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!

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Hello!

 

I have a question about using vibration (as with the Z-Vibe or Vibrator & Toothettes). I understand that using vibration can be used to "wake up" the sensory system, and I believe I’ve heard that it can have a temporarily positive effect on low muscle tone. I’ve read that vibration should be used in short durations, but I was wondering if you had any guidelines for the maximum or minimum duration of vibration? I’m thinking especially in a case of low muscle tone as in children with Down syndrome.

 

Thank you very much!

 

Jennifer

Hi Jennifer,

My name is Lori Overland and I teach the two day sensory-motor feeding class for TalkTools. Your email was forwarded to me, and it is an excellent question.

You cannot separate out the sensory and motor systems. Sensory feedback always impacts movement and movement provides feedback. It is important to make sure you have a specific motor goal (i.e.: in the case of spoon feeding, perhaps the goal is lip closure). Vibration facilitates a contraction of the muscle, so it may be used in conjunction with a tool to facilitate upper lip mobility for spoon feeding. If you leave vibration on a muscle for too long, the muscle relaxes. If you are using my pre-feeding exercises, I recommend  4-5 repetitions (maybe a little more or less depending on my client's sensory system) of an exercise. If you think about your motor goal and map sensory on to motor, you will not have to be concerned about using too much vibration. Feel free to email me if you have a follow up question.

Lori

Hello. I am working with a 6 year old boy who shifts his bottom jaw when producing most fricative and sibilant phonemes. According to his dentist he does not have any structural abnormalities. When working with him he is able to keep jaw stable but it is not without effort and he has yet to generalize. I was wondering what tool(s) you would recommend for me to use with him.

 

Thank you.

 

Pamela

Hi Pamela,

It sounds to me like you may be dealing with some underlying jaw weakness and instability. If you have not seen the 3 Part Treatment Plan video or read the "Assessment and Treatment of the Jaw" book these would be great references. I would work on using the z-vibe with blue tip, and the Bite Tube Set (red bite tube, yellow bite tube, purple grabber, and green grabber).  Jaw stability is the foundation for speech and feeding.  If there is any weakness on one side or both sides these tools will help to correct that. Please let us know if you have any other questions or if anything else comes up.

Thanks,

Elizabeth Smithson, MSP, CCC-SLP

Hi TalkTools,

 

I have a question about using vibration (as with the DnZ-Vibe or Vibrator & Toothettes). I understand that vibration can be used to "wake up" the sensory system, and I believe I’ve heard that it can have a temporarily positive effect on low muscle tone. I’ve read that vibration should be used in short durations, but I was wondering if you had any guidelines for the maximum or minimum duration of vibration? I’m thinking especially in a case of low muscle tone as in children with Down Syndrome.

 

Thank you very much!

 

Riley

Hi Riley,

I’m Renee, a TalkTools® Instructor, and I would be happy to help you. This is an excellent question, I am asked this many times when teaching and working with clients!

You are correct, vibration can give the muscle more input and therefore often trigger a better motor response, thus “waking up” or “stimulating” the muscle to move. There are no specific “time” or duration guidelines for this. It is our responsibility as the therapist to look at the motor response while providing the input. So for some children with significantly low tone and an extremely under-responsive sensory system, it may take longer for the muscle to respond. But for a child who may have a better sensory system, the client may only need quick input 1-2x to see the motor response. It is important to remember what specific motor movement you are looking for and that the stimulation given is causing the appropriate reaction.

For example if I am providing stimulation to the lateral margin of the tongue to facilitate tongue tip lateralization to the back molars, once I see the movement, the vibration has done its job. Then I need to decide if my goal is repetitive movement using the vibration - leading me to possibly provide the input several times until I no longer see the tongue tip follow the stimulus - or possibly to quickly transition that movement to function (i.e. placing a cube of food on the back molar so the client then uses the movement in a functional way) which is my highest priority but sometimes not yet obtainable in my first sessions with the client.

Once I am sure of the goal of the vibration stimulation (what am I looking for in the motor system) it is easier to determine how long I should use it! The goal is always to eventually eliminate the vibration so that the movement is then stimulated through functional activities such as eating and speaking.

I hope this helps!

Renee Roy Hill, MS, CCC-SLP