Tagged "Horn Hierarchy"


Ask a Therapist: Frontal Lisp

Posted by Deborah Grauzam on

Hi,

I am an SLP in an elementary school in Virginia. I have been recently viewing your course A Three-Part Treatment Plan for Oral Placement Therapy. I have found your information to be extremely fascinating and, although I have 2 more hours, I have learned so much through your training. I do have a question. I have a 3rd grade student that is considered having a frontal lisp. He fronts many sounds. He is able to accurately produce the /s/ in conversation, when structured and prompted. However, in the course a child was mentioned that was able to accurately produce the /s/ in the structured setting, but once the setting was relaxed, she reverted back to her resting/comfortable position  of frontal sounds. Being that he is a typically developing child (9 years), would the bubble blowing and/or horn hierarchy be appropriate?

My thoughts would be that I need to work on establishing tongue retraction. I am just wondering what your professional judgement would be, considering he sounds a lot like  the girl that played "golf-ball air hockey" against Sara's daughter. I appreciate any thoughts you may be able to share! Thank you so much for your time and expertise!

 

Hi,

Thank you so much for your interest in TalkTools.

I am so glad you are enjoying the course and learning so much.  You are definitely on track with the client you are referring to.  It takes a while to establish the correct resting position for the tongue.  Keep in mind that this child has had his tongue in the wrong position for many years now so you are correcting a bad habit as well.  It is difficult to give detailed suggestions without seeing the child but have you assessed his jaw?  I would look at his jaw placement when he is producing the sound in a variety of contexts.  An excellent tongue retraction exercise is also the straw hierarchy so you may want to consider adding this to his treatment plan as well.

I hope this helps.  Please let me know if you have any other questions.  Thanks so much and good luck.

Whitney Pimentel

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Ask a Therapist: Horn Hierarchy targeting specific phonemes?

Posted by Deborah Grauzam on

Hi,

I have a student that backs sounds meaning he has difficulty making /t/ & /d/ sounds.  Do you sell a horn that would help?  

School-Based Speech-Language Pathologist

Hi,

I am so pleased you decided to contact us as the Horn program has been very beneficial for so many of our child clients with muscle-based articulation disorders.

The question you asked is an interesting one.  I will try to answer it with as much information as I can.  The TalkTools Horn Hierarchy was developed, with the help of an engineer and palatograms, to address the following speech systems: grading in the muscles of the abdomen, velum, jaw lips and tongue.  So, you can see that one horn will not correct a phoneme error such as the one you mentioned.

The hierarchy then addresses all of the muscles in the tongue needed for standard speech sound production on the conversational level and is only one technique used to treat the /t/ and /d/ placement errors.  In most cases for those phoneme errors I would use the Horn Hierarchy in conjunction with the TalkTools Straw Drinking Hierarchy.

Because you seem to be interested in using Oral Placement Therapy (OPT) I would encourage you to attend a class or watch the video of my our 2-day class:  "A Three Part Treatment Plan for Oral Placement Therapy."  In it you will learn how this therapy works and step-by-step instructions for how to implement the Horn and Straw Hierarchies in addition to numerous other techniques to improve speech clarity.

I hope this has answered your question,

Sara Rosenfeld-Johnson

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Ask a Therapist: Adult Patients with Velopharyngeal Closure

Posted by Deborah Grauzam on

Hello, I am a Speech Pathologist from the Pittsburgh area.  Could you tell me what you use as far as horns so that I may incorporate them into my therapy sessions.  I see stroke patients who have issues without velopharyngeal closure, and wanted to try your techniques. Thank you so much!

Hi, Your email came at a very good time as I am just finishing my new book on using Oral Placement Therapy with adults. One of the chapters addresses the issue of VPI and how horns can be used in a hierarchy to improve mobility in the velum. The Horn Blowing Hierarchy develops a supported oral airflow and is a pre-requisite for direct work on velar mobility.  The real way to improve closure is by using the exercise called "Oral-Nasal Contrasts." 

Although the book will not be published for at least six months you can learn about these activities in my first book Oral Placement Therapy for Speech Clarity and Feeding. That book would give you the step-by-step instructions for how to progress through the horns and then how to implement the "Oral-Nasal Contrasts" program.
 

I hope this has answered your question but if not please feel free to email me again.  

Sara Rosenfeld-Johnson

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Ask A Therapist: Dystonic Cerebral Palsy Extension Patterns and Jaw Weakness

Posted by Deborah Grauzam on

Hi there,

I have just assessed an absolutely delightful little four year old boy with a diagnosis of Dystonic Cerebral Palsy. All four limbs are affected but the weakness is more apparent on the right side. My assessment has shown that he presented with significant jaw weakness and instability, he begins to jaw jut and slide after three seconds of trying a natural bite. In addition he has not sufficiently dissociated jaw, lips and tongue muscles. He has weak core muscles and very weak airflow when he speaks. Articulation is mainly open vowels with the occasional gutteral k/g and b produced with the upper teeth on the lower lip.

My main question has to do with his significant extension patterns. Whenever I presented food or a tool to the right side of his mouth it resulted in a huge neck extension round to the right with the left arm extending backwards. He needed his dad to consistently hold his head in midline. When I worked at midline e.g. frontal spoon feeding, horns and bubbles the extensor pattern to the right was still present but not as significant.

I am concerned that by working more on the right side (as I need to do because of his more significant muscle weakness on the right side) this will encourage further extensor patterns. Does anyone have experience of how to deal with this and suggestions on how to effectively work on his right side? I wondered if doing bilateral placement for bite blocks and chewy tubes would be advisable? Many thanks!

Hi and thank you for the question. In commenting, I would like to start with a question.  Is your client working with a PT and if so are they working on the rotation in his trunk?  You may want to work on airflow in rotation if you can cotreat.  One comment that many hear in my course is that "What you see in the body is what you get in the mouth" and this is particularly applicable to your comment about the upper teeth on the lower lip.

For your main question: Is your client in a well supported position when this occurs?  Also, does he have extensor patterns in his upper and lower extremities with any movement? You can also try working from behind (you are actually hip to hip with your upper arm keeping his head in neutral flexion and your fingers providing jaw/lower lip support) using a "v" finger position to support his jaw/lower lip. This will allow you to keep his head in neutral flexion vs extension. I would place a mirror in front of him so he can see himself ...and you.

For your next question: You answered your own question.  I think you should go outside the box and try to present the chewy tubes bilaterally.  I would work on symmetry first and then you may be able to alternate bilateral and unilateral chewy tubes ...so you can work bilaterally and then alternate sides.  Eventually you may be able to do two times right to one time left.  I might do a chew tube program before I introduced the bite block program. I hope this helps and let me know.

Lori Overland

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Ask a Therapist: Horn Hierarchy - Should clients puff their cheeks?

Posted by Deborah Grauzam on

Hi Sara,

I took your three-day introductory course years ago and one video course with Renee a couple of years ago.  There is a basic tenant to horn therapy that I cannot find in my notes, and I’m hoping you can clear this up for me.  When a child is blowing on a horn, is it correct that their cheeks should not puff out?  I have a couple clients that cannot seem to blow without puffing their cheeks.  Any solutions?  Thank you so much!  Your information is all so valuable!

Hi Monica,

How nice to hear from you and to know you are still using the therapy you learned from both me and Renee.  As to your question about the horns.  When you start a new horn sometimes kids will puff their cheeks out for a few blows but as you work towards the 25 blow criteria the cheeks should tighten.  If not then you will need to work on cheek tension.  

I have started including cheek muscles in my classes as many kids do not start using these muscles just with the horn, bubble and other lip protrusion activities.  Since you are still using this therapy you might want to learn what we are doing now.  For that reason I am going to recommend you take a class given by Lori Overland.  You can find out more about it here.  It is called, "Feeding: A Sensory-Motor Approach" and is given live, on video and online.  She does not teach dysphagia but rather the oral phase of feeding in which the muscles for speech are developed.  Even if you do not do feeding therapy this class would be good for you to take as in it she gives many suggestions for cheek exercises which you do need to learn about.

I hope this answers your question,

Sara Rosenfeld-Johnson

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