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Tagged "Lori Overland"

Ask A Therapist: Persons with DS have larger tongues?

Posted by Deborah Grauzam on

Hi,

I work for a not for profit helping connect families to community resources. I just attended an appointment with a mother and 3 month old infant with Down Syndrome at the child's Family Physician's office. When the mother made the statement that she feels like her child is choking on its tongue and asked if this would change, the doctor told the mother that persons with DS have larger tongues and hopefully as her child grows his mouth would grow. 

​***This is just not true. Low muscle tone may make the tongue appear to be enlarged but tongues of people with a diagnosis of DS are not larger than the typical population. If this child is choking it may be secondary to low muscle tone, the insertion of the tongue, or inability to coordinate suck, swallow and breath. Starting a muscle based program from birth will make a difference. Feel free to look at the resources on the TalkTools website, particularly the DS feeding class, at this point.***​

The mother also raised a question about her child's head shape and if it would change (there has been a referral for a helmet consult and a request for referral for PT that the PCP does not want to make until after the helmet consult). The PCP told the mother that it may or may not change and the PCP associated the child's head shape with the child's diagnosis of DS. How can I better educate this mother about this? I am beside myself. Is there not information that states otherwise?

​***I am not an expert in head shape...however some babies with DS do have some asymmetry or a flat back of the head. I have had a number of babies on my caseload that have successfully worn helmets.***​

Lisa

Lori Overland, MS, CCC-SLP, C/NDT

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Ask A Therapist: Task Analyzing Oral Sensory Motor Skills

Posted by Deborah Grauzam on

Hi Lori,

I have a 7 months old client who is a breast feeder. When trying to give her new things like applesauce, yogurt, etc. She makes the bolus but she doesn't swallow. What can I do for her to swallow, besides achieving lip closure? Specifically for swallowing. I hope you can help me. Thank you.

Rosy

Hi Rosy,

I wish it was as easy as just making recommendations for treatment ... but your treatment needs to be based upon assessment. You need to look at this child's medical issues (does this baby have respiratory issues, gut issues, allergies, etc? What is the primary diagnosis?), tone, posture and alignment issues (what you see in the body is what you get in the mouth), sensory system (is this a baby who has modulation, regulation or sensory discrimination issues?), oral structures (have you looked at the shape of the palate, the labial frenum, lingual frenulum, etc?) and then do a task analysis of oral sensory motor skills (you can task analyze any motor skill) to support safe nutritive feeding. Once you can target WHY this child is having difficulty managing purees, it will be appropriate to plan a program or to ask for suggestions for program planning. The two-day sensory motor class or the sensory motor feeding book may be helpful. Best,

Lori Overland, MS, CCC-SLP, C/NDT

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Ask A Therapist: The right duration of vibration

Posted by Deborah Grauzam on

Hello!

 

I have a question about using vibration (as with the Z-Vibe or Vibrator & Toothettes). I understand that using vibration can be used to "wake up" the sensory system, and I believe I’ve heard that it can have a temporarily positive effect on low muscle tone. I’ve read that vibration should be used in short durations, but I was wondering if you had any guidelines for the maximum or minimum duration of vibration? I’m thinking especially in a case of low muscle tone as in children with Down syndrome.

 

Thank you very much!

 

Jennifer

 

Hi Jennifer,

My name is Lori Overland and I teach the two day sensory-motor feeding class for TalkTools. Your email was forwarded to me, and it is an excellent question.

You cannot separate out the sensory and motor systems. Sensory feedback always impacts movement and movement provides feedback. It is important to make sure you have a specific motor goal (i.e.: in the case of spoon feeding, perhaps the goal is lip closure). Vibration facilitates a contraction of the muscle, so it may be used in conjunction with a tool to facilitate upper lip mobility for spoon feeding. If you leave vibration on a muscle for too long, the muscle relaxes. If you are using my pre-feeding exercises, I recommend  4-5 repetitions (maybe a little more or less depending on my client's sensory system) of an exercise. If you think about your motor goal and map sensory on to motor, you will not have to be concerned about using too much vibration. Feel free to email me if you have a follow up question.

Lori

 

Lori Overland, MS, CCC-SLP is a speech and language pathologist with more than 35 years of professional experience. Lori specializes in dealing with the unique needs of infants, toddlers, pre-schoolers and school-aged children with oral sensory-motor, feeding and oral placement/speech disorders. She has received an award from the Connecticut Down Syndrome Association for her work within this population. Lori consults with children from all over the world, providing evaluations, re-evaluations, program plans and week-long therapy programs. Lori also provides consults to local school districts and Birth-to-Three organizations. Her goal in addressing feeding and speech challenges is to improve the quality of life for both the children she serves and their families. In addition to her private practice, Alphabet Soup, Lori is a member of the TalkTools® speakers bureau. Lori has lectured on sensory-motor feeding disorders across the United States and internationally. Her classes, "Feeding Therapy: A Sensory-Motor Approach" and "Developing Oral-Motor Feeding Skills in the Down Syndrome Population" are approved for ASHA and AOTA CEUs. Lori is the co-author of A Sensory Motor Approach to Feeding. She holds degrees from Horfstra University and Adelphi University and has her neurodevelopmental certification.

Meet her!

- Oct. 14-15, 2016 for the workshop Feeding Therapy: A Sensory-Motor Approach in Cape Giraudoux, MO

- Oct. 29-30, 2016 for the workshop Feeding Therapy: A Sensory-Motor Approach in Minneapolis, MN

More dates at: TalkTools.com/Workshops

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Ask A Therapist: Straw Drinking

Posted by Deborah Grauzam on

Hello TalkTools,

 

I feel so defeated. My son is 2 years old and I can't get him to master straw drinking. He is an otherwise high-functioning, very successful child. He is starting to walk, can build with blocks ... What am I doing wrong?

 

David has Down Syndrome. (He has repaired cardiac defect, which thankfully has not been causing him any issues.) I find that he is very sensitive in the mouth. he is nervous to put anything in his mouth that he is not familiar with. I find him to be more motivated by familiarity (i.e. familiar foods) than special tastes. I tried putting all different juices in his mouth to get him to want to suck up but he is annoyed with the task.

 

Right now, my therapist suggested that I try using a large chocolate syringe ( it's an over sized syringe kids love to pour chocolate in their mouth!) which hopefully, will motivate him to suck the tip.

 

I am scheduled to see Lori Overland in November but I would love to get some tips now already.

 

Miriam

 

Hi Miriam,

I'm Whitney, a TalkTools® Instructor. Thanks for your email regarding your son. Please know you are not doing anything wrong. Often times straw drinking is very difficult to teach so be patient. I am very encouraged that you are scheduled to see Lori Overland in a few weeks. Hands on approach is so much better than any suggestions I can give you without getting my hands on your child.  

For now I would use the honey bear to teach this technique and add a highly flavored favorite liquid. I would also recommend to make the consistency a little thicker than water to help with tolerating this new motor skill. I often use a favorite yogurt or pudding and add water.   For now I would just continue to get acceptance of the honey bear and the straw to his mouth. Do not continue to push it if he becomes easily frustrated as we want to be able to address this skill when you see Lori Overland.  

Please let me know if you have any other questions.  

Thanks,

Whitney B. Pimentel MA, CCC-SLP

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Ask A Therapist: Feeding Therapy for a Medically Fragile Client

Posted by Deborah Grauzam on

Hello Talktools,

 

First of all, I cannot tell you how much I enjoyed Lori Overland's conference on Feeding Therapy: A Sensory Motor Approach in Savannah! I learned so much and have been able to apply the new (to me) strategies with many of my clients.

 

I have a question for Lori about a challenging client. My overall question is: how long after a frenectomy can we begin working on oral-motor therapy?

 

The client is medically fragile. He has 1/3 of his brain (brain stem, parts of occipital, visual cortex is present). He also suffers from CP and diabetes insipidus among other things. He is adopted, and his parents are EXTREMELY dedicated.

 

He is surprising us all with what he is able to do so far. He will be one year old in a couple of weeks, but he presents like a 3-4 month old right now.

 

He is able to consume liquids with a bottle, but his tongue tie is preventing him from being able to efficiently nurse, and he is gagging on pureed solids. His tongue tie is being corrected by an ENT surgeon this week. However, his mother is concerned because the doctor indicated the "easiest" thing to do would be to put in a peg tube.

 

While this baby is medically fragile, he is making progress in all developmental domains. His mother is realistic about him potentially needing a tube, but wants to make sure he truly has the opportunities to reach his maximum potential.

 

Any suggestions or insights would be welcome! He is very complex, and I know that without your class, I may not have been as prepared for him!

 

Thank YOU!

 

Amy

 

Hi Amy,

Thank you for taking the time to tell me how much you enjoyed the course!

You should be able to begin working on oral-motor therapy with your client within a few days after his frenectomy, but I usually do a two week follow-up, so I can see what the spontaneous results of the surgery will be vs. the impact of the therapy.

It is EXCELLENT to hear that he is surprising you with his abilities and how dedicated his mother is. Reach for the stars, it is nice to be surprised!

In regards to the tongue tie, releasing the tongue will not be a miracle for this little guy, but it will allow you to work on the oral sensory motor skills he needs for feeding. Even if at some point he does need a tube for adequate nutrition, it would be nice for him to do some safe recreational feeding. So...a week to two post-op, start to work on the lateral borders of the tongue, tongue blade stability, and tongue retraction.

I AGREE completely with making sure he has the opportunity to reach his maximum potential!

Good luck and feel free to check in with me if I can help!

Lori Overland, MS, CCC-SLP, C/NDT

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