Tagged "Lori Overland"


Ask A Therapist: Feeding Suggestions

Posted by Deborah Grauzam on

Hi TalkTools,

 

I was at the Feeding Therapy: A Sensory Motor Approach course Lori Overland taught in Manhattan this past January. I've been in love with using what I've learned and have even become a go-to feeding person at my school.  

 

I have a low-toned girl who has tongue protrusion at resting but can keep her mouth closed at times.  During all speech sounds, she produces with her tongue forward, and I am working on getting it back (have suggested use of straws).  Her teacher recently brought to my attention her difficulty with feeding.  

 

When observed eating eggs, fish, rice-softer foods with less crunch-her tongue weakness definitely shows. The food just pools in the front of her mouth until she eventually spits it out, because she can't swallow it. She turns her head to the side when chewing, which I'm assuming is her inability to dissociate her tongue from her head. With crunchier and longer foods, her teachers have done well teaching her to put it on the side. 

 

I would like to implement some of the tongue lateralization exercises as well as the chewing hierarchy for her. It seems she has so much trouble even just initiating a swallow. I appreciate any further suggestions you have, and if you have any idea how to explain why she's having difficulty with these softer foods. 

 

All the Best,

 

Lisa

 

Hi Lisa,

Thank you for your kind words about the feeding class. It sounds like you are doing a great job. Here are a few suggestions for you:

  • Check under her tongue to make sure she doesn't have a posterior tongue tie
  • Work on lateral tongue movement and the chewing hierarchy
  • Work on cheek mobility to help stabilize food
  • Use therapeutic feeding techniques at mealtime - she may be better able to swallow foods presented on the lateral molars
  • Work with her PT to establish a good seating position for feeding

Good luck!

Lori Overland, MS, CCC-SLP, C/NDT

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Ask a Therapist: Strong Gag Reflex

Posted by Deborah Grauzam on

Tervehdys!

 

I am speech pathologist from Finland, took your class about Feeding Therapy: a sensory-motor approach at Helsinki last May. I am sending you an e-mail, because I met a new client shortly after the class and this case really bothers me. I have asked permission from parents, to send this e-mail and pictures/short video when he's eating. So, this boy is 5 years old, he has had feeding issues since he was baby. Nowadays he eats almost anything but no meat. It seems like he doesn't have enough strength at his muscles to bite. When he eats, he puts lots of food into his mouth, only couple of bites and then he swallows. Looks like he's gagging when eating. He uses only couple of words, can't elevate his tongue without gagging. And when pronouncing for example sound /a/, he gags and tongue goes into "cup." He can't reach his upper alveoli with his tongue. The situation is horrible, I have only met him couple of times and it seems like the posterior tongue-tip would be one problem, maybe also tissue around it. I am writing a paper about him because he's going to see a doctor in September. But if it's possible, I would like to get another opinion - yours :-) Thank you so much, if you have time to answer me.

 

Yours,

 

Mrs. R

  IMG_0320 IMG_0343

Hello R,

You are absolutely correct. It looks like he has a type III posterior tongue tie. He probably cannot contract the lateral borders of his tongue. Chewing meat requires much more than just jaw strength, it requires being able to use the lateral borders of the tongue and cheeks together to stabilize the food. That is probably the problem when he is chewing meat. He cannot collect the bolus, and cannot stabilize the bolus on the molar ridge for mastication. He needs to be referred to an otolaryngologist (ENT) or an oral surgeon who understands the correlation between structure and function. Once his frenulum is released you may need to do the lingual exercises for function, BUT you will be able to facilitate the movements he needs for handling more difficult textures. GOOD OBSERVATION!!!!!!

Lori Overland, MS, CCC-SLP, C/NDT

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Ask a Therapist: Sensory Feeding For An Infant With Medical Issue

Posted by Deborah Grauzam on

Dear Lori,

I attended the Sensory Feeding Course in England in June, and would like to thank you for a full two days of professional input.  Before I left Manchester, I had already thought of how I was going to utilize some of the techniques in my therapy sessions.

You had mentioned that you would not mind answering questions, so I hope you do not mind me taking advantage of the very generous offer.

I have my first appointment to see a 4 month old boy with feeding problems next week.  Mom reports that he breast fed nicely (after an initial period of latching difficulty, and the need to suck using a nipple shield). After 1 week, baby got floppy, stopped feeding, and was taken to hospital, where he stayed for a few weeks. He is currently being fed through a nasal feed tube.  Although he is reported to have a strong suck, he does not suck on breast for long. Bottle feeding has the same results.  This child has had extensive genetic testing, endoscopy (up to larynx), videofluroscopy, and EMG--all without any abnormal findings. He is scheduled for an endoscopy to investigate the esophagus.  He has reflux, and I was told that milk came through the nose.  The ENT did not find any sub-cutaneous cleft, nor velo-pharyngeal insufficiency.  He will also have an MRI.  The current medical opinion seems to indicate problems with swallowing.   All this information was received by phone. I have not seen any reports, as yet.

My goal for the session (aside from meeting and assessing the child), is to show mom the oral and sensory-motor stimulation techniques and massages (as well as hand, foot and body massages).  I also would like to introduce some pre-feeding activities, to try to prevent, or, at least minimize oral sensitivity and aversion to food taken orally.

Question: With a dry spoon (Beckman E-Z feeder), shall I introduce spoon feeding with a front feed, or side feed technique? I am inclined to do both, as they involve different oral motor movements.  However, I do not want to instill incorrect feeding behaviors.  (This is the first time that I am working with an infant).

I would like to thank you in advance for your input.

Best regards,

You are absolutely welcome to ask questions! I am so glad you have been able to use the techniques in your therapy.  I am wondering if this baby was tested for food allergies. Does he have reflux? What are his bowels like? Was he scoped? Do you know if they explored inflammation of the intestines or colon?  Does he have infantile spasms? There sounds like there is an underlying medical issue which has not been identified yet. I agree that your best course of action is to address his underlying oral sensory motor skills to support feeding. At 4 months of age and with so many unanswered medical questions I would not want to start spoon feeding just yet. 

When you do get ready to address spoon feeding if he has low tone, I would recommend side spoon feeding with either the small maroon spoon or the EZ spoon. Good luck with this little one!

Lori Overland, MS, CCC-SLP, C/NDT

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Ask a Therapist: Down syndrome Program Plan

Posted by Deborah Grauzam on

Hi Lori,

I recently took your "Feeding Therapy: A Sensory-Motor Approach" workshop and it was great!!  In the past year I've completed the "Oral-Motor Therapy: Assessment & Program Plan DevelopmentDVD as well and started volunteering with the local Down Syndrome Association to practice what I've learned.

My current client is a 4 year old boy with Down syndrome who has tactile defensiveness, which I believe is secondary to having been through a 'feeding' approach that pushed more on him than his oral-motor skills could handle. Overall, he is low tone, with open mouth and significant tongue protrusion.  His current team has recommended a very expensive behavioral feeding program, which I don't believe will benefit him at this time.  He will currently only drink formula from a bottle, 6 times per day.  When he drinks from the bottle he is suckling with his tongue right out underneath the nipple, and he has been fed in a reclined bouncy chair. He is not able to drink from a cup as even thickened liquid is lost all over, and his tongue is still out under the cup rim.  He tilts the cup up and gets liquid on his top lip and inadvertently in his mouth.

We've figured out a seating position we can work with (in a booster seat - not the best, but all we have right now), but don't have an OT in the picture to make recommendations.  We started on a pre-feeding program to normalize sensory response, and, where he would not let anyone touch his face at all, he is now letting us do some facial massage, tapping (with hands and with vibration) and Gator kisses, and recently started putting the end of the Gator Jiggler in his mouth.  He will not yet tolerate any tools further inside his mouth than his lips, but we have started to get some lip rounding and tongue retraction when he puts the Gator Jiggler in his mouth.  He is also letting his Mom and I hold Horn #1 and he will blow on it 5 times at this point.

He is obviously still on the bottle at this point for nutrition, but his family and I are working towards lip closure, tongue retraction and getting his cheeks active.  The attempt with the honey bear was unsuccessful as too much liquid got squeezed into his mouth so he is now refusing it.  His parents report he can use the Straw #1 from the hierarchy to suckle and get liquids that way.

I'm really on my own right now, as there are very few therapists where I live that have been trained using these methods so I wanted to make sure I'm on the right path with him.  My goals are:  pre-feeding program to normalize sensory response and allow tools on his face/in his mouth, get lip-closure and tongue retraction, activate/develop his cheeks, and later start elongating the lateral margins of his tongue to get lateralization, and start with chewing hierarchy number 1.

Here are my questions:  1)  Am I on the right track, based on the little you now know about him?  2) Should I stick with the straw hierarchy, and not introduce the recessed-lid cup as too many things might be confusing?  3)  He has very limited different tastes in his diet right now, is it okay to introduce different tastes in liquid form, or will this interfere too much with our primary goal of getting into his mouth??  4)  Can I please get your recipe for natural thickener?

Thank you so much for any assistance/direction you can give me!

Hello,

Thank you for your email. I am impressed with both your assessment and your proposed treatment plan.  Given your description of his sensory motor skills I agree that a behavioral program is not warranted at this time. It sounds like you have made some initial gains which will allow you to access his oral musculature.  I think your priorities are massage, tap and tone, the cheek stretch, Mickey Mouse /m/, lateral tongue massage and chewing hierarchy level #1. If he is drinking from Straw #1, absolutely continue the hierarchy and do not introduce the cup and the straw at the same time.  You may try naturally thickened liquids such as fruit smoothies (yogurt, fruit and ice well blended) or stage 1 fruit purees thinned out with spring water.  You can also try adding club soda to the fruit puree to add the sensory input.  As for transitioning from liquids to puree. I would start with the mickey mouse /m/ in your pre-feeding program to develop the motor plan for spoon feeding, then work toward using the vibrating spoon with nothing on it to develop the motor plan for therapeutic spoon feeding. Then try liquids he tolerates on the spoon (I might start with water and work my way to a flavor)!!!! Thanks for sharing!

Good luck.

Lori Overland, MS, CCC-SLP, C/NDT

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Ask a Therapist: Feeding Therapy Self-Study Follow-Up

Posted by Deborah Grauzam on

Dear Lori,

I just completed your "Feeding Therapy: A Sensory-Motor Approach" DVD. What an amazing course! It certainly gave me a great deal of confidence in working with children with feeding disorders. While it was extremely thorough and informative, I do have several questions for you. I would love your input!

1. When would you typically recommend an OT evaluation?  Or perhaps I should say,  in which cases would you not refer a child (with an apparent feeding disorder) to an OT?  ***Great question! I look at the whole child and ask a lot of questions about how the child moves through life. In my case history form I ask questions like: does your child get upset easily, does your child have difficulty calming, does your child have difficulty in new situations, transitions, separation etc, does your child have complicated routines for bed, bath, daily living activities, etc... During the evaluation I watch how the child responds to input in the environment. If I observe underlying sensory concerns (sometimes parents just think their child is challenging, or high maintenance and do not realize the behaviors they observe are secondary to sensory issues) I immediately refer to an OT. If the child seems to be able to self regulate, modulate incoming information (for everything but feeding) ....I would not necessarily refer to an OT immediately. I might start an oral sensory motor pre-feeding program and see how the child progresses.***

2. You spoke a bit about breastfeeding, and I was wondering, what role would a lactation consultant play in breastfeeding support if you are working with a nursing mother?  Would our job be the same as a lactation consultant's or would you ever refer the family to one?***I work with great lactation consultants. They are often the first ones to see the baby. They call me in when they observe oral sensory motor issues which are not related to the mothers milk production, bonding, positioning etc. If it is a mom issue...it is definitely the lactation consultants role to consult. If the baby has oral sensory motor issues....that is our role.***

I would also like to order some tools from your website for my practice.  I want to add the Mickey Mouse attachment, but I am not sure if I should buy the hard or soft one.  ***It depends on your child's sensory system...but overall I prefer the soft mouse*** When would you use one vs the other? ***If a child needs more input I would recommend the hard one*** And what about the cat?  I don't think you talked about it in the video, but I am curious to know when it should be used. ***I use the cat ears to get tongue tip pointing. For example, I may present the cat ear at the lateral incisor for chewing hierarchy level #3, and then alternate lateral incisors!!!!***

I really wish I was able to physically attend your course and get to meet you in person!  You are such an inspiration to me!!  Thank you for all of your incredible work. ***Thank you for taking the class on video, and I hope one day we will meet in person. I am doing a one-hour seminar at ASHA this year!!!! If you are there, please come and introduce yourself!!!!

My very best,

Lori***

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