Tagged "sensory processing disorder"


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.

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Ask A Therapist: Introducing Therapy to a Child with Sensory Processing Disorder

Posted by Deborah Grauzam on

Hi,

 

I bought the Complete Jaw Program from you a few months ago to use with my three year old son who has Sensory Processing Disorder, and is in the Autism Spectrum. He has very low muscle tone in his mouth and does not chew at all. He eats a wide variety of foods but only in purees. He also drinks perfectly from a straw.

 

He drools constantly, mostly when he is doing an activity that requires his full attention.

 

He has great pronunciation of words, so for all the evaluations that he has had, the main problem in his mouth seems to be sensorial.

 

I have been struggling with the kit because he won't let me go into his mouth that easily and I'm afraid I might hurt him.

 

Do you have any course that I could take in order to learn how to use the kit?

 

Thank you for your comments.

 

Regards,

 

Amber

 

Hi Amber,

I am going to answer your question, as I teach a class on Oral Placement Therapy and Autism.

This is a typical problem in children with sensory processing issues, so the key is adding a desensitizing program prior to the Jaw Program. You can also use Applied Behavior Analysis strategies to condition the child to the therapy.

1.  Start the sessions with general body sensory tasks such as deep pressure, jumping on trampoline, etc. Ask your Occupational Therapist or your Physical Therapist for suggestions.

2. Engage in pre-feeding exercises from A Sensory Motor Approach To Feeding, Chapter 7, specifically massage, tapping and myofascial. The Jiggler and Z-Vibe tasks as well as the chewing hierarchy are also great.

3. Then introduce the tool. Do not place it in the mouth at first. Touch, accept to lips, accept to molars with no pressure, and then you can use vibration paired with the tool (Bite Blocks) to provoke a "bite and hold". The key is to be sure and provide direct , immediate reinforcers (often edibles) so the child pairs the tool with a positive.

For more information, please refer to the course Solving the Puzzle of Autism: Using Tactile Therapies.

Thanks,

Robyn Merkel-Walsh MA, CCC-SLP

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Ask A Therapist: Challenging Patient

Posted by Deborah Grauzam on

Hi TalkTools!

 

I have taken your Three-Part Treatment Plan for Oral Placement Therapy class and have 3 of your books. I am using OPT within my practice and see positive results in my patients. I do have one patient who is very challenging. She is 16 years old, globally delayed and has a diagnosis of cerebral palsy, sensory processing disorder, low cognition and is nonverbal. She loves to eat and does eat a fairly typical diet despite all of this, but of course, can't chew very tough meats. She drools. She has had very little oral motor therapy integrated into her speech therapy treatment plan over the years.

 

I will call my patient, M. We have been working on the bite tube hierarchy following the OPT evaluation, and she is able to compress the bite tubes (red bite tube- 10, bilaterally which is an improvement from where she started;  yellow bite tube- 7 on left and 5 on right- both sides of jaw are weak, but right is weaker). We are about to add purple bite tube when parent is ready. It has also resulted in less mouthing of objects, oral seeking and general calming.

 

M. is hypersensitive to facial touch and having her hair touched. She is also over responsive to some kinds of touch within the mouth despite use of sensory techniques from OPT (sensory program with toothette) and Beckman techniques used for several months. She has shown an improvement to tolerate tooth brushing at home since intervention.

 

1 - M. is using straw #1 on the straw hierarchy, but since it has been systematically cut to 1/4 inch, she is showing an increased jaw movement, which I'm thinking means she is still suckling the straw rather than using a true suck. She is getting better at not placing her lips over built in lip block. She only uses the straw for part of the evening at home with parent supervision, it is not used during the school day, but I might be able to arrange this with school staff. Do you think the reason she is not progressing on straws is that I have cut the straw too short, too soon, or is she just not getting enough practice with it? She likely has been suckling for many years now.

 

2 - I have not had any success using the bubble blowing hierarchy or horn hierarchy or pre-hierarchy horn, even with having a PT present to assist with positioning. She does not appear to understand how to grade her abdominal movements to exhale at all.

 

3 - I would appreciate any guidance you can give me regarding M., as I do want to help her with saliva control. We have had some success increasing her ability to request preferred snacks and activities with the PECS program, since she came to me with no communication system at all. I am about to visit her school to collaborate on her treatment program. Her parents are willing to work on PECS with her at home. They would like for her drooling to decrease, but they are only able to work on straws and bite tubes to a limited degree at home.

 

Thank you for your time.

 

Holly

 

Hi Holly,

Thanks for your question! Allow me to address each of your questions individually to make things easy to follow.

1 - Go back to the 1/2" length to see if she is moving her jaw.  If not, then go to 3/8" as she is 16 years old and may need that amount of the straw to give her enough room to protrude her lips.  The length is not as important as her ability to use only her lips with her tongue retracted and not biting on the straw.  If she can do that without jaw movement, progress to Straw #2 cut to 3/8".

2 - Try working with an OT who can bounce her on a ball to generate airflow.  Once she can do that, you can put the horn in her mouth as she is bouncing down to teach the relationship.  I have also described another technique below that I use with some kids.

Whispered “Huh”

Place the open palm of M's hand 1” in front of your mouth as you say a whispered “huh” sound.  Immediately place M's​ open palm in front of M's​ mouth as you model the whispered “huh” sound.  Continue to alternate between your mouth and M's​ mouth until M tires, refuses the intervention or produces a volitional exhalation.  Reward any attempt at imitation. (Goal:  Associate the feel of airflow on M's​ hand with volitionally controlled oral airflow for speech sound production)

3 - ​It sounds as though you are on the right track with this young girl.  Keep at it as the techniques you are suggesting are the correct ones and you are making progress.  Let the parents know that the horn blowing will be the best treatment for the drooling but that you need them to do the homework at least 3 times a week or it will not work. I hope this answers your question but if not, please let me know how else I can help.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Developmental Delay and Cerebral Palsy

Posted by Deborah Grauzam on

Hi, I have two clients that I need assistance with.

The first little girl is 5 years old and has developmental delay.  She is mostly non-verbal and communicates using Makaton.  We have used various bits of TalkTools equipment, combined with speech sound work (discrimination and encouragement to imitate single sounds).  So far we have worked through the straw hierarchy (as best we can given her level of understanding) and this has improved tongue retraction.  We have also used tongue depressor with pennies between the lips and she has enough strength to hold 3 pennies on each end without difficulty.  This has improved her lip closure and has stopped her dribbling but we have yet to hear her make any p, b or m sounds.  We have also been using the tubes and bite blocks for vowel sounds but she is still unable to imitate any vowels although can produce some spontaneously.  Her babble has really improved and she is making lots more involuntary vowel and consonant sounds but nothing on cue, and occasional approximation of words in the correct situation.  I have tried to work through the horn hierarchy and the bubble hierarchy but she is unable to blow.  She has just started to wobble the bubble on the wand by vocalizing but I don’t know how to get her to understand how to blow.  Do you have any ideas about where I should go next?

This is a very involved case - I will say that if she can't blow, she can't phonate and you need pre phonatory work to expand the rib cage. You may also need to order the exercises more carefully rather than bits and pieces. For example, sensory tasks such as Lori's mouse ears helps with the feel of the /m/ (see "Feeding Therapy: A Sensory Motor Approach" by Lori Overland).  Next feeding, then Oral Placement Therapy (OPT), then shaping OPT to Speech with Renee Roy Hill's Apraxia Kit.  This is a child who can't respond to "look at me and say what I say" so I'd skip the traditional auditory drills.  It sounds like Apraxia, so you need to be consistent each session and ensure there is true mastery at each level of the hierarchies.

The second little girl is the same age and has cerebral palsy. We have been doing similar things although she is able to make a noise through the horns but is unable to do so without vocalizing at the same time. She is able to blow bubbles well through a small piece of straw but is unable to coordinate her mouth to blow bubbles without physically having the straw in her mouth. Do you have any ideas for how to get around this?

Slowly shape the movement.  For example, 9x using bubble tube 1x without. Make sure they are practicing the best level in therapy at home daily and that the tube is wide enough that the lips are truly rounded - if you need a larger tube use the jaw closure kit. As far as voicing into the horn, that is a motor planning issue.  I usually use modeling, "quiet blowing" and if needed I whisper "hoo" with no voicing to help. These are the same kids that can not turn the voice on either but practice often helps. Make sure there's adequate posture to support the phonation tasks.

Best,

Robyn Merkel-Walsh

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