Tagged "TalkTools"


Ask A Therapist: Child with a small mouth

Posted by Deborah Grauzam on

Hi TalkTools,

I am working with a child with a very small mouth, and the Yellow Chewy Tube is still too big and too hard for him. What would you recommend I use with him instead until he can use that? Thanks.

Jennifer

 

Hi Jennifer,

I received your question regarding your patient with the very small mouth. There are two things that I would try. You could do the gum chewing exercise that is explained in detail in Sara Rosenfeld-Johnson's book Assessment and Treatment of the Jaw, page 115.  I would just use a small enough piece of gum to fit in your client's mouth.  I would also try to work on the Sensory Friendly Bite Blocks (Purple) and gradually work up from the smallest and see if this would eventually increase the oral range of motion for your client. I would then revisit the chewy tube and see if he is able after working on the other exercises.  I hope these ideas help.  Please let us know if you have any other questions.

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: 4 year old with Sensory Processing Disorder

Posted by Deborah Grauzam on

Hi TalkTools,

 

I am working with a 4 year old boy with Sensory Processing Disorder. When producing the /s/ phoneme he takes a quick inhalation of air. He is able to produce /z/ and /sh/ with appropriate outward flow of air. We have worked on discriminating correct vs. in correct airflow, horn blowing, air hockey with cotton ball or whiffle ball, and cheerio for tongue tip placement with adding the airflow as well. Despite max attempts he is unable to produce the sound in isolation. Any tips or advice you could provide would be greatly appreciated!

 

Thank you!!!

 

Randee

 

Hi Randee,

I would work on voice versus voiceless sounds. Having him feel your throat to see that with the "z" you are using your voice box and call "s" your quiet sound and work on the difference that way.  Another thing that I have tried to help with placement is a straw placed on the tongue down the middle out of the front of the mouth.  This helps kids to feel where the air needs to go. But it sounds like he has the placement piece since he is able to say the "z". Just something extra to try. There is also a complete list of oral placement activities to work on "s" and "z" on page 18 in Sara Rosenfeld-Johnson's book: Oral Placement Therapy for Speech Clarity and Feeding. This will give you a list of other activities to try. Let us know if we can do anything else 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: Vocalic R Materials

Posted by Deborah Grauzam on

What tools and continuing education materials do you recommend for working with children on vocalic r?

 

Rose  

 

Hi Rose,

The first thing that I would recommend that you purchase would be Sara Rosenfeld-Johnson's book: Oral Placement Therapy for Speech Clarity and Feeding.  On page 20 in the book, she gives you a list of oral placement activities to use to work on vocalic "R".  The activities listed on that page are included in the book.  After you look up each activity the book will tell you exactly what you need to order and how to use it.

Hope this helps. Please let us know if you have any other questions. 

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: Tips for Implementing the Horn Hierarchy

Posted by Deborah Grauzam on

Hello Talktools,

 

I'm a pediatric SLP with a clinical question for your experts. I attended the Three-Part Treatment Plan for Oral Placement Therapy (OPT) workshop last year. I have a little guy (3;4) who presents with low tone, has a breathy voice and speaks in short bursts.

 

I recently introduced the Horn Program, hoping that we could use it to improve his abdominal grading and breath support. However, we are having some problems with compensatory movements, and I'm having trouble remembering from the workshop what we are supposed to do about that!

 

When I hold up the horn, he leans, opens his mouth wide and reaches for it with his arms. If I can get him to sit back in the chair as I bring the horn to him, he inevitably opens his mouth wide. He also bites the horn for stability, and if I can get him to close his mouth as I present the horn, he grabs my shoulder for support.

 

I feel we need to back up, but I'm not sure where to go! Would one of the TalkTools® Instructors be able to help me with this? Do these sound like things his OT should work on? Are there some other activities you might recommend as a prerequisite for success with Horn #1?

 

Thank you in advance for any guidance on this issue.

 

Sincerely,

 

Kim

 

Hi Kim,

This is a common problem when starting with a client, especially if he is just beginning an OPT program, has overall low tone and also has jaw instability and difficulty with lip-jaw dissociation. The aforementioned are all good reasons to use the TalkTools Horn Hierarchy. Following are some things to remember about using the Horn Program that may be helpful.

1. Consider your seating - Is he well supported with his head, pelvis, knees and ankles at 90 degrees? Does he have a place to rest his hands, head and feet? These are important to think about initially, remembering that what happens in the body often is seen in the mouth. If you do not have access to good support from a chair, try lying him down on the floor (I like a wedge if possible, but if you are working in a home you may only have access to a pillow). Gravity can help him with stabilizing the body, and if he’s not working against his own lack of support through his core muscles, you may get a better start.

2. It is absolutely OK to provide jaw support when starting out. If you remember, you can also progress forward through Horn #1 and #2, even if you are still needing to give him support. Jaw support can help and is crucial in eliminating a few of the problems you are reporting: Moving forward (you are providing stability at the lowest level of oral function and often need good support to start. Think about getting his body and jaw positioned first with your support and THEN present the horn. Doing both at once often leads to habitual compensatory movements), controlling the opening of the jaw (increase your support as needed until he opens just wide enough - if he still has difficulty, think about where you are in his Jaw Program. If you are just beginning and he has poor jaw control, this may not be something you can completely control just yet, working on a jaw program simultaneously- the TalkTools® Bite Tube Set and/or the TalkTools® Jaw Grading Bite Blocks will help! You may also want to consider supporting him from behind if his chair seems to be supporting him OK at the hips, knees and feet but he has nowhere for his hands or head to stabilize. In this case, you would use your body as the support from behind while wrapping your hand around the head to support the jaw. This can also eliminate some of the leaning forward you may see, especially if he is seeking stability/sensory input.

3. If you continue to struggle, consider backing up and working with Step B of the Bubble Blowing Program to teach him to control airflow; this is where you blow the bubble and catch it on the wand, having him use a voiceless “ha” to teach him to isolate the abdominals. This would take out the focus of lip closure and jaw stability for now, while teaching him to access volitional air with control. I’d also really consider your jaw program, and see if several sessions of jaw input might help you gain a little more control over his oral function.

All great questions and I hope these suggestions help you find a starting point. Of course if it leads to more questions, please don’t hesitate to contact us again!

Sincerely,

Renee Roy Hill, MS, CCC-SLP

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Ask a Therapist: Jaw Stability Protocol for Severe Underbite

Posted by Deborah Grauzam on

Hi Therapists,

 

What do I do for a 19 year old student with a severe underbite (a gap of ½ inch between top and bottom teeth) when trying to use the jaw stability protocol?

 

Thank you 

talktools-retouched-16x20-0010

When you are working on the Bite Blocks for jaw stability and the Bite Tube hierarchy, you will want to make sure that you have optimal bite posture first. You will judge optimal bite posture from the back molars. From your email it sounds as if his under bite is structural rather than functional. In this case you will work with the bite blocks and chew tubes in his structural position. Unless he has orthodontic work you will not be able to change structure.

I hope this helps. Please let me know if you have any further questions.

Monica Purdy, MA, CCC-SLP

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