Tagged "program plan"


Ask A Therapist: My First Time Doing An Eval

Posted by Deborah Grauzam on

Hi TalkTools, 

 

I have a few questions for the staff SLP. I watched the "3 Part OPT" videos and I can see how it generally walks me through the eval process but the language doesn't seem clear to me on the Assessment Form. Did I miss something?

 

It is my first time doing an eval. Here are my questions regarding how to do the eval:

 

1. For "Jaw Grading Bite Blocks", do I use ALL of the in the A, B, and C positions? Or just some or the last one?

 

2. for "Tongue Tip Lateralization", what does this look like? Do I start with asking them to swipe the inside of their mouth left to right 10 times and if they can't then use the tool? What do I ask the client to do?

 

3. For "Tongue Tip Elevation " I don't understand the criteria of 50 seconds, 1 time. What does this mean?... hold the tongue tip at alveolar ridge for 50 secs? What do I ask the client to do?

 

4. "TT Depression"- Where does the tongue go? What do I ask the client to do?

 

5. Same for "TT Up and Down"  - where does the tongue go? What do I ask the client to do?

 

Sincerely,

 

Carrie 

 

Hi Carrie,

Great question!  The Oral Motor Skills for Feeding and Speech Checklist is not intended to “teach” you each section of the form but a place for you to write results, guide you through an assessment and then provide the information you would need to then develop a program plan for therapy. The form assumes you know each technique, or, have the resources to find the protocol for each exercise. The criteria for success listed is a reminder of what the final goal is to complete that activity or step (this is the part that so many, to include myself have difficulty remembering when you are new to using the protocols). You may want to consider looking into our next course, “Assessment and Program Plan Development” that would follow the 3 Part Treatment Plan. In this course we use this form for several different evaluations to help you become familiar with its use! I will answer your individual questions below, directing you to where the complete instructions for each of them are!  If you have further trouble don’t hesitate to email me!

1. Each Bite Block Height would be assessed at each level. For example, you would not move from Bite Block #2 Exercise A to Bite Block #2 Exercise B unless they have met the criteria for Exercise A and so on. These instructions can be found in the books “OPT for Speech Clarity and Feeding” “Assessment and Treatment of the Jaw” and included with the set of Bite Blocks.

2. There is a specific exercise outlined in “OPT for Speech Clarity and Feeding” using a Bite Block and complete instructions with the Tongue Tip Lateralization Tool. There are many steps to this activity to teach the client to lateralize the tongue tip to the lower back molar.

3. Yes, the final goal is that the client can hold the tongue tip to the alevolar ridge for a full 50 seconds, 1X. You will notice that in therapeutic practice we often request multiple repetitions of practice but it is not always the criteria for success.

4. This is another activity that is in “OPT for Speech Clarity and Feeding” or included in the instructions with the Tongue Tip Elevation Tool. 

5. The tongue tip will go to the same two locations previously practiced individually. These instructions are also in “OPT for Speech Clarity and Feeding” followed by a transition technique to teaching the /s/ sound once you have completed this activity!

Renee Roy Hill, MS, CCC-SLP

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Ask a Therapist: Therapy Cards and Chewy Tubes

Posted by Deborah Grauzam on

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

677

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Ask a Therapist: Down syndrome Program Plan

Posted by Deborah Grauzam on

Hi Lori,

I recently took your "Feeding Therapy: A Sensory-Motor Approach" workshop and it was great!!  In the past year I've completed the "Oral-Motor Therapy: Assessment & Program Plan DevelopmentDVD as well and started volunteering with the local Down Syndrome Association to practice what I've learned.

My current client is a 4 year old boy with Down syndrome who has tactile defensiveness, which I believe is secondary to having been through a 'feeding' approach that pushed more on him than his oral-motor skills could handle. Overall, he is low tone, with open mouth and significant tongue protrusion.  His current team has recommended a very expensive behavioral feeding program, which I don't believe will benefit him at this time.  He will currently only drink formula from a bottle, 6 times per day.  When he drinks from the bottle he is suckling with his tongue right out underneath the nipple, and he has been fed in a reclined bouncy chair. He is not able to drink from a cup as even thickened liquid is lost all over, and his tongue is still out under the cup rim.  He tilts the cup up and gets liquid on his top lip and inadvertently in his mouth.

We've figured out a seating position we can work with (in a booster seat - not the best, but all we have right now), but don't have an OT in the picture to make recommendations.  We started on a pre-feeding program to normalize sensory response, and, where he would not let anyone touch his face at all, he is now letting us do some facial massage, tapping (with hands and with vibration) and Gator kisses, and recently started putting the end of the Gator Jiggler in his mouth.  He will not yet tolerate any tools further inside his mouth than his lips, but we have started to get some lip rounding and tongue retraction when he puts the Gator Jiggler in his mouth.  He is also letting his Mom and I hold Horn #1 and he will blow on it 5 times at this point.

He is obviously still on the bottle at this point for nutrition, but his family and I are working towards lip closure, tongue retraction and getting his cheeks active.  The attempt with the honey bear was unsuccessful as too much liquid got squeezed into his mouth so he is now refusing it.  His parents report he can use the Straw #1 from the hierarchy to suckle and get liquids that way.

I'm really on my own right now, as there are very few therapists where I live that have been trained using these methods so I wanted to make sure I'm on the right path with him.  My goals are:  pre-feeding program to normalize sensory response and allow tools on his face/in his mouth, get lip-closure and tongue retraction, activate/develop his cheeks, and later start elongating the lateral margins of his tongue to get lateralization, and start with chewing hierarchy number 1.

Here are my questions:  1)  Am I on the right track, based on the little you now know about him?  2) Should I stick with the straw hierarchy, and not introduce the recessed-lid cup as too many things might be confusing?  3)  He has very limited different tastes in his diet right now, is it okay to introduce different tastes in liquid form, or will this interfere too much with our primary goal of getting into his mouth??  4)  Can I please get your recipe for natural thickener?

Thank you so much for any assistance/direction you can give me!

Hello,

Thank you for your email. I am impressed with both your assessment and your proposed treatment plan.  Given your description of his sensory motor skills I agree that a behavioral program is not warranted at this time. It sounds like you have made some initial gains which will allow you to access his oral musculature.  I think your priorities are massage, tap and tone, the cheek stretch, Mickey Mouse /m/, lateral tongue massage and chewing hierarchy level #1. If he is drinking from Straw #1, absolutely continue the hierarchy and do not introduce the cup and the straw at the same time.  You may try naturally thickened liquids such as fruit smoothies (yogurt, fruit and ice well blended) or stage 1 fruit purees thinned out with spring water.  You can also try adding club soda to the fruit puree to add the sensory input.  As for transitioning from liquids to puree. I would start with the mickey mouse /m/ in your pre-feeding program to develop the motor plan for spoon feeding, then work toward using the vibrating spoon with nothing on it to develop the motor plan for therapeutic spoon feeding. Then try liquids he tolerates on the spoon (I might start with water and work my way to a flavor)!!!! Thanks for sharing!

Good luck.

Lori Overland, MS, CCC-SLP, C/NDT

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