Tagged "Speech Therapy for Down Syndrome"


Ask A Therapist: 7 year old with Down Syndrome who can't drink

Posted by Deborah Grauzam on

My son who has Down Syndrome will be seven next month and still can't drink.

 

Ben had a high palate and was breastfed. He really latched with his tongue. He only drinks from a hard spout sippy cup. He grinds his teeth really bad too. But he still uses his tongue, even as he drinks from the sippy cup. You can see his tongue out on the bottom of the sippy cup, it's like his sucking reflex is so strong his brain won't let him not use his tongue to suck! He doesn't stick his tongue out and it's not a thick tongue either. We have tried the honey bear and tubing as well, he just wants to use his tongue! Any suggestions on how to help my little guy?

 

Thank you!

 

Robin

Hi Robin,

It sounds like your son is still demonstrating what we call a "suckle pattern" when drinking. If he is not able to drink from the honey bear straw cup at all, I would recommend that you consult a TalkTools Trained Therapist to have an evaluation and get more information on how to work on straw drinking with your child. There is a strategy of using a syringe to place small amounts of liquid in his cheeks by his back molars but I feel this technique would be best implemented by someone with experience, who can guide you through the process. If that is not an option, I would watch Sara Rosenfeld-Johnson's video-on-demand "A Three-Part Treatment Plan for Oral Placement Therapy" and try to teach yourself before implementing the techniques with your son. Please let me know if we can help you with anything else.

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: Tongue Retraction

Posted by Deborah Grauzam on

Hi,

 

I'm beginning to work with a 7 year old boy with Down Syndrome and Apraxia. For the straws, he protrudes his tongue under the straw. He also does this with the Honey Bear. His Mom says she has a verbal cue of "fishy kiss" which will help him to round lips, and tongue will retract.

 

He also does the horns. He mastered #1 today :) ! We're also working with chewy tubes. Red is great, compressions become weaker with yellow. Bubbles are still needing cueing with the blue apraxia tube to get the lips rounded. He has a lot of force, but his lower lip protrudes and elevates and all of his air is directed up instead of out. It's getting better.

 

Is there something else I should be doing to get that tongue to the right position for straw drinking?

 

Thank you,

 

Meredith


Hi Meredith,

Great question regarding tongue retraction. The straw kit will work on tongue retraction at different levels of the tongue. It is important to have your patient work through the whole straw kit to achieve the retraction. It is also important to note that he does not have to demonstrate tongue retraction with straw drinking until he reaches straw #5. I do think using the "fishy kiss" verbal prompt before offering the straw is a great idea to set him up for the right movement pattern on the straw.   As far as the bubbles, try using the toothette with vibration as a sensory warm up right before the bubble activity. This should help him to achieve lip rounding more at mid-line without the upward movement he is demonstrating. Then I would transition immediately to using the green bubble tube that comes in the kit for blowing bubbles. Attempt blowing bubbles with this tube and see if that helps. Please let me know if you have any other questions. I hope this all helps. Thanks,

Elizabeth Smithson, MSP, CCC-SLP


 

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: Straw Drinking

Posted by Deborah Grauzam on

Hello TalkTools,

 

I feel so defeated. My son is 2 years old and I can't get him to master straw drinking. He is an otherwise high-functioning, very successful child. He is starting to walk, can build with blocks ... What am I doing wrong?

 

David has Down Syndrome. (He has repaired cardiac defect, which thankfully has not been causing him any issues.) I find that he is very sensitive in the mouth. he is nervous to put anything in his mouth that he is not familiar with. I find him to be more motivated by familiarity (i.e. familiar foods) than special tastes. I tried putting all different juices in his mouth to get him to want to suck up but he is annoyed with the task.

 

Right now, my therapist suggested that I try using a large chocolate syringe ( it's an over sized syringe kids love to pour chocolate in their mouth!) which hopefully, will motivate him to suck the tip.

 

I am scheduled to see Lori Overland in November but I would love to get some tips now already.

 

Miriam

 

Hi Miriam,

I'm Whitney, a TalkTools® Instructor. Thanks for your email regarding your son. Please know you are not doing anything wrong. Often times straw drinking is very difficult to teach so be patient. I am very encouraged that you are scheduled to see Lori Overland in a few weeks. Hands on approach is so much better than any suggestions I can give you without getting my hands on your child.  

For now I would use the honey bear to teach this technique and add a highly flavored favorite liquid. I would also recommend to make the consistency a little thicker than water to help with tolerating this new motor skill. I often use a favorite yogurt or pudding and add water.   For now I would just continue to get acceptance of the honey bear and the straw to his mouth. Do not continue to push it if he becomes easily frustrated as we want to be able to address this skill when you see Lori Overland.  

Please let me know if you have any other questions.  

Thanks,

Whitney B. Pimentel MA, CCC-SLP

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Ask A Therapist: Using Vibration for Low Muscle Tone

Posted by Deborah Grauzam on

Hi TalkTools,

 

I have a question about using vibration (as with the DnZ-Vibe or Vibrator & Toothettes). I understand that vibration can be used to "wake up" the sensory system, and I believe I’ve heard that it can have a temporarily positive effect on low muscle tone. I’ve read that vibration should be used in short durations, but I was wondering if you had any guidelines for the maximum or minimum duration of vibration? I’m thinking especially in a case of low muscle tone as in children with Down Syndrome.

 

Thank you very much!

 

Riley

 

Hi Riley,

I’m Renee, a TalkTools® Instructor, and I would be happy to help you. This is an excellent question, I am asked this many times when teaching and working with clients!

You are correct, vibration can give the muscle more input and therefore often trigger a better motor response, thus “waking up” or “stimulating” the muscle to move. There are no specific “time” or duration guidelines for this. It is our responsibility as the therapist to look at the motor response while providing the input. So for some children with significantly low tone and an extremely under-responsive sensory system, it may take longer for the muscle to respond. But for a child who may have a better sensory system, the client may only need quick input 1-2x to see the motor response. It is important to remember what specific motor movement you are looking for and that the stimulation given is causing the appropriate reaction.

For example if I am providing stimulation to the lateral margin of the tongue to facilitate tongue tip lateralization to the back molars, once I see the movement, the vibration has done its job. Then I need to decide if my goal is repetitive movement using the vibration - leading me to possibly provide the input several times until I no longer see the tongue tip follow the stimulus - or possibly to quickly transition that movement to function (i.e. placing a cube of food on the back molar so the client then uses the movement in a functional way) which is my highest priority but sometimes not yet obtainable in my first sessions with the client.

Once I am sure of the goal of the vibration stimulation (what am I looking for in the motor system) it is easier to determine how long I should use it! The goal is always to eventually eliminate the vibration so that the movement is then stimulated through functional activities such as eating and speaking.

I hope this helps!

Renee Roy Hill, MS, CCC-SLP

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