Tagged "Sara Rosenfeld-Johnson"


Ask a Therapist: Down Syndrome and OPT

Posted by Deborah Grauzam on

Hello. I have a 10 year old daughter with Down Syndrome and severe speech and language delays. I am interested in your program, but don't know if it is appropriate for my daughter. Most of the information I could find seemed to refer to infants and very young children.

Last year at the NDSC conference I gave a presentation entitled "Oral Placement Therapy (OPT) for Teen and Adults: It is never too late."  In it I talked about the fact that muscles skills can improve at any age so even though your daughter is 10 years old if I were to evaluate her I would not be looking at her age or her diagnosis.  I am assuming with the diagnosis of DS that she has muscle weakness so OPT  has shown to improve those skills which in turn improves feeding skills and speech clarity.  OPT does not work on language development it is a  speech production technique which uses tactile cues in conjunction with auditory and visual cues to improve speech clarity.

I would like to know if you think your Parent Kit, straw and horn hierarchies would be something that would benefit my daughter, or is it geared more to younger children?  Also, is it something that I could implement on my own, without the help of an SLP?

Yes, to both questions. I use the items in the Parent Kit for clients of all ages and all ability levels as the programs address the development of muscle skills used in speech production. The Kit comes with three hour video that teaches you how to do each of the activities. In addition, I would suggest one of the following for you:

1. I teach a 2-Day class for SLPs and parents (who do not have a trained SLP to implement the activities). It is also online and will give you all of the information you would need to work with your daughter. It is called "A Three Part Treatment Plan for Oral Placement Therapy."

Or 2. If you learn better through reading then the book Oral Placement Therapy for Speech Clarity and Feeding might give you enough information. In the ideal world you would purchase both as you need the overall information in the class and th en can refer to the book to remind you of the sequence of each activity.

Unfortunately, Cindy has received poor quality speech therapy since she was a toddler, with the exception of one therapist, who stopped practicing less than a year after beginning to see my child.   All throughout her life, I have asked her speech therapists about oral motor therapy, and all of them thought it wasn't something worth pursuing.  The attitude almost seemed to be "she has enough other problems to worry about," and since she was eating well at the time, they urged me not to worry.  In reality, probably most of the therapists weren't well versed in this area, and they certainly didn't take into consideration the feeding issues Cindy has as an infant, which were quite severe.

I hear this a lot but please know it is not too late and you can still help your daughter to improve her speech skills.  Obviously, if you had a speech therapist who was willing to watch the class that would be best and then you could implement daily what the speech therapist was doing in her sessions.

Anyway, I'm tired of the wait and see attitude, and I want to take matters into my own hands.  Cindy's articulation is quite bad, she hardly opens her mouth when she speaks, and vowels give her a lot of trouble, esp. "long" vowels sounds, in particular "a" and 'i."  There is the possibility of apraxia, as well.

Again, I hear this a lot.  The reason she does not open her mouth when she speaks may be related to jaw weakness.  This is quite common in individuals with muscle based communication disorders.​

I live in a rural area in Northeast PA, and there don't seem to be any nearby therapists trained in your methods.  Can you give me an idea of whether or not this program may benefit my daughter (and why) and if I could implement the parent kit on my own.  Is ten years old too late to increase oral motor strength?

I think I have answered this one above.  Did you check on the TalkTools website to see if we have a trained SLP in your area? Or.. you can call a local speech therapy clinic to see if anyone has taken the class I mentioned above.  Please let me know if I have answered your question.  If you decide to watch the video then please feel free to email us with any specific questions.

I am so pleased you decided to email us at TalkTools.  I do receive numerous email questions like the one you sent and I hope I have helped answer your questions.  I have worked with numerous children with the diagnosis of DS and serve on the professional advisory board of NDSC.

Sara Rosenfeld-Johnson, MS, CCC-SLP

talktools-2013-0171

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Ask a Therapist: Teeth Grinding

Posted by Deborah Grauzam on

Hi,

 

My 7 year old son with Down Syndrome used to grind his teeth and had grown out of it (we thought). He recently had surgery and the grinding has returned with ferocity. It’s only during the day and is worse than before. His teeth have been ground down to next to nothing. I’m at a loss as to what to do and try, but I would really like to nip this in the bud before his permanent teeth come in – he as 2 bottom ones so far.

 

Do you have any suggestions of strategies I could try?

Hi,

It is not uncommon for children with jaw weakness or jaw instability to teeth grind, stop and then renew the habit when they are under stress.  Surgery can certainly be considered a stressful situation.  As I had mentioned above and reiterate in my book, Assessment and Treatment of the Jaw: Sensory, Feeding and Speech, the TMJ (temporomandibular joint) is the site of organization within the human body.  What your son is telling you, without using the words, is that he wants stimulation in that joint to calm himself down (to satisfy a need).  Once teeth grinding begins and the dentition becomes uneven the habit may continue after the stress has left.  The grinding continues to even out the biting surface of the teeth for chewing or may continue just because the child learns the grinding "feels good."  In either case, we know the grinding is detrimental to your son's teeth and we need to find a way to help him to stop doing it.

tmj
 

You asked for specific suggestions and here is what I would like you to do.  Since your son has the diagnosis of Down syndrome it is likely that he also has jaw weakness.  The activities taught in the book Assessment and Treatment of the Jaw: Sensory, Feeding and Speech are used as an alternative to the teeth grinding while addressing the root cause.  The activities will improve jaw symmetry, stability and grading.  Each of these jaw goals will also improve his feeding skills and his speech clarity.  If possible I would ask you to find a Speech-Language Pathologist in your area who has been trained in the TalkTools approach to muscle-based feeding and speech deficits.  She or he would be able to direct you through the two primary activities: "Jaw Grading Bite Blocks" and the "Bite Tube Hierarchy."  Used together these should reduce and hopefully eliminate the teeth grinding.  Additional activities in the book include: teaching him to chew gum without swallowing the gum, chewing on his back molars and a variety of other activities to address the identified jaw muscle needs.  

As in all cases it is best to read the entire book first to identify your son's specific needs and then to choose the activities that he enjoys.  An ideal time to practice each activity would be when he is teeth grinding.  In this way you will give him an alternative that will help him while acknowledging the fact that he needs stimulation to the TMJ. 

I hope this helps.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Vent Weaning with the Horn Hierarchy

Posted by Deborah Grauzam on

Hi Sara,

 

I attended one of your conferences in April.  I typically work with preschoolers with speech motor issues.  But my question is actually about a teenage boy on a ventilator.   Because it is not something that I typically do I didn't think of this sooner, but what I am wondering is if you have done any kind of vent weaning with your horn kits.  I know you talked about how they help with strengthening muscles for breathing and grading of airflow.

 

I'm asking because one of my friend's son was in a swimming accident 1 year ago.  He has a spinal cord injury and has been on a vent for a year.  He had surgery done in July to graft intercostal nerves to the phrenic nerve and from the vagus nerve to the phrenic nerve.  The idea was to see if new connections into the phrenic nerve would make it possible for him to be weaned from the vent.  Apparently the surgery was successful and the connections have formed and are good.  However, weaning someone who has been on a vent for a year is a big challenge.  Again not something I have much experience with but wondered if you have done any work or studies specifically regarding this issue.

 

I would love to try to help this boy and the family.  He was 18 at the time of the accident.  He had just graduated from high school and 2 months had the accident.  The injury was actually a C6-C7. He was not initially on a ventilator and could move his arms.   But due to a number of issues, the surgery to stabilize his spine wasn't done until 3 days after the accident.  This caused further damage up to C2.  Now he is paralyzed from the neck down and on a vent.  We are trying to get him to buy in to trying to wean which of course will be incredibly hard work on his part.  I am just looking for anything to guide or help in any way possible.

 

I appreciate any information you may have that could help me, even if it is to pass along information to the family.

 

Thank you!

Hi,

I have worked with kids and adults who were initially on a vent and then weaned but I cannot say if the horns did it or it was just spontaneous recovery.  My gut feeling is that the horn and bubble blowing helped but again cannot say that for sure.  Here is what I would do.  First get approval from the doctor to use the two techniques.  If the boy does not have a valve to block the air then that will be your first hurdle.  Once a blockage is achieved (there are many options) have him blow the horn or the bubble 1 time, open the valve and let him breath.  Transition between these tasks working only while he is relaxed and comfortable with what you are doing.  As skills are mastered increase in the number of blows following the instructions that come with the horn kit.  The horns will help him to see progress in duration so may be a big motivator and assurance that he is making progress towards the goal of weaning him from the vent.  

I hope this helps.  

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Down syndrome Infant Treatment Ideas

Posted by Deborah Grauzam on

Hi,

I have used your therapy approach for a while and would like to know what Sara would recommend for me as I am starting with a 7 month old child with Down syndrome.  I am ordering the CEU DVD, however, I wondered if there was some other resource that I should consider as I start out with this infant.

Thank you

Hi,

Your email was referred to me for a response but I have to say you have anticipated my answer.

Lori Overland's DVD entitled "Developing Oral-Motor and Feeding Skills in the Down Syndrome Population" is exactly what I would have encouraged you to purchase.  I say this because after 40 years of working with children with this diagnosis I have never met two who need the same exact intervention. Lori's DVD will give you the knowledge you will need to best address this client's individual needs.

Other suggestions at this time are the following:
1.  Feed the child with the ear higher than the mouth to prevent liquid from going into the child's ear via the Eustachian tubes.
2.  Do not push down or in on the child's tongue
3.  Read the The Oral-Motor Myths of Down Syndrome
 
Have fun with this client as the potential for the development of normal feeding and speech skills is very high based on appropriate intervention.  
 
Once this client reaches twelve months of age you might want to watch the DVD of my class "A Three-Part Treatment Plan for Oral Placement Therapy," as it will give the next steps in our treatment model.  
 

I hope this has answered your question,  

Sara Rosenfeld-Johnson

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Ask a Therapist: Horn Hierarchy targeting specific phonemes?

Posted by Deborah Grauzam on

Hi,

I have a student that backs sounds meaning he has difficulty making /t/ & /d/ sounds.  Do you sell a horn that would help?  

School-Based Speech-Language Pathologist

Hi,

I am so pleased you decided to contact us as the Horn program has been very beneficial for so many of our child clients with muscle-based articulation disorders.

The question you asked is an interesting one.  I will try to answer it with as much information as I can.  The TalkTools Horn Hierarchy was developed, with the help of an engineer and palatograms, to address the following speech systems: grading in the muscles of the abdomen, velum, jaw lips and tongue.  So, you can see that one horn will not correct a phoneme error such as the one you mentioned.

The hierarchy then addresses all of the muscles in the tongue needed for standard speech sound production on the conversational level and is only one technique used to treat the /t/ and /d/ placement errors.  In most cases for those phoneme errors I would use the Horn Hierarchy in conjunction with the TalkTools Straw Drinking Hierarchy.

Because you seem to be interested in using Oral Placement Therapy (OPT) I would encourage you to attend a class or watch the video of my our 2-day class:  "A Three Part Treatment Plan for Oral Placement Therapy."  In it you will learn how this therapy works and step-by-step instructions for how to implement the Horn and Straw Hierarchies in addition to numerous other techniques to improve speech clarity.

I hope this has answered your question,

Sara Rosenfeld-Johnson

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