Tagged "feeding course"


Ask a Therapist: Feeding Therapy Self-Study Follow-Up

Posted by Deborah Grauzam on

Dear Lori,

I just completed your "Feeding Therapy: A Sensory-Motor Approach" DVD. What an amazing course! It certainly gave me a great deal of confidence in working with children with feeding disorders. While it was extremely thorough and informative, I do have several questions for you. I would love your input!

1. When would you typically recommend an OT evaluation?  Or perhaps I should say,  in which cases would you not refer a child (with an apparent feeding disorder) to an OT?  ***Great question! I look at the whole child and ask a lot of questions about how the child moves through life. In my case history form I ask questions like: does your child get upset easily, does your child have difficulty calming, does your child have difficulty in new situations, transitions, separation etc, does your child have complicated routines for bed, bath, daily living activities, etc... During the evaluation I watch how the child responds to input in the environment. If I observe underlying sensory concerns (sometimes parents just think their child is challenging, or high maintenance and do not realize the behaviors they observe are secondary to sensory issues) I immediately refer to an OT. If the child seems to be able to self regulate, modulate incoming information (for everything but feeding) ....I would not necessarily refer to an OT immediately. I might start an oral sensory motor pre-feeding program and see how the child progresses.***

2. You spoke a bit about breastfeeding, and I was wondering, what role would a lactation consultant play in breastfeeding support if you are working with a nursing mother?  Would our job be the same as a lactation consultant's or would you ever refer the family to one?***I work with great lactation consultants. They are often the first ones to see the baby. They call me in when they observe oral sensory motor issues which are not related to the mothers milk production, bonding, positioning etc. If it is a mom issue...it is definitely the lactation consultants role to consult. If the baby has oral sensory motor issues....that is our role.***

I would also like to order some tools from your website for my practice.  I want to add the Mickey Mouse attachment, but I am not sure if I should buy the hard or soft one.  ***It depends on your child's sensory system...but overall I prefer the soft mouse*** When would you use one vs the other? ***If a child needs more input I would recommend the hard one*** And what about the cat?  I don't think you talked about it in the video, but I am curious to know when it should be used. ***I use the cat ears to get tongue tip pointing. For example, I may present the cat ear at the lateral incisor for chewing hierarchy level #3, and then alternate lateral incisors!!!!***

I really wish I was able to physically attend your course and get to meet you in person!  You are such an inspiration to me!!  Thank you for all of your incredible work. ***Thank you for taking the class on video, and I hope one day we will meet in person. I am doing a one-hour seminar at ASHA this year!!!! If you are there, please come and introduce yourself!!!!

My very best,

Lori***

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Ask a Therapist: Feeding after attending the Feeding course

Posted by Deborah Grauzam on

Hi Lori,

I attended your Feeding Therapy: Sensory Motor Approach 2 day course.  It was terrific and I’ve been implementing a lot of what I learned.  I’ve seen some progress already.  One of my students did such a great job drinking from a straw the other day! What an improvement from the liquid being squeezed into her mouth.  Now we have to work on transitioning to the classroom. ****Excellent! I always love to hear that!!!!****   Other students have been slower going and that’s one of my questions. 

One particular student is 14 years old.  She basically has a soft diet mostly consisting of sweet puddings and cakes with some fruits.  She manages those foods though she is definitely giving the OT trouble with self feeding and the behaviorist has suggested pairing eating with a pleasurable activity which is the IPAD.  So while she’s on the IPAD she will usually feed herself. 

She has a protruded jaw, her upper lip is pulled in, her tongue is bunchy and her cheeks are “puffy”.  Her teeth are a bit crooked and somewhat misplaced.  I’ve seen some nice movement and closure of the lips.  She also accepts the tongue massage.  I’ve tried the chewy tube and she will tolerate it in her mouth, but I haven’t seen any movement towards a bite.  That’s where I’m not sure what to do?  I model.  We have a mirror; I support her jaw but no change.  She bites on her shirt and a bib that she wears into school.  Any suggestions on how to move forward?  

****Well.....if you are working on straw drinking you really need to get cheek contraction, lip rounding and tongue retraction. You may have to focus on  a pre-feeding program before you introduce the honey bear. From your description of her puffy cheeks, upper lip pulled in, tongue bunchy.... she does not have the skills to successfully straw drink. THEN.... work corner to corner with the honey bear...one sip/one swallow !****

I have feeding objectives on many of my students IEPs.  I usually write the criteria as a level of participation because I’m not sure how else to measure the data for the IEP and don’t want to get myself stuck.  I’m also trying to track progress so I’ve developed a data sheet listing the exercises and how many times they have been done.  It seems ok, but I feel there must be a better way.  Do you have any suggestions regarding that?

****I work in many schools and it is amazing how different districts require tracking of progress. Some are so general....they are meaningless, and some get down to how many sips with lip rounding, cheek contraction and tongue retraction. SOOOO....I write my plans to develop the skill and let the schools figure out how they need to record data, and track progress. Sorry I can't be more helpful on that one...****

Wow, I guess I saved up a bunch of stuff.  I hope it is all clear.  I’ve been lucky to get to stay with my current caseload and I see oral motor and feeding therapy as a big part of our treatment  Any suggestions if you are able would be great.  I’d love to continue to learn more as I find this particular area to be really interesting and so important.  ****Good for you! It sounds like you have already done some nice work...and seen the progress your students are capable of making. ****

I look forward to hearing from you!  Have a great day. B

****Thanks again for the great questions!

Lori Overland****

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Ask a Therapist: Considerations for Altering Diets

Posted by Deborah Grauzam on

Hi Ms. Lori Overland,

I am an Occupational Therapist from Chicago. However, I am now working in Australia as an OT. I have always been interested in setting up a feeding program here and therefore began viewing your course. I just love how you integrate a child's individual sensory needs into their personal feeding program! I was just awed by how you were able to assist a child who only liked round brown foods!

I was wondering if you have the time to provide me with your expert tips on how to go about slowly changing the diet of a child who only prefers white bland foods. For example, this child will only drink milk from a bottle, have arrowroot cookies-which are plain tannish in color, chicken tenders, kids' cheese pizza, but without the cheese, and white bread.

At the moment he is tactile defensive, but is seeking much proprioceptive input, not just to his body, but also to the inside of his mouth. He chews on his pacifier and bites hard on his cookies. He tends to hold food in his mouth and then swallow hard. He does have some tongue lateralization, but not much of a rotary chew.

He had a brain tumor and has been through chemo. He is currently cancer free. He was then diagnosed with Autism. He is babbling and singing songs without saying the whole word, but attempting the words.

Only if you get a chance, I'd greatly appreciate any input you have regarding how I should go about varying his diet a little bit and increasing his rotary chew, as well as slowly getting him away from the bottle.

Thanks and take care.

Hello,

Thank you for your email and your kind words. I am wondering if you saw the first or second edition of my two day sensory motor feeding class? It seems like there are many layers with this child:

1)  Medical - I frequently see children who have had chemo therapy have difficulty swallowing and some of his self limited diet may be secondary to pain he had during chem. Are there any other medical issues? Has he had a swallow study?

2) Postural - You did not mention posture and alignment but I am wondering (based on your description of his mouth and his sensory system) whether there are any issues with tone, posture and alignment (when did he have cancer? Did he spend time in prone? Any issues with pec/abdominal synergy? Are his ribs/abs connected ? Is respiration a concern?

3) Sensory - Does he tolerate teeth brushing? Can he tolerate vibration peri or intra orally? Does he have difficulty with transitions in life (what you see in life is often what you get in the mouth)?  Have you tried a Spio garment on him (www.spioworks.com). If you are not familiar...spio is a flexible bracing system which provides dynamic stability and deep pressure sensory input.

4) Oral Sensory Motor - I have a few questions: is he actually chewing the foods he eats? Do you see food in the front third of his mouth? Does he collect a bolus or is the food spread across his tongue? Do you see food pooled on the surface of the tongue? Does he lateralize food using the tongue tip and lateral border or does he dump or use a protrusion retraction pattern to move food laterally? Is food masticated on the canines or on the first molar? I am concerned about the hard swallow (does he have a reverse swallow?) ....is this because he has difficulty collecting the bolus? Is it because he has not adequately masticated the bolus, because he is not using the lateral borders of his tongue? Is he using a repetitive reverse swallow pattern? Does he have lip closure and lip rounding? Does he have cheek contraction for sucking, chewing, swallowing and to stabilize solid food?  If not, you may want to start with a pre-feeding program before you try to change taste or texture. When I am sure that the medical, whole body sensory, postural and pre-feeding issues are being addressed I will start to try to change taste and temperature. Move very slowly away from his home base. I may start by doing "science experiments" or cooking with foods that are very similar to his foods...different types of chicken nuggets, making our own pizza, cutting out shapes using a variety of different white breads, baking sugar cookies and eventually going to smell, lick, bite with the "new" food. With children on the autistic spectrum I may have to work with a behaviorist once I have addressed the oral sensory motor issues...but not always. If you would like to send me a short video I would be happy to take a look!

Lori Overland

Thanks so much Lori for your quick response! I had no idea how much was involved. I am looking through each and every question you asked. When next I see the family I will ask his mother if I can take video of a session to pass on to you for your expert opinion. I am just so inspired and awed by you! You are absolutely brilliant and a GEM to even consider taking the time to respond to my query in so much depth. Thanks so much for your time and your expert knowledge. I truly appreciate it and so will the families I work with. I will write back when I have more info for you. Thanks again and take care.

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Ask a Therapist: Sensory Processing assistance with a client that has Down syndrome

Posted by Deborah Grauzam on

Hi Lori,
 
I am a speech pathologist working with Toddlers. A few years ago I attended your conference on feeding therapy. I haven’t had to use a lot of the techniques up until now, so I am a little rusty.  I currently have a little guy with Down syndrome who is not chewing a great deal. His mom told me that at home she is noticing a great deal of gagging and sometimes vomiting because of this. We have been trying different textures; however, nothing seems to be working. He is also pretty resistant to chewy tubes and allows them in his mouth for only a short time. He either lets go or will bite down and not let go. I have been looking at the chewing hierarchy, but tools are listed (e.g., z-vibe, etc.) that I can’t remember exactly what I am supposed to do with. Do you have any suggestions on how to target this or where to start? Thank you so much for your help. I appreciate it!
 

Hello and thank you for the questions.

As often occurs, I have a bunch of questions to start.

Does this little one have other sensory issues?  Is there an OT who specializes in sensory processing involved?  Have you made observations about what this little one is doing with his lips, cheeks and tongue (for purees, and for solids).

I would assume (based on the diagnosis) that you should probably be working on cheek mobility and bilabial closure for spoon, cup etc.  If a protrusion/retraction is the primary tongue movement, work on tongue lateralization.  Does the child tolerate vibration?  If so, use the vibe fine tip for the lateral tongue massage.  Try the vibe bite and chew XL head (looks like a yellow chewy tube) if he will not tolerate chewy tubes.  You may want to go outside the box and roll the tool from the lateral incisor to the first molar if this child does not like the tool on the molar ridge. By the way, I have just written a book which should be out in June if you need a review of the class (and updated exercises!!!!).

Best,

Lori Overland

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