these odd habits. Look for a tongue tie.

2. The sensory-motor systems cannot be separated. Though you say there are no feeding issues, I suspect there may be some breakdown in oral-motor development. Look carefully at developmental norms. This will soon be available in the feeding book Lori and I wrote, or you can look into taking Lori's feeding class if you have not already. If this child sucks his tongue at rest, there may be similar patterns on the straw.

3. Use of chewy tubes and sensory motor activities are most useful when you work from the outside of the mouth to the inside of the mouth and the therapy is led by the therapist. So I would not recommend handing the chewy tube to the child, but rather follow Lori's pre-feeding Chewing Hierarchy.

4. Finally, for the tongue sucking, I would recommend tasks that work on tongue retraction. The TalkTools Straw program and TalkTools Horn program, when executed by the directions on the tools kits would be excellent, as would TalkTools Bubble Kit. If you wanted to learn more, we have self-study courses for each of these kits!

Thanks for your interest in TalkTools!

Robyn Merkel-Walsh

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