Tagged "Oral Motor Therapy"


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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Ask A Therapist: Horn Help

Posted by Deborah Grauzam on

Hello,

 

I purchased the TalkTools Parent Kit back in December, and have been implementing the oral placement therapy with the support of my daughter's speech therapist since January.

 

We are making great progress with the straws and the bite tubes, but have hit a road block with the horns. My daughter, who will be two years old next month and has Down syndrome, is able to make a sound on Horn #1, but she also bites on the horn when she blows. As well, she sometimes uses her voice as well as blowing (sort of like a kazoo).

 

I'm not sure where to go from here.

 

Her speech therapist suggested stopping the horn hierarchy for a while and trying to get her to blow bubbles. I've tried blowing bubbles, and she can do it but isn't much interested. We've also taken a break from the horn, but any time I go back to it she does the same thing...although she's interested in the horn.

 

Please help! It is amazing what an improvement we've seen in such a short time. I know the horn hierarchy is an important component of what we're trying to do here, and I don't want to miss out on the benefits!

 

Thank you for the important work you are doing. I know my daughter is a bright, funny little girl. I want others to see what I see. Speech clarity and her appearance (tongue retraction) are critical to creating a positive first impression and breaking down negative stereotypes about people with Down syndrome.

 

Words cannot properly express the hope it gives me for her future to hear her speak clearly with confidence, when we were told she wouldn't be able to do that. Thank you for not accepting the status quo.  Thank you for using your expertise to help my little girl and others like her who needed someone to take the time to figure out the why and come up with the how.

 

Jerilee

 

Hi Jerilee,

Let me begin by saying how pleased I am that you are seeing such good progress in the short time you are using the Straw Hierarchy and the Bite-Tube Hierarchy with your two-year-old!

Your speech therapist's suggestion to go to bubble blowing was a good one, as it will establish the motor plan for blowing without making a vocal sound. Here is what I would suggest:

1. Have your daughter blow the bubble 1 time as you say "blow." Remove the bubble wand.

2. Place your non-dominant hand under her chin with your thumb against her lower jaw to keep her from biting on the horn.

3. Place the mouthpiece of the horn on her lower lip as you say "blow." Remove the horn, and if necessary, go back to the bubbles to establish the motor plan.

Thank you for your kind words about the work we are doing at TalkTools. Your comments about your daughter's emerging speech clarity put a smile on my face. Please let us know if you have any additional questions as you work through the program.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask A Therapist: Feeding Suggestions

Posted by Deborah Grauzam on

Hi TalkTools,

 

I was at the Feeding Therapy: A Sensory Motor Approach course Lori Overland taught in Manhattan this past January. I've been in love with using what I've learned and have even become a go-to feeding person at my school.  

 

I have a low-toned girl who has tongue protrusion at resting but can keep her mouth closed at times.  During all speech sounds, she produces with her tongue forward, and I am working on getting it back (have suggested use of straws).  Her teacher recently brought to my attention her difficulty with feeding.  

 

When observed eating eggs, fish, rice-softer foods with less crunch-her tongue weakness definitely shows. The food just pools in the front of her mouth until she eventually spits it out, because she can't swallow it. She turns her head to the side when chewing, which I'm assuming is her inability to dissociate her tongue from her head. With crunchier and longer foods, her teachers have done well teaching her to put it on the side. 

 

I would like to implement some of the tongue lateralization exercises as well as the chewing hierarchy for her. It seems she has so much trouble even just initiating a swallow. I appreciate any further suggestions you have, and if you have any idea how to explain why she's having difficulty with these softer foods. 

 

All the Best,

 

Lisa

 

Hi Lisa,

Thank you for your kind words about the feeding class. It sounds like you are doing a great job. Here are a few suggestions for you:

  • Check under her tongue to make sure she doesn't have a posterior tongue tie
  • Work on lateral tongue movement and the chewing hierarchy
  • Work on cheek mobility to help stabilize food
  • Use therapeutic feeding techniques at mealtime - she may be better able to swallow foods presented on the lateral molars
  • Work with her PT to establish a good seating position for feeding

Good luck!

Lori Overland, MS, CCC-SLP, C/NDT

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Ask A Therapist: Therapy Scheduling

Posted by Deborah Grauzam on

Hello,

 

I recently attended a TalkTools training and have a question about how to implement the therapy. Specifically for children under the age of 2, what are the frequency and length of your sessions? Do you schedule weekly standing appointments, or do you schedule as needed to reassess after the child has made progress?

 

I have some clients interested in this therapy, but am not sure how I should schedule them.

 

Thank you,

 

Anna

 

Hi Anna,

​In the ideal world, we should like to be able to see these kids weekly for 45 minutes sessions. At these early ages the parents need support in feeding skill development, and their children are changing so rapidly that you do not want large gaps between sessions. As you know, once the child starts using an incorrect placement it is very difficult to correct. Also, starting at 12 months we introduce the Horn, Bubble, Bite-Tube and Straw Hierarchies which need constant monitoring​.

I would not choose your second option as to scheduling as progress is made, as that means the parent is responsible for determining when the progress is seen. I find those first 2 years to be critical to prevent or at least limit incorrect placements for feeding and speech.

I hope this answers your question but if not, please let me know.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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