Hello!

 

I have a 13 month old with Down syndrome who has a significant tongue thrust swallow pattern and tongue protrusion. Her tongue is ALWAYS out of her mouth, far. Almost as if she is intentionally pushing it all the way out. She retracts her tongue when I place a straw in the corner of her mouth, place a puff on her molar ridge (and will maintain tongue lateralization for a short period), and when I place the elephant jiggler in her mouth. As soon as she attempts to control the puff with her tongue or swallow, her tongue pushes forward again. I can prompt her to retract her tongue at rest but it comes right back out. What else can I do? I only get to see her one time per month at this point. Mom sits in on sessions and carries over at home. Pediatrician and ENT have no concerns about size of tonsils; I have not observed them myself yet.

 

Aubrie

Hi Aubrie,

It sounds like you have been working really hard with this patient to address the tongue retraction.  Everything you are already doing sounds great.  I would add bubble blowing, horn blowing and chewing on the back molars (with cubes of food if able, z-vibe and the bite tubes). All of this will encourage tongue retraction in the mouth. The more you can work on the retraction the better.  

I hope this helps.

Please let me know if you have any other questions.

Thanks,

Elizabeth J. Smithson, M.S.P., CCC-SLP 

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.

When people need help with therapy or products, we put TalkTools® Instructors to work and then publish the exchange for anyone in the same situation to get help, too. This question is from Danielle, by Facebook message.

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

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.

Hi Chayie,

1. As far as the red and purple bite blocks go I have a set of both. I always try to use the red first because they are more durable and then use the purple if the client does not tolerate them. Many of my clients prefer the texture of the purple so I just know I have to replace those more frequently.

2. Yes, the straws do work on tongue retraction orally. They work on different levels of tongue retraction.  There is a diagram that will come in the straw kit and is also in the book that shows exactly where the retraction takes place with each individual straw. The Horn Kit and the Bubble Kit are two other activities that I often do while working on the straws for tongue retraction. These are all great!

Let me know if you have any other questions.

Always 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.

Hi Kellie,

It sounds like you have done a great job explaining the straws and how to use them to this mom. The only other idea I have would be to encourage her to put the straw in the large TalkTools cup with lid and have the curly part of the straw under the lid. That sometimes helps if it is tipping or they are playing with it. I just try to explain that the straw is working on tongue retraction in the mouth at different levels. It is important that they are that particular length because that is what makes them more difficult and requires more work for the tongue and lips.

As far as the insurance billing, I personally do not bill insurance but there is a CD called "OPT Goals & Objectives for IEPs and Insurance Reimbursement" that will help with goals and objectives for insurance reimbursement and IEPs. It does not include coding but it should help with what you are talking about. It sounded like it was more of what you were looking for than the CD you mentioned.

Good luck with the mom you are working with and please let me 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.