Tagged "Chewy Tubes"


Ask A Therapist: Bite Tube Compression

Posted by Deborah Grauzam on

Hi to TalkTools, I am an SLP who has taken the Three-Part Treatment Plan for Oral Placement Therapy course and am incorporating OPT into my practice. I greatly enjoy this as it benefits my patients! Thank you!

 

I have a question regarding the bite tube hierarchy. I want to make sure I know if a patient is using a full compression. It seems that on the DVD, Sara says that we need to hear the "clicking" sound to know that the red tube is fully compressed. Is this true or is it merely a matter of seeing that the patient did bite down? Also, is this true for the yellow bite tube as I am able to make a "squeaking sound" when I bite down? What about the purple and green since they are harder and no sound is emitted?

 

Also, I have read the article Oral Habits: Why They Exist and How to Eliminate Them. I am aware that we can make the bite tubes available (they can have unlimited access and control over the bite tube themselves) to those who use an appropriate motor plan for chewing (up and down movement.....no gnawing, jaw sliding or jutting). I understand that this will satisfy the need for Temporomandibular joint (TMJ) dysfunction stimulation, but have concerns that they will want to spend an inordinate amount of time chewing on this ....that it will take on a "life of its own", so to speak. How do you recommend dealing with this concern? Give them complete access to the bite tube or not?

 

Thanks for your response.

 

Holly

 TalkTools Blog | Ask A Therapist: Bite Tubes

 

Dear Holly,

My name is Monica Purdy and I am one of the instructors for the Three-Part Treatment Plan for Oral Placement Therapy course. First let me say I am pleased you are enjoying using OPT. It has made such a difference in my practice as well!

Regarding your question about the bite tube hierarchy, we recommend that when you do an evaluation you use a new chew tube. Often when the chew tube is new, you will hear a clicking or a sound; however this may not always be the case. What you do want to see is a full compression and a full release of the chew tube. As for the purple and green, you are right and will not hear a sound, but again you should be seeing a full compression.

As for your question regarding oral habits, you are correct. If the child is able to motor plan and chew in an up and down controlled manner, and if I am not using the chew tube in the bite tube hierarchy, giving the chew tube to the child is a good option for them to replace their oral habit. Typically children will chew until they get the input they need from the chew tube. However, if you are using the chew tubes in the bite tube hierarchy, you will want to do the chew tubes with the child in a controlled manner when you see the child doing their oral habit. You may also think about putting them on the gum chewing hierarchy, as this is a great way for the child to get the input they need to the TMJ.

I hope I have answered your questions for you. If you have any concerns or questions please do not hesitate to let us know.

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Ask a Therapist: Jaw Stability Protocol for Severe Underbite

Posted by Deborah Grauzam on

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 

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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

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Ask a Therapist: Unsupervised Chewing

Posted by Deborah Grauzam on

Hello, My patient was evaluated by you in June of 2014.  We are currently using the red chewy tube and yellow chewy tube in therapy and at home to improve jaw strength and stability. However, the patient is now seeking ‘input’ orally- especially with chewing, now more than ever before.  How can we support this sensory need without promoting undesirable skills like jaw sliding?  Is there something else she can chew on- unsupervised? Thank you!

The situation you describe is one I see with many of my clients.  Once the clients "feel" jaw mobility using the "Bite Tube Hierarchy" and are thereby receiving the needed temporo-mandibular joint stimulation for calming they often increase their need or desire to mobilize the jaw (seeking oral input).  The Bite Tube Hierarchy will eventually incorporate four tubes as described in the book, "Oral Placement Therapy for Speech Clarity and Feeding."  The goal of the tools is to give the needed stimulation to increase jaw stability so that the client will then transition that skill into feeding and speech thereby eliminating the need for the tool and the need to chew on non-food items.  For this reason I do ask therapists to not give these tubes to the kids as then they may use them with an inappropriate jaw slide or jut.

With that said, however, you do ask an important question, " Is there something else she can chew on - unsupervised?"  Since I do not know the name of your client I cannot refer to the Program Plan I wrote for her/him I can only list for you the additional options: Slow Feed for snacks, Gum Chewing (without swallowing the gum) and Jaw Grading Bite Blocks. Each of these therapy techniques is taught in that same book, "Oral Placement Therapy for Speech Clarity and Feeding."  In addition, they are taught in the class, "A Three part Treatment Plan for Oral Placement Therapy" which will give you the gestalt of why and how to work on muscle-based speech clarity deficits.

Our goal for anyone with jaw weakness and instability is to increase the skill so that the jaw can support the independent movement of the lips and tongue for speech clarity and feeding safety so that is why I am focusing on the therapy suggestions above.

However, I still have not answered your question.  There are many sensory tools sold by TalkTools and other companies that allow the child to hold the tool without supervision as they are not working on jaw grading but are instead focusing on sensory feedback.  They include the Star Vibrator, Chewy Tubes, and ARK products.  As long as you are not using the tools used in the "Bite Tube Hierarchy" your client can hold and chew on any of the other options.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Bite Tube Hierarchy for TMJ stimulation

Posted by Deborah Grauzam on

Dear TalkTools,

 

My son, David, is 4 years old and has Down Syndrome. He has in the last year started chewing on his tongue. I have tried giving him the P & Q to chew on and also the Gator Jiggler. The Gator works for a time and the P's and Q's do not seem to help at all. I looked on your website for potential ideas to no avail and was wondering if you have additional thoughts/ideas. We are a very oral family -- I chew on my pens (usually when I'm thinking), my two oldest daughters were thumb suckers until older, my 2nd daughter bites her nails, my 3rd daughter chews on her shoelaces...thanks for any ideas that you may have!!

 

Robyn

 

P.S. Sara has seen David informally the last two years at NDSC.

Hi Robyn,

I am so pleased you decided to email TalkTools with this question. I must say this tongue chewing is often seen in kids with the diagnosis of Down syndrome as well as with other children with low tone and associated muscle weakness. In my second book, Assessment and Treatment of the Jaw - Putting it all together: Sensory, Feeding and Speech, I devote an entire chapter as to why children with jaw weakness find these habits: tongue sucking is only one of them. Other kids choose teeth grinding, finger sucking, sucking on clothing, biting themselves or other, prolonged use of pacifiers or sippy cups and nail biting. What all of these "habits" have in common is the need for stimulation to the temporomandibular joint for calming. This is the joint where the bones of the upper jaw and the bones of the lower jaw meet right below the ears. This joint has more nerve endings than any other place in the human body. It is where we go to relax. In your email you mentioned you bite on a pen and your daughters bite on shoe laces or nails. The up-and-down movement of the jaw relaxes us and helps us to organize our bodies.

Because your son needs stimulation directly to the joint the two techniques you listed: P&Q and Jiggler vibrator are not giving him the correct input. The muscles that need to be activated are the masseter muscles and the tools you are using are not reaching those muscles.

We, at TalkTools, have developed many techniques to give this necessary TMJ stimulation. One which seems very appropriate for your son would be the Bite Tube Hierarchy, in which four tubes are used to not only satisfy the need for TMJ stimulation but also are used to improve speech clarity and chewing skill levels. The instructions for how to implement the technique is included with the therapy tools. There are many more options to substitute for the tongue sucking and these can be found in the book I mentioned above.

I hope this answers your question,

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Therapy Cards and Chewy Tubes

Posted by Deborah Grauzam on

Hi Sara, I am Jonathan's speech therapist, his Mom and I had a few questions for you. 1. When working with your therapy cards should we provide jaw support due to his jaw sliding or just stay on lower level cards that don't cause his jaw to slide until his jaw strengthens from the OPT exercises?

Stay on the lower level cards. As he progresses through the Bite Tubes and the Bite Blocks you can ​add higher level cards.

2. Is it okay for Joe to use the yellow chewy tube unmonitored throughout the day to replace his finger and tongue chewing even though his jaw may slide while he chews it? (The yellow tube causes his jaw to slide more than red).

No, those tubes need to be used only for exercises as stated in the program plan.  You can give him other tubes to chew on throughout the day.  TalkTools carries many other tubes for this sensory need.  Try one of the nubby ones as that may be just what he needs.

3. Is it possible his lower jaw pulls to the right during speech because of a structural issue and not muscle weakness?

I did not see any structural issue when I evaluated him in January so unless he has had an accident I would say no.  This sliding should be corrected as you progress through the jaw exercises.  It is only 4 months since I saw him and jaw weakness is a tough problem to correct. Give yourself at least one year before you start looking into other possibilities​.

Thanks for your time! These were questions concerns that come up during a conversation with mom.

Feel free to contact us at anytime

Sara Rosenfeld-Johnson, MS, CCC-SLP

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