Tagged "jaw strength"


Ask a Therapist: TMJ Sensory Feedback for Calming

Posted by Deborah Grauzam on

Hey Sara,

 

Recently you had a parent open question meeting in Corpus Christi, TX. I was there with my 8 month old baby. You were talking to a woman who's 5ish son with Down syndrome was repeatedly hitting his chin and you mentioned he was satisfying a feeling that was in his jaw by that action. I have noticed my baby has started doing that with her left hand. What do you recommend to help correct/redirect this behavior now?

 

-L

Hi L,

The sight of stability and calming for an infant is in the temporomandibular joint. This joint is where the upper and lower jaw meet right below the ear. There are more nerve endings going through that joint than any other location in the human body. When a baby sucks his/her thumb, sucks from a bottle, sucks on a pacifier, etc. the nerves in that joint are stimulated and the baby calms or even falls a sleep. If your child is doing other behaviors to stimulate the jaw like hitting the chin or for older children it may be teeth grinding, then it is probably time to introduce the Bite-Tube Hierarchy. You can learn more about this and other activities to increase jaw skills for both feeding and speech clarity in my book, "Assessment and Treatment of the Jaw: Putting it all together, Sensory Feeding and Speech."

If you do decide to purchase that book please read the chapter on Sensory first as it will explain to you in more detail the reason why babies and children with muscle-based deficits develop "habits" to compensate for the jaw weaknesses. I would also encourage you to share this information with your SLP as she may have additional suggestions.

I hope this has answered your question.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Optimal Bite and Structural Cross Bite

Posted by Deborah Grauzam on

Hello Sara,

I took your course in NYC Sept 2013. I have a question, if you don't mind answering, I have a student with down's syndrome who is 12 years old and up until now has not been motivated to work many aspects of speech and language.  This year she is more motivated and feel that I can take a more aggressive approach with TalkTools. She has also been diagnosed with a cross bite by her orthodontist. He states that it is both structural and positional. He does not feel hopeful that she will be a candidate for orthodontia for many reasons. How then can I work on jaw strengthening when she has a structural cross bite and poor prognosis for orthodontic intervention?

Thank you for you time.

-D

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Hi D,

In the class you learned about how to establish the most optimal bite using two #2 Bite Blocks.  Look back into your notes to see how they are placed.  As long as you can get the back molars to make contact with the Bite Blocks you can rotate them to the front, remove one and still do the Jaw Grading Bite Block exercise.  Sometimes, when you rotate to the front you lose the optimal bite position.  If that happens then keep both Bite Blocks in his mouth when you rotate to the front, keep both in his mouth as you introduce "Exercise A: Bite Block" but only pull on one side at a time.  The two in her mouth will maintain the optimal bite as the pull will be working on strength at only one side at a time.  

Once you can see the optimal bite you can use that same positioning to work on the Bite Tube Hierarchy.  I hope this answers your question. 

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Teeth Grinding

Posted by Deborah Grauzam on

Hi,

 

My 7 year old son with Down Syndrome used to grind his teeth and had grown out of it (we thought). He recently had surgery and the grinding has returned with ferocity. It’s only during the day and is worse than before. His teeth have been ground down to next to nothing. I’m at a loss as to what to do and try, but I would really like to nip this in the bud before his permanent teeth come in – he as 2 bottom ones so far.

 

Do you have any suggestions of strategies I could try?

Hi,

It is not uncommon for children with jaw weakness or jaw instability to teeth grind, stop and then renew the habit when they are under stress.  Surgery can certainly be considered a stressful situation.  As I had mentioned above and reiterate in my book, Assessment and Treatment of the Jaw: Sensory, Feeding and Speech, the TMJ (temporomandibular joint) is the site of organization within the human body.  What your son is telling you, without using the words, is that he wants stimulation in that joint to calm himself down (to satisfy a need).  Once teeth grinding begins and the dentition becomes uneven the habit may continue after the stress has left.  The grinding continues to even out the biting surface of the teeth for chewing or may continue just because the child learns the grinding "feels good."  In either case, we know the grinding is detrimental to your son's teeth and we need to find a way to help him to stop doing it.

tmj
 

You asked for specific suggestions and here is what I would like you to do.  Since your son has the diagnosis of Down syndrome it is likely that he also has jaw weakness.  The activities taught in the book Assessment and Treatment of the Jaw: Sensory, Feeding and Speech are used as an alternative to the teeth grinding while addressing the root cause.  The activities will improve jaw symmetry, stability and grading.  Each of these jaw goals will also improve his feeding skills and his speech clarity.  If possible I would ask you to find a Speech-Language Pathologist in your area who has been trained in the TalkTools approach to muscle-based feeding and speech deficits.  She or he would be able to direct you through the two primary activities: "Jaw Grading Bite Blocks" and the "Bite Tube Hierarchy."  Used together these should reduce and hopefully eliminate the teeth grinding.  Additional activities in the book include: teaching him to chew gum without swallowing the gum, chewing on his back molars and a variety of other activities to address the identified jaw muscle needs.  

As in all cases it is best to read the entire book first to identify your son's specific needs and then to choose the activities that he enjoys.  An ideal time to practice each activity would be when he is teeth grinding.  In this way you will give him an alternative that will help him while acknowledging the fact that he needs stimulation to the TMJ. 

I hope this helps.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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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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