Tagged "early intervention"


Ask a Therapist: Physical Therapist Question on Oral Motor

Posted by Deborah Grauzam on

Hi,

 

I am a physical therapist working in Early Intervention in NJ. I have a 12 month child that I suspect has an undiagnosed syndrome. She has very low muscle throughout. Her cognitive level is about 6 months. She cannot sit unsupported. She can imitate a play action. She is making very few sounds. Frequently sticks out her tongue, open mouth posture. She can only eat pureed foods. I called for a speech assessment and was told by the Speech Therapist that there is no evidence that Oral Motor Therapy can help her speech at this age. Is that true?

Thank you for your help!

 

Tal

 

Dear Tal, 

Thank you for your question.  My name is Monica Purdy and I am a speech and language pathologist that also specializes in oral placement therapy and feeding. There is a lot of research on oral motor and the effectiveness and evidenced based information. If you visit this page on the TalkTools website you will find articles that you can print off and give to the speech therapist. Many speech therapists assume when someone mentions "oral motor" that they are referring to exercises such as "tongue wagging" (moving the tongue from side to side outside of the mouth), puffing the cheeks, and/or elevating the tongue to the nose or chin (again outside of the mouth). These activities do not have any support and are not related to speech or feeding and should not be used. However as you know being a physical therapist you can address muscle function by working on stability, dissociation, grading, precision and endurance in order to help a client with feeding and speech intelligibility. At TalkTools we do this by using kinesthetic feedback or tactile cues to help a client achieve these skills. Many times we work on feeding because it is a precursor to speech and we can prevent speech sound distortions from occurring if we address the muscles in feeding.   

I hope this helps, if you have any further questions please do not hesitate to contact me. 

Monica Purdy, M.A., CCC-SLP

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Ask A Therapist: Therapy Scheduling

Posted by Deborah Grauzam on

Hello,

 

I recently attended a TalkTools training and have a question about how to implement the therapy. Specifically for children under the age of 2, what are the frequency and length of your sessions? Do you schedule weekly standing appointments, or do you schedule as needed to reassess after the child has made progress?

 

I have some clients interested in this therapy, but am not sure how I should schedule them.

 

Thank you,

 

Anna

 

Hi Anna,

​In the ideal world, we should like to be able to see these kids weekly for 45 minutes sessions. At these early ages the parents need support in feeding skill development, and their children are changing so rapidly that you do not want large gaps between sessions. As you know, once the child starts using an incorrect placement it is very difficult to correct. Also, starting at 12 months we introduce the Horn, Bubble, Bite-Tube and Straw Hierarchies which need constant monitoring​.

I would not choose your second option as to scheduling as progress is made, as that means the parent is responsible for determining when the progress is seen. I find those first 2 years to be critical to prevent or at least limit incorrect placements for feeding and speech.

I hope this answers your question but if not, please let me know.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Feeding Issue with child that has Beckwith Wiedmann syndrome

Posted by Deborah Grauzam on

Dear Lori,

My child who is 2 1/2 years old was diagnosed with Autism and Beckwith Wiedemann at 1 1/2 and is receiving Early Intervention and making great improvement.  His greatest issue is feeding: he eats all foods as long as they are smashed; when he bites into anything his tongue kicks the food back out and there is no chewing.  We have had endless visits to specialists and doctors but no one can correctly diagnose his feeding issue. I've been through numerous Feeding/Speech Therapists through EI and no improvement has happened and a lot of unanswered questions remain.  My OT suggested I reach out to you and do some networking and so I hope you can help and lead me in the right direction because I feel as if there are not enough resources for parents who have children with feeding issues. Thank you

I would be happy to try to help you with your son's feeding issues.  Children with Beckwith Wiedemann syndrome typically do not have good tongue mobility.   My experience has been that mobility through the lateral borders of the tongue and tongue tip are reduced so children use a protrusion retraction pattern to compensate.  If you think about eating solid foods, you take a bite and use your tongue tip and the lateral border of your tongue to move the food back to your chewing surface (about where your first molar inserts).  Food is then stabilized between the lateral border of your tongue and your cheek as you chew.  If the bolus of food is large you move the food to the opposite lateral molar ridge. When the food is well enough broken down you get sensory input to swallow.  Given the size of the lingual musculature in relation to the size of the oral cavity a true rotary chew pattern is difficult to facilitate. However, I have had children who can get increased lateral tongue movement.

In addition, many children with Beckwith Wiedemann have low muscle tone, and reduced sensory awareness which impacts breaking down food and knowing when it is adequately broken down for swallowing. When you are brushing your son's teeth you can stroke the side of the tongue from back to front (4-5x on each side) to help facilitate mobility through the lateral borders. You can also try introducing a Cheerio size piece of food on the side of your son's mouth (about where his first molars are) to see if he is better able to chew the bolus.  I teach a two day sensory motor feeding class which is available live and in self study.  I also have a feeding book that can help. These resources will help you with pre-feeding strategies which can facilitate the motor skills your son needs for safe effective nutritive feeding. You can also look on the website to see if there is a therapist in your area who can evaluate your child and plan a program. 

Best,

Lori Overland MS CCC-SLP, C/NDT

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