Tagged "horn blowing"

Ask a Therapist: Help with Breathing Issue

Posted by Deborah Grauzam on

I need your advice for a client with Treacher Collins Syndrome. The child has had his left lip and palate repaired, his face & skull are severely deformed. We have been doing OPT for 1 year: greatest improvement is in blowing (from not able to blow to Horn #4, Bubble Bear 1 feet; he can do depressor press with 14 coins and 6" button pull, /m/ sound ok but not /b/; many sounds backing as /g/, talking in simple sentences now).

His jaw is very problematic: he cannot open his jaw to more than 4-5mm, I let him bite on straws of different diameter, gum pressed flat and wrapped with gauze, Bite Block #2 held on first molar area. He's on oxygen mask at night, his doctor said he'll have us do OPT for half a year, and if he still can't open his jaw, he'll consider cutting his tongue out to prevent sleep apnea. Mommy is unwilling to let doctor cut his tongue nor open his trachea, and so she asked if I can train him to stick out his tongue so he has more space in his oral cavity to breathe? Can you give me some advice?

Thanks, Louisa

Hi Louisa. Have you tried using the Progressive Jaw Closure Tubes? Start with the smallest and have him bite and breathe through. When he can do this as you count slowly to 50 and without any compensatory posturing, go to the next larger tube. In this way you will see if the problem is muscular or structural. If it is muscular, then by going through the hierarchy to the largest one you should see some good results. If it is structural (boney, skeletal) then at one point he will not be able to progress.

To teach him to stick out his tongue, you can then go back to the smallest tube and ask him to push his tongue forward into the tube numerous repetitions. That will give him the jaw from tongue dissociation you are looking for.


Sara Rosenfeld-Johnson

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Ask a Therapist: “Fixing” During Horn Hierarchy Exercises

Posted by Deborah Grauzam on

I use the horn hierarchy and really love the results. One of my clients, a young girl, tenses her muscles - shoulder, stomach, facial, etc, to blow and make the appropriate sound for appropriate duration. How do I stop this compensation?

The client is “fixing” – using a compensatory pattern that lets the SLP know the client does not have adequate grading skills in her abdominal muscles. Without seeing the child, there are several possibilities based on the description above:

1. The horn is too difficult for the client. Go back to the previous horn on the hierarchy.

2. The horn is not too difficult, but she does not understand how to use duration of oral airflow without clavicular breathing. In this situation, use the Duration Tube Kit to teach her duration using abdominal grading.

3. Fixing could be a habit the client has developed. Use an easier horn on the hierarchy. Explain to the client she should blow the horn while keeping her shoulders down. Once she understands the feel of the "acceptable" body posture, begin progressing through the hierarchy.

4. Tactile cueing during the exercise may help. Push down on the client's shoulders as she is blowing -- the tactile pressure inhibiting her compensatory posturing may help her understand “acceptable” body posture.

5. The client's jaw is weak and she cannot perform the jaw from lip dissociation movement needed to blow the horn. In this case, stop the Horn Blowing Hierarchy and work on jaw stability. Each week, retry the horns to see if improved jaw skills enable the client to blow the horn without the compensatory postures.

The Horn Hierarchy is a small part of the TalkTools offerings to improve speech clarity. See our website for more information on live workshops in your area or Educational self-study courses (we offer continuing education credits for workshops and self-study courses), and learn about other TalkTools therapy techniques.

Sara Rosenfeld-Johnson

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