Tagged "criteria for success"

Ask A Therapist: My First Time Doing An Eval

Posted by Deborah Grauzam on

Hi TalkTools, 


I have a few questions for the staff SLP. I watched the "3 Part OPT" videos and I can see how it generally walks me through the eval process but the language doesn't seem clear to me on the Assessment Form. Did I miss something?


It is my first time doing an eval. Here are my questions regarding how to do the eval:


1. For "Jaw Grading Bite Blocks", do I use ALL of the in the A, B, and C positions? Or just some or the last one?


2. for "Tongue Tip Lateralization", what does this look like? Do I start with asking them to swipe the inside of their mouth left to right 10 times and if they can't then use the tool? What do I ask the client to do?


3. For "Tongue Tip Elevation " I don't understand the criteria of 50 seconds, 1 time. What does this mean?... hold the tongue tip at alveolar ridge for 50 secs? What do I ask the client to do?


4. "TT Depression"- Where does the tongue go? What do I ask the client to do?


5. Same for "TT Up and Down"  - where does the tongue go? What do I ask the client to do?






Hi Carrie,

Great question!  The Oral Motor Skills for Feeding and Speech Checklist is not intended to “teach” you each section of the form but a place for you to write results, guide you through an assessment and then provide the information you would need to then develop a program plan for therapy. The form assumes you know each technique, or, have the resources to find the protocol for each exercise. The criteria for success listed is a reminder of what the final goal is to complete that activity or step (this is the part that so many, to include myself have difficulty remembering when you are new to using the protocols). You may want to consider looking into our next course, “Assessment and Program Plan Development” that would follow the 3 Part Treatment Plan. In this course we use this form for several different evaluations to help you become familiar with its use! I will answer your individual questions below, directing you to where the complete instructions for each of them are!  If you have further trouble don’t hesitate to email me!

1. Each Bite Block Height would be assessed at each level. For example, you would not move from Bite Block #2 Exercise A to Bite Block #2 Exercise B unless they have met the criteria for Exercise A and so on. These instructions can be found in the books “OPT for Speech Clarity and Feeding” “Assessment and Treatment of the Jaw” and included with the set of Bite Blocks.

2. There is a specific exercise outlined in “OPT for Speech Clarity and Feeding” using a Bite Block and complete instructions with the Tongue Tip Lateralization Tool. There are many steps to this activity to teach the client to lateralize the tongue tip to the lower back molar.

3. Yes, the final goal is that the client can hold the tongue tip to the alevolar ridge for a full 50 seconds, 1X. You will notice that in therapeutic practice we often request multiple repetitions of practice but it is not always the criteria for success.

4. This is another activity that is in “OPT for Speech Clarity and Feeding” or included in the instructions with the Tongue Tip Elevation Tool. 

5. The tongue tip will go to the same two locations previously practiced individually. These instructions are also in “OPT for Speech Clarity and Feeding” followed by a transition technique to teaching the /s/ sound once you have completed this activity!

Renee Roy Hill, MS, CCC-SLP

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Ask a Therapist: Straw Drinking Progression

Posted by Deborah Grauzam on

I recently purchased the straw therapy kit for my 17 1/2 month old daughter with Down syndrome. She was breastfed for the first year and we began transitioning to a straw cup around 9-10 months old. I also have kept the tip of the straw short each time. She does not have tongue protrusion and only occasionally an open mouth posture when tired or concentrating. We began using the first straw for two weeks without any issues. We are now on the second straw of the series. She seems to have no difficulty with it either, good lip closure and rounding, no leakage or spills. How long do I need to stay with the 2nd straw? She is actually capable of using the more difficult straws already also, but I realize there is a reason to progress through the straw hierarchy in order. When do you recommend advancing to the next straw if there are no issues? Do we continue the recommended order of the straws? Is there a minimum time for each straw despite no issues? Any advice is greatly appreciated. I am also working with our Speech therapist, but she does not have much experience in this area.

Thank you for your time.


Dear Robin,

Thank you for your question!  When beginning the straw drinking hierarchy, you can either begin at straw #1 or #4.  You are correct in making sure the child is only putting 1/4 of the straw in their mouth, this way the child is using good lip rounding and the tongue is retracted.  It sounds like you might want to try straw #4 with your daughter.  If she only puts 1/4 of the straw in her mouth, then you will not need to cut the straw (straw #1 and 4 are the only ones you can cut).  If she is putting more than 1/4 of the straw tip in her mouth then you will need to cut the straw to 1/4 inch above the first twist.  By straw #4 the tongue must be completely retracted in the mouth and the jaw is stable.  She will not be allowed to suckle on straw #5.  If you see a forward and backward movement of the jaw - then she is still suckling.

The criteria for success involves:

1.  No liquid leakage or air leakage between the lips.

2.  The jaw should be relatively still/stable, indicating jaw-tongue independent movement.

3.  Lips should be slightly protruded.

4.  The child is able to drink 4 ounces of liquid in 2 min or less.

If you give your daughter straw #4 - you will know if it is too hard - she will be struggling to suck liquid up - then you will return to #3 until she meets criteria.

I hope this helps and let me know if you have any further questions!

Monica Purdy

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