Tagged "Speech Therapy"


Ask A Therapist: Communicate with a 16 year old with Down Syndrome

Posted by Deborah Grauzam on

Hello,

 

I have a teen with Down Syndrome who is 16 years old. He has difficulty expressing himself, however he has a lot of knowledge. I would like to help my son with verbal communication so that I can understand what he says and develop my relationship with him. He gets speech therapy twice a week but it is not helping him so much.

 

Will you please guide me to purchase the right products?

 

Thank you kindly!

 

Clarimar

 

Hi Clarimar,

My first question would be: is there a TalkTools trained therapist in your area? If so, I would start with an evaluation from a TalkTools therapist. A TalkTools therapist can do an evaluation and a full treatment, or work with another therapist to implement a plan after the initial evaluation is performed.  The next option would be to see if there is a therapist near you that you could travel to see for evaluation only. If that is not an option either, I would order the videos "Developing Oral Sensory Motor Skills to Support Feeding in the Down Syndrome Population" and "A Three Part Treatment Plan for Oral Placement Therapy". These videos are available online for viewing. Once you have taken those courses, you will have a better understanding of the tools needed. I would probably recommend the Parent Kit with a Bubble Kit and a Z-vibe. That I feel would be a good place to start. Please let me know if you have any other questions. We are 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.

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Ask A Therapist: Oral Placement Therapy for Teachers

Posted by Deborah Grauzam on

Hello,

 

I work in an inner city school with significant deprivation.

 

Many of the children have speech and language difficulties and when I wander into snack and lunchtime, many have immature eating patterns. Many have immature jaw and tongue movements, quiet voices and poor breath control.

 

I cannot hope to work with all the children directly.

 

I have keen K/1 teachers who would like to help.

 

I am pulling together some activities for the teachers to do with the class - songs, movements, etc., taken from voice TalkTools® and other sources. I want to include activities for respiration, phonation, resonation and articulation.

 

Has anyone tried to do this already?

 

Any pitfalls you can anticipate for me and the teachers? Any pointers?

 

I do use TalkTools® already with some students and I am finding an increasing need.

 

I am planning on doing a short pre- and post-screening possibly based on the SMILE book.

 

Many thanks,

 

Sarah

 
Hi Sarah,

First of all I admire you attempt to help so many children in need.  It is so difficult to not have availability to work with everyone one-on-one.  I think if I had to pick on thing to work on, it would be jaw strength with bite tubes because it will help in all the areas you mentioned. Horns would also be a fun rewarding task which would focus on respiration.  The challenge that I see would be not being able to monitor where they are placing the tools in their mouths, which is what makes it therapeutic. I would try to work with a different child each time to make sure they could feel where the tool needed to be and how they needed to breath or chew. Placement and form is very important.  You could watch the group as they perform the task and give verbal feedback.

That being said, I encourage you to consult your school's Speech-Language Pathologist first for advice and mention the procedure above, and only then follow their recommendations. You could work with them as a facilitator but are not licensed to practice Speech-Language Pathology yourself, as a teacher. If there is no Speech-Language Pathologist on duty at your school, consult your state association for support.

Looking forward to hearing back.

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: 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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Ask A Therapist: Client with Autism and Apraxia of Speech

Posted by Deborah Grauzam on

Hello TalkTools,

 

I am an SLP working with a four year old boy with autism and apraxia of speech. He has some significant drooling and is non-verbal. I completed the "Three-Part Treatment Plan for Oral Placement Therapy" on-demand course, but was hoping for some guidance from your Instructors.

 

He is the first child I've used Oral Placement Therapy (OPT) with, and we're working on the Drooling Remediation Program. He's progressing really well with the Chewy Tubes and the Straw Hierarchy but is not able to volitionally blow on Step 3 of the Bubble Blowing Hierarchy, nor is he able to blow for Horn #1 or hold a tongue depressor between his lips for any length of time.

 

He is able to produce the /m/ and /b/ sounds, but often not on command. He just recently began to show some lip rounding while producing a /w/ sound.

 

I did purchase the Pre-Hierarchy Horn and have been working on the ball/exhalation activities. Is there anything else I can/should be doing to help him with blowing?

 

Also, when he eats, he sometimes will chew the food, remove the bolus from his mouth, rest for a few seconds and then place the food back in his mouth and finish chewing/swallowing. Do you have suggestions on how to address this?

 

Thank you in advance,

 

Amber

 

Hi Amber,

I'm Robyn, a TalkTools® Instructor, and I will answer your questions the best I can without knowing the child.

I will start with the feeding issue first. This sounds like a self-stimulatory associated with the autism or an issue of bolus mobility. He certainly could have chewing fatigue, or perhaps cannot lateralize the bolus to where it needs to go to swallow it. You will need to assess this, and if needed, implement a pre-feeding program such as, Feeding Therapy: A Sensory-Motor Approach. If all is assessed and nothing is wrong from an oral motor perspective, I would work with the child's behaviorist on a regimented plan to keep his hands down and away from the mouth during feedings.

On to your OPT questions... Phonatory control and volitional blowing can be a very big problem with apraxia. The sounds the child is making can be reflexive in nature but not achievable on command. This is also a defining trait of apraxia. I would consult with OT/PT to start working on rib cage expansion, trunk stability, and core strength as prerequisites for blowing. For now, expose him to the Bubble Program staying on step 2 of the Bubble Hierarchy and practice placing Horn #1 in the mouth and taking it out for the lip closure motor plan. You may also model it for him with your own horn. I often sing, "If you are happy and you know it blow a horn toot toot" and place the horn in the lips when I say 'toot'. I also place children in a prone position on an OT wedge during this task. Immediately after drilling the horn, use the Apraxia Bilabial Shapes to practice the bilabials.

Good luck!

Sincerely,

Robyn Merkel Walsh, MA, CCC-SLP

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Ask A Therapist: Therapy Scheduling

Posted by Deborah Grauzam on

Hello,

 

I recently attended a TalkTools training and have a question about how to implement the therapy. Specifically for children under the age of 2, what are the frequency and length of your sessions? Do you schedule weekly standing appointments, or do you schedule as needed to reassess after the child has made progress?

 

I have some clients interested in this therapy, but am not sure how I should schedule them.

 

Thank you,

 

Anna

 

Hi Anna,

​In the ideal world, we should like to be able to see these kids weekly for 45 minutes sessions. At these early ages the parents need support in feeding skill development, and their children are changing so rapidly that you do not want large gaps between sessions. As you know, once the child starts using an incorrect placement it is very difficult to correct. Also, starting at 12 months we introduce the Horn, Bubble, Bite-Tube and Straw Hierarchies which need constant monitoring​.

I would not choose your second option as to scheduling as progress is made, as that means the parent is responsible for determining when the progress is seen. I find those first 2 years to be critical to prevent or at least limit incorrect placements for feeding and speech.

I hope this answers your question but if not, please let me know.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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