Tagged "Lori Overland"


Ask a Therapist: Oral Motor Strengthening

Posted by Deborah Grauzam on

I was just assigned a 13 month old who was diagnosed at birth with bells palsy. He is much better now and the weakness on one side only shows up when he smiles (mom showed me how it droops in pictures). I want to do some oral motor strengthening. I have chosen a combination of your oral motor work and some Beckman strategies, but do you have any specific tips for this case?

I think one of the most important things you can do is to work on his cheeks. (My course “Feeding Therapy: A Sensory Motor Approach” has been updated with new pre-feeding exercises.) I would start with the cheek stretch, then work on cheek resistance and finally fish lip pops. If you can make some specific observations about function, I may have additional suggestions.

Lori Overland

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Ask a Therapist: Feeding Evaluation Questions

Posted by Deborah Grauzam on

We are just beginning our feeding clinic at a Medical Center for outpatient pediatrics. I have done one feeding evaluation since taking your class Feeding Therapy: A Sensory-Motor Approach, but now have a child on my caseload with an EXTENSIVE medical history, whom I am to evaluate. He has Tubuler/Tuberous sclerosis (tumors growing in his brain and other organs). He has seizures (is on seizure meds), severe Autism, nonverbal, hyperventilates, central sleep apnea, severe GERD, Bradycardia (when sleeping), desaturations (when tired or sick). He is seen by nearly every doctor imaginable. He had an MBS which showed aspiration with thin liquids, but was cleared for nectar liquids and pureed foods. He does not feed himself; he is held down by a weighted blanket because when awake, he severely injures himself by hitting his face. His adoptive mother indicates he was eating very well (not puree - he refused it, but would eat mechanical soft - whole without chewing) until January when his PO intake severely decreased to where he will only eat 1/2 of a meal. He had a PEG tube, which is now a Mickey tube, and gets G-tube feeds following meals to cover the calories he didn't get by PO means. He needs 1980 calories a day due to his constant effortful breathing. The family's goals for him are to increase PO and be able to chew foods. I did a very brief oral motor stim with him, and he tolerated facial massage and accepted a toothette to his cheeks and tongue. I'm not even sure of what questions to ask, but am thankful for any insight you may be able to provide. Thank you in advance! 

This sounds like a complicated child for your second feeding evaluation! So...the most important thing to remember is ..no extraneous "oral stimulation.” It is important to make sure you are mapping sensory input on to motor goals to support nutritive feeding. As you presented the toothette under his top lip, did you get upper lip mobility? Did he contract his cheek when you did the cheek stretch? Did you observe lateral tongue movement? In your assessment, look at the motor skills he needs to support safe nutritive feeding of texture modified solids and use your pre-feeding exercises to facilitate them. If he doesn't respond to the input you use...you may have to increase the sensory input (i.e.: dip the toothette in ice chips, cautiously experiment with vibration...etc). He sounds like a child who needs intense sensory input (i.e.: the weighted blanket, self abusive behaviors). Has he had a good sensory processing evaluation? If not, this is really important...a good sensory diet may help decrease the self injurious behaviors. I also want you to make sure you look at posture and alignment for both your pre-feeding and feeding programs. As you make observations, feel free to email me.

Good luck!

Lori Overland

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Ask a Therapist: Picky Eater

Posted by Deborah Grauzam on

I have a question regarding a 4 year old boy diagnosed with autism in a school setting. At first, he was only eating baby food (various flavors). Now, he eats baby food with Beech Nut baby cereal, still a puree, but a thick oatmeal texture. Sometimes I add a mashed banana to that mixture. He also eats mashed potatoes with some mashed egg whites (although sometimes he needs that dipped in banana baby food in order to eat it). My problem is not getting enough for him to eat, but getting him to accept more textures, and CHEW FOOD!

He accepts a chewy tube, but he will not chew on it if he sees, smells, or feels anything come out of it. He spits out pieces of banana in his babyfood/cereal/banana mixture. He will not allow Gerber puffs near his mouth. It took 5-6 months to transition from the baby food-only stage to where we are now, and I am at a loss, as nothing is working. I would appreciate any and all suggestions for trying new textures that will eventually (hopefully) lead to chewing.

Thank you so much!

It sounds like you have made some nice gains with this child. Are you doing lateral tongue massage and bilateral tongue hugs? Have you progressed to chewing hierarchy level #2 with the chewy tubes? If so, do you see tongue retraction and lateral tongue movement? If so, will he tolerate cold temperatures? If yes, use a syringe to fill a thick straw (Starbucks or Dunkin Donuts thickness) with a favorite puree, and put it in the freezer. Present the ice straw using chewing hierarchy level #1 (perpendicular to the lateral molar ridge at the first molar) and work on facilitating repetitive chews. This could be a good transition to bite, chew and swallow. If moving directly to solid foods is not working, you may have to task analyze his goals.

Good luck! 

Lori Overland

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