Tagged "Monica Purdy"

Ask A Therapist: Thickened Textures, Straws & Horns

Posted by Deborah Grauzam on

Hello, I have some questions regarding your therapy tools/techniques:


1. Why is the goal to have 1/4 inch of the straw in the mouth for the straw hierarchy? Why does the length matter?


2. Do you work on the thickened textures program with the hierarchy straw program simultaneously or should they be done subsequently to the completion of one of the programs?


3. Where can you obtain nectar?


4. Many of the horns have the same type of mouth openings. What is the purpose of having multiple horns with the same type of openings - do they really target different sounds and oral motor postures?


Thanks for your help!




Dear Devorah,

Hi my name is Monica Purdy and I am a TalkTools® Instructor. I wanted to answer some of your questions.

1. The goal for having the straw 1/4 of an inch in the mouth is due to working on lip dissociation from jaw, and tongue dissociation from jaw. If clients are putting the straw on their tongue and are using 1/2 of an inch or an inch, they are probably suckling instead of using tongue retraction. Tongue retraction - especially back of tongue side spread (which is what straw #8 works on) - is important for co-articulation.

2. Once you get to straw #5, you can then begin to use the second straw hierarchy with thickened puree. Often you will be using both of these hierarchies simultaneously.

3. Nectar is the consistency of the puree. For example, use tomato juice. Remember you do not have to use tomato juice, but the consistency of tomato juice. You can also thicken any liquid using nectar packets.

4. The horns really do target different sounds. Some of the horns are flat mouthed horns but the child starts to work on lip dissociation, because the mouth piece becomes smaller and requires more lip tension to make the sound and an increase in tongue tension.

I hope this helps, if you have any additional questions please let me know.

Monica Purdy

Monica Purdy, MA, CCC-SLP has more than 14 years of professional experience specializing in helping children with special needs to communicate. Monica is PROMPT and SOS trained, familiar with sign language, and well-versed in the use of augmentative devices. She is the owner of Kids Abilities Pediatric Therapy Clinic in Indianapolis, IN. In addition to her private practice, Monica is a member of the TalkTools® speakers bureau and has been invited to speak at numerous conventions and seminars across the U.S. and internationally. She is a graduate of Ball State University.

Meet her!

January 29 - 30, 2016 - Oral Placement Therapy: Assessment & Program Plan Development - Middlesex, NJ

February 11 - 13, 2016 - 2016 ISHA Convention - Rosemont, IL

March 16 - 17, 2016 - Oral Placement Therapy: Assessment & Program Plan Development - Sacramento, CA

March 18 - 19, 2016 - Oral Placement Therapy: Assessment & Program Plan Development - San Diego, CA

April 7 - 10, 2016 - 2016 MSHA Convention - Osage Beach, MO

For more information and to register, visit our Event Calendar.

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Ask A Therapist: Bite Tube Compression

Posted by Deborah Grauzam on

Hi to TalkTools, I am an SLP who has taken the Three-Part Treatment Plan for Oral Placement Therapy course and am incorporating OPT into my practice. I greatly enjoy this as it benefits my patients! Thank you!


I have a question regarding the bite tube hierarchy. I want to make sure I know if a patient is using a full compression. It seems that on the DVD, Sara says that we need to hear the "clicking" sound to know that the red tube is fully compressed. Is this true or is it merely a matter of seeing that the patient did bite down? Also, is this true for the yellow bite tube as I am able to make a "squeaking sound" when I bite down? What about the purple and green since they are harder and no sound is emitted?


Also, I have read the article Oral Habits: Why They Exist and How to Eliminate Them. I am aware that we can make the bite tubes available (they can have unlimited access and control over the bite tube themselves) to those who use an appropriate motor plan for chewing (up and down movement.....no gnawing, jaw sliding or jutting). I understand that this will satisfy the need for Temporomandibular joint (TMJ) dysfunction stimulation, but have concerns that they will want to spend an inordinate amount of time chewing on this ....that it will take on a "life of its own", so to speak. How do you recommend dealing with this concern? Give them complete access to the bite tube or not?


Thanks for your response.



 TalkTools Blog | Ask A Therapist: Bite Tubes


Dear Holly,

My name is Monica Purdy and I am one of the instructors for the Three-Part Treatment Plan for Oral Placement Therapy course. First let me say I am pleased you are enjoying using OPT. It has made such a difference in my practice as well!

Regarding your question about the bite tube hierarchy, we recommend that when you do an evaluation you use a new chew tube. Often when the chew tube is new, you will hear a clicking or a sound; however this may not always be the case. What you do want to see is a full compression and a full release of the chew tube. As for the purple and green, you are right and will not hear a sound, but again you should be seeing a full compression.

As for your question regarding oral habits, you are correct. If the child is able to motor plan and chew in an up and down controlled manner, and if I am not using the chew tube in the bite tube hierarchy, giving the chew tube to the child is a good option for them to replace their oral habit. Typically children will chew until they get the input they need from the chew tube. However, if you are using the chew tubes in the bite tube hierarchy, you will want to do the chew tubes with the child in a controlled manner when you see the child doing their oral habit. You may also think about putting them on the gum chewing hierarchy, as this is a great way for the child to get the input they need to the TMJ.

I hope I have answered your questions for you. If you have any concerns or questions please do not hesitate to let us know.

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Ask a Therapist: Jaw Stability Protocol for Severe Underbite

Posted by Deborah Grauzam on

Hi Therapists,


What do I do for a 19 year old student with a severe underbite (a gap of ½ inch between top and bottom teeth) when trying to use the jaw stability protocol?


Thank you 


When you are working on the Bite Blocks for jaw stability and the Bite Tube hierarchy, you will want to make sure that you have optimal bite posture first. You will judge optimal bite posture from the back molars. From your email it sounds as if his under bite is structural rather than functional. In this case you will work with the bite blocks and chew tubes in his structural position. Unless he has orthodontic work you will not be able to change structure.

I hope this helps. Please let me know if you have any further questions.

Monica Purdy, MA, CCC-SLP

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Ask a Therapist: Bite Block Speech Sounds

Posted by Deborah Grauzam on


I am an SLP who attended the "A Three-Part Treatment Plan for Oral Placement Therapy" workshop. I would like to find out if there is a set of speech sounds corresponding to the jaw height for Bite Blocks? For example, Bite Block #7 corresponds to "ah" vowel. 



My name is Monica Purdy and I am a TalkTools Instructor and teach the mentioned course.  I just wanted to answer your questions regarding the sounds that go with the bite blocks.

Bite blocks 2 and 3 work on the high position of the jaw and address the following sounds:  m,b,p,f,v,n,s,z,sh,ch and r  and the following vowels:  I (as in big), e (as in me), u (as in blue).

Bite blocks 4 and 5 address the medium position of the jaw and work on following sounds:  "th" voiced and voiceless, l, t and d and the following vowels:  uh, o, a (as in ball), e (as in bed).

Bite blocks 6 and 7 work on the low position of the jaw and address the following sounds:  g,k, and h  and following vowels:  a (as in mad) and a (as in ahh).

I hope this helps, please let me know if you have any further questions.

Monica Purdy

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Ask a Therapist: Straw Drinking Progression

Posted by Deborah Grauzam on

I recently purchased the straw therapy kit for my 17 1/2 month old daughter with Down syndrome. She was breastfed for the first year and we began transitioning to a straw cup around 9-10 months old. I also have kept the tip of the straw short each time. She does not have tongue protrusion and only occasionally an open mouth posture when tired or concentrating. We began using the first straw for two weeks without any issues. We are now on the second straw of the series. She seems to have no difficulty with it either, good lip closure and rounding, no leakage or spills. How long do I need to stay with the 2nd straw? She is actually capable of using the more difficult straws already also, but I realize there is a reason to progress through the straw hierarchy in order. When do you recommend advancing to the next straw if there are no issues? Do we continue the recommended order of the straws? Is there a minimum time for each straw despite no issues? Any advice is greatly appreciated. I am also working with our Speech therapist, but she does not have much experience in this area.

Thank you for your time.


Dear Robin,

Thank you for your question!  When beginning the straw drinking hierarchy, you can either begin at straw #1 or #4.  You are correct in making sure the child is only putting 1/4 of the straw in their mouth, this way the child is using good lip rounding and the tongue is retracted.  It sounds like you might want to try straw #4 with your daughter.  If she only puts 1/4 of the straw in her mouth, then you will not need to cut the straw (straw #1 and 4 are the only ones you can cut).  If she is putting more than 1/4 of the straw tip in her mouth then you will need to cut the straw to 1/4 inch above the first twist.  By straw #4 the tongue must be completely retracted in the mouth and the jaw is stable.  She will not be allowed to suckle on straw #5.  If you see a forward and backward movement of the jaw - then she is still suckling.

The criteria for success involves:

1.  No liquid leakage or air leakage between the lips.

2.  The jaw should be relatively still/stable, indicating jaw-tongue independent movement.

3.  Lips should be slightly protruded.

4.  The child is able to drink 4 ounces of liquid in 2 min or less.

If you give your daughter straw #4 - you will know if it is too hard - she will be struggling to suck liquid up - then you will return to #3 until she meets criteria.

I hope this helps and let me know if you have any further questions!

Monica Purdy

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