Tagged "Sara Rosenfeld-Johnson"


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.

Read more →

Ask A Therapist: Vocalic R Materials

Posted by Deborah Grauzam on

What tools and continuing education materials do you recommend for working with children on vocalic r?

 

Rose  

 

Hi Rose,

The first thing that I would recommend that you purchase would be Sara Rosenfeld-Johnson's book: Oral Placement Therapy for Speech Clarity and Feeding.  On page 20 in the book, she gives you a list of oral placement activities to use to work on vocalic "R".  The activities listed on that page are included in the book.  After you look up each activity the book will tell you exactly what you need to order and how to use it.

Hope this helps. Please let us 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.

Read more →

Ask A Therapist: 3 year old with Moebius Syndrome

Posted by Deborah Grauzam on

You all have been amazing when I have asked for help with my students, so I have another question. I have just evaluated a 3 ½ year old who was diagnosed at birth with Moebius Syndrome. Although I have had difficulty finding information about this syndrome, I managed to find an article Sara Rosenfeld-Johnson wrote that was extremely helpful and plan to follow her recommendations. My main concern right now is that a Haberman bottle was used to feed him, so now he clamps his teeth down on the flute and straw when I try to work with him. Is there any tool that is beneficial to inhibiting the teeth biting and promoting the normal suck and swallow and blowing? And if you have any other references for oral motor therapy related to damage to the 7th cranial nerve I would appreciate it. THANK YOU!!!!!!   Thank you for the compliment and the question.  I have worked with Sara and the Moebius population for the past 10 years and hope I can help with your question!

 

The clamping of the teeth is common since the primary problem we are working with is the inability to close the lips.  So this is very common with most of the children and adults we work with.  The key initially is to make the mouthpiece big enough to fit into the current lip opening.  To determine if this is even appropriate to begin, you need to know if the client has paralysis or paresis.  If you have seen any upper facial movement, flutters or twitches then you are looking at paresis and working on these skills may improve lip and cheek function.  Here is a basic outline of what you might do with straw and horn blowing; both a part of a complete oral placement program that would also address any deficits in jaw stability as you are trying to achieve lip from jaw dissociation (I can give you more information on that if you would like):

1st:  Begin by using the TalkTools vibrator and trimmed Toothette (the vibration is the key) under the upper lip and in the cheeks to provide sensation to the muscles. This would be done for 1-2 minutes and therapy activities would then follow.

2nd:  Horn Blowing:  Measure the lip opening when the child is in a resting lip posture, or if possible, trying to close his lips on command.  You may begin with Horn #1 if they have the breath support and skill but also may want to start with the Alex Tub Flute (TalkTools has begun carrying them but you will need to check availability).  This horn is easier to blow and has a wider mouthpiece.  If you use Horn #1, wrap the tip of the horn in medical tape several times until the mouthpiece measures the lip open position.  This will allow you to then support the jaw with your non-dominant hand and place the horn between the lips, rather than the teeth (the pre-requisite is that they know to exhale on command).  Using the TalkTools Progressive Jaw Closure Tubes is also helpful in teaching this skill.  As they meet the criteria, you can unwrap the horn mouthpiece one time and repeat until you have removed all the tape.  The lip, assuming there is the ability to gain movement will follow with practice.

3rd:  Straw drinking:  I would suggest starting with the Honey Bear with Flexible Straw.  There is a program Sara and I wrote several years ago called the Ice Sticks Program that has a technique using a syringe to teach a client to retract the tongue and swallow.  This same program can also be used with Moebius Syndrome with the goal of teaching the child to “slurp and swallow”.  You can use the Honey Bear following the same principles as the syringe technique to place the straw in the buccal cavity, squeeze and then tell the child to slurp.  You would need to ensure he is not biting on the straw (support with your non-dominant hand if needed) and that the tongue is retracted (you will often see the tongue protrude between the central incisors as an additional compensatory strategy if tongue retraction is difficult for them.  As they learn to “slurp” the liquid you have squeezed into the cheek, it activates the cheek, lip and tongue muscles, eventually leading to the child's ability to “slurp” the straw on their own.  There are several steps to teach this and I’m happy to share more detail if you need it as well!

I would also encourage you to visit the Moebius Foundation website.  Our past presentations should be available for you to view and may be helpful as well.

I hope this gets you started!  Clients with Moebius Syndrome are a joy to work with once you have the appropriate tools and starting point!  We’ve had great success with many individuals using these techniques!

Thank you,

Renee Roy Hill, MS, CCC-SLP

Read more →

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

Read more →

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

Read more →
script type="text/javascript" src="//downloads.mailchimp.com/js/signup-forms/popup/unique-methods/embed.js" data-dojo-config="usePlainJson: true, isDebug: false">