Tagged "horn therapy"

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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Ask a Therapist: Tongue Placement

Posted by Deborah Grauzam on

Hi, I am hoping you can offer a suggestion.

I am an SLP and see a 2 YO child who began sucking on his tongue and had a forward tongue posture before I started seeing him. Once I started working with him I had the family switch to straws only and eliminated the sippy cup. They did that and he continued to have tongue sucking behaviors. Now, he has switched to twisting/turning his tongue around his mouth and it is interfering with his speech sound productions.

I tried to introduce vibration to provide sensory stimulation, but he does not tolerate that in his mouth. I also gave him a chewy tube as a substitution and he will tolerate it, but it is not eliminating the problem.

Do you have any product suggestions? I would greatly appreciate it. He has no drooling, no muscle weakness, and no feeding difficulties. I have never seen a child do this before.

Thank you in advance for any suggestions or product recommendations!

I have a few thoughts on this to help you:

1. Make sure there is not a structural or physiological problem, for example enlarged tonsils and adenoids. If the tongue must be displaced forward for breathing for example it could start these odd habits. Look for a tongue tie.

2. The sensory-motor systems cannot be separated. Though you say there are no feeding issues, I suspect there may be some breakdown in oral-motor development. Look carefully at developmental norms. This will soon be available in the feeding book Lori and I wrote, or you can look into taking Lori's feeding class if you have not already. If this child sucks his tongue at rest, there may be similar patterns on the straw.

3. Use of chewy tubes and sensory motor activities are most useful when you work from the outside of the mouth to the inside of the mouth and the therapy is led by the therapist. So I would not recommend handing the chewy tube to the child, but rather follow Lori's pre-feeding Chewing Hierarchy.

4. Finally, for the tongue sucking, I would recommend tasks that work on tongue retraction. The TalkTools Straw program and TalkTools Horn program, when executed by the directions on the tools kits would be excellent, as would TalkTools Bubble Kit. If you wanted to learn more, we have self-study courses for each of these kits!

Thanks for your interest in TalkTools!

Robyn Merkel-Walsh

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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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