Tagged "school therapist"

Ask a Therapist: Feeding after attending the Feeding course

Posted by Deborah Grauzam on

Hi Lori,

I attended your Feeding Therapy: Sensory Motor Approach 2 day course.  It was terrific and I’ve been implementing a lot of what I learned.  I’ve seen some progress already.  One of my students did such a great job drinking from a straw the other day! What an improvement from the liquid being squeezed into her mouth.  Now we have to work on transitioning to the classroom. ****Excellent! I always love to hear that!!!!****   Other students have been slower going and that’s one of my questions. 

One particular student is 14 years old.  She basically has a soft diet mostly consisting of sweet puddings and cakes with some fruits.  She manages those foods though she is definitely giving the OT trouble with self feeding and the behaviorist has suggested pairing eating with a pleasurable activity which is the IPAD.  So while she’s on the IPAD she will usually feed herself. 

She has a protruded jaw, her upper lip is pulled in, her tongue is bunchy and her cheeks are “puffy”.  Her teeth are a bit crooked and somewhat misplaced.  I’ve seen some nice movement and closure of the lips.  She also accepts the tongue massage.  I’ve tried the chewy tube and she will tolerate it in her mouth, but I haven’t seen any movement towards a bite.  That’s where I’m not sure what to do?  I model.  We have a mirror; I support her jaw but no change.  She bites on her shirt and a bib that she wears into school.  Any suggestions on how to move forward?  

****Well.....if you are working on straw drinking you really need to get cheek contraction, lip rounding and tongue retraction. You may have to focus on  a pre-feeding program before you introduce the honey bear. From your description of her puffy cheeks, upper lip pulled in, tongue bunchy.... she does not have the skills to successfully straw drink. THEN.... work corner to corner with the honey bear...one sip/one swallow !****

I have feeding objectives on many of my students IEPs.  I usually write the criteria as a level of participation because I’m not sure how else to measure the data for the IEP and don’t want to get myself stuck.  I’m also trying to track progress so I’ve developed a data sheet listing the exercises and how many times they have been done.  It seems ok, but I feel there must be a better way.  Do you have any suggestions regarding that?

****I work in many schools and it is amazing how different districts require tracking of progress. Some are so general....they are meaningless, and some get down to how many sips with lip rounding, cheek contraction and tongue retraction. SOOOO....I write my plans to develop the skill and let the schools figure out how they need to record data, and track progress. Sorry I can't be more helpful on that one...****

Wow, I guess I saved up a bunch of stuff.  I hope it is all clear.  I’ve been lucky to get to stay with my current caseload and I see oral motor and feeding therapy as a big part of our treatment  Any suggestions if you are able would be great.  I’d love to continue to learn more as I find this particular area to be really interesting and so important.  ****Good for you! It sounds like you have already done some nice work...and seen the progress your students are capable of making. ****

I look forward to hearing from you!  Have a great day. B

****Thanks again for the great questions!

Lori Overland****

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Ask a Therapist: Frontal Lisp

Posted by Deborah Grauzam on


I am an SLP in an elementary school in Virginia. I have been recently viewing your course A Three-Part Treatment Plan for Oral Placement Therapy. I have found your information to be extremely fascinating and, although I have 2 more hours, I have learned so much through your training. I do have a question. I have a 3rd grade student that is considered having a frontal lisp. He fronts many sounds. He is able to accurately produce the /s/ in conversation, when structured and prompted. However, in the course a child was mentioned that was able to accurately produce the /s/ in the structured setting, but once the setting was relaxed, she reverted back to her resting/comfortable position  of frontal sounds. Being that he is a typically developing child (9 years), would the bubble blowing and/or horn hierarchy be appropriate?

My thoughts would be that I need to work on establishing tongue retraction. I am just wondering what your professional judgement would be, considering he sounds a lot like  the girl that played "golf-ball air hockey" against Sara's daughter. I appreciate any thoughts you may be able to share! Thank you so much for your time and expertise!



Thank you so much for your interest in TalkTools.

I am so glad you are enjoying the course and learning so much.  You are definitely on track with the client you are referring to.  It takes a while to establish the correct resting position for the tongue.  Keep in mind that this child has had his tongue in the wrong position for many years now so you are correcting a bad habit as well.  It is difficult to give detailed suggestions without seeing the child but have you assessed his jaw?  I would look at his jaw placement when he is producing the sound in a variety of contexts.  An excellent tongue retraction exercise is also the straw hierarchy so you may want to consider adding this to his treatment plan as well.

I hope this helps.  Please let me know if you have any other questions.  Thanks so much and good luck.

Whitney Pimentel

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Ask a Therapist: Horn Hierarchy targeting specific phonemes?

Posted by Deborah Grauzam on


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


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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