My 2 year old (almost 3 year old) daughter with Down Syndrome is still having difficulty with speech. She has many signs, but her words are limited to ones such as "ball" and "book." I have asked her speech therapist about the Straw Kit. Her therapist does not seem to be in favor of anything other than traditional speech therapy. Does the straw kit help accelerate speech?

Also, her OT would like her to drink out of a cup. Which cup would be best, or is it best to continue with straws for now? Thank you!

Ana

Hi Ana,

Sorry to hear that your daughter is having difficulty with speech. I do believe that the straw kit is something worth pursuing.  I often work with children with another therapist in a situation like this.  One can work on traditional speech techniques and the other oral placement for speech production and feeding.  That might be something to think about.  The straws work on different levels of tongue retraction and lip rounding which are both movements used in speech production. I do find with my patients that speech comes faster with oral placement therapy.  As far as a cup I would recommend starting with the pink cut out cup.

Please let me know if you have any other questions.  We are always here to help.

Thanks,

Liz Smithson

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,

 

I'm beginning to work with a 7 year old boy with Down Syndrome and Apraxia. For the straws, he protrudes his tongue under the straw. He also does this with the Honey Bear. His Mom says she has a verbal cue of "fishy kiss" which will help him to round lips, and tongue will retract.

 

He also does the horns. He mastered #1 today :) ! We're also working with chewy tubes. Red is great, compressions become weaker with yellow. Bubbles are still needing cueing with the blue apraxia tube to get the lips rounded. He has a lot of force, but his lower lip protrudes and elevates and all of his air is directed up instead of out. It's getting better.

 

Is there something else I should be doing to get that tongue to the right position for straw drinking?

 

Thank you,

 

Meredith

Hi Meredith,

Great question regarding tongue retraction. The straw kit will work on tongue retraction at different levels of the tongue. It is important to have your patient work through the whole straw kit to achieve the retraction. It is also important to note that he does not have to demonstrate tongue retraction with straw drinking until he reaches straw #5. I do think using the "fishy kiss" verbal prompt before offering the straw is a great idea to set him up for the right movement pattern on the straw.   As far as the bubbles, try using the toothette with vibration as a sensory warm up right before the bubble activity. This should help him to achieve lip rounding more at mid-line without the upward movement he is demonstrating. Then I would transition immediately to using the green bubble tube that comes in the kit for blowing bubbles. Attempt blowing bubbles with this tube and see if that helps. Please let me know if you have any other questions. I hope this all helps. Thanks,

Elizabeth Smithson, MSP, 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.

Lori,

I've taken your courses for Down's syndrome and Assessment and Planning. I'm fairly new to feeding, but am having some success with Down's clients (thank you and they thank you :).

I just got a 15 month old with cleft on my caseload.  He's had lip repair and his palate only has a small hole after surgery (will be fixed at 3).  His mother said she used a squirt bottle because he couldn't suck (and still uses it before he goes to bed).  He can drink from a cup without spilling if it only has a tiny amount in it.  Is there any reason this child could not start using a straw or have more control with a cup with intervention?  His upper lip has no movement for retraction or protrusion, but he does get closure for the /m/ sound.

Thanks

Hi,

Thanks for your email. I am so glad you have been using what you learned in the Down syndrome class with success! You should absolutely start working on upper lip mobility and lip rounding with this child!  You may have to work through the scar tissue, and I have found that a vibrating upper lip stretch (one gloved finger under the scar, one outside the lip on top, use a vibrating movement with your fingers through the scar tissue) or a myofascial release.  Then do your upper lip stretch, and mickey mouse /m/. Once you get mobility, start doing single sip cup drinking.

Best of luck and let me know how your client progresses!

Lori Overland

Hi Lori,

I attended your Feeding Therapy: Sensory Motor Approach 2 day course.  It was terrific and I’ve been implementing a lot of what I learned.  I’ve seen some progress already.  One of my students did such a great job drinking from a straw the other day! What an improvement from the liquid being squeezed into her mouth.  Now we have to work on transitioning to the classroom. ****Excellent! I always love to hear that!!!!****   Other students have been slower going and that’s one of my questions. 

One particular student is 14 years old.  She basically has a soft diet mostly consisting of sweet puddings and cakes with some fruits.  She manages those foods though she is definitely giving the OT trouble with self feeding and the behaviorist has suggested pairing eating with a pleasurable activity which is the IPAD.  So while she’s on the IPAD she will usually feed herself. 

She has a protruded jaw, her upper lip is pulled in, her tongue is bunchy and her cheeks are “puffy”.  Her teeth are a bit crooked and somewhat misplaced.  I’ve seen some nice movement and closure of the lips.  She also accepts the tongue massage.  I’ve tried the chewy tube and she will tolerate it in her mouth, but I haven’t seen any movement towards a bite.  That’s where I’m not sure what to do?  I model.  We have a mirror; I support her jaw but no change.  She bites on her shirt and a bib that she wears into school.  Any suggestions on how to move forward?  

****Well.....if you are working on straw drinking you really need to get cheek contraction, lip rounding and tongue retraction. You may have to focus on  a pre-feeding program before you introduce the honey bear. From your description of her puffy cheeks, upper lip pulled in, tongue bunchy.... she does not have the skills to successfully straw drink. THEN.... work corner to corner with the honey bear...one sip/one swallow !****

I have feeding objectives on many of my students IEPs.  I usually write the criteria as a level of participation because I’m not sure how else to measure the data for the IEP and don’t want to get myself stuck.  I’m also trying to track progress so I’ve developed a data sheet listing the exercises and how many times they have been done.  It seems ok, but I feel there must be a better way.  Do you have any suggestions regarding that?

****I work in many schools and it is amazing how different districts require tracking of progress. Some are so general....they are meaningless, and some get down to how many sips with lip rounding, cheek contraction and tongue retraction. SOOOO....I write my plans to develop the skill and let the schools figure out how they need to record data, and track progress. Sorry I can't be more helpful on that one...****

Wow, I guess I saved up a bunch of stuff.  I hope it is all clear.  I’ve been lucky to get to stay with my current caseload and I see oral motor and feeding therapy as a big part of our treatment  Any suggestions if you are able would be great.  I’d love to continue to learn more as I find this particular area to be really interesting and so important.  ****Good for you! It sounds like you have already done some nice work...and seen the progress your students are capable of making. ****

I look forward to hearing from you!  Have a great day. B

****Thanks again for the great questions!

Lori Overland****

Hi, I have two clients that I need assistance with.

The first little girl is 5 years old and has developmental delay.  She is mostly non-verbal and communicates using Makaton.  We have used various bits of TalkTools equipment, combined with speech sound work (discrimination and encouragement to imitate single sounds).  So far we have worked through the straw hierarchy (as best we can given her level of understanding) and this has improved tongue retraction.  We have also used tongue depressor with pennies between the lips and she has enough strength to hold 3 pennies on each end without difficulty.  This has improved her lip closure and has stopped her dribbling but we have yet to hear her make any p, b or m sounds.  We have also been using the tubes and bite blocks for vowel sounds but she is still unable to imitate any vowels although can produce some spontaneously.  Her babble has really improved and she is making lots more involuntary vowel and consonant sounds but nothing on cue, and occasional approximation of words in the correct situation.  I have tried to work through the horn hierarchy and the bubble hierarchy but she is unable to blow.  She has just started to wobble the bubble on the wand by vocalizing but I don’t know how to get her to understand how to blow.  Do you have any ideas about where I should go next?

This is a very involved case - I will say that if she can't blow, she can't phonate and you need pre phonatory work to expand the rib cage. You may also need to order the exercises more carefully rather than bits and pieces. For example, sensory tasks such as Lori's mouse ears helps with the feel of the /m/ (see "Feeding Therapy: A Sensory Motor Approach" by Lori Overland).  Next feeding, then Oral Placement Therapy (OPT), then shaping OPT to Speech with Renee Roy Hill's Apraxia Kit.  This is a child who can't respond to "look at me and say what I say" so I'd skip the traditional auditory drills.  It sounds like Apraxia, so you need to be consistent each session and ensure there is true mastery at each level of the hierarchies.

The second little girl is the same age and has cerebral palsy. We have been doing similar things although she is able to make a noise through the horns but is unable to do so without vocalizing at the same time. She is able to blow bubbles well through a small piece of straw but is unable to coordinate her mouth to blow bubbles without physically having the straw in her mouth. Do you have any ideas for how to get around this?

Slowly shape the movement.  For example, 9x using bubble tube 1x without. Make sure they are practicing the best level in therapy at home daily and that the tube is wide enough that the lips are truly rounded - if you need a larger tube use the jaw closure kit. As far as voicing into the horn, that is a motor planning issue.  I usually use modeling, "quiet blowing" and if needed I whisper "hoo" with no voicing to help. These are the same kids that can not turn the voice on either but practice often helps. Make sure there's adequate posture to support the phonation tasks.

Best,

Robyn Merkel-Walsh