Tagged "oral motor"


Ask A Therapist: Open Mouth Posture

Posted by Deborah Grauzam on

Hi TalkTools,

 

I have purchased the Jaw Grading Bite Blocks to assist a client I have who has an open mouth posture most of the time and some significant difficulty with articulation and moderate amounts of drooling. Unfortunately I think I was premature in attempting the Bite Blocks assessment. I read through the book Oral Placement Therapy for Speech Clarity and Feeding thoroughly before beginning. He had a lot of difficulty attending to the specific directions I was giving. In addition, when he did bite down on the #2 block at the very beginning of the assessment, his jaw kept moving laterally. He doesn’t have a “natural bite”.

 

Could someone please advise me as to how I should proceed with this client?  I’m new to the TalkTools world and would appreciate an idea on where to start with this client.

 

Karen

 

Hi Karen,

I would advise that you work on the Bite Tube Set starting with the Red Bite Tube. This will work on your client's jaw strength and as you work through the bite tubes you can revisit the bite blocks. You would look to see if he is later able to achieve the "natural bite" and "bite hold" required with the bite blocks. Please let me know if you have any other questions.

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: 4 year old with Sensory Processing Disorder

Posted by Deborah Grauzam on

Hi TalkTools,

 

I am working with a 4 year old boy with Sensory Processing Disorder. When producing the /s/ phoneme he takes a quick inhalation of air. He is able to produce /z/ and /sh/ with appropriate outward flow of air. We have worked on discriminating correct vs. in correct airflow, horn blowing, air hockey with cotton ball or whiffle ball, and cheerio for tongue tip placement with adding the airflow as well. Despite max attempts he is unable to produce the sound in isolation. Any tips or advice you could provide would be greatly appreciated!

 

Thank you!!!

 

Randee

 

Hi Randee,

I would work on voice versus voiceless sounds. Having him feel your throat to see that with the "z" you are using your voice box and call "s" your quiet sound and work on the difference that way.  Another thing that I have tried to help with placement is a straw placed on the tongue down the middle out of the front of the mouth.  This helps kids to feel where the air needs to go. But it sounds like he has the placement piece since he is able to say the "z". Just something extra to try. There is also a complete list of oral placement activities to work on "s" and "z" on page 18 in Sara Rosenfeld-Johnson's book: Oral Placement Therapy for Speech Clarity and Feeding. This will give you a list of other activities to try. Let us know if we can do anything else 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: Straw Drinking

Posted by Deborah Grauzam on

Hello TalkTools,

 

I feel so defeated. My son is 2 years old and I can't get him to master straw drinking. He is an otherwise high-functioning, very successful child. He is starting to walk, can build with blocks ... What am I doing wrong?

 

David has Down Syndrome. (He has repaired cardiac defect, which thankfully has not been causing him any issues.) I find that he is very sensitive in the mouth. he is nervous to put anything in his mouth that he is not familiar with. I find him to be more motivated by familiarity (i.e. familiar foods) than special tastes. I tried putting all different juices in his mouth to get him to want to suck up but he is annoyed with the task.

 

Right now, my therapist suggested that I try using a large chocolate syringe ( it's an over sized syringe kids love to pour chocolate in their mouth!) which hopefully, will motivate him to suck the tip.

 

I am scheduled to see Lori Overland in November but I would love to get some tips now already.

 

Miriam

 

Hi Miriam,

I'm Whitney, a TalkTools® Instructor. Thanks for your email regarding your son. Please know you are not doing anything wrong. Often times straw drinking is very difficult to teach so be patient. I am very encouraged that you are scheduled to see Lori Overland in a few weeks. Hands on approach is so much better than any suggestions I can give you without getting my hands on your child.  

For now I would use the honey bear to teach this technique and add a highly flavored favorite liquid. I would also recommend to make the consistency a little thicker than water to help with tolerating this new motor skill. I often use a favorite yogurt or pudding and add water.   For now I would just continue to get acceptance of the honey bear and the straw to his mouth. Do not continue to push it if he becomes easily frustrated as we want to be able to address this skill when you see Lori Overland.  

Please let me know if you have any other questions.  

Thanks,

Whitney B. Pimentel MA, CCC-SLP

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Ask A Therapist: Using Vibration for Low Muscle Tone

Posted by Deborah Grauzam on

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

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Ask A Therapist: Feeding Therapy for a Medically Fragile Client

Posted by Deborah Grauzam on

Hello Talktools,

 

First of all, I cannot tell you how much I enjoyed Lori Overland's conference on Feeding Therapy: A Sensory Motor Approach in Savannah! I learned so much and have been able to apply the new (to me) strategies with many of my clients.

 

I have a question for Lori about a challenging client. My overall question is: how long after a frenectomy can we begin working on oral-motor therapy?

 

The client is medically fragile. He has 1/3 of his brain (brain stem, parts of occipital, visual cortex is present). He also suffers from CP and diabetes insipidus among other things. He is adopted, and his parents are EXTREMELY dedicated.

 

He is surprising us all with what he is able to do so far. He will be one year old in a couple of weeks, but he presents like a 3-4 month old right now.

 

He is able to consume liquids with a bottle, but his tongue tie is preventing him from being able to efficiently nurse, and he is gagging on pureed solids. His tongue tie is being corrected by an ENT surgeon this week. However, his mother is concerned because the doctor indicated the "easiest" thing to do would be to put in a peg tube.

 

While this baby is medically fragile, he is making progress in all developmental domains. His mother is realistic about him potentially needing a tube, but wants to make sure he truly has the opportunities to reach his maximum potential.

 

Any suggestions or insights would be welcome! He is very complex, and I know that without your class, I may not have been as prepared for him!

 

Thank YOU!

 

Amy

 

Hi Amy,

Thank you for taking the time to tell me how much you enjoyed the course!

You should be able to begin working on oral-motor therapy with your client within a few days after his frenectomy, but I usually do a two week follow-up, so I can see what the spontaneous results of the surgery will be vs. the impact of the therapy.

It is EXCELLENT to hear that he is surprising you with his abilities and how dedicated his mother is. Reach for the stars, it is nice to be surprised!

In regards to the tongue tie, releasing the tongue will not be a miracle for this little guy, but it will allow you to work on the oral sensory motor skills he needs for feeding. Even if at some point he does need a tube for adequate nutrition, it would be nice for him to do some safe recreational feeding. So...a week to two post-op, start to work on the lateral borders of the tongue, tongue blade stability, and tongue retraction.

I AGREE completely with making sure he has the opportunity to reach his maximum potential!

Good luck and feel free to check in with me if I can help!

Lori Overland, MS, CCC-SLP, C/NDT

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