Tagged "Low Tone"


Ask a Therapist: Physical Therapist Question on Oral Motor

Posted by Deborah Grauzam on

Hi,

 

I am a physical therapist working in Early Intervention in NJ. I have a 12 month child that I suspect has an undiagnosed syndrome. She has very low muscle throughout. Her cognitive level is about 6 months. She cannot sit unsupported. She can imitate a play action. She is making very few sounds. Frequently sticks out her tongue, open mouth posture. She can only eat pureed foods. I called for a speech assessment and was told by the Speech Therapist that there is no evidence that Oral Motor Therapy can help her speech at this age. Is that true?

Thank you for your help!

 

Tal

 

Dear Tal, 

Thank you for your question.  My name is Monica Purdy and I am a speech and language pathologist that also specializes in oral placement therapy and feeding. There is a lot of research on oral motor and the effectiveness and evidenced based information. If you visit this page on the TalkTools website you will find articles that you can print off and give to the speech therapist. Many speech therapists assume when someone mentions "oral motor" that they are referring to exercises such as "tongue wagging" (moving the tongue from side to side outside of the mouth), puffing the cheeks, and/or elevating the tongue to the nose or chin (again outside of the mouth). These activities do not have any support and are not related to speech or feeding and should not be used. However as you know being a physical therapist you can address muscle function by working on stability, dissociation, grading, precision and endurance in order to help a client with feeding and speech intelligibility. At TalkTools we do this by using kinesthetic feedback or tactile cues to help a client achieve these skills. Many times we work on feeding because it is a precursor to speech and we can prevent speech sound distortions from occurring if we address the muscles in feeding.   

I hope this helps, if you have any further questions please do not hesitate to contact me. 

Monica Purdy, M.A., CCC-SLP

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Ask A Therapist: A client bites down on baby bottle

Posted by Deborah Grauzam on

Hello! 

 

My name is Yael and I have a patient who is 18 months, has low tone in the oral area, likes a lot of sensory input inside the mouth but won't suck on a straw or drink from a cup. He only drinks from a baby bottle and kind of bites down on it. How can I start working on his suckling skills so I can work with the straws and all the other tools?

 

Thank you!

 

Yael

 

Hi Yael,

I will give you a number of things to try and see what works for your patient.  I would work on providing a good sensory warm up with the Vibrator & Toothette, chewing on gloved finger, using the z-vibe, or red Chewy Tube (depends on where your client is with jaw strength). I would question if your patient has jaw weakness based on your description.  You can also try rocking the bottle in and out of the mouth to encourage more of a front/ back pattern versus the up/ down biting. Then I would try to use the Honey Bear with Flexible Straw to encourage drinking.  You will load the straw for the patient and provide jaw and cheeks support if needed. I hope some of this helps.

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

Thanks,

Liz

 

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.

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Ask A Therapist: 17 year old with Autism

Posted by Deborah Grauzam on

Hi, 

 

My son is 17 and has Autism. He has received speech services since he was 2.8 months old. The most successful therapy has been PROMPT for him. Currently he has 3 therapists working with him. One specializes in PROMPT, the other specializes with his talker device and the other is on the team. My son rarely uses his talker which he acquired about 3 years ago. He basically uses one word to meet his wants.  Unknown people can't understand him. He has hypotonia. He drops off the ending of his words. We recently (Fall of 2015) brought back PROMPT therapist as his speech was regressing with traditional imitative speech therapy. He was saying the /sh/ sound for the /s/ sound and we were having trouble getting the retraction.  Would the horn program help and if so how? And could I do it as a parent? I use PROMPT with my son to correct the /s/ as in yes, but I am not using PROMPT extensively as the SLP is in therapy.

 

Thanks for your advice.

 

Gina

 

Hi Gina,

I am a speech language pathologist who is trained in Prompt as well as TalkTools. I often use the two together for many of the patients I see. I feel they are two approaches that often help my patients with difficulty with verbal communication. I think it is great that you are considering pursuing both for your son. I would encourage you to try to find a TalkTools trained therapist in your area to evaluate your son and create a program plan for you to follow if that is available. You can do it all yourself but you would need to watch the video A Three-Part Treatment Plan for Oral Placement Therapy and follow the directions included in your kit. The horns would work on tongue retraction as well as the Bubble Kit and straw drinking. I often use these activities together with patients working on tongue retraction.

Please let me know if you have any other questions.

I am happy to help.

Thanks,

Liz

 

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.

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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: Tips for Implementing the Horn Hierarchy

Posted by Deborah Grauzam on

Hello Talktools,

 

I'm a pediatric SLP with a clinical question for your experts. I attended the Three-Part Treatment Plan for Oral Placement Therapy (OPT) workshop last year. I have a little guy (3;4) who presents with low tone, has a breathy voice and speaks in short bursts.

 

I recently introduced the Horn Program, hoping that we could use it to improve his abdominal grading and breath support. However, we are having some problems with compensatory movements, and I'm having trouble remembering from the workshop what we are supposed to do about that!

 

When I hold up the horn, he leans, opens his mouth wide and reaches for it with his arms. If I can get him to sit back in the chair as I bring the horn to him, he inevitably opens his mouth wide. He also bites the horn for stability, and if I can get him to close his mouth as I present the horn, he grabs my shoulder for support.

 

I feel we need to back up, but I'm not sure where to go! Would one of the TalkTools® Instructors be able to help me with this? Do these sound like things his OT should work on? Are there some other activities you might recommend as a prerequisite for success with Horn #1?

 

Thank you in advance for any guidance on this issue.

 

Sincerely,

 

Kim

 

Hi Kim,

This is a common problem when starting with a client, especially if he is just beginning an OPT program, has overall low tone and also has jaw instability and difficulty with lip-jaw dissociation. The aforementioned are all good reasons to use the TalkTools Horn Hierarchy. Following are some things to remember about using the Horn Program that may be helpful.

1. Consider your seating - Is he well supported with his head, pelvis, knees and ankles at 90 degrees? Does he have a place to rest his hands, head and feet? These are important to think about initially, remembering that what happens in the body often is seen in the mouth. If you do not have access to good support from a chair, try lying him down on the floor (I like a wedge if possible, but if you are working in a home you may only have access to a pillow). Gravity can help him with stabilizing the body, and if he’s not working against his own lack of support through his core muscles, you may get a better start.

2. It is absolutely OK to provide jaw support when starting out. If you remember, you can also progress forward through Horn #1 and #2, even if you are still needing to give him support. Jaw support can help and is crucial in eliminating a few of the problems you are reporting: Moving forward (you are providing stability at the lowest level of oral function and often need good support to start. Think about getting his body and jaw positioned first with your support and THEN present the horn. Doing both at once often leads to habitual compensatory movements), controlling the opening of the jaw (increase your support as needed until he opens just wide enough - if he still has difficulty, think about where you are in his Jaw Program. If you are just beginning and he has poor jaw control, this may not be something you can completely control just yet, working on a jaw program simultaneously- the TalkTools® Bite Tube Set and/or the TalkTools® Jaw Grading Bite Blocks will help! You may also want to consider supporting him from behind if his chair seems to be supporting him OK at the hips, knees and feet but he has nowhere for his hands or head to stabilize. In this case, you would use your body as the support from behind while wrapping your hand around the head to support the jaw. This can also eliminate some of the leaning forward you may see, especially if he is seeking stability/sensory input.

3. If you continue to struggle, consider backing up and working with Step B of the Bubble Blowing Program to teach him to control airflow; this is where you blow the bubble and catch it on the wand, having him use a voiceless “ha” to teach him to isolate the abdominals. This would take out the focus of lip closure and jaw stability for now, while teaching him to access volitional air with control. I’d also really consider your jaw program, and see if several sessions of jaw input might help you gain a little more control over his oral function.

All great questions and I hope these suggestions help you find a starting point. Of course if it leads to more questions, please don’t hesitate to contact us again!

Sincerely,

Renee Roy Hill, MS, CCC-SLP

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