Hi TalkTools,

 

I have a question about using vibration (as with the DnZ-Vibe or Vibrator & Toothettes). I understand that 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!

 

Riley

Hi Riley,

I’m Renee, a TalkTools® Instructor, and I would be happy to help you. This is an excellent question, I am asked this many times when teaching and working with clients!

You are correct, vibration can give the muscle more input and therefore often trigger a better motor response, thus “waking up” or “stimulating” the muscle to move. There are no specific “time” or duration guidelines for this. It is our responsibility as the therapist to look at the motor response while providing the input. So for some children with significantly low tone and an extremely under-responsive sensory system, it may take longer for the muscle to respond. But for a child who may have a better sensory system, the client may only need quick input 1-2x to see the motor response. It is important to remember what specific motor movement you are looking for and that the stimulation given is causing the appropriate reaction.

For example if I am providing stimulation to the lateral margin of the tongue to facilitate tongue tip lateralization to the back molars, once I see the movement, the vibration has done its job. Then I need to decide if my goal is repetitive movement using the vibration - leading me to possibly provide the input several times until I no longer see the tongue tip follow the stimulus - or possibly to quickly transition that movement to function (i.e. placing a cube of food on the back molar so the client then uses the movement in a functional way) which is my highest priority but sometimes not yet obtainable in my first sessions with the client.

Once I am sure of the goal of the vibration stimulation (what am I looking for in the motor system) it is easier to determine how long I should use it! The goal is always to eventually eliminate the vibration so that the movement is then stimulated through functional activities such as eating and speaking.

I hope this helps!

Renee Roy Hill, MS, CCC-SLP

Hello TalkTools,

 

I purchased the Horn Kit about a year ago, and the Horn #9 (airplane) in my kit does not have the propellers on it. My husband was informed via a recent email that they were taken off as a precaution because they could pose a choking hazard.

 

My son is now at this horn in the Horn Program, and his therapist is not sure how to assess whether he is doing this horn correctly without the propellers. With previous patients of hers, if both propellers spun, then she could tell the child was blowing hard enough/correctly. She is now not sure how to assess when my son is ready to move to the next horn, since the propellers are not there.

 

Can someone please tell us how to assess this horn correctly?

 

Thank you for your time!

 

Brianna

Hi Brianna,

I'm Renee, a TalkTools® Instructor, and I would be happy to answer your question.

You are correct, the new horn #9 does not have propellers, but not to worry, the movement of the propeller is not the determining factor of duration.

What your therapist will want to do is “listen" for a 2-second blow that is steady and controlled using a stable jaw, cheek tension, lip protrusion and abdominal grading. Although the propellers added a “fun” factor, the goal is not to make them move. The movement of the propellers actually led to some clients trying to blow too hard, so I believe the removal of the propellers has really improved the horn!

I hope this helps!

Renee Roy Hill, MS, CCC-SLP

Hello TalkTools,

 

I am Speech and Language Therapist working with an 11 year old with autism. He has a TalkTools® Program Plan, but I would value the opinion/support of one of your Instructors.

 

A significant priority at present is supporting him with dissociation of his jaw movements and then with grading. However, we have not been able to get a reliable bite on the Jaw Grading Bite Blocks. Interestingly, after about a month, he has achieved a bite/hold on the DnZ-vibe (not what I had initially planned that we would work on) with the vibration turned on. When the vibration is turned off, his bite is not so reliable. We are working at present on transferring the bite/hold to the #5 Jaw Grading Bite Block.

 

Do your instructors have any thoughts or experience with this? He does have complex sensory needs that are clearly factors in his eating, speech and other motor skills. I will certainly seek out advice from his Occupational Therapist once he has settled into a new school placement soon.

 

Many thanks,

 

Sally

Hi Sally,

I'm Robyn, a TalkTools® Instructor, and I've received your inquiry.

You are actually answering your own question, so great observation! This client needs more input to understand what's expected.

Hold the Bite Block in your right hand. With your left hand, hold a Jiggler in place on the top of the Bite Block and place at the correct spot as directed. I usually grab both tools with one hand and apply upward pressure on the mandible and say " bite and hold".

If this doesn't work, try reversing the hierarchy and working from 7 to 2 on the Bite Blocks, because the weakness may be in the high position. If there is a low jaw posture, sometimes reversing the order of the hierarchy is required.

I hope this helps!

Sincerely,

Robyn Merkel-Walsh, MA, CCC-SLP

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