Sara,

 

I have an adult woman who has had surgery for oral cancer and has had resection of right hard palate. I have been treating her for Trismus using the TheraBite. This has worked successfully as she was able to wear an obdurator.

 

She is now at a point where she can no longer wear the obdurator and the TheraBite is therefore not an appropriate tool to help maintain her jaw opening as she has no functional surface to place the TheraBite on her right side. Have you had any experience using the Bite Blocks as a treatment for Trismus?

 

Thank you for your help in this matter.

 

Tracy

Hi Tracy,

I have been using Oral Placement Therapy techniques with adults for many years. Trismus or difficulty with the controlled opening and closing of the jaw is often seen after oral cancer resection and/or radiation treatments. To treat it, I use a combination of the Bite Block Hierarchy and the Bite Tube Hierarchy to increase mobility and opening of the jaw. Bite Blocks work on static opening of the jaw muscles while the Bite Tubes work on dynamic mobility used for speech as well as for feeding. If you are not familiar with these techniques you can learn about them by watching the video of my 2-day class "A Three part Treatment Plan for Oral Placement Therapy."

The success of the program depends not so much on the severity of the truisms but on the compliance of the client. It will be necessary to practice each activity 10 times per day to ensure success.

I have just completed my newest book A Therapist’s Guide to Improving Speech Clarity and Feeding Skills in the Adult Population using Oral Placement Therapy. It is with the publisher now and will be available within the next few months. In it I teach these techniques as well as the other OPT activities I use with the adult population.

I hope this has answered your question,

Sara Rosenfeld-Johnson, MS, CCC-SLP

Dear TalkTools,

 

My son, David, is 4 years old and has Down Syndrome. He has in the last year started chewing on his tongue. I have tried giving him the P & Q to chew on and also the Gator Jiggler. The Gator works for a time and the P's and Q's do not seem to help at all. I looked on your website for potential ideas to no avail and was wondering if you have additional thoughts/ideas. We are a very oral family -- I chew on my pens (usually when I'm thinking), my two oldest daughters were thumb suckers until older, my 2nd daughter bites her nails, my 3rd daughter chews on her shoelaces...thanks for any ideas that you may have!!

 

Robyn

 

P.S. Sara has seen David informally the last two years at NDSC.

Hi Robyn,

I am so pleased you decided to email TalkTools with this question. I must say this tongue chewing is often seen in kids with the diagnosis of Down syndrome as well as with other children with low tone and associated muscle weakness. In my second book, Assessment and Treatment of the Jaw - Putting it all together: Sensory, Feeding and Speech, I devote an entire chapter as to why children with jaw weakness find these habits: tongue sucking is only one of them. Other kids choose teeth grinding, finger sucking, sucking on clothing, biting themselves or other, prolonged use of pacifiers or sippy cups and nail biting. What all of these "habits" have in common is the need for stimulation to the temporomandibular joint for calming. This is the joint where the bones of the upper jaw and the bones of the lower jaw meet right below the ears. This joint has more nerve endings than any other place in the human body. It is where we go to relax. In your email you mentioned you bite on a pen and your daughters bite on shoe laces or nails. The up-and-down movement of the jaw relaxes us and helps us to organize our bodies.

Because your son needs stimulation directly to the joint the two techniques you listed: P&Q and Jiggler vibrator are not giving him the correct input. The muscles that need to be activated are the masseter muscles and the tools you are using are not reaching those muscles.

We, at TalkTools, have developed many techniques to give this necessary TMJ stimulation. One which seems very appropriate for your son would be the Bite Tube Hierarchy, in which four tubes are used to not only satisfy the need for TMJ stimulation but also are used to improve speech clarity and chewing skill levels. The instructions for how to implement the technique is included with the therapy tools. There are many more options to substitute for the tongue sucking and these can be found in the book I mentioned above.

I hope this answers your question,

Sara Rosenfeld-Johnson, MS, CCC-SLP

Hi Sara, I am Jonathan's speech therapist, his Mom and I had a few questions for you. 1. When working with your therapy cards should we provide jaw support due to his jaw sliding or just stay on lower level cards that don't cause his jaw to slide until his jaw strengthens from the OPT exercises?

Stay on the lower level cards. As he progresses through the Bite Tubes and the Bite Blocks you can ​add higher level cards.

2. Is it okay for Joe to use the yellow chewy tube unmonitored throughout the day to replace his finger and tongue chewing even though his jaw may slide while he chews it? (The yellow tube causes his jaw to slide more than red).

No, those tubes need to be used only for exercises as stated in the program plan.  You can give him other tubes to chew on throughout the day.  TalkTools carries many other tubes for this sensory need.  Try one of the nubby ones as that may be just what he needs.

3. Is it possible his lower jaw pulls to the right during speech because of a structural issue and not muscle weakness?

I did not see any structural issue when I evaluated him in January so unless he has had an accident I would say no.  This sliding should be corrected as you progress through the jaw exercises.  It is only 4 months since I saw him and jaw weakness is a tough problem to correct. Give yourself at least one year before you start looking into other possibilities​.

Thanks for your time! These were questions concerns that come up during a conversation with mom.

Feel free to contact us at anytime

Sara Rosenfeld-Johnson, MS, CCC-SLP

Hi Sara,

 

My friend Diane told me that you have been exploring alternate tongue positions for sibilants and recommended that I ask you the following question: Assuming there are no airway issues, how important is it to correct the resting posture of the tongue in order to enable correct production of sibilants?

 

I am working with a seven year-old boy with a perpetually low resting posture of his tongue. He keeps his lips closed at rest, but his tongue is quite lax while he speaks, and it affects his /s/ (frontal lisp), /r/ (vowelized), and /l/ (imprecise). We have done the straw program and he is capable of producing a good /s/, but I just have a concern that with his tongue lying around at the bottom of his mouth, he will not conquer the /s/ in his spontaneous speech. In discussing this with Di, she posited that you might have an opinion on my question.

 

I’d appreciate your thoughts when you get a chance.

 

Thank you,

 

Lana

Hi Lana,

I am so pleased Diane suggested you email me as she is correct, I have been very interested in tongue tip position for the standard production of /s/ and /z/.

It is important to teach the tip to elevate and depress in order to move fluidly within the oral cavity. Using the straw hierarchy will result in retraction but will not improve tip mobility. You may want to look at the tongue tip tools which teach lateralization of the tip and tongue tip elevation/depression.

Once a child has those skills he will be able to show you which position is right for him. Do you have a copy of my book Oral Placement Therapy for Speech Clarity and Feeding? In it I list the sequence of activities to ensure the oral skills are adequate to produce the /s/ and /z/ in addition to the other sounds you say this child is having trouble producing.

I hope this answers your question and have a nice day,

Sara Rosenfeld-Johnson, MS, CCC-SLP

Hi Sara,

I have taken your Oral Placement course and you currently have devised a plan regarding this program for my son Cole. I have a question however it is regarding something I am seeing in treatment (I am an OT) when using the straw program. I have a patient who has down syndrome, 6 months ago could not form a seal around a straw much less retrieve fluid. She had/has frequent tongue protrusion which limited this skill. Using your techniques she has gained the ability to form a good lip seal (with cheek cueing provided) and can retrieve liquid. What is happening however is that after she sucks 1-2 times (I believe when she is going to swallow) she protrudes her tongue which then breaks the seal and continues to use a pattern we are trying to correct. Any suggestions or insight on this situation? This child has also learned to blow horn #1 and can do with cheek cueing for 8 blows before compensation. At times she has some nasal airflow which I believe her tongue (midblade) elevates and impacts based on the sound she makes when this happens. She can do bubbles as well with same cueing. Last bit of information on whistles and bubbles I included in case it helped with answering my original question. Thank you for your time!

I have seen the behaviors you describe concerning the suckle pattern with straw drinking.  Here is what I would try.  Have her draw the liquid 1 time, remove the straw, once she swallows, put the straw in again.  See if the single-sip technique helps with the tongue retraction.  Also, make sure the tip of the straw is on the surface of her lower lips and that she is drawing the liquid back using lip protrusion with tongue retraction.  If the straw is on her tongue blade that might also explain why you are seeing the protrusion.  I hope this helps. 

Sara Rosenfeld-Johnson, MS, CCC-SLP