Hi TalkTools,

I have a question about the straw hierarchy. I have a 5 year old with severe phonological processing disorder and recently repaired posterior tongue tie. I have started the straw hierarchy with her. She is on straw #3 and able to take in a single sip and multiple, consecutive sips, but seems to take too big of a water bolus which causes her to pause before swallowing to make a suckling motion to manage it in her mouth before swallowing it. Any suggestions? Thank you.

Jody

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Hi Jody,

I am thinking based on what you are saying that she is demonstrating a reverse swallow. I am gathering that you are saying that this is what you are seeing on multiple swallows and not single sips. If she is not doing it on single sips I would try to stay there for an extended period of time to get her used to swallowing in the correct way and then build up to multiple sips. Your client can demonstrate tongue protrusion with the first 4 straws but cannot move to #5 without tongue retraction. I hope this helps. Please let me know if you have other questions.

Thanks,

Liz

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Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 11 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.

My 2 year old (almost 3 year old) daughter with Down Syndrome is still having difficulty with speech. She has many signs, but her words are limited to ones such as "ball" and "book." I have asked her speech therapist about the Straw Kit. Her therapist does not seem to be in favor of anything other than traditional speech therapy. Does the straw kit help accelerate speech?

Also, her OT would like her to drink out of a cup. Which cup would be best, or is it best to continue with straws for now? Thank you!

Ana

Hi Ana,

Sorry to hear that your daughter is having difficulty with speech. I do believe that the straw kit is something worth pursuing.  I often work with children with another therapist in a situation like this.  One can work on traditional speech techniques and the other oral placement for speech production and feeding.  That might be something to think about.  The straws work on different levels of tongue retraction and lip rounding which are both movements used in speech production. I do find with my patients that speech comes faster with oral placement therapy.  As far as a cup I would recommend starting with the pink cut out cup.

Please let me know if you have any other questions.  We are always here to help.

Thanks,

Liz Smithson

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.

Dear Sir/Madam,

 

I am a speech and language therapist working in the UK. I had the TalkTools training a couple of years back.I assessed a child last week taking over from another therapist who has just left. This child was advised to drink thick and thin fluids from a thick straw (McDonald's thickness). The child can drink thin fluids easily from straw #7 but has not had any success with straw #8. I observed the child with the thick fluid from a thick straw and they managed really well. When drinking from a cup with no straw there was still notable tongue protrusion. I am not quite sure where to move this child on? Should we move to straw #8 (thin fluids) and continue with thick fluids from a thicker straw? Should you be continuing on the straw hierarchy until there is efficient tongue retraction when drinking from an open cup? I would appreciate some guidance.

 

Best wishes,

 

Melissa

Hi Melissa, 

I would continue on the next straw if she is drinking at ease with tongue retraction as you said. I would want to use the straws for all drinking attempts and minimize the use of the cup. I would work on activities that promote tongue retraction before working on the cup. This will reinforce the motor plan.  I would then make sure to place the cup under her tongue and prevent her from using her tongue as her lower lip.  If this is not working you may want to remove the cup for a short time and work only with the straw and then revisit the cup.  Giving the child a break and only reinforcing the tongue retraction may help.

It is possible for a child to continue demonstrating tongue protrusion with cup drinking after the straw protocol but I would consider that atypical.

Keep me posted and let me know if you have any other questions.

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.

Hi, 

 

I have a student who just started straw D with the pudding today and after 25 mins with very little progress we called it a day (I work on a school so missing an hour of class won't work). After he left, I tried it myself with the same results! What is normal for this straw? He has gone through the whole program working on his /r/ and I know this last straw is very important for retraction but it seems impossible to drink pudding through straw D. Is it common for people to feel this way initially?

 

Also, any recommendations for cleaning the straw? Water from the faucet didn't get the pudding out and neither blowing. I see quite a few kids for the program so I would prefer to only have to use one straw per student and not one each day.

 

Thank you so much!

 

Alicia

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 Chayie,

1. As far as the red and purple bite blocks go I have a set of both. I always try to use the red first because they are more durable and then use the purple if the client does not tolerate them. Many of my clients prefer the texture of the purple so I just know I have to replace those more frequently.

2. Yes, the straws do work on tongue retraction orally. They work on different levels of tongue retraction.  There is a diagram that will come in the straw kit and is also in the book that shows exactly where the retraction takes place with each individual straw. The Horn Kit and the Bubble Kit are two other activities that I often do while working on the straws for tongue retraction. These are all great!

Let me know if you have any other questions.

Always 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.