Tagged "Sara Rosenfeld-Johnson"


Ask a Therapist: TMJ Sensory Feedback for Calming

Posted by Deborah Grauzam on

Hey Sara,

 

Recently you had a parent open question meeting in Corpus Christi, TX. I was there with my 8 month old baby. You were talking to a woman who's 5ish son with Down syndrome was repeatedly hitting his chin and you mentioned he was satisfying a feeling that was in his jaw by that action. I have noticed my baby has started doing that with her left hand. What do you recommend to help correct/redirect this behavior now?

 

-L

Hi L,

The sight of stability and calming for an infant is in the temporomandibular joint. This joint is where the upper and lower jaw meet right below the ear. There are more nerve endings going through that joint than any other location in the human body. When a baby sucks his/her thumb, sucks from a bottle, sucks on a pacifier, etc. the nerves in that joint are stimulated and the baby calms or even falls a sleep. If your child is doing other behaviors to stimulate the jaw like hitting the chin or for older children it may be teeth grinding, then it is probably time to introduce the Bite-Tube Hierarchy. You can learn more about this and other activities to increase jaw skills for both feeding and speech clarity in my book, "Assessment and Treatment of the Jaw: Putting it all together, Sensory Feeding and Speech."

If you do decide to purchase that book please read the chapter on Sensory first as it will explain to you in more detail the reason why babies and children with muscle-based deficits develop "habits" to compensate for the jaw weaknesses. I would also encourage you to share this information with your SLP as she may have additional suggestions.

I hope this has answered your question.

Sara Rosenfeld-Johnson, MS, CCC-SLP

Read more →

Ask a Therapist: Optimal Bite and Structural Cross Bite

Posted by Deborah Grauzam on

Hello Sara,

I took your course in NYC Sept 2013. I have a question, if you don't mind answering, I have a student with down's syndrome who is 12 years old and up until now has not been motivated to work many aspects of speech and language.  This year she is more motivated and feel that I can take a more aggressive approach with TalkTools. She has also been diagnosed with a cross bite by her orthodontist. He states that it is both structural and positional. He does not feel hopeful that she will be a candidate for orthodontia for many reasons. How then can I work on jaw strengthening when she has a structural cross bite and poor prognosis for orthodontic intervention?

Thank you for you time.

-D

talktools-retouched-16x20-0010

 

Hi D,

In the class you learned about how to establish the most optimal bite using two #2 Bite Blocks.  Look back into your notes to see how they are placed.  As long as you can get the back molars to make contact with the Bite Blocks you can rotate them to the front, remove one and still do the Jaw Grading Bite Block exercise.  Sometimes, when you rotate to the front you lose the optimal bite position.  If that happens then keep both Bite Blocks in his mouth when you rotate to the front, keep both in his mouth as you introduce "Exercise A: Bite Block" but only pull on one side at a time.  The two in her mouth will maintain the optimal bite as the pull will be working on strength at only one side at a time.  

Once you can see the optimal bite you can use that same positioning to work on the Bite Tube Hierarchy.  I hope this answers your question. 

Sara Rosenfeld-Johnson, MS, CCC-SLP

Read more →

Ask a Therapist: Nasal Emission of "sh", "ch", and "j"

Posted by Deborah Grauzam on

Hi Sara,

 

I have a student who is turning four years old next month. I have been seeing her for several months for nasal emission on /sh/, /ch/ and /j/. She never had any anatomical problems and has been seen by an ENT. Oddly, she produces /s/ and /z/ just fine in spontaneous speech. I've been trying to work off the /s/ to /sh/, or /h/ to /sh/ by raising the jaw while producing /h/, the butterfly position, etc. I don't think she is able motorically to follow the instructions but then again it could be she doesn't understand due to her age. I can tell she is trying as she will crunch her nose trying to stop the air from coming out. She is bright and discrimination training has been mastered. She understands oral versus nasal sounds. Do you have any suggestions?

Let me begin by saying there may be a few options for her and without seeing this almost 4 year old I can only give some suggestions. You will have to try each of them to see which is the most beneficial.

To begin, the difference between the /s/ and /z/ and the "sh" "ch" and "j" is the increased use of the lateral margins of the tongue resting against the upper palate.

1. If your client can say "ee" then you might want to work from that position rather than from the ones you tried. Show her a picture of the upper jaw with the sides of the tongue resting against the upper jaw. You can find this graphic in the handout for the class, "A Three-Part Treatment Plan for Oral Placement Therapy" if you have taken that class or if not it is also in the book, "Oral Placement Therapy for Speech Clarity and Feeding". Once this child can feel the sides of the tongue elevated and making contact with the upper palate you can have her freeze in that tongue position and try to say the standard "sh." Sometimes it is easier to get the "ch" from this position so I would try both.

2. If that does not work then I would see if she has the ability to elevate the sides of her tongue. The prerequisite movements for this placement would be the ability to a) lateralize her tongue tip to the back molars on alternating sides of her mouth without sliding her jaw, b) elevate and depress her tongue tip from an "ah" jaw position without moving her jaw. If she cannot do these prerequisites then the Straw Hierarchy would help develop these skills. Again you would refer to the book "Oral Placement Therapy for Speech Clarity and Feeding," for complete instructions.

3. You might also want to try the activity entitled, "Oral-Nasal Contrasts" from "Oral Placement Therapy for Speech Clarity and Feeding," as that activity works directly on mobilizing the velum.

I hope this helps,

Sara Rosenfeld-Johnson, MS, CCC-SLP

Read more →

Ask a Therapist: Unsupervised Chewing

Posted by Deborah Grauzam on

Hello, My patient was evaluated by you in June of 2014.  We are currently using the red chewy tube and yellow chewy tube in therapy and at home to improve jaw strength and stability. However, the patient is now seeking ‘input’ orally- especially with chewing, now more than ever before.  How can we support this sensory need without promoting undesirable skills like jaw sliding?  Is there something else she can chew on- unsupervised? Thank you!

The situation you describe is one I see with many of my clients.  Once the clients "feel" jaw mobility using the "Bite Tube Hierarchy" and are thereby receiving the needed temporo-mandibular joint stimulation for calming they often increase their need or desire to mobilize the jaw (seeking oral input).  The Bite Tube Hierarchy will eventually incorporate four tubes as described in the book, "Oral Placement Therapy for Speech Clarity and Feeding."  The goal of the tools is to give the needed stimulation to increase jaw stability so that the client will then transition that skill into feeding and speech thereby eliminating the need for the tool and the need to chew on non-food items.  For this reason I do ask therapists to not give these tubes to the kids as then they may use them with an inappropriate jaw slide or jut.

With that said, however, you do ask an important question, " Is there something else she can chew on - unsupervised?"  Since I do not know the name of your client I cannot refer to the Program Plan I wrote for her/him I can only list for you the additional options: Slow Feed for snacks, Gum Chewing (without swallowing the gum) and Jaw Grading Bite Blocks. Each of these therapy techniques is taught in that same book, "Oral Placement Therapy for Speech Clarity and Feeding."  In addition, they are taught in the class, "A Three part Treatment Plan for Oral Placement Therapy" which will give you the gestalt of why and how to work on muscle-based speech clarity deficits.

Our goal for anyone with jaw weakness and instability is to increase the skill so that the jaw can support the independent movement of the lips and tongue for speech clarity and feeding safety so that is why I am focusing on the therapy suggestions above.

However, I still have not answered your question.  There are many sensory tools sold by TalkTools and other companies that allow the child to hold the tool without supervision as they are not working on jaw grading but are instead focusing on sensory feedback.  They include the Star Vibrator, Chewy Tubes, and ARK products.  As long as you are not using the tools used in the "Bite Tube Hierarchy" your client can hold and chew on any of the other options.

Sara Rosenfeld-Johnson, MS, CCC-SLP

Read more →

Ask a Therapist: Vocalic /r/

Posted by Deborah Grauzam on

Hi Ms. Rosenfeld-Johnson,

 

I took your oral placement technique course in New York a few weeks ago. I have a few clients who have difficult with the /r/ and tried out the robot technique. A lot of those same kids also have trouble producing the glottal fry -- do you have any pointers for me?

 

Thanks so much! And thanks for your wealth of knowledge. Your course really changed the way I look at a lot of my kids!!

 

Karen

Hi Karen,

Thank you for your kind words about the class content. I love this therapy and hope to share its benefits with other SLPs who have not had the opportunity to learn the techniques through their schooling. To hear that my work has changed, and I hope, benefited the way you look at your clients is a true gift so I thank you for that.

As to your question.... I have two responses:

1) You can hold a jiggler vibrator next to the child's neck so he/she can feel extra vibration in the laryngeal area. Use the direction of turning on the motor in your throat as you ask the child to say the "ee" sound.

2) You will not need to teach the robot voice if the client can produce the required placement without the voice. It is only used if the client has trouble feeling the "back of tongue side spread" placement against the upper palate. I hope one of these options answers your question.

441

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">