Hi, 

 

My son is 17 and has Autism. He has received speech services since he was 2.8 months old. The most successful therapy has been PROMPT for him. Currently he has 3 therapists working with him. One specializes in PROMPT, the other specializes with his talker device and the other is on the team. My son rarely uses his talker which he acquired about 3 years ago. He basically uses one word to meet his wants.  Unknown people can't understand him. He has hypotonia. He drops off the ending of his words. We recently (Fall of 2015) brought back PROMPT therapist as his speech was regressing with traditional imitative speech therapy. He was saying the /sh/ sound for the /s/ sound and we were having trouble getting the retraction.  Would the horn program help and if so how? And could I do it as a parent? I use PROMPT with my son to correct the /s/ as in yes, but I am not using PROMPT extensively as the SLP is in therapy.

 

Thanks for your advice.

 

Gina

 

Hi Gina,

I am a speech language pathologist who is trained in Prompt as well as TalkTools. I often use the two together for many of the patients I see. I feel they are two approaches that often help my patients with difficulty with verbal communication. I think it is great that you are considering pursuing both for your son. I would encourage you to try to find a TalkTools trained therapist in your area to evaluate your son and create a program plan for you to follow if that is available. You can do it all yourself but you would need to watch the video A Three-Part Treatment Plan for Oral Placement Therapy and follow the directions included in your kit. The horns would work on tongue retraction as well as the Bubble Kit and straw drinking. I often use these activities together with patients working on tongue retraction.

Please let me know if you have any other questions.

I am happy 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.

 

 

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.

 

 

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.

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.

Sara Rosenfeld-Johnson, MS, CCC-SLP

 

 

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