Hello,

I was wondering if you could possibly help me. My six-year-old son has Moebius syndrome and recently had facial reanimation surgery. We have been doing TalkTools therapy for years and love it. We do a lot, from the Z-Vibe to Chewy Tubes to the horns! We have him try to follow the Z-Vibe with his tongue, but I can’t get his tongue to lift up. My question is: how can I help my son improve tongue movement? He has twelfth cranial nerve palsy, and his tongue has become so much stronger with therapy, but tongue tip elevation is still so hard for us. Any tips? Thanks so much for your help.

Danielle

Hi Danielle,

Here are some questions that may help us think about why he may be having difficulty. When we are looking for tongue tip elevation we need to know first if he has jaw stability, tongue retraction and tongue tip lateralization skills first; these are prerequisite movements we look for. If you are unsure of any of the terminology let me know!

1. Does your son get any lateral movement? If so is he getting lateral movement to both sides? What activities do you see this movement in?

2. Can he chew on his back molars and hold the food there? Do you see his tongue move toward the food as he chews? Does this look easy for him?

3. Can he drink from a straw with tongue retraction? (Or does he protrude his tongue forward)

4. Have you done the Jaw Grading Bite Blocks so we know that he has adequate jaw stability as well?

If you’d like to send a quick video clip doing some stimulation of his tongue I may be able to see something.

All questions that may help us get a “why” answer and maybe a plan! Also, if you haven’t already, you should read this article by Sara Rosenfeld-Johnson about Moebius Syndrome. I look forward to hearing from you and helping any way I can!

Renee Roy Hill, MS, CCC-SLP

Renee Roy Hill, MS, CCC-SLP has provided therapeutic assessments and program planning for adults and children with oral placement, feeding and motor speech deficits for over 17 years. She is the owner of Crossroads Therapy Clinic in New Braunfels, TX and a member of the TalkTools® speakers bureau. Renee has been an invited speaker for ASHA state conventions and has received specialized training in speech/oral-motor/feeding therapy, Apraxia, sensory processing disorders, Hanen Courses, NDT training, TAMO therapy and PROMPT. She is the creator of the TalkTools® Schedule Board Kit, co-author of Ice Sticks, and author of the TalkTools® Apraxia Program.

Meet her!

• February 10-11, 2017 in Pasadena, CA
• February 23-25, 2017 in Austin, TX
• March 3-4, 2017 in Mobile, AL
• March 18-24, 2017 in the Caribbean
• April 7, 2017 in Charlotte, NC
• April 28-29, 2017 in New Orleans, LA
• March 6-7, 2017 in Springfield, VA

For more details, visit TalkTools Event Calendar

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

Hi Lucy,

What you are mentioning is a common concern I hear from parents of children with Down Syndrome.  You are right to follow your instincts. Often we see children grind their teeth as a sign of jaw weakness and a need for sensory input. When I see patients who are often grinding their teeth we work on chewing on the chewy tubes frequently throughout the day. This will help with jaw strengthening and providing sensory input.  If you would like more information about how to do this and why, there are two video that you might find helpful: "A Three Part Treatment Plan for Oral Placement Therapy" and "Developing Oral Sensory Motor Skills to Support Feeding in the Down Syndrome Population.". Please let me know if you have anymore questions. 

We are always happy to help.

Thanks,

Liz

Hi TalkTools,

 

I have a new patient who is 2 years and 7 months old. His tactile system is not organized at this time. He has bit chunks out of his crib. I recommended the blue Chewy Tube to help give him the prop he is seeking; however, his mom said he throws it. He enjoys biting the red Chewy Tube. Should I recommend she allows him to use the red to chew in spite of it being a therapy tool?

 

I look forward to your response. Thank you for having a question based email account. It is such a beneficial service.

 

Amy

Hi Amy,

I would not recommend him chewing on the red Chewy Tube on his own. What I would recommend is having the mom do his chewing exercises that you recommend multiple times a day when he is seeking that input (ex: he will chew on the red Chewy Tube 6 times on both sides). I know it is a huge commitment on her part but this will help strengthen his jaw while giving him the sensory input he is seeking. I would explore other chewing items that he might like and let him control those, but not the red. 

I hope this helps.

Let me know if you have other questions.

Thanks,

Liz

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