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.

Hi Therapists,

 

What do I do for a 19 year old student with a severe underbite (a gap of ½ inch between top and bottom teeth) when trying to use the jaw stability protocol?

 

Thank you 

When you are working on the Bite Blocks for jaw stability and the Bite Tube hierarchy, you will want to make sure that you have optimal bite posture first. You will judge optimal bite posture from the back molars. From your email it sounds as if his under bite is structural rather than functional. In this case you will work with the bite blocks and chew tubes in his structural position. Unless he has orthodontic work you will not be able to change structure.

I hope this helps. Please let me know if you have any further questions.

Monica Purdy, MA, CCC-SLP

Hi Lori,

I attended your Feeding Therapy: Sensory Motor Approach 2 day course.  It was terrific and I’ve been implementing a lot of what I learned.  I’ve seen some progress already.  One of my students did such a great job drinking from a straw the other day! What an improvement from the liquid being squeezed into her mouth.  Now we have to work on transitioning to the classroom. ****Excellent! I always love to hear that!!!!****   Other students have been slower going and that’s one of my questions. 

One particular student is 14 years old.  She basically has a soft diet mostly consisting of sweet puddings and cakes with some fruits.  She manages those foods though she is definitely giving the OT trouble with self feeding and the behaviorist has suggested pairing eating with a pleasurable activity which is the IPAD.  So while she’s on the IPAD she will usually feed herself. 

She has a protruded jaw, her upper lip is pulled in, her tongue is bunchy and her cheeks are “puffy”.  Her teeth are a bit crooked and somewhat misplaced.  I’ve seen some nice movement and closure of the lips.  She also accepts the tongue massage.  I’ve tried the chewy tube and she will tolerate it in her mouth, but I haven’t seen any movement towards a bite.  That’s where I’m not sure what to do?  I model.  We have a mirror; I support her jaw but no change.  She bites on her shirt and a bib that she wears into school.  Any suggestions on how to move forward?  

****Well.....if you are working on straw drinking you really need to get cheek contraction, lip rounding and tongue retraction. You may have to focus on  a pre-feeding program before you introduce the honey bear. From your description of her puffy cheeks, upper lip pulled in, tongue bunchy.... she does not have the skills to successfully straw drink. THEN.... work corner to corner with the honey bear...one sip/one swallow !****

I have feeding objectives on many of my students IEPs.  I usually write the criteria as a level of participation because I’m not sure how else to measure the data for the IEP and don’t want to get myself stuck.  I’m also trying to track progress so I’ve developed a data sheet listing the exercises and how many times they have been done.  It seems ok, but I feel there must be a better way.  Do you have any suggestions regarding that?

****I work in many schools and it is amazing how different districts require tracking of progress. Some are so general....they are meaningless, and some get down to how many sips with lip rounding, cheek contraction and tongue retraction. SOOOO....I write my plans to develop the skill and let the schools figure out how they need to record data, and track progress. Sorry I can't be more helpful on that one...****

Wow, I guess I saved up a bunch of stuff.  I hope it is all clear.  I’ve been lucky to get to stay with my current caseload and I see oral motor and feeding therapy as a big part of our treatment  Any suggestions if you are able would be great.  I’d love to continue to learn more as I find this particular area to be really interesting and so important.  ****Good for you! It sounds like you have already done some nice work...and seen the progress your students are capable of making. ****

I look forward to hearing from you!  Have a great day. B

****Thanks again for the great questions!

Lori Overland****