Tagged "Speech Therapy"


Ask a Therapist: OPT with Adult suffering from MSA

Posted by Deborah Grauzam on

Adult Speech Therapy

Hi!

I am a trained speech-language pathologist, working in Sweden. I have taken part of the video-based course in the OPT-method and have very positive experiences from using the program with my former clients in a children’s rehabilitation center.

Now I work with elderly patients, primarily suffering from stroke but also with a wide spectra of neurological diseases.

This week, I met with a patient suffering from syndrome MSA, earlier misdiagnosed as Parkinson's. My colleague have worked with his dysarthria inspired by the Lee Silverman-method, which had a mildly effect on his difficulties with controlling the airflow. I proposed that we should try the instruments from OPT as a complement which the patient felt very positive about.

Though the patient recently started to experience difficulties with chewing food I wonder if it would be appropriate to work with the bite-tubes? We are all aware that his condition will continue to progress and that he most likely will suffer from dysphagia, not far from now. What are your thoughts about training when the patient have a progressive disease?

Best regards

Hi, Your email was referred to me for a response as I have been using OPT with adults for many years and have seen significant progress in both stagnate conditions and degenerative conditions such as MSA.  I am so pleased you see the benefits of this work and encourage you to continue to implement the techniques with your adult clients.

As a matter of fact I have just completed my newest book on using OPT with adults and am hoping it will be available for purchase within the next 6 months.    
In the case of a degenerative disease the hierarchy of intervention would remain the same as would the criteria for success to progress to the next level in each activity.  The major change is that your goal will be to maintain function rather than to improve function.  That is not to say in the initial phase of the disease the client will not progress but as the disease progresses the gain will become first minimal, then only maintaining and finally reducing.  
 
As you are working with these clients be aware of their fatigue and do not push them higher than their highest level before failure in each activity during the therapy session or for daily practice.  
 
You mentioned you are using the Bite-Tubes and that is wonderful.  I would also suggest the Horn Blowing Hierarchy and the Straw Drinking Hierarchy if the client is approved for thin liquids such as water or juice.  You can begin the Straw Hierarchy with liquids and if the client develops a pharyngeal phase dysphagia you can continue to use the Straw Hierarchy without liquid.  Instead use twenty 1 inch cubes of paper.  Have the client use the designated straw to pick up the piece of paper, to hold it for 10 seconds and then to rotate the head to drop the paper.  Remember to rotate to alternating sides of the body to ensure symmetrical muscle involvement. This technique has proven to be very beneficial for clients as a maintenance activity as the disease progresses.  
 
I hope this has answered your question but if not please feel free to email me.  
 
PS:  I loved my time in Sweden and hope to return there some day to teach and visit with friends.       
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Ask a Therapist: Teeth Grinding

Posted by Deborah Grauzam on

My child has no problems with eating or drinking, but grinds his teeth until I want to grind mine! His dentist says it's common in kids with Down syndrome. I saw your teeth grinding items and wondered if they might help? He is 5 years old, does not speak much – he imitates sounds, growls and whale noises from his favorite movies, but has no interest in forming words. He is in speech therapy through school.

Teeth grinding is generally used to help children with special needs to organize their bodies or to calm down; they are seeking stimulation to the temporomandibular joint (TMJ). This joint is where the upper jaw and lower jaw meet right below the ears. Babies suckle their thumbs or suckle on a pacifier to get the same needed stimulation. As your dentist noted, teeth grinding is common in children with the diagnosis of Down syndrome, but there are reasons and a treatment protocol. Because your son is not talking, I suspect he has weakness in the masseter muscles (muscles of the jaw) as related to his diagnosis, he too may need that additional stimulation to the TMJ.

This is such a huge issue that I have written a book on the subject called, Assessment and Treatment of the Jaw.

There is a whole chapter on why kids grind their teeth or have other habits that provide direct stimulation to the TMJ. I encourage you to read the book before you invest in any therapy tools, as it will help you identify what tools and activities would most benefit your son.

In addition, if there is a gap between what your son understands and what he can say, then his jaw weakness may be a primary factor in keeping him from using oral language. You may want to look into having him evaluated by an SLP in your area who is familiar with Oral Placement Therapy. Many SLPs have taken our introduction classes and would be able to work with your son if there are muscle-based deficits related to his difficulty in learning to talk. 

Sara Rosenfeld-Johnson

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