I recently completed the self-study course "A Three Part Plan for Oral Placement Therapy." Really enjoyed the course and hoping to use the knowledge with patients. I have 2 questions to start:
1) I see that the jaw assessment is done with bite blocks and then the bite blocks are used for therapy as well, if jaw instability exists. I am confused as to when the bite tube hierarchy is used. I see that the bite tube hierarchy (hierarchy for strength and compression) is used for ages birth to 3, but I believe bite tubes can be used for adults as well. So, when do you recommend the use of bite blocks versus bite tubes?
We do use the Bite Tube Hierarchy for the birth to 3 population. Not only is this hierarchy developing jaw grading (the up and down jaw movement we are looking for in speech), it also facilitates the chewing movement we need for feeding. Since it does not require the same cognitive skills that the TalkTools Jaw Grading Bite Blocks requires for teaching bite and hold, our young clients can do this activity. You are correct that we can use this tool at any age both for feeding, if we are working on teaching chewing skills or for speech, or if we want to reinforce the jaw grading necessary for syllables.
The Bite Blocks have been one of our best tools for developing jaw grading (because it isolates the jaw in multiple positions and works to increase skill at the position) as well as teaching a client the motor plan for the specific positions needed for speech. We often use them in conjunction with the Bite Tube Hierarchy because each gives the client a different sensory-motor experience, working both in movement and in isolation. So it is not always an either/or choice. If appropriate, I always assess in both hierarchies, analyze the results and then determine my goals. If both tools can provide input and skill the client is missing, I may do both with a client.
2) Sara says on DVD that parents need to do homework 3x per week and that if parent is only going to do it 2x per week, child is not likely to progress. The homework manual mentions that if parents don't return the folder, homework will not be sent home and child will progress at slower rate. I see patients once weekly. If parents don't wish to be involved in homework, can the child progress? What has your experience been with this?
This can be tricky as we as therapists try to make decisions on the best therapies to use. Sara is referring to the literature stated in exercise physiology. If a muscle is not worked regularly then we cannot change the function of the muscle. In our experience we've seen this and often with children who have special needs and sensory-motor based speech and feeding deficits more frequent exercise is necessary to change muscle function. If a family is not involved and working at home, you are more than likely not going to see changes in their muscle function.
Remember that this program as a whole allows multiple opportunities to practice the same functions. For example, we may target jaw grading through the TalkTools Bite Tube Hierarchy, TalkTools Jaw Grading Bite Blocks, chewing solids on the back molars, gum chewing or the slow feed technique. I might be able to encourage a family to practice gum chewing and chewing on the back molars at meals 2-3X during the week while I focus on the Bite Blocks and Bite Tubes in therapy. Even though we are performing different activities we are targeting the same muscles and therefore they are getting practice throughout the week. Although the ideal is always that the client practices daily in all areas of the desired home program, in reality we know this may be difficult. The best way to determine if the therapy is making a change in function is to take good data. If you are seeing progress, you are more than likely on track! If I don't see progress over a months time, my tendency is to look at why and change my approach or my goals.
My experience has been that if I can give a family just one activity to work on, then point out the successes we see in that technique, I can often get them on board for supporting this program. The most important piece of information parents need is understanding what it is they are doing, why they are doing that activity, and how it is going to impact their goals. I have to question why a family is seeking speech and language services if they do not want to participate in assisting me in working toward their goals. The more I can reinforce their successes, however small, the more involved they may become! I hope this helps!
Renee Roy Hill, MS, CCC-SLP