Tagged "horn #1"


Ask A Therapist: Horn blowing for a 3-year-old with Autism Spectrum Disorder

Posted by Deborah Grauzam on

Hello,

 

I'm hoping for some advice. My 3 year old ASD (Autism Spectrum Disorder) son is doing TalkTools through our SLT. He couldn't blow at all to start with so we taught him using a water flute first, now he has gone onto Horn #1 but he can't make a sound. His neurotypical twin sister can't either so I'm wondering if his lungs are maybe too small to be able to use this horn? (He is small - more the size of a two year old.) Our SLT said just keep trying but I'm worried it will put him off blowing as he won't be getting any noise feedback like he did with the water flute.

 

Thanks,

 

Claire

 picture1

Hi Claire,

I think I would continue working on the horn as your therapist recommended but I would also try using the Pre-Hierarchy Horn while bouncing on a therapy or yoga ball and providing abdominal pressure. This horn is extremely easy to blow and with the abdominal pressure and bouncing I feel you would be more likely to get a sound, which would be rewarding for your son. I do not think the lung size is the issue but that is not really a question I can answer.

Please let me know if you have any other questions.  

We are here and happy to help.

Thanks,

Liz

 

Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy. She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask A Therapist: Jaw Jutting

Posted by Deborah Grauzam on

Hi TalkTools,

 

How can I inhibit jaw jutting for Horn #1? We are working on the Bite Tube Set and establishing the natural bite with Bite Blocks but this child presents with frequent jaw slide or jaw jutting. Thanks,

 

Anne

 

Hi Anne,

I would provide firm jaw support to inhibit the jaw jutting. You can use jaw support for Horn #1 and Horn #2. Beginning with Horn #3 you would no longer provide jaw assistance.  I would be using the jaw support and gradually try to decrease use as the patient will tolerate. I hope this helps. Please let us know if you have any other questions.

Thanks,

Liz

 

Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy.  She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask A Therapist: 3 year old with Moebius Syndrome

Posted by Deborah Grauzam on

You all have been amazing when I have asked for help with my students, so I have another question. I have just evaluated a 3 ½ year old who was diagnosed at birth with Moebius Syndrome. Although I have had difficulty finding information about this syndrome, I managed to find an article Sara Rosenfeld-Johnson wrote that was extremely helpful and plan to follow her recommendations. My main concern right now is that a Haberman bottle was used to feed him, so now he clamps his teeth down on the flute and straw when I try to work with him. Is there any tool that is beneficial to inhibiting the teeth biting and promoting the normal suck and swallow and blowing? And if you have any other references for oral motor therapy related to damage to the 7th cranial nerve I would appreciate it. THANK YOU!!!!!!   Thank you for the compliment and the question.  I have worked with Sara and the Moebius population for the past 10 years and hope I can help with your question!

 

The clamping of the teeth is common since the primary problem we are working with is the inability to close the lips.  So this is very common with most of the children and adults we work with.  The key initially is to make the mouthpiece big enough to fit into the current lip opening.  To determine if this is even appropriate to begin, you need to know if the client has paralysis or paresis.  If you have seen any upper facial movement, flutters or twitches then you are looking at paresis and working on these skills may improve lip and cheek function.  Here is a basic outline of what you might do with straw and horn blowing; both a part of a complete oral placement program that would also address any deficits in jaw stability as you are trying to achieve lip from jaw dissociation (I can give you more information on that if you would like):

1st:  Begin by using the TalkTools vibrator and trimmed Toothette (the vibration is the key) under the upper lip and in the cheeks to provide sensation to the muscles. This would be done for 1-2 minutes and therapy activities would then follow.

2nd:  Horn Blowing:  Measure the lip opening when the child is in a resting lip posture, or if possible, trying to close his lips on command.  You may begin with Horn #1 if they have the breath support and skill but also may want to start with the Alex Tub Flute (TalkTools has begun carrying them but you will need to check availability).  This horn is easier to blow and has a wider mouthpiece.  If you use Horn #1, wrap the tip of the horn in medical tape several times until the mouthpiece measures the lip open position.  This will allow you to then support the jaw with your non-dominant hand and place the horn between the lips, rather than the teeth (the pre-requisite is that they know to exhale on command).  Using the TalkTools Progressive Jaw Closure Tubes is also helpful in teaching this skill.  As they meet the criteria, you can unwrap the horn mouthpiece one time and repeat until you have removed all the tape.  The lip, assuming there is the ability to gain movement will follow with practice.

3rd:  Straw drinking:  I would suggest starting with the Honey Bear with Flexible Straw.  There is a program Sara and I wrote several years ago called the Ice Sticks Program that has a technique using a syringe to teach a client to retract the tongue and swallow.  This same program can also be used with Moebius Syndrome with the goal of teaching the child to “slurp and swallow”.  You can use the Honey Bear following the same principles as the syringe technique to place the straw in the buccal cavity, squeeze and then tell the child to slurp.  You would need to ensure he is not biting on the straw (support with your non-dominant hand if needed) and that the tongue is retracted (you will often see the tongue protrude between the central incisors as an additional compensatory strategy if tongue retraction is difficult for them.  As they learn to “slurp” the liquid you have squeezed into the cheek, it activates the cheek, lip and tongue muscles, eventually leading to the child's ability to “slurp” the straw on their own.  There are several steps to teach this and I’m happy to share more detail if you need it as well!

I would also encourage you to visit the Moebius Foundation website.  Our past presentations should be available for you to view and may be helpful as well.

I hope this gets you started!  Clients with Moebius Syndrome are a joy to work with once you have the appropriate tools and starting point!  We’ve had great success with many individuals using these techniques!

Thank you,

Renee Roy Hill, MS, CCC-SLP

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Ask a Therapist: Speech and language delay with the Straw and Horn Kits

Posted by Deborah Grauzam on

Hello! I am Maria and I live in Singapore. I have just purchased the parent kit and started with the Horn #1 and have not seen any major problem so far. I am concerned about the Straw #1. When I started my son (he has some speech and language delay), he seemed to stop learning how to drink with a straw. Well, he could use a normal staw before - but with biting, but when he uses the Straw #1, he tries to bite and no longer sips - when he was able to bite and sip on normal straws before. Do you think I must start with a pre-requisite tool before Straw #1? I am helping him straw with the support of my hand but to no avail.

Thank you,

Maria

Sometimes changing the straw texture can be difficult if they've been using a motor plan for one that can not transition to another. My suggestion would be to use the Honey Bear with straw that has a flexible tubing that is firm but not completely stiff. It is designed so that if he cannot initiate the suck easily, you can squeeze the cup and help him learn the motor plan without biting. Providing jaw support can help. Once he is independent on the Honey Bear with Straw, you can again transition to Straw #1.

Your local TalkTools distributor may be able to help you find a local therapist with TalkTools training who can better assess and monitor your son's therapy.

I hope this helps!

Renee Roy Hill

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